Clinical neuro-oncology rotation



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CLINICAL NEURO–ONCOLOGY ROTATION



  1. Introduction

  2. Objectives

    1. General

    2. Specific

  3. Staff

  4. Trainees who may benefit from this elective

  5. Duration

  6. Activities

  7. Procedures

  8. Weekly schedule



  1. Introduction.

A neuro-oncologist was recruited in 2005 with the aim of providing care to not only patients with primary and metastatic brain tumors, but also to any cancer patient with neurological symptoms or complications. We are seeing more of these patients in the clinic and at the West Jefferson Medical Center because we are the only institution in the Southern Gulf area with a well-assembled neuro-oncology team. This resource offers an enormous learning experience to residents and fellows, and at the same time stimulates an environment of interdisciplinary work that interfaces Medicine, Neurology, Neurosurgery, Oncology, and Radiation Oncology. Our patients from Louisiana and neighbor states will be the ultimate beneficiaries of this effort. We hope it will be a time–intensive yet rewarding rotation.



  1. Objectives.

    1. General:

      1. To introduce trainees to the discipline of Neuro–Oncology

      2. To help develop in trainees a standardized approach to the cancer patient with neurologic symptoms or complications

      3. To help develop in trainees a standardized approach to the patient with primary brain and spine tumors

      4. To help develop in trainees a standardized approach to the patient with brain and spine metastases

      5. To prepare residents for neuro-oncology questions in the American Board of Psychiatry and Neurology Board Exam

      6. The residents will receive instruction in appropriate and compassionate methods of end-of life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues.




    1. At the end of this elective, trainees should:

      1. Efficiently evaluate the mental status of patients in the office or at the bedside, and conduct time–efficient, focused neurological exams for anatomical localization

      2. Based on the data collected from the history, physical exam, and ancillary studies, formulate a diagnosis, make treatment recommendations, and establish a prognosis

      3. To become familiar with the Karnofsky Performance Score (KPS) as the most commonly used performance scale used in Neuro–Oncology, and the recursive partitioning analysis (RPA) classes for prognosis in brain metastases

      4. To be familiar with the pathology, radiology, prognosis, and current treatment options for:

        1. Glioblastoma multiforme

        2. Anaplastic astrocytoma

        3. Anaplastic oligodendroglioma

        4. Low grade gliomas (astrocytomas, oligodendrogliomas, or mixed)

        5. Meningiomas: benign, atypical, malignant

        6. Brain metastases

        7. Leptomeningeal disease

        8. Other tumors: skull base, head and neck, primary CNS lymphoma

      5. To break bad news to patients and families in a compassionate, human, and empathetic way

      6. To promptly recognize and treat the following emergencies or complications:

        1. Intracranial hypertension, with or without brain herniation

        2. Seizures

        3. Spinal cord compression

        4. Delayed neurotoxicity from radiation therapy

        5. Polyneuropathy from chemotherapeutic agents

        6. Neuropathic pain




  1. Staff: Ivo W. Tremont, M.D., Frank Culicchia, M.D.




  1. Trainees who can benefit from this rotation: Neurology, Medicine, Hematology–Oncology, Radiation Oncology, and Neurosurgery residents or fellows




  1. Duration: One month at least




  1. Activities: Clinic, inpatient consults, inpatient rounds, family conferences (if applicable), operating room (OR, optional), tumor board.




  1. Procedures (when indicated): Lumbar puncture, intrathecal administration of chemotherapy; Puncture of Ommaya reservoirs and intraventricular administration of chemotherapy




  1. Weekly schedule




Time

Monday

Tuesday

Wednesday

Thursday

Friday

AM

Rounds, Clinic

Rounds

Clinic


Tumor Board

Clinic


Consults

Rounds


Rounds

Clinic


PM

Clinic

Clinic

Consults

Rounds


-

Clinic


References


We will follow the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology, v.1.2006 on CNS Cancers, and the World Health Organization textbook on the Pathology of Tumors of the Nervous System IARC Lyon, 2000
SUB-SPECIALTY: Neurology

ROTATION EXPERIENCE: Inpatient Neurology Service


PATIENT CARE

Neuro-Oncology Patient Care

Objectives

Teaching Methods

Assessment Strategy


Introduce the trainee to the basic principles & desiplines of Neuro-oncology

Clinical Teaching

Review of guidelines



Global ratings



Gather essential patient history and data to formulate a diagnostic differential

Clinical Teaching/Patient Care

Global ratings


Develop a standardized approach to the patient with primary brain & spine tumor

Clinical Teaching

Direct Patient Care



Global ratings

Case Conference Evaluations


MEDICAL KNOWLEDGE



Neuro-oncology Medical Knowledge

Objectives

Teaching Methods

Assessment Strategy

Familiar with the Karnofsky Performance Scale (KPS)

Clinical Teaching


Global ratings

End of Rotation Quiz



Familiar with the pathology, radiology, prognosis and current treatment options for:

        1. Glioblastoma multiforme

        2. Anaplastic astrocytoma

        3. Anaplastic oligodendroglioma

        4. Low grade gliomas (astrocytomas, oligodendrogliomas, or mixed)

        5. Meningiomas: benign, atypical, malignant

        6. Brain metastases

        7. Leptomeningeal disease

        8. Other tumors: skull base, head and neck, primary CNS lymphoma




Required Reading

Clinical Teaching

Case Conference


End of Rotation Quiz

INTERPERSONAL AND COMMUNICATION

Neuro-oncology- Interpersonal and Communication

Objectives

Teaching Methods

Assessment Strategy

Learn to break bad news to patients & families in a compassionate, human and empathetic way

Patient Care

Global ratings

Present Cases in a organized and detailed manner

Case Conference

Modeling


Global rating


Demonstrate the ability to compassionately relate to the family of a patient

Clinical Practice

Modeling


Global ratings


PRACTICE BASED LEARNING AND IMPROVEMENT



Neuro-oncology Practice Based Learning and Improvement

Objectives

Teaching Methods

Assessment Strategy

Research clinical questions regarding potential treatments for their patients, using information technology to access on-line medical information

Case presentations

Global ratings

End of Rotation Quiz



Familiar with published clinical care guidelines

Case presentations

Clinical Care



Global ratings

End of Rotation Quiz


PROFESSIONALISM



Neuro-oncology Professionalism

Objectives

Teaching Methods

Assessment Strategy

Interact responsibly and compassionately with patients, families and co-workers

Clinical care

Modeling


Global ratings

SYSTEM BASED PRACTICE



Inpatient Neurology Service (PGY1 or 2) System Based Practice

Objectives

Teaching Methods

Assessment Strategy

Develop an understanding of cost effective health care

Modeling

Clinical Teachings



Global ratings


Advocate for patients when dealing with resource allocation issues and complex payer system problems

Direct patient care

Clinical Teachings



Global ratings



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