Fellowship Clinical Rotations
Clinical rotations will generally consist of clinical days evaluating new patients and those undergoing proton/photon radiation therapy and days for radiation therapy planning and other clinically relevant activities. Clinical rotations for the fellow will be selected by the program director. The currently available rotations will include Central Nervous System, Base of Skull, Head and Neck, Sarcoma, Pediatric, and Gastrointestinal. These will generally be 3-months in length. Other clinical rotations may be selected should there be sufficient clinical proton treatment volume and interest by the fellow. No arrangements are currently in place for rotations at other institutions. Fellows will not bill for their services; billing will be performed by the attending radiation oncologist supervising the fellow in Royal Oak.
Independent clinical rotations
The fellow will be required to have his own independent clinical service at Beaumont Dearborn (Oakwood) and to treat patients as a junior faculty. An acquisition of a full medical license in Michigan required for their credentialing and for their contract to be in force. The trainee will learn how to treat and manage patients with different types of malignancies. He will spend time at Beaumont Dearborn (Oakwood) one to two days a week.
Educational content and didactic activities
The fellow will spend their clinical rotation on a proton radiation therapy service working closely with radiation oncology specialty board-certified attending physicians involved in the care of these patients. The attending physicians will supervise the fellow directly as they see selected in-patient consultations as well as selected new outpatient consultations in the Radiation Oncology department and the combined modality, multidisciplinary clinics. Selected follow-up patients who provide appropriate education opportunities for the fellow will also be seen. Supervision and teaching during these clinic sessions will include review of the patient presentation, discussion about patient work-up, review and discussion of pertinent imaging, discussion and formalization of a treatment plan.
The fellow will see patients weekly during their radiation therapy and be available at other times during the week to see patients experiencing treatment-related complications. Fellows will be expected to work with residents and students on the clinical service, offering guidance and teaching to the more junior trainees based upon the greater clinical experience of the fellow. Patient assignment will be based upon departmental guidelines that recognize the other demands on and responsibilities of the fellows, such as treatment planning and time for reading and study.
Treatment planning will be performed by the fellow in selected cases with direct supervision by the attending radiation oncologist and physicist. This will include discussion of the type of treatment immobilization, discussion of the appropriate CT treatment planning technique (intravenous, oral, and or intrathecal contrast, slice thickness, anatomic region and appropriate margins to be scanned), acquisition and fusion of additional tumor imaging (PET, MRI), contouring of the clinical target volumes, and in-depth review of the target volumes, target dose prescriptions, and normal tissue constraints with the attending radiation oncologist.
Didactic activities will include one-hour morning teaching conferences in the Department of Radiation Oncology, Chart Rounds, weekly Proton Rounds, Physics research presentations, monthly Proton research meetings, Radiation Oncology Journal Clubs, as well as multiple subspecialty tumor boards and teaching conferences. He/she will also have one hour weekly didactic session with the program director to review the clinical settings, cases and concepts.
Teaching can be formally divided into:
- faculty precepting, one-on-one, as patients are evaluated, planned, and treated
- conferences - fellows are expected to attend and participate in regularly scheduled teaching conferences on the assigned clinical service
- individual study - pertinent references will be provided to fellow by staff
Fellow is expected to read:
- chapter(s) in appropriate Radiation Oncology textbooks on Proton Radiation Therapy
- literature reprints of references provided to fellow by staff. These will change frequently as the literature evolves
The fellow will present on a regular basis (a case discussion of appropriate teaching cases) at the regularly scheduled department teaching conferences with attending staff radiation oncologist present to add additional instruction as indicated. Relevant conferences include resident teaching conferences, weekly proton rounds, weekly chart rounds, Radiation Oncology Journal Club, and service specific conferences.
The fellow is expected to have a total of 1-3 dedicated research months. These can be subdivided into clinical, physics, and biologic research opportunities. Clinical research opportunities include involvement in ongoing, IRB-approved proton clinical trials, the opportunity to write new clinical trial protocols in conjunction with radiation oncology attendings, and participate in the collection, analysis, and preparation of IRB-approved clinical research studies evaluating clinical proton radiation therapy. Opportunities are available to collaborate with proton physicists studying clinically relevant proton physics questions. Similar opportunities are available to collaborate with radiation biologist studying clinically relevant proton radiobiology questions (i.e. relative biologic effectiveness of protons compared to photons). Beaumont Health guidelines for presentation and authorship will be used. The fellow is expected to continue his independent clinic at Beaumont Dearborn.
We will make every effort to make funds available to support fellow travel to a national oncology meeting. Additional funds will be sought for presentation of research finding arising from their research projects.