APPLICATION FOR FELLOWSHIP IN GERIATRIC ONCOLOGY
Name of Institution: McGill University
Location: Montreal General Hospital, Room D6-237.F
Type of Fellowship: Clinical fellowship in Geriatric Oncology
Fellowship Program Director: Dr. Doreen Wan-Chow-Wah
Program Information:
Number of fellowship positions requested: 2
Academic affiliation: Geriatric Medicine
Hospitals involved in training and approximate % time spent by fellow in each institution:
- Jewish General Hospital 35%
- Royal Victoria Hospital 35%
- St-Mary’s Hospital 15%
- Montreal General Hospital 15%
Background: Aging is the main risk factor for developing cancer. There is a growing interest worldwide in the field of Oncology and Aging (Geriatric Oncology) given the increasing number of seniors diagnosed with cancer. In Canada, 44% of cancer incidence and 62% of cancer mortality occur in persons aged ≥70 years (Canadian Cancer Statistics 2016). Older persons often differ from the younger adult population in terms of biological, psychological, functional, and social perspectives; as such, they have particular needs which require an interdisciplinary approach and intervention, especially when faced with a cancer diagnosis. The elderly population is heterogeneous, ranging from healthy seniors with no disability and few comorbidities to frail seniors who are disabled and have multiple comorbidities. This makes the assessment and management of this population challenging, especially when deciding on cancer treatment modalities.
Mission: The mission of this fellowship program is to provide fellows with solid basic science and clinical knowledge in the fields of Geriatric Medicine and Oncology (Medical Oncology, Hemato-Oncology, Radiation Oncology) to ultimately improve the care of older patients with cancer.
This fellowship is unique in that the type and number of rotations in Geriatrics and/or Oncology will be tailored to the candidates’ background, prior residency training and learning objectives. For instance, a Radiation Oncology resident wishing to do this fellowship will likely do more rotations in Geriatrics, since he/she already has a strong background in Oncology.
Applicant profile/requirements: The applicant must have satisfactorily completed residency training as well as Royal College or Board Certification in a medical (e.g. geriatric medicine, medical oncology, hematology, general internal medicine) or non-medical (e.g. surgical oncology, radiation oncology) specialty which involves providing care to older patients with cancer.
Learning objectives in Geriatrics:
a) To understand and perform Comprehensive Geriatric Assessments (5M framework: Multicomplexity, Medications, Mind, Mobility, Matters Most) in the inpatient setting (medical and surgical wards) as well as outpatient settings (Emergency department, outpatient Geriatric clinic, Neurocognitive Disorders clinic, Fall clinic, Geriatric Day Hospital).
b) To participate in the care of older patients on the inpatient Geriatric Unit, and in a consultative and co-management role as the Geriatric Medicine consultant.
c) To work effectively in an interdisciplinary team setting.
Specific educational objectives in Geriatrics:
1. Assessment and management of multiple comorbidities
2. Evaluation of polypharmacy and approach to appropriate prescribing and deprescribing
3. Diagnosis and management of common neurocognitive disorders
4. Evaluation and management of delirium
5. Diagnosis and management of functional decline, failure to thrive, general deterioration
6. Assessment of frailty
7. Understanding of the principles of capacity assessment
8. Evaluation of gait patterns and mobility in the elderly patient
9. Identification and approach to elder abuse
10. Understanding of the role of each member of the interdisciplinary team
11. Understanding of the different community resources for home care, options for relocation in assisted living facilities (Residence for seniors, nursing homes) and the application process.
Learning objectives in Oncology:
Modified version of the McGill Medical Oncology residency program, as described on their website (https://www.mcgill.ca/oncology/education-training/postgraduate-medical-education/medical-oncology).
The general educational objectives are to impart to the trainee an understanding of the basic scientific principles which relate to cancer and its treatment and to ensure that the trainee acquires clinical competence in the investigation and management of neoplastic diseases.
Specific objectives, which represent a general overview of oncology topics, given that the fellowship is of 1 year duration rather than the 2 year Medical Oncology residency curriculum:
a) The epidemiology and natural history of cancer including causation risk factors, the biology of growth and spread and prognostic variables.
b) General basic scientific knowledge including molecular biology, biochemistry, pathophysiology, pharmacology, growth kinetics, genetics, endocrinology and immunology as they relate to the understanding of cancer and its diagnosis and treatment.
c) Assessment and investigations of patients with cancer, including the history, physical examination, laboratory and imaging techniques.
d) Principles of cancer therapy and the indications for and complications of the various treatment modalities alone or in combination.
e) Management of medical emergencies and complications which arise as a result of cancer or its treatment.
f) The principles and practice of palliative symptomatic treatment of patients with cancer.
g) Nutritional needs of cancer patients and the methods of management.
h) Psychological and ethical aspects of treating patients with cancer and communicating with patients and their families and other members of the health care team.
i) General understanding of epidemiology and biostatistics in conducting clinical trials.
j) Though proficiency in performing specific technical skills including aspiration of effusions, lumbar puncture, bone marrow aspiration and biopsy, maintenance of vascular access is not expected of the geriatric oncology fellow, he/she should understand the indication for and interpretation of such procedures and be able to organize their execution (e.g. via Interventional Radiology or referring to a specialist). Understanding of examination techniques for specific systems (example: pharyngo-laryngeal area) and their interpretation.
k) Comprehensive knowledge of site specific tumours, encompassing all the aspects enumerated above.
Research activity: Participating in research is strongly encouraged. Several members of the McGill Division of Geriatric Medicine are very active in research and eager to assist trainees in conducting research. We will help facilitate the supervision and support to conduct research on a topic related to Geriatrics and Oncology during the fellowship year, with the aim of publication of the project.
Names of the Teaching Faculty:
Dr. Doreen Wan-Chow-Wah: Geriatrician-internist who completed a fellowship in Medical Oncology at McGill University. Geriatric Oncology Fellowship program supervisor, clinical tutor, research supervisor. Practices as a geriatrician-internist at the McGill University Health Centre (Royal Victoria Hospital and Montreal General Hospital); Medical director of and physician in the Geriatric Oncology Clinic of the Segal Cancer Center, Jewish General Hospital (outpatient-based clinic). Physician in the Geriatric Oncology Clinic of the Cedars Cancer Center (McGill University Health Centre).
- Dr. Johanne Monette: Geriatrician-epidemiologist, research supervisor, clinical tutor. Will directly supervise candidates conducting research. Practices as a geriatrician at the Jewish General Hospital and is a physician in the Geriatric Oncology Clinic of the Segal Cancer Center, Jewish General Hospital.
- Dr. Francine Gaba: Geriatrician-internist who completed the Geriatric Oncology fellowship at McGill. Currently practices at the Centre Hospitalier de l’Université de Montréal (CHUM) and remains actively involved in Geriatric Oncology at McGill both clinically in the outpatient clinic and in research.
- Dr. Carmela Pepe: Respirologist/Pulmonary Oncologist with special interest and expertise in lung cancer in the elderly. Currently pursuing a Master’s degree in Epidemiology. Clinical tutor, research supervisor. Practices at the Jewish General Hospital.
As a group, the teaching faculty named above have clinical and research expertise in the fields of Geriatrics and Oncology. Certainly, other members of the Division of Geriatric Medicine and the Department of Oncology will also have an active teaching role.
Academic Facilities: Facilities for clinical and academic pursuit include all those McGill
University-affiliated institutions where fellows will perform rotations, namely one or more of the academic teaching hospitals (Jewish General Hospital, Royal Victoria Hospital, Montreal General Hospital, St-Mary’s Hospital). The candidate will work in various inpatient and outpatient settings in Geriatric Medicine as well as in Oncology, depending on his/her background. A Geriatric Oncology fellowship reading package will be provided. Access to the library and multimedia learning materials will be made available.
Fellow Duties and Responsibilities:
- Call duty: On average once per month (5 weekdays, 1 weekend).
- Fellows are expected to supervise and teach junior trainees in both inpatient and outpatient settings.
- Certain rotations at designated institutions will be mandatory.
- Outpatient clinic responsibilities will include participation in the Geriatrics clinic, Memory/Cognitive Disorders clinic, Geriatric Oncology Clinics, Medical Oncology and Hemato-Oncology clinics, Radiation-Oncology clinic. Fellows are expected to evaluate, diagnose and propose treatment plans, and communicate effectively with other members of the treating team. A longitudinal clinic whereby fellows can follow patients’ progress over time will be scheduled.
- Attendance and participation in various academic activities such as journal clubs, teaching sessions (e.g. MORE sessions in Oncology), tumour boards, Geriatric Medicine Grand rounds, Medical Oncology rounds will be mandatory. Attendance at conferences in Geriatrics and/or Oncology during the fellowship year will be strongly encouraged (Société Québécoise de Gériatrie, Canadian Geriatrics Society, American Geriatrics Society, American Society of Clinical Oncology, Société Internationale d’Oncologie Gériatrique, etc).
- Support staff available to the fellows include: Geriatric Oncology Fellowship program director, Geriatric Medicine Residency program director, Medical Oncology Residency program director, Hematology Residency program director, Radiation Oncology Residency program director, attending staff physicians, nurses, Clinical nurse specialist in Geriatrics, Nurse coordinator (Infirmiere Pivot) in Oncology, administrative assistants/secretaries in Geriatrics and Oncology.
- Participation in a research project is strongly encouraged. To be discussed with each fellow.
Curriculum:
- Intended case load: 8-10 patients on an in-patient ward; 1-2 patients per half-day clinic in Geriatrics; 4-8 patients per half-day clinic in Oncology.
- Fellows will receive a broad exposure to cases in Geriatrics (neurocognitive disorders, functional disability, mobility problems, frailty, geriatric syndromes, etc.) and in Oncology (various tumour types, solid and hematological malignancies, etc.).
- Key articles in Geriatric Oncology will be recommended.
- Fellows will be active members of each respective service they are assigned to. They will evaluate patients, present cases (verbal and written), propose treatment plans, communicate with other team members, plan follow-ups, supervise medical students and junior residents. They will be asked to present relevant articles at journal clubs.
For further information on the application process, please visit the McGill Faculty of Medicine
Post-Graduate Medical Education website at:
https://www.mcgill.ca/pgme/admissions/prospective-fellows/apply