Rotation Specific Goals & Objectives: Lower Gastrointestinal
Role 1. Medical Expert/Clinical Decision Maker
Disease Site: Colorectal and Anal Cancer
i) Cognitive Goals & Objectives
Regarding primary colorectal and anal tumors (including colorectal adenocarcinoma,
squamous cell carcinoma of the anal canal and rare neoplasms of the colon, rectum
and anus), the general surgical oncology resident will be able to
1) Takes an appropriate history and conduct an appropriate physical examination for a
patient with primary colorectal and anal neoplasms (including colorectal
adenocarcinoma, squamous cell carcinoma of the anal canal and rare neoplasms of
the colon, rectum and anus).
2) Work-up and evaluate colorectal and anal masses, including the differentiation of
benign and malignant lesions and the implications of unusual histologic diagnoses
(e.g. carcinoid, GIST, melanoma, lymphoma)
a) Utilize the appropriate imaging techniques, recognizing the utility and limitations
of each technique (CT Chest/Abdo/Pelvis, Pelvic MRI, Trans-rectal Ultrasound,
PET, etc.)
b) Request histologic review and consideration of special histologic tests at the
appropriate times (e.g. ICE, etc.)
c) Conduct pre-operative endoscopic evaluation of colorectal tumours and manage
polyps appropriately
3) Demonstrate appropriate knowledge of tumor biology, etiology, tumour pathology
and immunohistochemistry
4) Determine prognosis following treatment, patterns of recurrence and treatment
options for recurrence
5) Determine a treatment plan that will include all the pertinent information, including:.
a) implications of margins in different tumors
b) anatomical considerations
c) functional implications of various colorectal resections and importance of
strategies (techniques such as Laparoscopic Surgery, TAMIS, Robotic
Surgery) available to derive best result functionally and psychologically
6) Recommend resection of benign and malignant colorectal and anal neoplasms in
appropriate circumstances and recognize scenarios when non-surgical primary
therapy may be indicated or no therapy at all ought to be directed at the primary
lesion. Incorporate multi-disciplinary options that complement surgical approaches
chemotherapy, radiation, and ablation
7) Utilize the AJCC TNM staging system for colorectal cancer
8) Manage oncologic emergencies that can arise in conjunction with complex colorectal
resection including anastomotic dehiscence and intraabdomial sepsis
9) With respect to genetics and colorectal cancer
a) Demonstrate an understanding of the role of genetic counselling and refer
patients appropriately
b) Demonstrate an understanding of the importance of the family history
c) Demonstrate an understanding of the clinical management of FAP, aFAP, MAP
and HNPCI
10) With respect to colorectal cancer and Inflammatory bowel disease (IBD)
a) Recognize the risk of colorectal cancer in patients with IBD
b) Implement surveillance strategies in appropriate circumstances
c) Manage the patient with neoplasm and IBD
11) Regarding recurrent colorectal and anal neoplasms:
a) Understand the evaluation of patients with recurrent tumours that are either
diagnosed or suspected.
b) Describe the criteria indications and contraindications for resection of recurrent
rectal and anal neoplasms
c) Demonstrates an understanding of the implications of margins in different
tumors, including considering sacrectomy in recurrent rectal cancer as
appropriate
d) Appropriately reflect on anatomical considerations
12) Conduct an appropriate evaluation of the patient’s psychological state
13) Provide for palliation with stents, placed by endoscopy or interventional radiology
ii) Clinical and Technical Goals & Objectives
The general surgical oncology resident will be able to :
1. Evaluate patients in clinic, as well as lead the discussion regarding surgical
resection options, outcomes and complications
2. Develop an individualized treatment plan despite uncertainties in diagnosis
and staging, and taking into account patient-based risk factors
3. Complete surgical technique of colorectal resection with special focus on:
a) Anatomical considerations and variations
b) TME
c) Transanal excision
d)
e)
f)
g)
Multivisceral resection including pelvic exenteration
Recurrent Colorectal Cancer
Laparoscopic management of colorectal surgery
TAMIS
4. Perform operations for the palliation of symptoms and complications in
incurable patients
5. Manage the critically ill patient with cancer. This includes demonstrating skills
in treating fluid and electrolyte imbalances, multisystem organ failure and
nutritional problems.
Role 2. Communicator
The general surgical oncology resident will be able to:
1. Establish therapeutic relationships with patients and their families, showing great
interpersonal skills, including demonstrating effective listening.
2. Obtain and synthesize relevant history from patients/ families/ communities of
varying social, ethnic and religious background
3. Discuss appropriate information with patients/families, showing compassion and
the ability to support the morale of the patient throughout the course of the
disease, and to address issues in terminal care
4. Demonstrate insight into newer educational methods of disseminating
information and improving the care of the cancer patient, particularly in cases of
interpersonal conflict or ethical dilemmas
5. Demonstrate an appreciation of the special psychological, social, sexual, ethical
and functional problems that the patient and family must face when coping with
cancer and its treatment
6. Demonstrate compassion and the ability to support the morale of the patient
throughout the course of the disease, and to address issues in terminal care
7. Provides a clear and thorough explanation of the diagnosis, investigations and
appropriate therapeutic risk/benefit information for surgical management in a
professional and compassionate manner.
Role 3. Collaborator
The general surgical oncology resident will be able to:
1. Establish and maintain an effective working relationship with other physicians
and health care professionals, being able to, if needed, resolve conflicts
amongst team members in a fair, respectful and positive manner
2. Participate effectively, providing surgical input and leadership, in
interdisciplinary team activities, including tumour boards, site group
conferences, interdisciplinary work rounds
3. Access ancillary resources necessary to provide interdisciplinary care to
manage the problems of the patient with cancer, in conjunction with palliative
care services, especially in the area of pain control.
4. Appropriately sign over responsibly to others and accept signed over
responsibilities
Role 4. Manager
The general surgical oncology resident will be able to:
1. Work effectively and efficiently in a health care organization, balancing patient
care, learning needs, and outside activities
2. Work effectively as a member of a cancer disease site group to accomplish
tasks whether in the role of team leader or team member, allocating finite
health care resources wisely
3. Plan relevant elements of the health treatment process (eg. Sequence of
therapies, OR schedules, etc.)
4. Utilize information technology to optimize patient care, facilitate life-long
learning and other dissemination of research findings
5. Demonstrate an understanding of the structure, financing, and operation of
regional and provincial health systems and their facilities
6. Access and utilize health care resources necessary to provide care to cancer
patients in a spectrum of settings including ambulatory care, acute tertiary
care hospitals, rehabilitation centres, palliative care centres, home palliative
care, academic cancer centres, community cancer centres and general
hospitals
7. Demonstrate an understanding of population-based approaches to cancer
prevention, screening and early detection and their implications for surgical
oncology practice
8. Direct and manage a meeting (MCC, Ward discussion or Consult with other
specialties) with other members of the health care team.
9. Appropriately delegate responsibilities.
Role 5. Health Advocate
The general surgical oncology resident must be able to:
1. Demonstrate an understanding of current policies that affect cancer risk or
treatment, either positively or negatively (e.g. policies regarding screening,
tobacco, substance abuse)
2. Assess determinants of health as relevant to the management of individual
patients by assessing the patient's ability to access various services in the
health and social system and advise the patient appropriately
3. Identify determinants of health as relevant to the identification of high risk
groups (Inflammatory Bowel Disease, Genetic Syndromes, Obesity, Physical
inactivity, etc.) and apply the knowledge about prevention to "at risk" groups
within general surgical oncology practice
4. Demonstrate an understanding of the determinants of health as relevant to
the general population by describing, in broad terms, the key issues currently
under debate regarding changes in the regional, provincial and national
health care systems, e.g. cancer surgery waiting time policies, privatization
of health care insurance and delivery
5. Direct patients and families toward palliative care options available towards
the end of the disease process
Role 6. Scholar
The general surgical oncology resident will be able to:
1. Critically appraise sources of medical information, including assessing new
surgical techniques procedures, new systematic and targeted therapies, and
trials for emerging chemotherapy.
2. Demonstrate an understanding of preferred learning methods in dealing with
students, residents, and colleagues in order to facilitate learning of these
individuals
Role 7. Professional
The general surgical oncology resident will :
1. Demonstrate appropriate personal and interpersonal professional behaviours,
including punctualilty, self-discipline in obligations on the ward, in clinic, in
case conferences and other professional activities.
2. Practise medicine ethically, consistent with obligations of a physician and the
requirements of legislation (e.g. HCCA).
3. Continually evaluate one's abilities, knowledge and skills and know one's
limitations of professional competence
4. Recognize signs of burnout in oneself and one’s colleagues and be able to
access sources of advice and support
5. Recognize, analyse and attempt to resolve in clinical practice ethical issues
such as truth-telling, consent, advanced directives, confidentiality, end-of-life
care, conflict of interest, resource allocation, research ethics, intimidation
and harassment etc.
6. Consult an ethicist or make a referral to the ethics committee in appropriate
circumstances
7. Recognize bias based on gender, age, sexuality, religion, race, education or
social status and attempt to eradicate it in oneself and others