Rotation Specific Goals & Objectives: Mount Sinai Hospital
Peritoneal Based Malignancies
i) Cognitive Goals & Objectives
By the end of the rotation, the general surgical oncology resident will be able to
demonstrate knowledge of:
a. Categories and pathological subtypes of peritoneal based malignancies
including pseudomyxoma peritonei (PMP), peritoneal carcinomatosis and
peritoneal mesothelioma, including specific immunohistochemical stains
b. Epidemiology, presentation and prognosis of peritoneal based malignancies,
including environmental risk factors; relationship of peritoneal and pleural
mesothelioma
c. Principles of surgical techniques for peritonectomy and administration of
intraperitoneal chemotherapy; Sugarbaker classification
d. Short- and long-term complications of peritonectomy and administration of
intraperitoneal chemotherapy
e. Results of peritonectomy with, and without, administration of intraperitoneal
chemotherapy
f. Other ablative techniques such as electrocoagulation and argon beam
therapy
g. Comparative results of systemic therapy for peritoneal based malignancies
h. Relevant investigational modalities for diagnosis, staging, and re-assessment
during, and following, treatment and long-term follow-up of peritoneal based
malignancies including laparoscopy and role of tumour markers
i. Long-term complications of PMP and its treatment
ii) Clinical and Technical Goals & Objectives
The general surgical oncology resident must be able to:
a. Conduct a relevant and focused history and physical examination, appropriate
to the patient’s presentation.
b. Select appropriate patients for peritonectomy and administration of
intraperitoneal chemotherapy, including presentation and discussion at
multidisciplinary tumour boards
c. Select techniques and procedures to be used for the assessment of
peritoneal based malignancies
d. Determine the proper staging of patients and formulate an appropriate
treatment plan
e. Interpret imaging studies, including ultrasound and computed tomography
(CT) scans, recognizing the limitations of such diagnostic techniques, and
integrate with biopsy results in the context of multidisciplinary tumour boards
and conferences
f. Interpret current diagnostic examinations utilizing radioactive isotopes,
including PET scans, and integrate with results of other imaging modalities
g. Perform endoscopic procedures necessary for the investigation of patients
with peritoneal based malignancies
h. Perform diagnostic procedures such paracentesis and thoracentesis
i. Develop an individualized treatment plan despite uncertainties in diagnosis
and staging, taking into account patient-based risk factors and recognizing
timeframes for appropriate treatment
j. Conduct appropriate pre-operative planning (including review of all aspects of
the case) to ensure effective performance of surgery
k. Apply sound intra-operative judgment/decision-making and appropriate
surgical technique.
l. Participate in resection of peritoneal based malignancy with inclusion of
visceral resection as appropriate, including thorough preoperative planning,
intraoperative decision-making and meticulous surgical technique.
j. Perform operations for the palliation of symptoms and complications in
advanced peritoneal based malignancies
k. Manage the critically ill patient with cancer. This includes treating
perioperative complications, fluid and electrolyte imbalances, multisystem
organ failure and nutritional problems
l. Recognize emergency or potentially catastrophic situations, including
massive bleeding or anastomotic leak, and responds effectively
m.Provide diligent and timely post-operative care (acute and subacute
timeframes) that includes management of wound healing, infections,
anastomotic leak, nutritional deficiencies, post-op pain, and psychosocial
issues
Role 2. Communicator
By the end of the rotation, the general surgical oncology resident must be able to:
a. Establish therapeutic relationships with patients and their families
b. Obtain and synthesize relevant history from patients/ families/
communities of varying social, ethnic and religious background as well as
be able to discuss appropriate information and obtain informed consent,
including for cytoreductive surgery
c. Provide clear and thorough explanation of diagnosis, investigation and
management in professional manner; in particular, describing the extent of
surgery and the extent of time for recovery and the long term effects of the
surgery, and provide the families with appropriate therapeutic risk/benefit
information
d. Prepare written notes that clearly communicate with referring physicians
and clearly summarize and communicate key points and plan.
e. Create timely, complete and accurate operative reports
f. Utilize appropriate interpersonal skills when dealing with patients and
families particularly in cases of interpersonal conflict, ethical dilemmas and
breaking bad news
g. 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
h. 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
Role 3. Collaborator
By the end of the rotation the general surgical oncology resident must be able
to:
a. Shows leadership in the operating room when appropriate.
b. Effectively provide and receive information.
c. Handle conflict situations well.
d. Collaborate with physicians and teams from other subspecialties in planning
and executing combined modality therapy
e. Establish and maintain an effective working relationship with other physicians
and health care professionals in and out of the operating room
f. Function effectively to the interdisciplinary team and affiliated groups such as
at tumour boards, site group conferences, interdisciplinary work rounds
g. Direct patients and families toward palliative care options available towards
the end of the disease process
h. Provide appropriate supportive care in conjunction with the existing palliative
care service, especially in the area of pain control
i. Develop strategies to resolve conflict amongst team members in a fair,
respectful and positive manner
Role 4. Manager
By the end of the rotation the general surgical oncology resident must be able
to:
a. Work effectively and efficiently in a health care organization
b. Utilize information technology to optimize patient care, facilitate life-long
learning and other dissemination of research findings
c. Utilize resources effectively to balance patient care, learning needs, and
outside activities
d. 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
e. Work effectively as a member of a cancer disease site group to accomplish
tasks whether in the role of team leader or team member
f. Appropriately delegate responsibilities
g. Strive to balance personal and professional roles and responsibilities and
demonstrate ways of attempting to resolve role strain
Role 5. Health Advocate
By the end of the rotation the general surgical oncology resident must be able
to:
a. Identify the important determinants of health affecting patients
b. Recognize and respond to those issues where advocacy is appropriate
c. Demonstrate an understanding of the determinants of health as relevant to
the identification of high risk groups and application of the available
knowledge about prevention to "at risk" groups within general surgical
oncology practice
d. 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 and
delivery including the development of new cancer programs
Role 6. Scholar
By the end of the rotation the general surgical oncology resident must be able
to:
a. Critically ap praise sources of medical information
b. Facilitate learning of housestaff/students and other health professionals
Role 7. Professional
The general surgical oncology resident must be able to:
a. Deliver the highest quality care with integrity, honesty and compassion
b. Exhibit appropriate personal and interpersonal professional behaviours
c. Practise medicine ethically consistent with obligations of a physician
d. Foster a caring, cooperative, compassionate attitude to patients, their families
and close friends
e. Be punctual, show self-discipline in obligations on the ward, in clinic, in case
conferences and other professional activities; appropriately sign over
responsibly to others and accept signed over responsibilities
f. Enunciate the principles of medical ethics as applied to surgical oncology
g. 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, etc.
h. Consult an ethicist or make a referral to the ethics committee in appropriate
circumstances
i.
Recognize, analyse and know how to deal with unprofessional behaviours in
clinical practice, taking into account local and provincial regulations
j.
Recognize and understand the nature of intimidation and harassment and
know how to deal with them
k. Recognize bias based on gender, age, sexuality, religion, race, education or
social status and attempt to eradicate it in oneself and others
l.
Demonstrates insight into his/her limitations and is responsive to constructive
feedback