radiotherapy and oncology - gcps...problems, including interpreting available data and integrating...

RADIOTHERAPY AND ONCOLOGY

GHANA COLLEGE OF PHYSICIANS AND

SURGEONS

FELLOWSHIP IN

RADIOTHERAPY AND ONCOLOGY

2018/19

RADIOTHERAPY AND ONCOLOGY 2018/2019

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Contents

GENERAL INFORMATION .............................................................................................................................. 2

1.1 Rationale ...................................................................................................................................................... 2

1.2 Goal .............................................................................................................................................................. 2

1.3 Objectives .................................................................................................................................................... 2

1.4 Entry requirements ....................................................................................................................................... 3

1.5 Course Duration/Requirement for Certification ........................................................................................... 3

1.6 Examinations ................................................................................................................................................ 4

1.7 Rotations for Part III Fellowship Program ................................................................................................... 4

1.8 Routine for Residents ................................................................................................................................... 5

SYLLABUS FOR PART III EXAMINATION ........................................................................................................... 5

2.1 Learning Portfolio .................................................................................................................................................. 5

2.2 Dissertation ............................................................................................................................................................ 6

2.3 Syllabus in Statistics as Applied to Oncology ....................................................................................................... 6

2.4 Critique of a published phase III study. ............................................................................................................... 7

2 .5 Assessment ............................................................................................................................................................ 8

2.6 Advanced Clinical Skills ........................................................................................................................................ 8

3.0 Suggested Reading ................................................................................................................................................ 9

LEARNING PORTFOLIO FOR FELLOWSHIP PART 3 ....................................................................................... 10

List of subsites chosen ............................................................................................................................................. 10


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GENERAL INFORMATION

1.1 Rationale

There is the need to develop a well structured programme for the training of CLINICAL

ONCOLOGISTS for the country. This will help with Service delivery, Research and

Teaching. There is increasing incidence of non-communicable diseases and cancer

brought on by demographic transition. These trained oncologists will fill the vacancies in

institutions as appropriate. Furthermore they will help in the training of technical and

graduate support staff as well as promote research needed for sustainability of cancer

control in the Country.

1.2 Goal

The aim of the Ghana College of Physicians and Surgeons therefore is to train high caliber

oncologists to provide accessible high quality oncological service throughout the country.

1.3 Objectives

The Trainees by the end of the program will function effectively as specialists and

consultants. Provide optimal, ethical and patient-centered medical care. Demonstrate a

commitment to their patients, profession, and society through ethical practice.

Establish and maintain clinical knowledge, skills and attitudes appropriate to Radiation

and Oncology treatments.

Demonstrate effective clinical problem solving and judgment to address patient

problems, including interpreting available data and integrating information to

generate differential diagnoses and management plans including use of systemic

therapy.

Effectively communicate and contribute to multidisciplinary team management of

cancer patients based on evidence-based practices.

Demonstrate competent planning and execution of radiation therapy.

Contribute to the development, dissemination, and translation of new knowledge and

practices to undergraduate and graduate medical and allied health support services.

Trainees will be encouraged to use the Learning Portfolio to learn applied basic

sciences and the associated roles of an Oncologist in Health Care Practice i.e.

Collaborator, Communicator, Health Advocate, Manager, an ethically based

Professional and Scholar.


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1.3.1 Proposed title

Fellow of the Ghana College of Physicians

1.4 Entry requirements

1.4.1 The candidate must possess MB ChB certificate or its equivalent from a recognized

university.

1.4.2 The candidate must be fully registered with the Ghana Medical and Dental Council

1.4.3 The candidate must have done four post qualification rotations in the four major

disciplines: namely Medicine, Surgery, Obstetrics and Gynecology and Pediatrics.

1.4.4 The candidate must have passed an entrance examination and interview

1.4.5 The candidate must provide 2 Referees, one of whom must be his or her immediate

supervisor

1.5 Course Duration/Requirement for Certification

Council may exempt a candidate from part of the training program and examination

following an application and approval, on the recommendation of the Credentials

Committee through the Faculty Board.

The duration of the fellowship is 2 years .

The candidate will continue to train by upgrading of skills toward independent

practice of oncology for a minimum of 12 months to be qualified to be admitted for

the fellowship examination. This examination will dwell on research development

and ability to demonstrate highly skilled oncology practice, teaching and

supervisory skills.

.Fellowship Examination

For admission a candidate must

Have passed the Part II examination

Have done at least one year of work under supervision by college fellows.


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During this one year the candidate should be formulating and identifying

areas of research to be used for a dissertation, identify a supervisor and write

a proposal.

At the fellowship selection interview, the candidate should present a draft

proposal reviewed by the supervisor.

On successful completion of the fellowship examination the trainee shall be

awarded a certificate of Fellow of Ghana College of Physicians (FGCP).

1.6 Examinations

1.6.1 The Part III Fellowship Examination will consist of

Part 1. Written paper consisting of a statistical critique of 2 published articles (1HOUR)

Part 2. Defense of Dissertation (45 MIN)

Part 3. VIVA VOCE (1 HOUR)

Questions ABOUT Statistics as Applied to Oncology (10min)

Questions about Statistical critique (20 min)

Questions on cases presented in learning portfolio (30 min)

Final mark will include marks awarded from assessment of dissertation and critique of an

article.

1.7 Rotations for Part III Fellowship Program

The Trainee will rotate through the following Specialties:

1.7.1 General Surgery (oncology cases) 2 weeks

1.7.2 Urology (oncology) 2 weeks

1.7.3 Hematology 2 weeks

1.7.4 Pediatric Oncology 2 weeks


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1.7.5 Pathology 2 weeks

1.7.6 Radiology (CT/MRI) 2 weeks

1.8 Routine for Residents

Daily scheduled outpatient clinics and simulation for treatment .

Once a week teaching with the Consultant

Weekly chart rounds/tutorials with the Consultant

Weekly film rounds /tutorials with the Consultant

At least once a week planning sessions

Monthly journal club meeting with the Consultant

Biweekly seminars in specific topics with Consultants

Trainees will co- author clinical research and publish an abstract or paper per

year.

Attend all multi disciplinary meeting in oncology

SYLLABUS FOR PART III EXAMINATION

2.1 Learning Portfolio

The Learning Portfolio documents the fellow’s experience.

It includes a guideline to a list of procedures and templates for the completion of

case reports in Radiation Oncology and Medical Oncology and concentrates on four

broad areas in detail, commenting on evidenced based practices and

recommendations of how to adapt to resource sparing settings .

The Learning Portfolio is analyzed by all trainers directly involved with the trainee

and signed off with comments. The signatures are verified by the Head of

Department and forwarded to the Faculty Chair, three (3) months prior to intended

examination date.


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2.2 Dissertation

AIM

To establish an understanding of research methodology

Ensure participation in research as an integral component of radiation oncology

training and subsequent specialist practice.

To encourage trainees to contribute to the oncology literature.

A Topic which illustrates aspects of the

• Basic Science of Oncology

• Analysis and modelling of treatment techniques

• A critical /substantial literature review as relevant to practice in Ghana

Reviewed by supervisor before submission to college.

• Completed at least 3 months prior to the Part III examination and submitted to

college for examiners

• Should be presented in publishable FORM

2.3 Syllabus in Statistics as Applied to Oncology

2.3.1 Scientific Knowledge

• Rationale of Clinical Trials

• Levels of Evidence in Medicine

• Sequenced Phases leading to Randomized Trials

Phase I Clinical Trials

Phase II Clinical Trials

Phase III Clinical Trials

2.3.2 The Study Protocol

• Study Patients

• Treatment

• Follow up of Patients

• Endpoints in Oncology studies


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2.3.3 Statistics

• Descriptive Statistics

Mean, Median and standard deviation

Life table and Kaplan Meier survival plots

• Statistical planning of a Phase III study

Null hypothesis

Type 1 and Type II errors

Probability of Type I and type II errors in studies – alpha and beta.

Numbers of patients needed in a study.

Statements of probability and confidence intervals, P-values and

their meanings. The normal distribution

• Types of Data and Statistical Tests

Binary Data and the chi square

Continuous Data and the t test or z score

Survival Analyses and the log rank test

Hazard Ratios and confidence intervals

Prognostic Factors - multivariate analysis

Correlation and regression

2.3.4 Principles of Statistical Design: Factorial Experiments

Decision Analysis and Choosing Sample Size

Adaptive Designs of Clinical Trials

Outcomes Methods

- Outcomes or Endpoints

- Measures of Quality

2.4 Critique of a published phase III study.

2.4.1 Presentation - sample outline of critique of a published article on two

Phase III studies (more than 2 pages in length)

2.4.2 Study aim and phase

2.4.3 Protocol.


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• Similarity of prognostic factors in treatment arms

• Adequacy of treatment in control arm

• Endpoints – comment on their appropriateness and determination

• Other comments

2.4.4 Statistical design of study

• Hypothesis – the null and alternate hypothesis

• Alpha error and power of the study

• Determination of number of patients needed

• Other comments

2.4.5 Statistical evaluation

• Descriptive statistics used

• Statistical test used to evaluate endpoints - p value findings

• Findings in terms of odds ratio or Hazard ratio and confidence intervals

• Other comments

2 .5 Assessment:

The critique will be examined by a designated supervisor appointed by the

College.

The critique should be presented to the GCPS together with the Research

project.

2.6 Advanced Clinical Skills

During the fellowship period, the candidate is to improve proficiency in oncological

clinical skills pertaining to diagnosis, treatment planning, complications of therapies

both in radiation and medical oncology, palliation, as well as administrative and

leadership skills.


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3.0 Suggested Reading

1. DEVITA, V.T., HELMANN, S., ROSENBERG, S., Cancer: Principles and Practice

of Oncology, 7th ed. Lippincott Williams & Wilkins.

2. GUNDERSON, L.L., TEPPER, J.E., Clinical Radiation Oncology, 2nd ed. Elsevier

(2007).

3. HALL, E.J., GIACCIA, A.J., Radiobiology for the Radiologist, 6th ed., Lippincott

Williams &Wilkins (2005).

4. KHAN, FAIZ M., Treatment Planning in Radiation Oncology, 2nd ed., Lippincott

Williams &Wilkins (2006).

5. LEIBEL, S.J., PHILLIPS, T. J., Textbook of Radiation Oncology, Saunders (2004).

6. PEREZ, C.A., BRADY, L.W., HALPERIN, E.C., Principles and Practice of

Radiation Oncology, 5th ed. Lippincott Williams & Wilkins, (2007).

7. PODGORSAK, E., Radiation Oncology Physics: a handbook for teachers and

students,International Atomic Energy Agency (2005).

8. STEEL, G., Basic Clinical Radiobiology, 3rd ed. Hodder Arnold (2002).

9. Applied sciences in oncology distance learningavailable at

https://humanhealth.iaea.org/HHW/RadiationOncology/Training/Teaching/ASO/index.

html

10. Handbook of evidence based medicine by by Eric K. Hansen and Jeffery D. Long.

11. Targeted volume delineation for conformal and intensity-modulated radiation

therapy by by Nancy Y. Lee, Nadeem Riaz and Jiade J. Lu

12. Delineating organs at risk in radiation therapy by Giampiero Ausili Cèfaro

13. Molecular biology of cancer by Lauren Pecorino

14. Understanding clinical papers by David Bowers and Allan House.

15. Radiotherapy in practice series- External beam therapy by by Peter Hoskin

16. Radiotherapy in practice series –Brachytherapy by by Peter Hoskin and Catherine

Coyle

17. Radiotherapy in practice series -Radioisotope therapy by by Peter J. Hoskin

18. Handbook of targeted therapy by by Daniel D. Karp;Gerald S. Falchook MD MS

https://humanhealth.iaea.org/HHW/RadiationOncology/Training/Teaching/ASO/index.html

https://humanhealth.iaea.org/HHW/RadiationOncology/Training/Teaching/ASO/index.html

https://www.amazon.com/Lauren-Pecorino/e/B001IU4YO4/ref=sr_ntt_srch_lnk_1?qid=1536927050&sr=8-1


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LEARNING PORTFOLIO FOR FELLOWSHIP PART 3

(1) Biodata of the trainee

(2) Scientific training documentation( data management)

(3) Record of formal presentations by the trainee,

(4) Publications,(Please attach)

(5) Training courses ATTENDED OVER 2 YEARS .

(6) Record of external attachments.

Dates Rotations Site Supervisor Comment

(7) Dissertation Title And Name Of Supervisor

Clinical experience

List of core cases covering 5 subsites and 5 Special /complicated cases FOR EACH

SUB SITE ( total of 25 cases to be logged)

List of subsites chosen

1

2

3.

4

5.


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Clinical

problem

Date RT/Chemo Trainer Comments about case

Signed DATE:

CANDIDATE

SUPERVISOR

HOD

FACULTY CHAIR

Comments by evaluators

Designation Comment Approved Not

approved

FINAL DECISION

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