Internship Program in Oncology
Paul Hess, DVM
Department of Clinical Sciences
919-513-6183 or Paul_Hess@ncsu.edu
Description of Program
NC State University's Oncology Internship is a one-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 promote a deeper understanding and appreciation of veterinary oncology. Participation in the program will strengthen a candidate’s qualification in applying for a residency or in moving into a practice with a high oncology caseload.
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, 2 radiation 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 Officers seminars will be required. Elective rotations are available in other clinical specialties within the Veterinary Teaching Hospital.
A DVM or equivalent degree is required for this program. Upon acceptance to the program a North Carolina Veterinary license will be required. 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.
To be highly qualified and competitive for advancement into an oncology residency in an approved American College of Veterinary Internal Medicine (ACVIM) program by:
1. Developing the clinical expertise in client and referring veterinarian interactions, patient care, problem-orient case management, and advanced diagnostic and therapeutic techniques.
2. Developing teaching skills through leadership and participation in student and house officers rounds, clinical “on-floor” training of students and interns, student laboratories, and presentation of rounds and seminars to students and peers.
3. Acquiring exposure to experience in research and scientific writing.
The following guidelines are not an all-inclusive summary of intern responsibilities, but serve as a general orientation to the program.
1. Clinical responsibilities
The oncology intern will be assigned clinic duty 10 months during the year. Four weeks will be available for preparation of an abstract or a manuscript or participation on other VTH services. Two weeks will be available for vacation. We expect you to assume responsibility for teaching students and working with other interns and residents. During the initial weeks of the internship, cases are seen in conjunction with a senior faculty member. After this period of “dual” receiving, you are expected to begin seeing cases independently.
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. 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 pager or phone any time they have a case in the hospital (24 hours/day, 7 days/week). If you must be absent, another intern or resident must be responsible for your hospitalized cases. If you anticipate more than a few hours absence, notify the student and 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 seminars.
b. Responsibility to the referring veterinarian
i. Call the referring veterinarian and record the content of your conversation in the medical record when:
(i) 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.
(ii) A patient dies or is euthanized. This is to ensure that the rDVM knows about the adverse outcome.
(iii) 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).
(iv) 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. House officers are responsible for returning the majority of client/rDVM calls on ongoing patients.
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.
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. 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, you may see cases without students.
We expect the oncology intern to promptly attend morning rounds when on the New Patient service, provided attendance is not required at other rounds during this time. We also expect you to actively contribute to student rounds.
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 COFs 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 upgrades 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" - 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, and 3-5 house officers. By 7:30 am every weekday morning, the resident 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 meets for morning rounds from 8:30 – 9:30 am. Between 4-5 new appointments are scheduled each day, Monday through Thursday. Emergency appointments are added on as necessary. The Chemotherapy / Recheck service begins receiving patients at 7:30 am and sees between 8-15 appointments each day Monday through Thursday. The oncology intern spends approximately equal time on each of these services (e.g., Monday and Wednesday on the New Patient service, Tuesday and Thursday on the Chemotherapy / Recheck service). Afternoon rounds are held from 2:30 – 3:30pm 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 appointments on Fridays.
Emergency appointments and in-house consultations are handled as needed every day of the week.
You are required to attend the following rounds and seminars:
Surgery/Oncology Rounds: Monday (8:00-8:30)
House Officers Rounds: Wednesday (8:00 – 9:00)
House Officers Seminar Series: Thursday (8:00 – 9:00)
Cardiology/Neurology Critical Rounds: Friday (8:00 – 9:00)
Cancer Class: alternate Fridays (9:00 – 10:00)
Oncology Journal Club: Friday (10:15 – 11:00)
Cytology Rounds: alternate Fridays (2:00 - 3:00)
Protocol Rounds: quarterly Friday (10:15 – 11:00)
There are a number of seminars offered throughout the year within the college or at nearby institutions. If you are interested in particular presentations, discuss the possibility of attending with the faculty member on service.
2. Seminars, presentations, and didactic teaching
You will present 1 house officer seminar on a Thursday morning each year 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 officers 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.
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 DVM selective courses. Before volunteering to assist, check with your advisor regarding the feasibility/scheduling aspects of teaching.
3. Continuing education
Attend the annual Veterinary Cancer Society meeting yearly (typically in the fall). Funds may be available to help defray your expenses.