Comprehensive Core Curriculum Outline
Service: Tumor
Attendings:
 Dr. Schwartz
 Dr. Holt
 Dr. Halpern
Ancillary Staff:
 Anabel Atkinson (NP) Monday-Thursday
Resident Coverage (PGY levels):
 Junior Resident – R2
 Senior Resident – R4
Weekly Schedule:
Monday
OR
Tuesday
PM - Clinic
Wednesday
Thursday
OR
Friday
Clinic 9-2
Dr. Schwartz
Dr. Holt
Dr. Halpern
AM - OR
PM - Clinic
Clinic
OR
OR
OR
OR (alternate
PGY 2 and 4
Coverage)
OR
Clinic
Catch all
Service-specific Guidelines:
 Order Sets:
o Standard post op orders for Orthopaedics
o Total Hip and Total Knee Arthroplasty Order Set for Dr. Holt
 Pre-Op
o Antibiotics are to be held and given after cultures are taken if a diagnosis is in question
o If a diagnosis is established (FNA or lipoma/ LSA) antibiotics may be given
 Surgery involving endoprosthesis follow arthroplasty guidelines for ancef and VAnco
with alternatives for allergies or special consideratons
 Surgery NOT involving endoprosthesis follow ancef with alternatives for allergies or
special consideratons
o Foot pumps, not SCDs for patients in holding
 Post-op Protocals:
o Case by case basis, should be discussed at the completion of OR case
o Drains tend to be removed on POD 2. *Drain study pateint’s drains DC’d with less than 15cc q8hr
or less than 45cc q24hr. Xrays only when hardware placed. ***However, when an allograft is in
place, drains may need to be in longer than two days. Please ask attending whether it is ok to
remove drains in those situations.
o Clinic f/u 2 weeks s/p surgery—all known sarcomas scheduled with attendings, otherwise
schedule with Anabel . Halpern will see her own patients unless specified.
o Use RxStar for discharge medications
o Ancef for antibiotics.
o Anticoagulation: must give something in house except for children. (mechanical, LMWH,
coumadin, etc.)
o Anticoagulation for Holt total knee: coumadin x 21 days, total hip=28 days. INR goal 1.5-2.0—if
high risk, Anabel has reviewed previous history and will notify residents & Coumadin clinic.
o
o
Anticoagulation for a megaprosthesis, Lovenox in house (unless contraindicated) and 325mg
aspirin BID x 6 weeks.
Allografts receive 6 months of post-op oral antibiotics, usually cephalexin.

Starpanel Templated Notes:
o Ortho Oncology Progress note
o Anabel to place template orders and H&P’s for all of Dr. Holts THA/TKA on Fridays which
include under “Forms”: PRE-OP: Standard Orders for Orthopedics - Total Joints & POST-OP
Outpatient/Home Health Orders for Total Hip & Outpatient/Home Health Orders for Total or
Unicodylar Knee

Service Guides:
o Tumor Crib Sheet
o Tumor OKU-2
Resident Roles and Expectations (Based on PGY level):
 Hospital Roles (Rounding, Notes, Orders, Pre-op, Post-op, etc)
o Roles are the same. See the patients you operated on
o It is helpful for everyone if the resident team touches base with Anabel daily. Anabel can off-load
a lot of floor work like wound vac changes, complex discharges, but communication is key.
o All patients admitted post operatively need a documented post op note in the computer – which
documents neuro exam, concerns. If it is not possible for the oncology team to do this note, then
they need to alert the on call team about the patient.


Clinic Roles (Seeing patients, Dictating, Scheduling, etc)
o Gravitate to New and Consult
Patients
o Dictate all Patients you See.
o Use “Green Charts”—do not take
home
o Dictate using “Letter” template (#5)
within 24 hours, and include “cc”
to all physicians – that would
include referring, primary, and
potential rad on or med onc
physicians – the more the better.
o Notes dictated within 24 hours of
seeing patient, attested and pushed
to Attendings within 72 hours.
o Include ‘ this is the initial
Orthopaedic oncology Clinic visit’
o
o
o
Last paragraph should start with the
diagnosis – even if it is a working
differential.
Be very specific regarding PMH,
PSH and Radiographic appearance
of Tumor- based on your note, we
should be able to localize where a
tumor is – i.e 6 – 8cm distal to the
tip of the acromion
End by stating your name and the
attending you are dictating for.
“this is dr crazy bone dictating for
dr. Hebrew hammer.”
Conference Roles and Guidelines
o Tumor Board – Interdiscipliniary Meeting (Oncology, Radiology, Ortho, etc.): meets 2nd and last
Wednesdays of the month. Residents do not have responsibility but to listen. 7- 8 AM in MCN C2203
Goals and Objectives (Based on PGY level):
1. Medical Knowledge and Patient Care
o Learn/know the relevant applied anatomy.
o Become proficient performing a history and physical exam.
o Know the indications for radiologic imaging as well as the interpretation of these tests.
o Be able to formulate a differential diagnosis.
o Understand the concepts of non-operative treatment, indications for/risks of surgery, and basic principles of
postoperative rehabilitation.
2.
3.
o Know the basic surgical approaches
Surgical Indications
o Types of Biopsy
o Types of Resection
o Sarcoma Work-Up
o Metastatic Work Up
Post-operative critical review
Operative Core Competencies:
 Junior Resident
o Soft Tissue Mass Resection
o Bony Curretage
o Bone Cementing
o Tumor Fixation
 Senior Resident
o Mega Prosthesis
o Pelvis Mass Resection
o
o
o
Staging / Grading of Sarcoma
Prophylactic Surgery
Limb Salvage Surgery
o
o
Upper/Lower Extremity Anatomy
Advancement of General Surgical
Skills
Attending Preferences (Pre-op, OR, Post-op, etc):
o Prep twice as wide as you think, always prep/ drape the entre involved extremity
o Do not enter a case without a discussion with the attending about the plan
o Skin sutures for Dr. Schwartz. Halpern and Holt will use staples or sutures.
o Schwartz post-op dressings stay in place until f/u appt. GEH & JLH surgical dressing changed
post-op day 2 followed by daily dry dressing change until f/u
o If patient discharged with a drain in place than needs to go home on oral antibiotics
o Consult Attending before patient goes home with drain and an implant (endoprosthesis or
otherwise)
Selected Readings (Based on PGY level):
 Books
o OKU Tumor
 Classic Journal Articles
 Techniques
o Stryker app
o Synthes app
 Anatomy
o Extensile Exposures, Henry
o Hoppenfeld Surgical Exposures