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Program Coordinator

Dr. Paul Hess
Phone: 919.513.6183
Email: Paul_Hess@ncsu.edu

 

Residency Program in Oncology

Description of Program

NC State University's Oncology Residency is a three-year training program that emphasizes a multidisciplinary approach to diagnosis, treatment and management of dogs and cats with neoplasia. Expertise in basic and applied aspects of radiotherapy, chemotherapy, and immunotherapy within the College of Veterinary Medicine provide training in both conventional and investigational aspects of cancer management. The primary goal of the program is to insure eligibility for ACVIM board certification in Veterinary Oncology.

The NCSU Oncology program includes 5 board-certified medical oncologists, 2 board-certified radiation oncologists, 3 medical oncology residents, 2 radiation oncology residents, 3 medical oncology technicians, 1 veterinary assistant, 1 clinical trials coordinator and a receptionist. Participation in daily and regularly scheduled rounds, Cancer Class, Cytology Rounds, Journal Club, and House Officer seminars will be required. Elective rotations are available in other clinical specialties within the Veterinary Teaching Hospital and within the medical community of Raleigh-Durham- Chapel Hill. Participation in didactic lectures and laboratories for professional students is expected. A minimum of one manuscript, suitable for publication, dealing with cancer biology and/or treatment will be required.

A North Carolina Veterinary license is required. This can be obtained after successful acceptance to the program. Professional liability insurance is supplied with our program.

If you have special needs as addressed by the American Disabilities Act and need assistance with any portion of the application process, please notify us at the address or telephone number above as soon as possible.

Goals

1. To become board certified by the American College of Veterinary Internal Medicine (ACVIM), Specialty of Oncology. During the first 3 years of the program, the resident will have their credentials accepted and sit for both the general and certifying examinations.

2. To be highly qualified and competitive for advancement into an academic faculty position, speciality referral practice, government or industry by:
Developing clinical expertise in client and referring veterinarian interactions, patient care, problem-oriented case management, and advanced diagnostic and therapeutic techniques.
Developing teaching skills through leadership and participation in student and house-officer rounds, clinical "on-floor" training of students and interns, and student laboratories, and presentation of lectures to students, peers, and practicing veterinarians.
Acquiring experience in research and scientific writing through the publication requirement of the ACVIM and presentation of a research abstract at the Veterinary Cancer Society annual meeting (during Year 2 and 3 is desirable), or other scientific meeting.

Specific Responsibilities

The following guidelines are not an all-inclusive summary of resident responsibilities, but serve as a general orientation to the program.

1. ACVIM requirements to be met during the residency
a. Register with the ACVIM during the first month of your program. Contact the ACVIM and obtain the registration form and copy of the certification requirements (General Information Guide). The absolute deadline for receipt of the completed application form is October 1. This can be done by regular mail, or via the web, see Residency Program Registration on the home page.
Address for the ACVIM office:
American College of Veterinary Internal Medicine
1997 South Wadsworth Blvd, Suite A
Lakewood, CO 80215-3327
Phone: 1-800-245-9081 or 303-231-9933
FAX: 1-303-231-0880
E-mail: ACVIM@ACVIM.org

Plan to sit for the General Examination in May of your second year, and for the Certifying examination in your third year.
Take responsibility for making sure your program meets all ACVIM requirements. There may be oversights in this set of guidelines or the accompanying checklist, and requirements do change.

Examples of American College of Veterinary Internal Medicine Reading List for Oncology Click Here


b. Write at least 1 first author publication, generally a retrospective study or short-duration prospective study, in conjunction with an oncology faculty member. Plan clinical studies and publication submission early in the program to satisfy the acceptance deadline for ACVIM credentials. Because of delays in manuscript review and processing, publication in some journals may take as long as 18 months from the time of submission.
c. You are assigned a residency advisor, who serves as ACVIM mentor, before starting your program. In conjunction with your advisor, you will select the remaining two faculty members for your residency committee, including one additional member of the oncology faculty and one other faculty member (also see Resident Reviews, below).

2. Clinical responsibilities
We expect you to assume increasing levels of responsibility for teaching students and supervising interns and other residents as you progress through your program. During the initial weeks of the residency cases are seen in conjunction with the senior faculty member. After this period of “dual” receiving, you are expected to begin seeing cases independently. By Year 3, we expect you to function in the same capacity as an oncology faculty member.


a. Responsibilities to the patient and client
i. Admission - after the student has seen the case, discuss the case and plan with the student, meet the owners, revise the history and physical examination if needed, and discuss the plan and written cost estimate with the owners. At the beginning of your residency, you will also review your cases and plans with the senior faculty member on service prior to speaking with the owners.
ii. Diagnostic evaluation and therapeutic management - perform all hands on procedures with which you are comfortable. Specific training and supervision are required for use of rigid and flexible endoscopic equipment. Perform daily complete physical examinations on all patients - do not rely on student information alone.
iii. Owner communication - contact owners daily during hospitalization to relay the patient's condition, test results, plan, and current bill/update of estimate (once to twice weekly for radiation patients). Students perform this duty whenever possible, but you are responsible for the accuracy of the discussions. All client communications must be recorded in the medical record. Review student records daily and provide constructive comments.
iv. Availability - all clinicians are expected to be available by beeper or phone any time they have a case in the hospital (24 hours/day, 7 days/week). If you must be absent, another resident or an intern must be responsible for your hospitalized cases. If you anticipate more than a few hours absence, notify the student and your faculty member, and note the new clinician in the medical record (and ICU sheet if applicable). If more than a day is involved, the client must also be informed.
v. Unfinished business - keep an on ongoing record of loose ends, such as necropsy reports and mailed-out laboratory tests. Do not rely on the appearance of lab reports to remind you of these responsibilities.
As described below in "Records", it is essential that records be complete and helpful to other clinicians unfamiliar with the case. It is common for a client to call or appear unexpectedly when the original clinician is unavailable.
vi. Professional Development Time - Time will be scheduled for release from clinical responsibilities (see Approximate Rotation Schedule). We expect you to maintain the continuity of the management of your patients by being reachable if there are questions regarding case management. Be sure the record is complete, and effectively communicate the transfer of patient care to the other clinician, the owner, and the referring veterinarian. We expect you to continue attendance at Cancer Class, Cytology Rounds, Journal Club, and House Officer seminar. Residents studying for board examinations during the spring are exempt from attending.


b. Responsibility to the referring veterinarian
i. Call the referring veterinarian and record the content of your conversation in the medical record when:
the diagnostic evaluation and/or initial treatment plan is completed. Usually this occurs near the time of discharge. Ensuring the discharge instructions convey the necessary information for follow-up care and faxing them to the rDVM is usually adequate. In more complex cases, particularly when the client will be discussing treatment options with the referring veterinarian, a phone call may be needed as well. This is extremely important, and insures appropriate care should a problem develop at home and to ensure the client is receiving accurate information. For animals hospitalized for more than 3 days, call the rDVM with a progress report.
the patient dies or is euthanized. This is to insure that the rDVM knows about the adverse outcome.
results of laboratory tests pending at the time of discharge are available, or if treatment plans are changed. This can be done through the CTs or included on the next discharge if the patient is currently undergoing a course of therapy (i.e. will be seen in a short time period).
he/she has called regarding patients referred previously. The CTs will place the medical record in the rounds room; return these calls as soon as possible.
ii. Send a printed copy of the discharge summary to the rDVM when:
a hospitalized patient is discharged. These must be as complete as possible, including all prescribed drugs and dosages, and short and long-term plans for follow-up. Give these to the receptionist to fax.
if requested, a copy of the preliminary or final necropsy report.
iii. In general, faculty will be responsible for returning consultation calls/fax consultations. As you progress through your residency, you will participate in these communications. Initially, take responsibility for returning client/rDVM calls on ongoing patients (“green sheets”) unless they are in regard to a current patient of another clinician on service.


c. Teaching in clinics
i. Interns - Be available to the intern rotating on the oncology service to provide consultation, assistance with special procedures and advice regarding patient care. The oncology "backup" resident must be immediately available to the intern on emergency duty during evenings and weekends. This responsibility may require returning to the hospital to assess the patient's status.
ii. Students - Allow the student to present to you their findings, differential diagnoses, and diagnostic and treatment plans for each of their cases. Do not allow the students to act on their suggestions without your permission.
You are responsible for supervising all special procedures and providing suggestions and guidance to students and interns. Encourage students to perform those procedures that are consistent with their abilities and that do not compromise the patient.
Students do not need to be involved in the management of every case. In general, if the students are overwhelmed with patient management responsibilities, the intern (and/or you) will see cases without students. If necessary, students can also be excluded from recheck appointments-they will learn the most from new appointments.
We expect interns and residents on clinic duty to promptly attend student rounds during the first year of the residency. We also expect you to actively contribute, and to lead student rounds at least one day each week by the second year of your residency.


d. Records
i. Check ICU orders and clinician order forms (in-patient wards) at least twice daily to assure accuracy, to sign and to note new observations or problems. Review the observations made by the ward and ICU technicians each morning. Review ICU orders and COF's with the students (when applicable) before 8:00 a.m. rounds begin.
ii. Review medical records daily. Edit SOAP entries thoughtfully to assist the student in problem-oriented thinking. Scrutinize records for accuracy and completeness of documentation. As a general rule, SOAPs should not be long narratives. Succinct explanations and short lists of major differentials and plans are expected. Each problem must be addressed individually (not the whole animal) and differential diagnoses must be prioritized. With radiation patients, the students should SOAP the patients’ individual problems once the first week. The second week, the SOAP can address the entire animal. Daily updates should be recorded as part of the SOAP.
iii. Complete medical records as soon as possible after patient discharge. Under no circumstances should records remain incomplete for longer than 3 weeks. Case summaries must be accurate. In ALL cases, provide written follow-up plans with contingency plans to insure continuity of patient care in the event that you are unavailable when follow-up of any kind is needed.
iv. Again, record all client and rDVM conversations (in person or by phone). Communication logs should include the date and time of any conversation, and the person with whom you spoke.


e. Case material
We expect you to be a "gunner" - be eager to receive new cases. Your best learning experiences and stimuli for reading and research all come from your own case material. It is impossible to accurately predict case outcome ahead of time , and it is very much to your advantage to be involved with the management of as many cases as possible.


f. General clinic schedule:
i. Receiving schedule:
The hospital oncology service consists of 1-2 faculty members, 3-5 house officers.. By 7:30 am every weekday morning, the residents and interns pick up cases admitted the previous evening or weekend and check their inpatients. The clinic service is divided into two groups: a New Patient service and a Chemotherapy / Recheck service. The new patient service meeds for morning rounds from 8:30 - 9:30am. Between 4-5 new appointments are scheduled each day, Mon - Thurs. Emergency appointments are added on as necessary. It is not unusual for new patients to spend the night or return the next day to complete their staging or evaluation. CT scans (and any procedure that requires general anesthesia) are generally performed the day following the initial appointment.

The Chemotherapy / Recheck service begins at 7:30am and sees between 8-15 appointments each day Mon - Thurs. The CTs will generate a Clinician Order Form (COF) with the procedures scheduled AS INDICATED ON THE PREVIOUS VISIT'S DISCHARGE ORDERS. It is the responsibility of the clinician on the cast o review the orders, add any procedures deemed necessary and to sign the orders early in the day (preferably before rounds or immediately afterwards).

Residents spend approximately equal time on each of theses services (e.g., Mon and Wed on the New Patient service, Tues and Thurs on Chemotherapy / Recheck Service). Afternoon rounds are held from 2:30 - 3:30 each afternoon and attendance by all members of both services is required. Fridays are teaching days for the oncology service. A boarded oncologist works independently seeing Chemotherapy / Recheck appointment on Fridays.
iv. Emergency appointments and in-house consultations are handled as needed every day of the week.


g. Rounds and seminars
You are required to attend the following rounds and seminars:

Surgery / Oncology Rounds: Monday (8:00 - 8:30am)

House Officer Rounds: Wednesday (8:00 - 9:15am)

Cardiology / Neurology / Critical Care Rounds: Friday (8:00 - 9:00am)

Cancer Class: alternate Fridays (9:00 - 10:00am)

Oncology Journal Club: Friday (10:15 - 11:00am)

Cytology Rounds: alternate Fridays (2:00 - 3:00pm)

Protocol Rounds: quarterly Fridays (10:15 - 11:00am)

There are a number of seminars offered through the year within the College or at nearby institutions. If you are interested in a particular presentation, discuss the possibility of attending with the faculty member on service.

3. Publication(s)
Within the first 6 months of your program, work with your advisor, residency committee members and other faculty to select material and projects for the ACVIM required publication.

4. Seminars, presentations, and didactic teaching
You will present 1 house officer seminar on a Thursday morning your second and third years with students, house officers and faculty as the audience. These seminars are often based upon areas of research or publication interest and are geared towards other house officer and faculty. The schedule for the year is available when you arrive, along with a handout describing the requirements of this seminar series. Discussion with your advisor regarding the content of your seminar should occur no later than 2 months prior to your presentation. Your advisor will expect to review the fully prepared presentation prior to your formal presentation as well.


You will present cases for discussion in House Officer Rounds on Wednesday mornings according to the schedule prepared by the medicine resident. You will receive more detailed information about how to prepare for these case discussions after you arrive. In general, select cases that will invoke good discussion. Be familiar with the pathophysiology and current veterinary and human literature relating to your case. House Officer Rounds should facilitate brief topical reviews that can assist your preparation for board examinations.
Plan to have a research abstract prepared for presentation at the Veterinary Cancer Society meeting during the second and/or third year of your program. The abstract could describe the same project that is the basis for a publication.
During the year you will be asked to participate in a limited number of laboratories, and possibly lectures, for veterinary students. These may include: second year physical examination laboratory and final examination, second year clinical methods laboratory, third year case discussions and clinical methods laboratories and laboratories taught as part of end-of-semester courses. Before volunteering to assist check with your advisor regarding the feasibility/scheduling aspects of teaching.
During the third year of your program, we encourage you to give one continuing education lecture to practicing veterinarians (e.g., local association meetings, North Carolina Veterinary Conference).

5. Continuing education
Attend the annual Veterinary Cancer Society meeting yearly (typically in the fall) and the ACVIM Forum in spring of the second and third years of your program (necessary to take the general and specialty exams). Funds from your departmental account can be used to help defray your expenses.

6. Resident reviews
Your residency committee will work with you to help you achieve the goals of your program. Meet with your advisor during the three months of your program. Scheduled meetings with your entire committee should be held in December and April of each year. Be prepared to provide a constructive critique of your program. Your residency committee is in place for your benefit. Take advantage of their expertise in making plans and decisions.

Approximate Rotation Schedule


Year 1
6-7 months of Oncology
1-2 months of Radiation Therapy
2 months Internal Medicine
2 months Professional Development
(Register with the ACVIM by October 1)

Year 2
6-7 months Oncology
1-2 months Internal Medicine/Other Specialties (immediately preceding time off for studying)
1 Radiation Oncology (if only 1 month taken in year one)
3 months Professional Development: (this must be constructively scheduled with your advisor an will include time for board preparation)
[Credentials due October 1 for the General examination]

Year 3
6.5 months Oncology (or 3 months Oncology or other service-e.g. ICU)
0.5 months in cytology

0.5 months in histopathology

0.5 months radiology
4 months Professional Development: (this must be constructively scheduled with your advisor an will include time for board preparation)
[Credentials due October 1 for the Certifying examination, including one publication] Ten days of vacation per year are taken during Professional Development time.

Scheduling considerations: When an oncology resident is taking a medicine rotation, it should coincide with a medicine resident going to their service (= an even exchange). If residents from other services plan more than one medicine rotation, additional rotations are scheduled when only one medicine resident is on duty.