Oncology Fellow Advisor - Vol. 1 No. 4 by McMahon Group

ONCOLOGYFellow

Vol. 1, Issue 4

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

Fellowship Training

PHYSICIAN FINANCE

Learn about the business of managing a private practice.

FELLOWSHIP TRAINING

Improve physician–patient communication by honing your counseling skills.

Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

Mentor Memos

Survey Says

Physician Finance

Exam Tracks Training Progress

DAY IN THE LIFE

We highlight the work of oncologist Andrew Seidman, MD.

advisor

n the past, there was no standardized way to measure proficiency across medical oncology and hematology fellowships on a national basis. Curricula were organized around the core competencies but there was no overall system in place to compare programs over the longterm or to evaluate how fellows were performing from year to year. All this changed in 2007 with the introduction of the Medical Oncology In-Training Examination (MedOnc ITE). Although the Accreditation Council for Graduate Medical Education does not mandate the exam, it is now a regular part of the late-winter training experience at more than 110 medical

oncology and combined hematology/ oncology fellowship programs in the United States and Canada.1 “It’s probably the best Q&A resource we have, and what I saw on the [in-training] exam itself was very reflective of what was on the boards,” said Gheath Alatrash, DO, PhD, an assistant professor of stem cell transplantation at the University of Texas M.D. Anderson Cancer Center in Houston, who took the in-training exam in 2007 and has since passed the medical oncology board exam. “The multiple-choice questions and the case-based presentations were very similar to the boards.” see Exams, page 7

Oncologists Slow to Social Network

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query from a physician regarding a patient who developed alopecia from an anticoagulant popped up on The Oncology Portal, a social networking site that US Oncology created for the company’s medical oncologists. The patient needed 3 years of anticoagulation and without a definitive answer in the medical literature, the doctor decided to post the query on the social networking site, asking colleagues from around the country to comment.

“There was a very good debate in terms of whether the data was real in the literature and the treatment approaches one would take,” said Roy Beveridge, MD, medical director for US Oncology. In many ways, this example embodies the potential of social networking in medicine—a way to pool the collective knowledge of more than 1,000 oncologists and answer clinically meaningful questions in real time. see Social Networking, page 6

MENTOR MEMOS

A Day in the Life of Andrew Seidman, MD …

ncology Fellow Advisor presents our Day in the Life

Oncology Fellow Advisor • Vol. 1, Issue 4

Academia Hospital based

Furthermore, he had the good fortune to work in the offices of some medical oncologists outside the hospital where he was a resident—an experience that exposed him thought leader about how they got into the field of oncolto the bricks and mortar of the profession. “That was a ogy and their typical workday. very formative experience for me. For many medical residents, all they see of oncology are hospitalized patients at In this issue, we interview Andrew Seidman, MD, an the end of their battle with cancer and at the end of their attending physician at the Memorial Sloan-Kettering lives,” he said. “They get a skewed sense of what oncology Cancer Center’s Breast Cancer Medicine Service, and a is all about.” professor of medicine at Weill Cornell Medical College, New In this group practice setting, Dr. Seidman instead saw York City. Dr. Seidman serves as an editorial board member the outpatients, the ones still living well and experiencing of Oncology Fellow Advisor and Clinical Oncology News. a high quality of life thanks to the treatment they were Years ago, Andrew Seidman decided not to spend his receiving. “It made me aware that there is a very bright summer getting large animal experience and milking side to medical oncology. It’s not all about death and cows on a dairy farm in upstate New York—a decision dying,” he said. that proved to be quite fateHis parents were concerned ful to the future oncologist that oncology would be too and his many patients. “Often in the second or third year of fellowdepressing a field, but he reas“Once upon a time, I was ship, you are asked to select a mentor—for sured them. “I realized there actually planning to pursue some it’s a laboratory mentor, for others it’s would be difficult moments veterinary medicine,” said Dr. a clinical mentor, but for some and hours and days, but I Seidman. “I think that [not it could be both. I would think one has to trust one’s going that summer] probably encourage fellows to stay own sense of the road they made it impossible for me to have traveled down and the get into veterinary school.” open-minded as long as really significant impact you It was the first of many decipossible before committing to can have on people’s lives sions that led Dr. Seidman to a speciﬁc mentor.” as an oncologist,” said Dr. where he is today. Reflecting —Andrew Seidman, MD Seidman. “I don’t know if my on that path, he observed parents believed me initially, that many crossroads arise but after many years they see throughout the course of a the reward that I get back from my patients in my day-tomedical career, and careful consideration should be given day job. There is a lot more to smile about than to frown at each step. “The first decision you make, obviously, is to about in a typical day of caring for cancer patients.” go to medical school,” he said. “The next thing is which When he first began pursuing a fellowship, Dr. Seidman residency to pursue, whether your talents lie in general figured he would ultimately land in private practice, proprimary care or in a specific subspecialty.” viding community oncology care. He even said so during Although Dr. Seidman received honors in medical a 1989 interview for the Memorial Sloan-Kettering fellowschool for surgery, the field held limited allure for him. “I ship training program when asked where he saw himself kind of knew I wasn’t cut out to be a surgeon. I like thinkin 10 years. “I wasn’t sure if I gave the right answer or the ing through problems in my head rather than fixing them wrong answer, but it was the honest answer,” he said. “I with my hands,” he said. This realization led him to interhad no idea what academic medicine was about, and I nal medicine, and ultimately to oncology, which he chose had very little idea about clinical research.” based on positive patient encounters and the appeal of Once he was exposed to academic medicine, however, the field’s specificity. Dr. Seidman’s career goals shifted in that direction. In “I always felt that oncology was very tangible. Unlike the first year of his fellowship, Howard Scher, MD, “kidendocrinology, where you have to think abstractly about napped” him and got him involved in clinical research, endocrine pathways, cancer is very concrete. You feel it, writing review articles and lecturing. “He had me doing you see it on an x-ray or a scan. You treat it and if it gets things I felt I may not have been ready for, but it exposed smaller, the patient is getting better; if it gets larger, the me to what academic medicine was all about. I was compatient is doing worse,” said Dr. Seidman. “It was the simpletely enamored with it,” he said. ple, concrete aspect of oncology that I connected with.” series. In each segment, we interview a prominent

Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

MENTOR MEMOS

Vol. 1, Issue 4 • Oncology Fellow Advisor

Editorial Board Karin Hahn, MD

“Eventually I gravitated toward breast cancer, but those formative experiences as a first-year fellow working on writing protocols and managing patients in clinical trials made me decide to pursue an academic career,” said Dr. Seidman. In his current practice, Dr. Seidman sees outpatients 2 days a week and fills the other 3 days with a myriad of activities. Some involve patient care, such as reading lab results and x-ray reports, speaking to other physicians, and talking to patients on the phone. Others focus on clinical research activities, such as meeting with radiologists to review scans of patients in clinical trials and meeting with fellows whom he mentors. He also serves on various hospital committees and lectures both in and out of the hospital. “I think the reason I’m happy in my current setting is because there is a real balance between patient care, teaching, and research,” said Dr. Seidman. “It’s not for everybody—I think there are some who would prefer to see patients 4 or 5 days a week, and others who are more driven to administrative roles or basic research. The nice thing about oncology is that there are many possible careers within the career.” His advice to those early in fellowship training is to be exposed to a broad spectrum of cancers and the physicians who treat them. “Often in the second or third year of fellowship, you are asked to select a mentor—for some it’s a laboratory mentor, for others it’s a clinical mentor, but for some it could be both. I would encourage fellows to stay open-minded as long as possible before committing to a specific mentor,” said Dr. Seidman. “Talk to experienced oncology fellows already in their second or third year, learn from them and others about their positive and potentially negative experiences in choosing a mentor for those next years. Choosing a path that will be largely influenced by second- and third-year mentors is a large part of your growth in a fellowship program,” said Dr. Seidman.

Associate Program Director, The University of Texas M.D. Anderson Hematology/Oncology Fellowship Chief of Medical Oncology Assistant Professor Lyndon B. Johnson General Hospital Houston, Texas Jamal Rahaman, MD Fellowship Director Division of Gynecologic Oncology Mount Sinai School of Medicine New York, New York

Andrew D. Seidman, MD Attending Physician, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center Professor of Medicine Weill Cornell Medical College New York, New York

Marc Stewart, MD Program Director, Hematology/Oncology Fellowship University of Washington/Fred Hutchinson Cancer Research Center Medical Director, Seattle Cancer Care Alliance Professor of Medicine, University of Washington Seattle, Washington

Publisher of

Oncology Fellow Advisor survey results show that 92% of oncology fellows want to receive information via a Web site. Please visit www.oncologyfellowadvisor.com to subscribe or send an e-mail to oncologyfellowadvisor@mcmahonmed.com with your name, institution, e-mail address, and mailing address.

Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

PHYSICIAN FINANCE

Oncology Fellow Advisor • Vol. 1, Issue 4

The Business of Private Practice

edical schools provide future doctors with a great deal of information; however, they neglect to teach them how to manage the finances of a practice, including how to determine a budget, read a financial statement, control inventory, and maintain the bottom line. “There is so much more to a successful practice than doing what you have to do to treat your patients well,” said Christopher R. Jarvis, MBA, O’Dell Jarvis Mandell, LLC. “The probability of long-term financial success is directly proportional to the amount of time the physician spends on the business side of the practice.” The level of input and oversight in business matters required by a practicing oncologist will have some relation to the type of practice they join. Those who join a hospital or very large oncology group serve as employees during their tenure. But those who join a smaller group or private practice—with the possibility of becoming a partner—have a greater responsibility when it comes to the financial ins and outs, the backbone of running a business. “When you go into private practice, you’ll have to deal with finding a space; negotiating a lease; employee-related issues like hiring, firing, and conducting reviews; as well as employee benefits and how to structure retirement plans,” said Jason O’Dell, principal, O’Dell Jarvis Mandell, LLC. An oncologist would not be solely responsible for running every aspect of the practice’s business side, but there does seem to be a link between the degree of physician involvement and a practice’s financial health. “In my professional opinion, I think physicians should be extremely involved,” said Mr. O’Dell. “Medicine has turned into a business and you want to make sure that you’re taking advantage, as a business owner, of everything that’s available to you.” It is unlikely that a new member of a practice would immediately be involved in managing the finances—this often is designated to a particular shareholder. But it is a good idea for the newcomer to learn from that individual what was not taught in medical school, residency, or fellowship, and to gain knowledge of what lies ahead.1 A healthy practice relies on a number of individuals to maintain its business side. “Most physicians use their office manager as their business manager,” said Mr. O’Dell. “In other instances, it may make sense to bring someone in from the outside to be their consultant or practice manager.” Many groups delegate the day-to-day details to their office manager and hire an accountant for periodic audits, record keeping, cutting checks, and preparation of financial statements. “Your team is going to consist of an attorney, a certified public accountant, a financial advisor, and an insurance/ benefits consultant,” said Mr. O’Dell. Finding these people can be challenging; look for individuals who have expeOncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

rience explicitly dealing with physicians and who understand the unique financial concerns of medical practices. In addition, oncologists have the unique responsibility of monitoring their pharmaceutical supplies. A 2006 survey showed that pharmaceutical expenditures comprise 61% of the expenses in the average oncology practice1; it is critical to the practice’s bottom line that purchases are made soundly and that inventory is carefully controlled. Again, the oncologist will probably not be responsible for this oversight, but should ensure that a good system is established. “They definitely need to have controls in place to monitor the inventory as well as the expense that’s associated with the drugs,” said Mr. O’Dell. As with any other business, a medical practice should have a system of checks and balances to protect against mismanagement, embezzlement, or simple errors that can erode the business over time. “Often a physician is so busy seeing patients that he or she entrusts all of the financial management to one individual. But if no safeguards are in place, there is a potential for significant abuse,” said Mr. O’Dell. The individual who has most of the control over the practice’s finances should be monitored. “I recommend they have an accountant audit information provided by the office manager,” said Mr. O’Dell. The office manager should provide monthly financial statements to the accountant or accounting firm, and an on-site, physical audit of the books should be conducted every 6 months. Furthermore, “you shouldn’t have the same person who does the bills also signing the checks,” said Mr. O’Dell. A good way to make sure that money doesn’t leave the office in a nefarious way is to implement a policy whereby the physician must personally sign all checks over a certain dollar amount. “Maybe it’s $1,000 or more; you can set the number, but that would be a key step,” he said. Today’s medical climate is in flux; it is clear that practicing medicine in the 21st century requires more than clinical knowledge and a good bedside manner. “Ultimately, the physician is the one who will reap the rewards or suffer the repercussions of a poorly run practice,” said Mr. Jarvis. “I’ve met with a lot of doctors over the past 12 years and success seems to be skewed heavily toward the ones who think of themselves as business owners who happen to provide medical services.”

Reference 1. Akscin J, Barr TR, Towle EL. Key practice indicators in officebased oncology practices: 2007 report on 2006 data. J Oncol Pract. 2007;3(4):200-203.

Vol. 1, Issue 4 • Oncology Fellow Advisor

FELLOWSHIP TRAINING

Improve Physician Communication Skills

hile most US medical schools train students to provide quality medical care, few programs teach the skills students need to effectively communicate with patients. These skills are critical to counseling patients and they can be learned.1 Aref Agheli, MD, a hematology and oncology fellow at Brookdale University Hospital and Medical Center, New York City, gained valuable counseling skills when he worked with a settlement agency in Canada helping recent immigrants adjust to their new lives. “We were trained for mental counseling, and almost every client of mine needed that kind of help,” he said. “The skills I learned in the agency helped me understand more about ethics and counseling patients.” Those skills have earned him high regard among his peers. “I brought a lot of those counseling skills to my fellowship and I get a lot of comments from my attending that I’m good to the patients,” said Dr. Agheli. Patients with serious illness must consider the possibility of a terminal diagnosis, but actually discussing treatment failure and end-of-life care can be overwhelming and extremely emotional for both the patient and physician. Learning to sense and acknowledge a patient’s emotions and to address your own emotional responses are 2 keys to providing care for the terminally ill (Table). “A common pitfall for oncology fellows is to just respond [to the patient’s emotional response] with more facts and information,” said Anthony Back, MD, professor of medicine, Division of Medical Oncology, University of Washington in Seattle. “But if you don’t acknowledge the emotion, people just stay in that emotion and everything you say to reassure them will go right over their heads.” Oncologists can help patients with serious illness secure a community of support by encouraging them to lean on their friends and family. “A lot of patients are reluctant to ask their friends and families for help because they’ve already asked for so much,” said Dr. Back. “But family members tell me there’s nothing more important at that time than taking care of them and being with them.” Although it can be uncomfortable for both parties, endof-life discussions should not be delayed. “A lot of doctors think if they don’t tell patients things until the last minute,

Table. Communication Tips for Working With Terminally Ill Patients Acknowledge emotions, both the patient’s and your own Maintain open contact with the patient’s family Encourage the patient to lean on family/friends Reflect on the situation and why/how it affects you Seek help when necessary (eg, psychiatry, counseling)

they’ll minimize the time they’re upset. But that also will minimize the time they have to decide what they’re going to do with the time they have left,” he said. Finally, it’s important to maintain contact with patients and their families up to and even after death. Patients may experience many strong emotions, not just about what will happen to them, but also what will happen to their relationship with their oncologist. Patients and families who do not hear from the oncologist after treatment has stopped may feel abandoned. A couple of phone calls can go a long way.

“I think it’s critical to develop self-awareness and the ability to reﬂect on what one is feeling, particularly in the setting of serious illness. Those skills are integral to avoid distancing yourself from patients.” —R. Sean Morrison, MD “When I talk to a family member after someone has died, I’m expressing my condolences; I’m asking how the death went and making sure that they know they can call me if they have a question or if something comes up later,” said Dr. Back. “It’s quite simple.” This approach also can help the oncologist obtain closure, which brings us to the other side of the coin. Caring for seriously ill patients is an emotional experience for physicians, and how they deal with those emotions will affect their ability to provide quality care.2 “When caring for patients with serious illnesses, physicians can experience emotions that range from satisfaction and pleasure to anger and profound sadness when patients die,” said R. Sean Morrison, MD, director, National Palliative Care Research Center, Mount Sinai School of Medicine, New York City. But most physicians are not trained to self-reflect and recognize their emotions, or to understand the effect their own emotions can have on the patients they care for. “I think it’s critical to develop self-awareness and the ability to reflect on what one is feeling, particularly in the setting of serious illness,” said Dr. Morrison. “Those skills are integral to avoid distancing yourself from patients.” Developing self-awareness is a practice that requires some diligence. “It’s to be aware of situations that might predispose you to high emotions or feelings,” said Dr. Morrison. “It’s to be able to recognize in yourself the signs and symptoms of those feelings; and, once you’re aware of that, to be able to reflect on why you feel that way.” Physicians might ask themselves why a situation or see Communication, page 7

Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

FELLOWSHIP TRAINING

Oncology Fellow Advisor • Vol. 1, Issue 4

Social Networking continued from page 1

Yet the potential of social networking sites has yet to be broadly embraced in medicine. A recent survey by the Centre for Global eHealth Innovation published in The Lancet Oncology found that only a handful of the 36 North American organizations in the International Union Against Cancer had embraced any form of social networking online.1 But these tools—which include blogs, discussion forums and wikis, as well as sites like Facebook—have been widely embraced by the cancer survivor community. A July 2008 survey of Facebook turned up more than 500 groups exchanging cancer-related information, which included providing cancer support, lobbying and fundraising.1 As one example, the Campaign for Cancer Prevention, a Facebook-driven cause, enrolled a halfmillion members online and has raised more than $100,000 for cancer prevention research at Brigham and Women’s Hospital in Boston.2 When cancer physicians have utilized mainstream social networking sites, they are often limited to policy issues. For example, the American Society for Radiation Oncology has a Facebook site that provides news updates, and the American Society of Clinical Oncology recently unveiled “Oncology EHR Exchange” (www.ehr.ascoexchange.org), a social networking site “for oncology professionals, oncology practice managers, and vendors interested in promoting EHR [electronic health record] adoption.” But in terms of sharing clinically meaningful information, mainstream social networking sites present several problems for practicing oncologists. “Facebook and these other [social networking sites] have some serious limitations from an oncology standpoint,” argued Dr. Beveridge. Chief among them is the anonymity of the users. Even if a case could be discussed on a mainstream social networking site without violating Health Insurance Portability and Accountability Act guidelines, an oncologist looking to tap a social network for clinical advice can never know whether their correspondent has any authority to comment on the problem. In 2007, noting the potential of social networking, and the drawbacks of existing sites, US Oncology began developing The Oncology Portal solely for oncologists and hematologists (www.theoncologyportal.com). According to Dr. Beveridge, between one-third and one-half of all medical oncology fellows will ultimately work in a US Oncology practice after graduation, and the site was developed in part to address this annual influx of oncologists. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

“When fellows or new physicians are coming into US Oncology practices, they are asking some very basic questions in terms of business and just the things that they don’t get taught [in fellowship],” said Dr. Beveridge. For example, fellows, because of their facility with computers, can be brought up to speed very quickly on policy decisions through a social networking site. By the end of this year, the company expects to have all of its medical oncologists registered on The Oncology Portal. It is also building out functionality to support radiation oncologists, pharmacists and nurses. Although The Oncology Portal is a secure site that only US Oncology physicians can currently enter, the company plans to open up the portal to all medical oncologists in the United States next year. Each account includes the physician’s CV and bio, so users can be sure they are collaborating with knowledgeable colleagues. “It’s important that you know what someone’s real parameters are, so you know whom you are collaborating with,” said Dr. Beveridge. “With Facebook you don’t know who you are collaborating with.” In addition to broader discussion topics, the site also has built-in special interest groups for specific disease and tumor types where member discussions are archived and searchable. While the site provides a quick way to discuss a challenging case or a new treatment option, it also functions as a kind of living database of research trials. “There is no site in the world that lists every research trial that is available. It doesn’t exist,” said Dr. Beveridge. “But if you are talking to 1,000 medical oncologists, or 300 radiation physicians, they’ll read it and say, ‘Well, you fit into a very particular category. Have you tried talking to this program, or that university or this drug trial?’” The site also includes direct links to more traditional online sources of information, such as the American Society of Clinical Oncology, the National Comprehensive Cancer Network, PubMed, UpToDate, The New England Journal of Medicine, and Continuing Medical Education (CME) partners. Dr. Beveridge says that when the portal goes national next year, oncologists can capitalize on social networking technology in a secure environment. “What we are really going after is: How do you personalize care, how do you increase research, and how do you do it rapidly?” said Dr. Beveridge.

References 1. Briceño AC. Fighting cancer with the internet and social networking. Lancet Oncol. 2008;9(11):1037-1038. 2. Campaign for Cancer Prevention. http://apps.facebook.com/ causes/210. Accessed October 26, 2009.

FELLOWSHIP TRAINING

Vol. 1, Issue 4 • Oncology Fellow Advisor

Exams

will use when studying for the boards—review materials from ASCO; the ASCO-SEP or Medical Oncology SelfEvaluation Program; and the National Comprehensive continued from page 1 Cancer Network guidelines. The best approach to studying for the in-training exam, according to Dr. Alatrash, is Although it may be the best reflection of the board to focus on evidence-based care for diseases in which the exam content that fellows have, key differences exist fellow has the least experience and to rely on training and according to Frances Collichio, MD, associate fellowship personal experience for the rest. director, University of North Carolina in Chapel Hill, who Because of the difference in has been writing questions for the preparation, the in-training exam in-training exam since its introduc“There is a correlation between actually can seem more difficult, tion. One key difference is that it what [fellows have] actually seen claimed Dr. Alatrash. “If anything, focuses more specifically on comand done in clinic and I would have thought that the inpetencies outside of medical knowlhow well they do service was just a notch more difedge; questions on professionalism, on the in-training ficult,” he said. “But I don’t know if for example, may deal with medical that is because I ended up studying ethics, cultural disparities, or physiexam; many of the a lot for the boards.” cian burnout. questions are taken Although the in-training exams— Another key difference is that from real-life cases.” which are also often referred to the in-training exam is meant to be —Frances Collichio, as “in-service” exams—function on taken “cold,” to function as a snapMD many levels, the medical oncology shot of a fellow’s knowledge at a exam was originally created to track given moment. program progress and to determine “Fellows should learn on an everywhere training could be improved. day basis. The people they are see“When this exam was originally ing in clinic are the people they developed, it was not developed so need to learn from,” said Dr. Collicio. much for the individual as more or “And there is a correlation between less an overview of what that [spewhat they’ve actually seen and done cific] training program was like,” in clinic and how well they do on the said Dr. Collichio. in-training exam; many of the quesNevertheless, the exam provides many benefits for tions are taken from real-life cases.” individual fellows. Because it is only 3 years old, there Nevertheless, many fellows prepare in some way. is not an abundance of data; however, according to Dr. “Nobody hit it hard like we do for the boards, but I would Collichio, preliminary results demonstrate that fellows go out on a limb and say probably everybody did some sort of a preparation,” said Dr. Alatrash. see Exams, page 8 The best review materials are the same ones a fellow

Communication continued from page 5

patient makes them feel uncomfortable. “With that, one can bring [these thoughts] to consciousness rather than letting them sit in the unconscious, and be aware of how one is acting and feeling in the setting with the patient,” said Dr. Morrison. It helps for physicians to have a trusted colleague or mentor with whom to discuss their feelings and to help them gain solutions to patient/emotional struggles. “Having a clinical mentor was invaluable to me at the early stages of my career,” said Dr. Morrison. “Even now, those are the people I talk to about these issues.” Some institutions have Schwartz Center Rounds, a multidisciplinary forum where caregivers discuss dif-

ficult emotional and social issues that arise in caring for patients, which can be helpful.3 “And for really stressful, difficult situations, counseling and psychiatry can be very helpful,” said Dr. Morrison. “Physicians are terrible at seeking help for themselves, but that type of expertise and help should be available and we shouldn’t be afraid to seek it when things are difficult.”

References 1. Back AL, Arnold RM, Tulsky JA, Baile WF, Fruyer-Edwards KA. Teaching communication skills to medical oncology fellows. J Clin Oncol. 2003;21(12):2433-2436. 2. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007-3014. 3. Kenneth B. Schwartz Center Executive Report. http://www. theschwartzcenter.org/Final%20Executive%20Summary%20 Rounds%20evaluation.pdf. Accessed October 21, 2009. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

ONCOLOGYFellow S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Oncology Fellow Advisor • Vol. 1, Issue 4

Exams continued from page 7

improve as they take the test each year. And although the American Society of Clinical Oncology (ASCO) has not been able to correlate a solid performance on the intraining exam with passing the board exams, the relationship has been confirmed among internists who do well on their specialty’s in-service exam.2 But the maintenance of certification exam, which is required every 10 years, is not quite as straightforward. In addition to the exam, which is generally very similar to the initial certification exam, recertification has 2 additional requirements: self-evaluation of medical knowledge and self-evaluation of practice performance. The self-evaluation of medical knowledge component is essentially reading with an at-home exam. Although physicians have a choice of specific topics to complete, some of the materials also function as excellent reviews for the recertification exam itself. For example, completing the American Society of Hematology Self-Assessment Program fulfills nearly all of the self-evaluation of medical knowledge requirements while also giving physicians a good review for the actual board exam. The self-evaluation of practice performance component requires physicians to complete one of a number of practice improvement modules (PIM). Physicians pick a particular area (eg, hematologists might pick myelodysplastic syndromes or multiple myeloma) and review a set number of patient charts. Based on this evaluation, physicians then redesign their practice to align their care with evidence-based guidelines and evaluate a set of charts several months later to see whether their practice has changed. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

One unique PIM is a communication module in which physicians poll patients or their peers on how they can improve their practice. “I haven’t done that module, but I’m told that it is very revealing, and you actually learn a lot about yourself and how you practice,” said Charles Abrams, MD, associate chief of hematology/oncology at the University of Pennsylvania in Philadelphia, and chair of the Hematology Board of the American Board of Internal Medicine. Dr. Abrams, who has twice been through the recertification process, advises physicians to begin early to ensure that they finish before any lapse in certification. The length of time it will take to complete the recertification process is largely dependent on how well informed a physician has stayed over the past decade. “If it’s the first time you’ve picked up a book since the last time you took an exam, then you will probably have to spend a lot of time not only preparing for the exam, but bringing yourself up to current knowledge in the field,” said Dr. Abrams. “If, on the other hand, you are consistently keeping up on your knowledge, then probably not that much preparation is required.” The next MedOnc ITE will be offered Feb. 23-24, 2010. The American Society of Hematology will hold its in-training exam April 6-7, 2010.

References 1. Collichio FA, Kayoumi KM, Hande KR, et al. Developing an in-training examination for fellows: the experience of the American Society of Clinical Oncology. J Clin Oncol. 2009;27(10):1706-1711. 2. McDonald FS, Zeger SL, Kolars JC. Associations between United States Medical Licensing Examination (USMLE) and Internal Medicine In-Training Examination (IM-ITE) scores. J Gen Intern Med. 2008;23(7):1016-1019.