At the conclusion of the residency rotations on this service, the graduate is expected to be proficient in the management of musculoskeletal oncology conditions encountered in the general practice of orthopaedics. It is important to recognize that competency as a physician extends beyond medical knowledge and direct patient care. Therefore, evaluations for the Musculoskeletal Oncology Service will include not only these competencies, but also demonstration of abilities in medical knowledge and patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
The goal of the Musculoskeletal Oncology Service is to provide a well-rounded learning experience for the resident staff through a combination of clinical, surgical, and didactic experiences. The service allows a truly multidisciplinary approach to the evaluation, diagnosis and treatment of patients with benign, malignant and metastatic neoplasms of the musculoskeletal system. The educational goal of the service is to educate orthopedic surgery residents in the appropriate diagnosis and management of neoplastic processes of the musculoskeletal system. This includes primary malignant and benign bone tumors, metastatic bone tumors, benign and malignant soft tissue tumors, and metabolic processes At the start of the rotation, the resident must contact Dr. Fox’s secretary to schedule a beginning, mid-rotation, and end of the rotation final evaluation.
The Reading List can be found on the Department of Orthopaedics and Rehabilitation Intraweb under the Residency/Curricula section.
Residents are expected to read appropriate chapters for monthly multidisciplinary conference.
Goals and Objectives
Medical Knowledge and Patient Care:
It is expected that junior level residents on the Oncology Service will:
- Develop keen listening skills in obtaining and performing a physical examination of the tumor patient.
- Develop an appreciation of the significance of key elements in the clinical history such as the importance of age, pain patterns, etc.
- Understand the use of appropriate imaging studies including plain x-rays, CT scans, MRI scans, bone scans, and PET scans.
- Become familiar with the histological appearance of common bone and soft tissue neoplasms.
- Understand the appropriate treatment for common tumors.
- Develop an appreciation for the role of other health care specialists in the treatment of malignant disease.
It is expected that senior level residents on the Oncology Service will:
- Develop a differential diagnosis based on patient history, physical exam, and imaging studies.
- Be able to develop treatment planning based on tumor diagnosis.
- Know proper biopsy technique, whether via needle or open surgery.
- Know when to consult a musculoskeletal oncologist or refer a patient with primary malignant bone or soft tissue tumor.
- Understand the natural history of common tumors, the presentation of each, radiographic findings of each, histological appearance of each, and treatments.
Interpersonal and Communication Skills – Goal: Both junior and senior level residents will be expected to be respectful to patients and all members of the health care team at all times. This includes the following objectives:
- Both junior and senior level residents will demonstrate the ability to discuss difficult matters with patients and families in a compassionate manner. The level of discussion should be commensurate with the medical knowledge and experience of the resident.
- Both junior and senior level residents will demonstrate the ability to allow patients and families to fully express their concerns and/or symptoms.
- Both junior and senior level residents will demonstrate the ability to explain operative procedures, risks and post-operative care to the patient/family, commensurate with their medical knowledge and experience.
- Both junior and senior level residents will demonstrate the ability to develop a professional relationship with the patient/family.
- Both junior and senior level residents will maintain professional communications and relationships with ancillary staff and medical colleagues.
- Both junior and senior level residents demonstrates effective communication in the informed consent process.
Professionalism – Goal: Both junior and senior level residents will be expected to act professionally toward patients and all members of the health care team at all times. This includes the following objectives:
- Both junior and senior level residents will demonstrate sensitivity and responsiveness to differences in culture, gender, age and impairments.
- Both junior and senior level residents will demonstrate sensitivity to the needs of patients/families.
- Both junior and senior level residents will respect the need for confidentiality of patient information.
- Both junior and senior level residents will always demonstrate honesty in written and oral communications.
- Both junior and senior level residents will demonstrate awareness of limitations and seek advice when appropriate.
- Both junior and senior level residents will accept advice without personal offense and use it constructively.
- Both junior and senior level residents will assess their performance with objectivity and accuracy.
Practice-Based Learning and Improvement: - Goal: Both junior and senior residents will demonstrate commitment to continuous learning and improvement in their patient care, benefiting from previous experiences and ongoing review of the literature, and contributing to the education of those around them. This includes the following objectives:
- Both junior and senior level residents will contribute to the education of medical students and other health care professionals. Although senior level residents will provide the leadership in this, the more junior level residents can play a meaningful role as well.
- Evaluate medical research/scientific evidence and apply findings to patient care. The more junior level residents will frequently utilize textbooks, review articles, and “classic” articles. More senior level residents will actively seek out more recent and perhaps “cutting edge” manuscripts that are applicable to patient care.
- Both junior and senior level residents will monitor their own practice of medicine to identify opportunities for improvement.
- Both junior and senior level residents participate in the morbidity and mortality process.
- Both junior and senior level residents will effectively utilize information technology to manage and access medical information.
- The resident, during their entire residency training, gradually assumes increasing levels of independence with decreasing need for faculty supervision, commensurate with the medical knowledge and patient care competencies outlined previously.
Systems-Based Practice – Goal: Residents will recognize their role in a complex and financially challenged health care system, identify resources available to them to contribute to patient care, and demonstrate familiarity with internal and external regulations and policies that impact care delivery. This includes the following objectives:
- Both junior and senior level residents will complete medical records accurately and in a timely manner.
- Both junior and senior level residents will effectively utilize health care system resources to provide optimal patient care.
- Junior level residents should be aware of the need to provide cost efficient patient care, and have a basic understanding of the factors that impact this. Senior level residents should have an advanced understanding of the costs associated with their treatment recommendations, and be able to justify treatment not only on medical decision making but cost considerations as well.
- Both junior and senior level residents will assist patients in dealing with health care complexities and serve as advocates for patients within the health care system.
- Both junior and senior level residents are attentive to the manner in which the health care system may impact patient safety and take steps to prevent errors. This includes awareness of National Patient Safety Goals and federal and hospital quality improvement projects.
- Both junior and senior level residents are attentive to medication errors, surgical site infection and venous thromboembolic disease.
- Both junior and senior level residents adhere to the standards of surgical site identification, awareness of wrong site surgery and adherence to surgical time out.