It is expected that each fellow participate in more than 200 surgical oncologic cases over the course of the Musculoskeletal Oncology Fellowship. The technical aspects of the program are surgically based and depend on the individual's surgical skills. It is anticipated that as you progress through the training program, your skills will improve. It is also anticipated that in most cases you are the primary surgeon with the consultant as your assistant, providing direction as needed.
During the Musculoskeletal Oncology Fellowship, you participate in quarterly rotations with each of the four operating surgical oncologists. This ensures maximum exposure to tumor cases while minimizing the service component, so that you're not required at nononcology cases.
Using this approach, you should have access to most if not all of the tumor cases that are treated on each of the individual consultant's services. You are exposed to collaborating disciplines through departmental educational formats and daily patient-based clinical interactions. This includes basic concepts of oncogenesis and molecular oncology, adult and pediatric oncology, immunology, and radiation oncology.
During clinical days, you see new tumor patients, evaluate the clinical situations, and formulate treatment plans. Each patient's case is then presented to the consultant, the case is discussed, and the treatment plan is either finalized or revised. You are then responsible for initiating the treatment plan, including coordinating with collaborating services, medical oncology, radiation oncology, pediatric hematology oncology, radiology, and pathology.
During surgical days, you work as a team with the consultant. Your responsibility is dependent upon your previous experience and level of competency. In the majority of cases, you assume the role of surgeon and the consultant acts as the first assistant. The consultant is present for the entirety of the case, providing supervision and direction for you.
In the postoperative period, you assume primary responsibility for the day-to-day management of hospital patients. You make rounds with the consultant on a daily basis.
Emergency room experience involves management of patients with pathologic fractures and emergencies that are encountered by orthopedic oncology patients. You take primary responsibility for emergency room evaluation and communication with the consultant in a joint formulation of the plan of intervention.
Academic training takes a scholarly approach that uses tumor conferences, literature reviews, journal clubs, patient clinical evaluations, surgical judgment, and retrospective and prospective clinical analysis.
During weekly sarcoma rounds facilitated by the fellow, cases accumulated over the previous week are presented by residents on the respective services. These highly instructive rounds are multidisciplinary and generate much discussion and reference to pertinent literature.
Additionally, the staff hosts journal clubs at their homes. The nature and emphasis of the discussion are finalized by the fellow and staff. The fellow collates the pertinent literature and assigns review to the oncology residents. Anatomical dissection labs are conducted quarterly, allowing for interactive demonstration of reconstructive options after resection. The fellow coordinates these sessions, which are attended by staff and residents.
If you choose to participate in the two-year program for the Musculoskeletal Oncology Fellowship, you spend your first year conducting basic research in sarcoma biology. During your second year, you are given time to continue your research or complete an alternative clinical research project. Fellows who choose the one-year program are encouraged to complete a clinical research project during the course of the year.
Your call schedule varies by rotation. Mayo Clinic follows the schedule recommendations of the Accreditation Council for Graduate Medical Education.
In addition to increasing your own knowledge base, you are expected to participate in orthopedic resident and medical student education through tumor conferences as well as resident education conferences on Tuesday evenings, Wednesday mornings, and Saturday mornings for the Department of Orthopedic Surgery in general.
You are responsible for anatomic dissections on a quarterly basis to further resident education. In conjunction with an orthopedic consultant, an anatomic region is identified, and the surgical approaches, oncologic resections, and reconstructive options are demonstrated on a cadaver.
The evaluation procedures used in the fellowship include quarterly written evaluations prepared by each consultant. The evaluations are reviewed with you and then filed in your permanent file. At the end of each quarter, you're encouraged to submit a written evaluation of your experience with each consultant.