Surgical Oncology Resident The Division of Surgical Oncology supports the North Carolina Tissue Consortium,

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    Surgical Oncology Resident

    Handbook

    Division of Surgical Oncology Department of Surgery

    East Carolina University, Brody School of Medicine

  • 2

    Table of Contents:

    Weekly Schedule Page 3

    NC Tissue Consortium Page 4

    Communication Page 5

    Admissions Page 6

    Deportment Page 6

    Pain Management Page 8

    Operating Room Conduct Page 8

    Education Page 8

    Rounding Page 9

    Consultations Page 11

    Clinic Page 12

    Tumor Board Page 12

    Chain of Command Page 12

    Reading Schedule Page 14

    Surgery Oncology Investigations Page 15

    Breast Issues Page 21

    Clinical Pathways Page 23

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    D r. Z

    erv o s in

    th e O

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    MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

    9am-12pm

    Dr. Zervos

    GI Clinic MANDATORY

    8am-9am

    Breast Conf.

    LJCC 248 MANDATORY

    M&M

    Grand Rounds

    (please see

    attachment for

    schedule)

    PCMH Audit.

    7am-8am

    GI Tumor Board

    LJCC 248

    MANDATORY

    7am-9am

    Teaching Conf.

    Surgical Library

    .

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    9am-9:30am

    Case Conf.

    Location TBD

    (led by Chief

    Residents)

    9am-12pm

    Dr. Bellin

    Brst. Clinic MANDATORY

    9am-

    Service Rounds 9am-12pm

    Dr. Zervos

    GI Clinic

    MANDATORY

    9am-12pm

    Dr. Bellin

    Brst. Clinic

    MANDATORY

    9am-12pm

    Dr. Fitzgerald

    GI Clinic

    MANDATORY

    1pm-5pm

    Dr. Bellin Brst. Clinic MANDATORY

    9:15am-12pm

    Dr. Fitzgerald

    Brst. Clinic

    MANDATORY

    12pm-1pm

    Tumor Board

    Oncology Conf.

    PCMH Audit.

    12pm-1pm Teaching Conf

    BSOM 4S20 MANDATORY

    1pm-5pm

    Dr. Bellin

    Brst. Clinic

    MANDATORY

    1pm-5pm

    Dr. Fitzgerald

    GI Clinic

    MANDATORY

    1:30pm-5pm

    Dr. Fitzgerald

    Brst. Clinic

    MANDATORY

    1pm-5pm

    Dr. Zervos

    GI Clinic

    MANDATORY

    Surgical Oncology Rotation Schedule for Residents

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    North Carolina Tissue Bank:

    The Division of Surgical Oncology supports the North

    Carolina Tissue Consortium, a tissue bank sponsored

    by the UNC Lineberger Comprehensive Cancer

    Center. The objective of the NCTC is to promote

    cancer- related and basic science research by

    providing a facility for procurement, processing, and

    storage of normal and malignant human specimens.

    Patients are approached for consent to participate in

    research during their clinic visit prior to surgery. No

    specimen is procured unless the patient has been

    appropriately informed and signed a consent form for

    procurement. On the day of surgery, tissue bank

    staff is paged by a circulating nurse to retrieve the

    specimen and transport it to the pathology

    department for assessment. Tissue is only procured

    after the pathologist has obtained the appropriate

    specimen information for patient care (e.g.

    diagnosis, inking of margins, etc.). All samples are

    frozen and stored at the Brody School of Medicine

    until requested for use by an investigator.

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    SURGICAL ONCOLOGY SERVICE MANUAL

    COMMUNICATION

    Communication is first in this manual for a reason. COMMUNICATION is

    always first. When in doubt, call. When not in doubt, call. You will receive

    a call schedule at the beginning of the rotation – attending call coverage

    begins during the week when that attending leaves the hospital and from that

    time Friday evening until 7 am Monday. You are only responsible to

    communicate with the on-call attending during off hours – they will decide

    whether to contact the patient specific off call attending. During business

    hours, communicate directly with the attending of record.

    Text messaging:

    Texting is here to stay but until a text message is acknowledged it is only a

    ONE WAY form of communication. This is due to different attending

    preferences about carrying cell phones and sporadic cellular coverage at

    PCMH. Please, do not communicate or report your intention to carry out a

    test or procedure by text message unless that text is acknowledged as

    received by the intended recipient. Absence of this acknowledgement can

    be regarded as the message not being received or communicated.

    Pagers:

    Since we all carry pagers and pager coverage is universal, this form of

    communication does not require acknowledgement of receipt. Remember,

    when in doubt, communicate. You will NEVER be discouraged from doing

    so. Paging is the preferred method by which to contact the attending.

    Cell Phones:

    Cell phone calls are the easiest method of communication provided the

    phone is answered or within range. Again, don’t assume that any voice

    message left on a cell phone has been received or appropriately

    communicated for the reasons stated above. Paging is the only foolproof

    method of one-way communication.

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    PATIENT ADMISSIONS

    If you are not notified of a patient transfer after hours, discuss this with the

    on call attending. Ideally, any patient accepted from an outside hospital or

    asked to go to the ER will be discussed with the on call resident before that

    patient arrives. Regardless of time of day, after you have had a chance to

    meet the patient and go over their records, contact the responsible attending

    to discuss the plan of care. This can save hours, if not days from the ensuing

    hospitalization as the accepting attending may be privy to information or

    details of the patient’s illness that are not apparent in the patient’s record and

    may have a specific plan of care in mind.

    If an attending is out of town, you can not admit a patient under their name

    regardless of whether or not there is an established relationship with that

    patient. Admit those patients to the responsible covering physician.

    DEPORTMENT

    Cancer is a serious illness. On this service it is commonly a terminal

    diagnosis. Many of you have been touched by cancer either personally or

    though family. Please keep in mind the following general guidelines:

    When a patient is informed of a cancer diagnosis, they will remember the

    exact words in which it is imparted to them for the rest of their life. It is

    important to keep this in mind in patients who do not yet know their

    diagnosis or pathology. Unless you are asked directly by a patient, and you

    feel comfortable, do not discuss pathology or new diagnoses of cancer until

    the attending has a chance to do so. Simply state that “The pathology is

    complete and Dr. will discuss it with you when he or she rounds.”

    Discussion of intraoperative findings “his belly was ate up with cancer” with

    patients or family members may be taken out of context and create

    insurmountable obstacles in subsequent care and treatment planning. As

    with anything else in life, presentation is everything, learn from your

    attending in this regard so that you can add this skill to your armamentarium.

    This is the art of medicine, and is not easily taught. Complete

    understanding of the implications of a diagnosis or pathology report is

    crucial in having a meaningful discussion about pathology.

    Similarly, present yourselves with the necessary countenance to impart your

    seriousness about the task at hand. Do not laugh, joke or carry on in patient

    care areas, that is anywhere on 1 south, the ASU, the recovery room.

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    Anywhere that a patient or patient’s family might have opportunity to

    observe or overhear. Keep this in mind regardless of the patient’s state of

    consciousness or even their own frame of mind. You would be surprised

    what a patient is capable of comprehending despite being seemingly

    oblivious.

    You are our eyes and ears, our representatives when we cannot be there,

    please act accordingly and, whenever in doubt, just treat the patient or

    patient’s family the way that you or your family member would wish to be

    treated under like circumstances.

    PAIN MANAGEMENT

    All laparotomy patients should receive postop pain management in the form

    of a PCA without basal rate. Do not institute a basal rate without the

    permission of the attending. A standard PCA dose is 1mg morphine every 6

    minutes with a 10 mg lockout. Dilaudid is 0.2-0.4 mg every 6 minutes.

    Again, basal rates are forbidden unless explicitly requested by the attending.

    Oncology