Residency Program in Oncology
Program Contacts
Marlene Hauck, DVM, PhD
DACVIM (Oncology)
Associate Professor and Oncology Residency Program Coordinator
Department of Clinical Sciences
919-513-8274 or marlene_hauck@ncsu.edu
Laurel Williams, DVM
DACVIM (Oncology)
Associate Professor
Department of Clinical Sciences
919-513-6477 or laurel_williams@ncsu.edu
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, hyperthermia 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 opportunity for a combined residency/graduate program is available.Participation in didactic lectures to professional students, regularly scheduled Oncology Grand Rounds, residency seminars and local as well as national continuing education presentations will be required. Elective rotations in other clinical specialties within the medical community of Raleigh-Durham-Chapel Hill can be arranged. A minimum of one manuscript, suitable for publication, dealing with cancer biology and/or treatment will be required.
A North Carolina Veterinary faculty certificate 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, 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 by 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. The option of combining
this program with advance scientific training (Ph.D.) is available.
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 (http://www.acvim.org); 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 May of 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.
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, select the remaining two faculty members for your
residency committee by January 1 of your first year (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. The initial several weeks of the residency
cases are seen in conjunction with the senior faculty member. After
several weeks 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. As such, you will be
scheduled for 1 block as Chief of Service during Year 3.
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
(weekly on radiation 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 Journal club and grand rounds.
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. Early in the year, this responsibility frequently requires
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 3-9 months 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, 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.
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, the person with whom you spoke, and your signature or initials.
e. Case material
We expect you to be a "gunner" - be aggressive about receiving
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 which will be a "good" case or "bad" case
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 oncology service consists of 1-2 faculty members, at least
1 resident and sometimes 1 intern. 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 emergency intern is free to leave at 9:30
am sharp. At 9 a.m. (except on Wednesdays), board rounds will begin promptly
in the oncology rounds room. The days’ cases will be briefly reviewed
by the entire service to ensure that necessary information regarding the
morning’s drop-off patients is conveyed to the clinicians and tentative
scheduling of expected procedures can be performed.
ii. Referral and recheck appointments are seen on Tuesday and
Thursday mornings. Receiving has the highest priority on these days. Limited
recheck/chemotherapy patients are also scheduled. In house referral patients
are seen on Wednesday. Emergency appointments are added on as necessary.
It is not unusual for new patients to need 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.
iii. Day cases are only seen on Mondays, Wednesdays and Fridays.
Day cases are defined as animals that are dropped off by their owners
BETWEEN 7:30 and 8:30 a.m. to be hospitalized for the day. Day case appointments
are reserved for routine rechecks and chemotherapy treatments. The CTs
will submit a Clinician Order Form (COF) with the procedures scheduled
AS INDICATED ON THE PREVIOUS VISIT’S DISHCARGE ORDERS. It is the
responsibility of the clinician on the case to review the orders, add
any procedures deemed necessary and to sign the orders early in the day
(preferably before rounds or immediately afterwards).
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:
Journal Club: Tuesday (8:00-9:00) Except for the first Tuesday
of each month.
House Officer rounds: Wednesday (8:00-9:15)
House Officer Seminar Series: Thursday (8:00-9:00)
Grand Rounds: Friday (7:00-8:00 a.m.)
Cardiology/Critical Care Rounds: Friday (8:00-9:00)
Daily board rounds: 9:00-9:30 and 2:00-2:45 (morning rounds are
later on Wednesday)
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 your 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
each year with primarily house officers and faculty as the audience.
These seminars are often based upon areas of research or publication
interest. Though students will sometimes attend, gear your presentation
to 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. Continuing house officers are scheduled early in
the year. 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 second
year 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 usually occur on Fridays, and may include: second year physical
examination laboratory and final examination, second year clinical methods
laboratory, third year case discussions, and third year oncology lectures.
Assistance with selective laboratories may also be requested. Before volunteering
to assist in teaching, 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 first month
of your program. Schedule a meeting with your entire committee within
6 months after beginning your program. Subsequent meetings should occur
at least every 6 months, or as needed. 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
Clinician Investigator Program
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 months Oncology
1 month Internal Medicine (immediately preceding time off for
studying)
1 Radiation Oncology (if only 1 month taken in year one)
4 months Professional Development:
3 months Professional Development: this must be constructively
scheduled with your advisor
1 month Board Preparation
[Credentials due October 1 for the General examination]
Year 3
1 month Oncology as Chief of Service
4.5 months Oncology (or 3 months Oncology and 1 month other service-e.g.
ICU)
0.5 months in cytology
6 months of Professional Development:
5 months constructively schedule professional development
1 month Board Preparation
[Credentials due October 1 for the Certifying examination, including one publication] Two weeks of vacation per year are taken during Professional Development time.
Scheduling considerations:1. During the block the 3rd year resident is Chief of Service, the 1st or 2nd year resident must also be on duty. The timing of this block is determined by the faculty rotation schedule.
2. 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.