It is expected that each fellow will participate in more than 200 surgical oncologic cases over the course of the year. The technical aspects of the program will be surgically based and depend on the individual's surgical skills. It is anticipated that as you progress through the training program, your skills will improve. It is also anticipated that in most cases you will be the primary surgeon with the consultant as your assistant, providing direction as needed.
During the fellowship, you will participate in quarterly rotations with each of the four operating surgical oncologists. This ensures maximize exposure to tumor cases while minimizing the service component so that the fellow will not be required at non-oncology cases. Using this approach, the fellow should have access to most if not all of the tumor cases that are treated on each of the individual consultant's services. The fellow will be exposed to collaborating disciplines through departmental educational formats and daily patient based clinical interactions. This includes basic concepts of oncogenesis and molecular oncology, adult and pediatric oncology, immunology and radiation oncology.
During clinical days, you will see new tumor patients, evaluate the clinical situations and formulate treatment plans. The patient is then presented to the consultant, the case is discussed, and the treatment plan is either finalized or revised. You will then be responsible for initiating the treatment plan including coordinating with collaborating services, medical oncology, radiation oncology, pediatric hematology oncology, radiology and pathology.
During surgical days you will work as a team with the consultant. Your responsibility is dependent upon your previous experience and level of competency. In the majority of cases, you will assume the role of surgeon and the consultant acts as the first assistant. The consultant is present for the entirety of the case providing supervision and direction for you.
In the post-operative period, you will assume primary responsibility for the day-to-day management of hospital patients. You will make rounds with the consultant on a daily basis.
Emergency room experience involves management of patients with pathologic fractures or emergencies that are encountered by orthopedic oncology patients. You will take primary responsibility for emergency room evaluation and communication with the consultant in a joint formulation of the plan of intervention.
The academic training will come through a scholarly approach that uses tumor conferences, literature reviews, journal clubs, patient clinical evaluations, surgical judgment, and retrospective and prospective clinical analysis.
During weekly Sarcoma Rounds facilitated by the fellow, cases accumulated over the previous week, are presented by residents on the respective services. This is highly instructive, as the rounds are multidisciplinary and generate much discussion and reference to pertinent literature. Additionally the staff hosts the journal clubs at their respective homes. The nature and emphasis of the discussion are finalized by the fellow and staff. The fellow collates the pertinent literature and assigns review to the residents on the oncology services. Anatomical dissection labs are conducted quarterly, allowing for interactive demonstration of reconstructive options after resection. The fellow coordinates these sessions that are attended by staff and residents.
If you choose to participate in the two-year tract for the Musculoskeletal Oncology Fellowship, you will spend your first year conducting basic research in sarcoma biology. During your second year, you will be given time to continue your research or complete an alternative clinical research project. Fellows who choose the year-long tract will be encouraged to complete a clinical research project during the course of their year.
In addition to increasing your own knowledge base, you will be expected to participate in orthopedic resident and medical student education. This is through educational efforts at the tumor conferences as well as resident education conferences on Tuesday evenings, Wednesday mornings, and Saturday mornings for the Orthopedic Department in general. You will be responsible for anatomic dissections on a quarterly basis to further resident education. In conjunction with an orthopedic consultant, an anatomic region will be identified. The surgical approaches, oncologic resections and reconstructive options will be demonstrated on a cadaver.
The evaluation procedures used in the fellowship include a written evaluation at the end of each quarter that is prepared by each consultant. The evaluations are reviewed with you and then filed in your permanent file. Likewise at the end of each quarter, you will be encouraged to submit a written evaluation of your experience with each consultant.
Your call schedule will vary by rotation. Mayo Clinic follows the schedule recommendations of the Accreditation Council for Graduate Medical Education.