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City of Hope


​​​Surgical Service Rotation at City of Hope

City of Hope is an independent biomedical research treatment and education center dedicated to preventing and curing cancer and other life-threatening diseases. City of Hope is one of only 45 National Cancer Institute-designated Comprehensive Cancer Centers nationwide and a founding member of the National Comprehensive Cancer Network. Research opportunities are available within the Division of Surgery with one of the over 100 basic science principal investigators. The General and Oncologic Surgery services include the disciplines of breast, colorectal, melanoma, bone and soft tissue sarcoma, and gastrointestinal malignancies. Residents will complete a 3 month rotation on the surgical oncology service in the PGY 4 year.

Surgical Case Volume performed on average:

  • Skin/soft Tissue: 36
  • Head/Neck: 125
  • Breast: 685
  • Alimentary tract – esophagus: 29
  • Alimentary tract - stomach: 75
  • Alimentary tract – small intestine: 40
  • Alimentary tract – large intestine: 192
  • Alimentary tract – ano-rectal: 16
  • Abdomen – general: 13
  • Abdomen – liver: 40
  • Abdomen – biliary: 42
  • Abdomen – pancreas: 18
  • Abdomen – spleen: 141
  • Endocrine: 57
  • ​​

    City of Hope Goals & Objectives

    Postgraduate Year 4

    ​​Goals:

    City of Hope will prov​ide a learning environment for the management and care of the surgical oncology patient.  Surgical basic science, including fluids and electrolytes, wound healing, and nutrition, will be emphasized.  Clinically, residents will assess surgical pathology pre-operatively, develop clinical judgment on managing these issues, and learn operative skills to address the problem.  Careful postoperative care and follow up will be emphasized. In addition, residents will participate in the various tumor boards and become familiar with the different adjuvant treatment options. Residents will develop cognitive and technical skills in dealing with complex oncological issues.

    Objectives:

    Medical Knowledge

    • Describe the anatomy of the breast, skin, soft tissue, stomach, and esophagus
    • Summarize the incidence, epidemiology, and risk factors associated with colon, liver, and pancreas cancer.
    • List and distinguish between various tumors of the colon, liver, and pancreas.
    • List and explain the evidence-based methods for colon cancer screening.
    • Describe the diagnostic workup associated with colorectal, liver and pancreatic cancers.
    • Outline the diagnostic work-up and the differential diagnosis of rectal bleeding.
    • Describe the principles of surgical treatment of colon cancer.
    • Outline the genetic and environmental factors associated with carcinoma of the colon and rectum.
    • Explain the use of tumor, nodes, and metastases (TNM) staging in the treatment of
    • colon and pancreatic cancer.
    • Summarize the rationale for using a team approach to facilitate the complex discussions and explanation of options for the newly diagnosed rectal cancer patient prior to definitive treatment (e.g., team of medical oncologist, surgical oncologist, radiation oncologist, etc).
    • Understand the importance and function of clinical trials in oncology, including knowing the entry criteria and treatment algorithms for trials.
    • Have current human subjects training.

    Patient Care

    • Establish basic proficiency in providing pre-operative and post-operative care (write appropriate pre-op and post-op orders for floor patients, handle nursing calls appropriately, and manage most routine post-operative care with minimal intervention by supervisor).
    • Take an appropriate history to evaluate patients with surgical oncology issues to include:
      • A complete history of present illness
      • Presence of any co-morbidities
      • A review of social and family history impacting the present problem
      • A complete review of systems
    • Demonstrate an increasing level of skill in the physical examination of the surgical oncology patient.
    • Develop a proficiency in evaluation and interpretaton of the different diagnostic modalities including: X-Rays, ultrasound, CT scan, contrast studies and MRI.
    • Discuss treatment options, risks and potential complications of patients with surgical issues.
    • Develop proficiency in performing the basic operations available for the treatment of colon and rectal cancer such as:
      • Endoscopic polypectomy
      • Segmental colectomy
      • Hemicolectomy
      • Transanal resection of rectal tumors
      • Low anterior resection
      • Abdominoperineal resection
    • Develop proficiency in performing the basic operations available for the treatment of liver tumors, including:
      • Hepatic segmentectomy
      • Hepatic lobectomy
      • Hepatic trisegmentectomy
      • Biliary resection with reconstruction
    • Develop proficiency in performing the basic operations available for the treatment of pancreatic cancers, including:
      • Enucleation
      • Ampulloduodenectomy
      • Distal pancreatectomy
      • Pancreaticoduodenectomy (whipple resection)
    • Have clear indications and know when it is appropriate to perform a surgical procedure.
    • Have an understanding of when it is not appropriate to operate.
    • Demonstrate knowledge of steps to be taken to have a patient ready for surgery including preop workup and medical clearance.

    Professionalism

    • Be receptive to feedback on performance, attentive to ethical issues and be involved in end-of-life discussions and decisions.
    • Understand the importance of honesty in the doctor-patient relationship and other medical interactions.
    • Treat each patient, regardless of social or other circumstances, with the same degree of respect you would afford to your own family members.
    • Learn how to participate in discussions and become an effective part of rounds, attending staff conference, etc.
    • Complete all assigned patient care tasks for which you are responsible or provide complete sign out to the on-call resident / fellow.
    • Maintain a presentable appearance that sets the standard for the hospital this includes but is not limited to adequate hygiene and appropriate dress. Scrubs should be worn only when operating or while on call.
    • Assist with families of critically injured/ill patients and guidance of families towards or through difficult decisions.
    • Demonstrate mentoring and positive role-modeling skills

    Systems-Based Practice

    • Understand, review, and contribute to the refinement of clinical pathways
    • Understand the cost implications of medical decision-making
    • Partner with health care management to facilitate resource efficient utilization of the hospital's resources.
    • Describe in general terms the benefits of clinical pathway implementation
    • Develop a cost-effective attitude toward patient management.
    • Develop an appreciation for the benefits of a multi-disciplinary approach to management of critically ill surgical patients.
    • Comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations regarding patient privacy and confidentiality

    Practice Based Learning & Improvement

    • Demonstrate the ability to:
      • Evaluate published literature in critically acclaimed journals and texts
      • Apply clinical trials data to patient management
      • Participate in academic and clinical discussions
    • Accept responsibility for all dimensions of routine patient management on the wards
    • Apply knowledge of scientific data and best practices to the care of the surgical patient
    • Facilitate learning of medical students and physician assistant students on the team.
    • Use the COH and RCRMC library and databases on on-line resources to obtain up to date information and review recent advances in the care of the surgical patient.
    • Demonstrate a consistent pattern of responsible patient care and application of new knowledge to patient management.
    • Demonstrate a command and facility with on line educational tools.

    Interpersonal & Communication Skills

    • Work as effective team members
    • Cultivate a culture of mutual respect with members of nursing and support staff
    • Develop patterns of frequent and accurate communication with team members and attending staff
    • Gain an appreciation for both verbal and non verbal communication from patients and staff
    • Demonstrate consistent respectful interactions with members of nursing and support staff
    • Demonstrate consistent, accurate and timely communication with members of the surgical team
    • Demonstrate sensitivity and thoughtfulness to patients concerns, and anxieties.
    • Demonstrate the ability to provide and request appropriate consultation from other medical specialists.​