Clinical Oncology
In the UK 1 in 3 people will suffer from cancer in their lifetime. The Eurocare study highlighted deficiencies in cancer care delivery in the UK. In response to the initial audit the NHS Cancer Plan sought to address some of the issues ranging from prevention through diagnosis, establishment of patient pathways, the development of functional site specialist MDTs, issues relating to treatment delivery, rehabilitation, long term sequelae, palliative care and end of life. NICE have issued Improving Outcomes Guidance for each site with a rolling programme of peer review audits. They have also issued a number of single technology assessments relating to oncology. Recent re audit has shown considerable improvement in survival across the board.
Cancer medicine or non surgical oncology is one of the fastest moving disciplines in modern medicine. There are strong academic links with basic sciences, pharmacology and physics research. Although many medical and surgical career pathways will include contact with patients with cancer the structured training programmes fall into palliative care, haemato oncology, medical and clinical oncology. A Clinical Oncologist is trained in the use of radiotherapy as well as chemotherapy for a range of cancers. In many other countries they are called radiation oncologists or radiotherapists but unlike the UK they have no post graduate general medical training and or cannot prescribe chemotherapy.
Clinical Oncology training is supervised by the Royal College of Radiologists on PMETB approved schemes. The entry criteria is at ST3 and currently includes satisfactory competency assessments at core medical training and success at MRCP or equivalent. It is a five year programme with part one exam between year one and year two. The exam is changing but is modular and examines physics, radiobiology and tumour biology, cancer pharmacology and medical statistics. The second part is more clinically based and is undertaken in year 4.
Framework of Training scheme in Yorkshire
Yorkshire has a very successful clinical oncology programme. An RCR trainee questionnaire showed 82% of trainees felt their training was above average.
Clinical oncology historically has had a hub and spoke arrangement of large central hospitals where complex chemotherapy and radiotherapy are delivered and a visiting model to the surrounding network of unit hospitals with outpatient clinics and chemotherapy for the commoner cancers. Dual site training is encouraged nationally and within Yorkshire there are two radiotherapy centres one based in Leeds and the other in Hull. Trainees will therefore spend up to 12 months within their first three years at the centre in Hull. A new state of the art hospital is currently under construction there.
Central clinical oncology services in Leeds are based in the newly constructed St James Institute of Oncology, Bexley Wing, St James University Hospital as we have outgrown the former Cookridge Hospital site. The oncology building houses non surgical oncology, histopathology, some surgical oncology and supporting services in a landmark building that is the largest of its kind in Europe. The radiotherapy services include virtual simulation, 3D, 4D , IGRTand IMRT facilities with a world acclaimed brachytherapy team. There are 26 site specialist clinical oncology consultants and 18 specialist registrars ( three at any one time in Hull and one in the medical oncology rotation).
Teaching and education.
All of the consultants are educational supervisors. Rotations consist of 4 monthly attachments to a team of consultants with appraisal and supervision as per the IRMER regulations and formal assessments via the Deanery. Specific work based assessments are being developed by the RCR.
In year one there is a half day release to attend the taught oncology course in preparation for the FRCR1. Medical oncology trainees attend other than for the physics component. There is also a formal programme for FRCR2.There are weekly radiotherapy planning meetings, journal club and joint lecture with medical oncology and haematology as well as monthly audit meetings.
An extensive programme of personal development courses are available through the Yorkshire Deanery.There are 18 resident FY2, ST1/ST2 for non surgical oncology in Leeds who are part of the core medical training rotation and also have protected teaching time. Registrars mentor specific CMT doctors during their time in oncology.
Teaching commitments also include the University of Leeds and Hull and York Medical School undergraduates.
On call.
The non resident on call commitment for registrars is around 1.10 while in Leeds. During the day the on call registrar does not attend peripheral clinics and is expected to respond to referral and enquiries from the assessment unit and the SJUH A and E department.
The Cinical Oncology training group are very committed to the School of Medicine to the continued success of the training programme in Yorkshire.