pediatric oncology curriculum

Pediatric Oncology

Curriculum

Preface

T he Egyptian Fellowship Board and the Pediatric Oncology scientific council worked collabo-

ratively to make this curriculum available for trainees’ guidance and support.

Postgraduate medical education world wide are now governed by sets of academic standards that

describe the qualities and abilities of graduates. In addition, there are standards for the training

processes , trainers’ selection and methods of assessment. standards ensure transparency and

clarify expectations.

The Egyptian fellowship board had defined and published its standards for the general and profes-

sional competencies expected from our graduates in different specialties upon successful comple-

tion of training. These expectations has been reflected in the pediatric oncology curriculum.

The curriculum describes what trainees will know and be able to do upon completion of training.

In additions, methods of teaching and learning needed to deliver the curriculum are listed . The

curriculum also describes in details, expectations from trainees during their rotations in “The

training rules and regulations section”. Methods of assessment and examination regulations are

also available in the last section of the curriculum.

All topics covered during practical and theoretical studies are outlined. This will help trainees to

guide their readings and their choice of learning activities. The scientific council also recommends

that trainees and trainers refer frequently to the logbook, where they will find requested clinical

cases and practical procedures. The logbook will also serve as the source of evidence that pediat-

ric oncology trainees have attended required rotations and achieved requested competencies.

The trainees, trainers and Educational supervisors will get significant benefits from regular check-

ing of the Egyptian Board website. All announcements related to training and exam will be avail-

able there. In addition, you will find many useful electronic resources that we hope it will be bene-

ficial in your preparation for the exam and continuous professional development.

Esmat Ahmed Sheba

Secretary General

The Higher Committee of Medical Specialties

Acknowledgement

This curriculum has been created through collaboration between The Pediatric Oncology

Scientific Council and The Egyptian Fellowship Curriculum Committee. The following mem-

bers of the Pediatric Oncology Scientific Council have made substantial contribution to the

curriculum development as subject matter experts

The Egyptian Fellowship Curriculum Committee has made significant contribution to the cur-

riculum through Collaboration with the council in the design and formulation of the educa-

tional structure. The member who participated in the work is

The Committees consulted international and national curricula in pediatric oncology.

The external references for the development of this curriculum are:

1. The pediatric oncology curriculum approved by the Royal College of child health

and PMETB 2007

2. The previous Egyptian Board curriculum in pediatric oncology

3. The Egyptian Board Guidelines for curriculum development 2007

4. Postgraduate Medical Education and Training Board UK (Guidelines for curricu-

lum development 2006)

Professor Dr Alaa El Haddad, Professor of pediatric oncology and Chair of the Pe-

diatric Oncology department at the National Cancer institute, Cairo University

Associate Professor Dr Hany Abd El Rahman, Associate Professor of pediatric on-

cology, National Cancer Institute. Cairo University

Professor Dr Eman Abd El Raouf Mohammed ,Professor of pediatric hematology,

Cairo University and the educational advisor of the Egyptian Fellowship Board

Pediatric Oncology Curriculum Egyptian Fellowship 7

7

CONTENTS………………….

The structure and regulations of Pediatric Oncology training…... 9

Curriculum aim ……………………………………………………. 13

General intended learning outcomes………………………………. 14

Module I……………………………………………………………... 17

Module II …………………………………………………………… 22

Module III ………………………………………………………….. 27

Module IV…………………………………………………………... 33

Methods of assessment …………………………………………….. 37

Pediatric Oncology curriculum Egyptian Fellowship Board

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Pediatric Oncology Curriculum Egyptian Fellowship Board

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The Structure and regulations of

Pediatric Oncology training

The Egyptian Board of pediatric oncology requires two years of supervised

training program that must be conducted in accredited pediatric oncology hospitals

and centers before sitting for the final examination. The board publish an updated

list of accredited centers at its website. Entry to the pediatric oncology-training

program has the following requirements for trainees who are affiliated to MOHP:

1. Graduation from medical school and successful completion of the pre-

registration house officers' year

2. Successful completion of the Egyptian Fellowship in Pediatrics or equiva-

lents (e.g. MRCPCH) with evidence of practical training.

Trainees, who finished their master degree in pediatrics within five

years must join the pediatric fellowship training for two years and pass

successfully the final certifying exam before joining the pediatric on-

cology training program

During the entire program, the candidate must work as a full time residents in the

training center. He or she must get gradually increasing responsibilities for patient

care according to the stage of training and available supervision.

1.Pediatric-Oncology trainees must spent their training period in the following

services:

a. Pediatric Hematological malignancies services (10 months)

b.Pediatric Solid tumor services (10 months)

c. Bone marrow transplantation service (3 months).

d. In addition, attendance to radiotherapy services, oncology surgery wards,

clinical pharmacy and clinical pathology department will be organized by

the educational supervisor on part-time basis to allow for the attainment

of required intended learning outcomes

2.The first two modules of the curriculum must be completed by the end of the first

year of training. However only module one will be the subject for assessment in

the first part exam.

3.The third and fourth modules must be covered by theoretical and practical studies

during the second year of training and the whole curriculum is a subject for the

final exam

Any changes to this guidelines would be announced at the board website and

we advise trainees to regularly visit the site for announcements and updates

Training rotations


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1. Trainees must attend at least 75% of lectures on pediatric oncology subjects.

2. They should pass successfully through the first part exam before being eligible

for the final exam. Trainees who failed the first part exam twice may be asked

for additional period of training up to one year and successful pass of the first

part exam before being allowed to sit for the final certifying exam

3. Trainees should be actively involved and responsible for patient care including

sharing in making decisions about diagnosis and management under supervi-

sion of the consultants.

4. They must attend 75% of weekly meetings including clinical rounds, tutorials

and journal clubs

5. Their performance will be monitored and evaluated by trainers and a report

made of their performance on monthly basis to the Egyptian Fellowship

Board.

6. All trainees will work as residents in the training specialty and they must ful-

fill all residents jobs defined by supervisors and trainers

7. They should be responsible under supervision for outpatient and in patients'

routine work.

8. They must take supervised shifts according to the hospitals requirements and

regulation.

Important notice

Trainees must pass successfully all the seven foundation courses before

being promoted to the second year of training. Full information about

foundation courses is available at the EF website and administration office.

Trainees who finished their foundation courses during their pediatric fellow-

ship will not repeat the courses.

Trainees duties and obligations


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Specific requirements and obligations

The trainees will be responsible for supervised admission of patients from the out-

patient department or emergency.

They will share in the completion of the following documents under supervision

Complete history and physical examination form.

Investigation requests, (laboratory, radiology, pathology, etc.).

Reporting and documenting the results of the investigations

Writing the plan of management after consultation and approval from supervi-

sors

Daily progress notes.

Order and medication sheets

Orders of the necessary diagnostic procedures

Discharge summaries.

Sick leaves and medical reports

The Trainee should inform the senior staff of any high-risk patient admission.

The trainees should attend various pediatric oncology outpatient clinics and clinics

related to the rotation in radiotherapy, nuclear medicine and surgical oncology as

requested by trainers and supervisory staff. They should participate in different pa-

tients' interviews and share in management under supervision.

The trainees must attend and participate in the mandatory academic and clinical

activities of the department. Attendance and participation should not be less than

75% of the total number of activities within any training rotation / period including.

Daily morning patients' rounds and meetings

Clinical round and staff round presentation

Journal club meeting

Interdepartmental Meetings/ morbidity and mortality meetings

Grand staff rounds

1- Obligations towards the Admitted Patients

2- Obligations in the outpatient Clinics

3- Mandatory Clinical and Academic Activities


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The trainees must keep and update their logbook where they record all activities

and skills performed and learned during the training program. The activities

should be dated and categorized to whether been performed by the trainee him/

herself or as an assistant or participant. The trainer and finally the educational

supervisor should counter sign activities registered in the logbook. The Trainer

and educational supervisor must sign the completed Log Book. Trainers must

revise the logbook weekly. Educational supervisors must revise the logbook and

provide feedback on monthly basis.

The trainees shall undertake at least one research or audit project during the

training program under the guidance and supervision of their trainers. Such pro-

ject should be written and presented to a committee from the scientific council

before the trainee is accepted for admission to the final certifying examination.

The scientific council will announce topics and themes for the research or audit

projects.

Before the completion of the training program, the trainee should have com-

pleted satisfactorily the rotations described in the structure of the program, per-

formed him/herself, and assisted in the various requested procedures.

According to Ministry of Health and Population regulation

Performance of the trainee must be evaluated on regular and continuous basis.

The evaluation process should involve all aspects of the training including theo-

retical, clinical and investigative procedures skills as well as the attendance and

participation.

The trainers who are required to write confidential reports on the performance of

each trainee should evaluate the trainee periodically. The trainee should not be

allowed to proceed in the training program and move to the next year unless he/

she attains a satisfactory level of performance acceptable to the responsible

trainer and educational supervisor.

4. The Log Book

5. The Research project

General rules and regulations

1.Holidays and on call duties

2.Evaluation Procedures:


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Interruption of training

It is not permissible to interrupt such a structural training program except in major

unavoidable circumstances. Such circumstances should be convincing and approved

by the Secretary General. The Interruption once approved should not be for more

than one year. Interruption of the training program for more than one year shall re-

sult in dismissal from the program and cancellation of the preceding training period.

Curriculum aim

The aim of this curriculum is equip Egyptian fellowship trainees in the specialty of

pediatric oncology with knowledge, skills and attitudes necessary for efficient, inde-

pendent and safe practice as pediatric oncology specialists. It gives you - as a fellow-

ship trainee - a clear picture of what you have to achieve by the end of this fellow-

ship program. Therefore, when it comes to your assessment at the end of the train-

ing, we will want to know how well you have achieved the program objectives and

be confident that you are fit to practice as a pediatric oncology specialist with com-

petence.

Rational Statement

The purpose of this curriculum is to describe the competencies expected

from pediatric oncologists upon completion of training . The curriculum also

describes the methods of teaching and learning that will be used to facilitate

the delivery of the curriculum. In addition, it highlights the different methods

of trainee's performance evaluation. The curriculum contents have been for-

mulated through the following methods:

1. Revision of previous Fellowship pediatric oncology curriculum

2. Revision and benchmarking of international curricula for postgraduate

training in pediatric oncology.

3. Consultation of experts in the field of pediatric oncology.

Representatives from the pediatric oncology scientific council have partici-

pated in the process of curriculum development in collaboration with repre-

sentatives from the Egyptian Board curriculum Committee. The curriculum

was finally approved by the council in July 2008


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General intended learning outcomes

By the end of training in Pediatric Oncology, trainees should have acquired the

following knowledge, skills, attitudes and be able to:

1. Describe the Incidence and mortality rates for various childhood cancers with

emphasis on ethnic and geographical variabilities.

2. Explain the etiological background of childhood cancer both the facts and

theories.

3. Distinguish between national , regional and international cancer registration

policies.

4. Explain the role of clinical trials in pediatric oncology and recall the history

of evolution of current clinical trials and treatment outcomes.

5. Discuss the normal and abnormal mechanisms of cellular growth control.

6. Explain the genetic basis of malignant disease.

7. Discuss the features and clinical presentations of different childhood malig-

nancy.

8. Discuss the role of biological factors as diagnostic and prognostic aids.

9. Describe the indications and techniques of biopsy and optimal methods for

tissue handling for diagnosis and biological studies.

10. Discuss the principles and strategies of various modalities of treatment for all

stages of solid tumors and hematological malignancies that affect children.

11. Discuss the principles of cancer treatment with chemotherapy and the ration-

ale of combination chemotherapy regimens.

12. Discuss the principles and applications of high dose therapy and the rationale

for bone marrow transplantation in various childhood malignancies.

13. Discuss various techniques for bone marrow support including the use of

growth factors.

14. Summarize the basics of radiobiology and different planning techniques used

in the delivery of radiotherapy to children.

15. Recall the principles of less commonly used radiotherapy techniques, includ-

ing brachytherapy and targeted therapy.

16. Outline the role of onco surgery in the diagnosis and management of various

childhood cancers.

17. Discuss the acute toxicities of cancer treatment (individual drugs and radio-

therapy).

18. Discuss the late side effects and consequences of therapy, including effect on

learning, endocrine consequences, major organ toxicities and their causative

agent.

Knowledge and understanding


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19. Outline the importance of tumor and DNA banking for future research.

20. Outline the basic principles of biological and novel therapies for the management

of pediatric malignancy.

21. Explain the working structure, aims and functions of the pediatric oncology ser-

vices in the country.

22 Take full and focused clinical history and perform complete and organ targeted

clinical examination for children presented with various malignancies.

23 Request appropriate diagnostic studies and formulate a rational differential diag-

nosis.

24 Interpret the results of investigations correctly (laboratory, radiological imaging

and pathology) and modify his differential diagnosis list accordingly.

25 Timely recognize and manage various oncological emergencies such as septic

shock, tumor lysis, SVC obstruction, spinal cord compression, and raised ICP.

26 Perform independently bone marrow aspiration and trephine biopsy.

27 Prescribe and administer safely intrathecal drugs according to local and national

policies.

28 Prescribe, handle and administer chemotherapy safely

29 Timely recognize and manage acute drug reactions to chemotherapy and manage

the extravasation of chemotherapy agents appropriately.

30 Manage competently fever with neutropenia , including management after the

failure of first line antibiotic therapy.

31 Investigate and manage fungal and viral infections in the immune-compromised

child.

32 Organize and participate in long-term follow up programs for children with vari-

ous malignancies.

33 Participate as a team member in surveillance of survivors using national guide-

lines.

34 Manage pain related to cancer appropriately and recognize the different patterns

of pain and their different therapeutic interventions including non pharmaceutical

approaches.

35 Identify and control other symptom such as breathlessness and bowel obstruc-

tion.

36 Perform complete nutritional assessment for children with cancer and prescribe.

appropriate nutritional support during and after chemotherapy.

37 Consult appropriately nutrition specialists and seek their advice when indicated.

Skills


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Communication skills, ethics and

professional attitudes

38 Appreciate the concept of ‘Good Clinical Practice'

39 Communicate effectively and empathetically with children and families and

be able to convey bad news in appropriate manner

40 Discuss the concept of phase I, II and III trial and be able to explain this to

patients and parents

41 Discuss with patients and care givers various treatment options and gain in-

formed consent for treatment and for enrollment in clinical trial

42 Be confident in discussing these issues with adolescents and their families

and in making appropriate referrals

43 Educate families and patients about fertility preservation techniques for ado-

lescents who will receive treatment that may impair fertility in the long term

44 Work within multidisciplinary teams to manage various oncological prob-

lems

45 Collaborate with neuropsychiatric specialists in the management of learning

and psychological consequences of cancer treatment

46 Communicate both verbally and in written concerning the impact of treat-

ment on learning, patients school education and other possible short and long

term effects.


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17

Module I

This module aims to equip trainees with essential knowledge and problem solving

skills in the following domains:

Cancer biology

Pathology & molecular biology

Clinical Pharmacology

Chemotherapeutic agents

Epidemiology & Biostatistics

Basics of Surgical Oncology

Basics of Radiation Oncology

Radio-diagnosis

Basics of Cancer

Intended learning outcomes

By The end of the module, trainees will be able to:

1.Discuss the principles of cancer biology, genomics & proteomics, molecular

targets and explain the processes of invasion, metastasis, angiogenesis & cancer

immunology.

2.Describe the Molecular and genetic characteristics of normal & malignant cells

(Genomics & proteogenomics).

4.Describe the principles of various epidemiologic studies , types of re-

search designs and principles of biostatistics including survival analysis

and mortality indices.

5.Discuss the indications for and role of surgery in diagnosis, staging and

management in different types of childhood malignancies.

6.Discuss the indications for and role of radiation oncology in the manage-

ment of childhood cancer. In addition, they must identify and initiate man-

agement for its expected side effects.

7.Recognize the indications for and interpret the results of different imaging

modalities including radiography, Ultrasound, CT, MRI, PET scan and

nuclear medicine (these include their use for the diagnosis, staging and

follow up of pediatric cancers).

8.Discuss the Classification, mode of action, toxicities, basis of combination

therapy and precautions of the use of chemotherapeutic agents including

late effects and teratogenicity.

9.Prescribe judiciously various chemotherapeutic agents through various

routes of administration.

10.Monitor children on chemotherapy, recognize the toxicities of chemo-

therapeutic agents and manage it appropriately.


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18

Caner biology Topics Method Of

Learning

Method

Of

Expected

Year Of

Achievement

Normal chromosomal structure & func-

tion, gene transcription, DNA repair

mechanisms

Lectu

res an

d se

lf-stud

y

First p

art ex

am

1st y

ear

Molecular basis of Cancer

Transformation of normal cells into

cancer cells

Chromosomal & genetic changes in

malignancy, point mutation, transloca-

tions, deletions, gene amplification &

over-expression

Mechanism of spread, invasion

migration & metastasis

Tumor markers

Basics of caner virology

Oncogenic viruses

Laboratory diagnosis of

viral infection

Micro array

Surgical Oncology Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Role of surgery in diagnosis and

staging of pediatric tumors

Lectu

res an

d ro

tatio

ns in

Su

rgica

l On

colo

gy

First p

art ex

am

1st y

ear

Different types of surgery

Role of surgery in management of

disease complications

Role of surgery in Palliation

Common post operative

complications

Venous access, management and

maintenance


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19

Pathology Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement L

ectures

S

elf stud

y

p

ractica

l atten

da

nce o

f pa

tholo

gy

lab

First p

art ex

am

1st y

ear

Introduction to general pathology

Morphologic criteria of malignancy

The range of tumors that can

develop from normal tissue

components

Classification of malignant tumors

Morphology of common tumors

(macro & micro), grading &

differentiation of tumors

The natural history of malignant dis-

eases, presentations, characteristics

of their growth & spread

Principles and application of ad-

vanced techniques in tumor

diagnosis

Use of specialized pathology tech-

niques e.g. Immuno-histochemistry,

phenotype, cluster of differentiation

( CD) classifications, FISH & CISH,

micro array & gene print

Use of clinic-pathological data within

multidisciplinary approach for pa-

tients management


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20

Pharmacology Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Classification and mode of action of cyto-

toxic drugs

Lectu

res

First p

art ex

am

1st y

ear

Drug resistance, doses &

administration

Phases of drug development & screen-

ing at pre-clinical levels

Pharmacokinetics & pharmacodynam-

ics: general principles, plasma concen-

tration, AUC

Protein & tissue binding, drug concen-

tration at the target site

Principle of clinical use: dose intensity,

combination therapy, new adjuvant

therapy

High dose chemotherapy

Cancer Chemotherapy Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Mode of action of cytotoxic drugs ,

phases of the cell cycle,

Lectu

res an

d o

n jo

b tra

inin

g ro

tatio

ns in

Clin

ical P

ha

rma

colo

gy

First p

art ex

am

1st y

ear

Mechanisms of intrinsic & acquired

The indications & goals of chemo-

therapy, adjuvant & neoadjuvant

Clinical use of cytotoxic drugs

Principles of adverse effects of cy-

totoxic drugs & their management

Antiemetics and targeted therapy

( monoclonal antibodies, TKI, tu-

mor vaccines, cellular therapy,

antiangiogenesis, cytokines)

Dose intensification: indications,

complications & adverse effects


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21

Radiation Oncology Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Principles of radiation biology &

normal tissue tolerance Lectu

res an

d

rota

tion

s in

Ra

dia

tion

On

colo

gy

First p

art ex

am

1st y

ear

Principles of radiation physics,

fractionation & dosing

Clinical aspects of radiation oncol-

ogy & toxicity, interaction with

chemotherapy, potentiation &

protectors

Diagnostic Radiology Topics Method Of

Learning

Method

Of

Expected

Year Of

Achievement

Imaging modalities: indications

and cost/benefit

Lectu

res an

d sm

all g

rou

p

sessio

ns o

n

Rad

iolo

gic film

First p

art ex

am

1st y

ear

Radiography, U/S CT & PET MRI

nuclear medicine: indications

intervention radiology

Interpretation exercises

Biostatistics Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Introduction to epidemiology Lectu

res with

ha

nd

s on

train

ing

First p

art

exa

m

1st y

ear

Measuring occurrence of disease

Surveillance and overview

Study designs

Basic statistics


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22

Module II

This module aims to equip trainees with comprehensive knowledge , problem

solving and patients' management skills in the following domains:

1. Oncologic Emergencies

2. Infectious diseases

3. Clinical pathology and blood banking

4. Hematologic Malignancies:

Acute Lymphoblastic Leukemia (ALL)

Acute Myeloid Leukemia (AML)

Chronic Myeloid Leukemia (CML)

Myelodysplastic Syndrome (MDS)

Non-Hodgkin's Lymphoma (NHL)

Hodgkin's disease (HD).


1. Discuss emergency situation related to cancer development, treatment side ef-

fects or organ dysfunction.

2. Discuss the Principles of antimicrobial treatment in febrile neutropenic cancer

patients.

3. Identify the role of clinical pathologists in diagnosing hematological malig-

nancies and in supporting the transfusion management of cancer patients.

4. Discuss the indications for, precautions and procedures of blood product trans-

fusion in children with cancer.

5. Discuss the etiology, Incidence, epidemiology, clinical presentation, prognostic

factors, differential diagnosis and different strategies of management of child-

hood hematologic malignancies.

Knowledge


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23

Skills

1. Timely recognize and properly manage various types of oncological emergencies

e.g. tumor lysis syndrome, cord compression, septic shock, fever and neutropenia,

bleeding ….etc

2. Prevent, anticipate and competently management febrile neutropenic cancer

patients, with emphasis on diagnostic work up, early wide spectrum antibiotics

coverage and proper introduction of antifungal and antiviral treatment

3. Classify malignant hematologic disorders using different investigations and for-

mulate a rationale differential diagnosis and reach a final correct diagnosis

4. Use blood product transfusion judiciously in the management of hematological

malignancies

5. Anticipate, prevent and manage reactions related to blood product transfusions

6. Make appropriate evidence based decision-making regarding the choice of

treatment strategy, dealing with treatment complication, follow up during chemo-

therapy and early identification of relapsing and/or resistant cases needing second

line chemotherapy or BMT.

Oncological emergencies Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Identification of causes, clinical

presentation, and management of

oncologic emergencies

L

ectures

A

ttend

an

ce of o

utp

atien

ts

A

ttend

an

ce of in

patien

ts

Seco

nd

part ex

am

1st y

ear

Septic Shock, bleeding, coagulation

disorders

Tumor lysis syndrome

Cord Compression, increased intrac-

ranial tension, encephalopathy

Dyspnea, massive effusion, ascites

Fever and neutropenia

SVC syndrome, cardiac tamponade


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24

Infectious diseases Topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Epidemiology, strategies for

managing of infectious diseases in

pediatric oncology patients

L

ectures

A

ttend

an

ce of o

utp

atien

ts

A

ttend

an

ce of in

patien

ts

Seco

nd

pa

rt ex

am

1st y

ear

Risk assessment and clinical

manifestations of fever

in children with and neutropenia

cancer

Prevention of infections in children

with cancer

Antibacterial treatment of febrile

neutropenic patients

Antifungal agents

Antiviral agents

Clinical pathology and blood

banking Topics

Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Classification of malignant

hematologic disorders

L

ectures

A

ttend

an

ce of o

utp

atien

ts

A

ttend

an

ce of in

patien

ts

Seco

nd

pa

rt ex

am

1st y

ear

IPT

Cytogenetics in acute leukemia

Molecular biology

HLA typing

Uses of blood components in

hematologic malignancies

Management of transfusion reaction


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……………………

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25

Acute leukemia Topic

Topics

Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Epidemiology of infant and child-

hood acute leukemia

Lectu

res an

d o

n jo

b tra

inin

g in

hem

ato

logica

l malig

nan

cy w

ard

s

Seco

nd

part ex

am

1st y

ear

Etiology and genetic associations

incidence, clinical presentations of

ALL, AML

Diagnostic investigations, prognos-

tic factors and risk stratification.

Treatment protocols and monitoring

the response

Minimal residual disease

Role and indications for bone

marrow transplant

Role and indication of radiotherapy

management of rarer forms of

childhood leukemia

management of testicular, CNS and

bone marrow relapse

Chronic myeloid leukemia and

myelodysplastic syndromes

Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Epidemiology; incidence and

molecular abnormalities of

childhood CML and MDS Lectu

res an

d o

n jo

b tra

inin

g in

hem

ato

logica

l malig

nan

cy w

ard

s

Seco

nd

pa

rt ex

am

1st y

ear

Classification, clinical presentations

Laboratory and prognostic features

of CML, and MDS

Chemotherapy for CML, MDS

Monitoring of response and

treatment outcome

Role of bone marrow transplant in

the treatment of myelodysplasia and

chronic myeloid leukemia in


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26

Hodgkin’s Lymphoma

Topics

Method Of

Learning

Method

Of

Expected

Year Of

Achievement

Epidemiology, clinical presentation,

and laboratory features Lectu

res an

d o

n jo

b tra

inin

g in

hem

ato

log

ical m

alig

nan

cy

ward

s

Seco

nd

pa

rt ex

am

1st y

ear

Histological subtypes and their ef-

fects on prognosis

Ann-Arbor staging system

Diagnostic work up

current treatment strategies includ-

ing the role of radiotherapy

FDG-PET scan

complications and late effects of

chemotherapy and radiotherapy

Non-Hodgkin's Lymphoma

Topics

Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Histological subtypes of NHL in chil-

dren and adolescents

Lectu

res an

d o

n jo

b tra

inin

g in

hem

ato

log

ical m

alig

nan

cy w

ard

s

Seco

nd

pa

rt ex

am

1st y

ear

Clinical presentation

Cytogenetic and molecular genetic

Association of EBV and HIV with NHL

investigations and diagnostic work up

Prognostic features

Current treatment strategies accord-

ing to immunophenotype and patho-

Management of the acute presenta-

tions: SVC obstruction, airway

compression, spinal cord compres-

Indications and role of BMT in

Management of relapsed NHL


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27

Module III

This module aims to equip trainees with comprehensive knowledge , problem

solving and patients' management skills in the following themes:

1-Solid Tumors:

Renal Tumors.

Neuroblastoma.

Germ cell Tumors.

Hepatic Tumors.

Retinoblastoma

Bone Tumors.

Soft Tissue Sarcoma.

Central Nervous System Tumors.

2-Practical Procedures & Investigations

3-Therapeutic Procedures:

Lumbar Puncture

Bone Marrow Aspiration & Biopsy

IV Fluids

Infusion pumps

1. Discuss the etiology, incidence, clinical presentation, differential diagnosis,

pathological subtypes and management guidelines of pediatric solid tumors

2. Discuss the indications and steps of performance for different practical proce-

dures used during the course of diagnosis or treatment of cancer patient e.g.; col-

lection of blood sample, LP, BM aspiration& biopsy and tapping of ascetic fluid

3. Outline the contraindications and expected complications of various procedures


Knowledge


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28

Take appropriate evidence based decisions regarding treatment strategy,

Discuss the indication of surgery and/or radiotherapy

Deal with treatment complication appropriately

Follow solid tumor pediatric patients during chemotherapy and early identify

relapsing and/or resistant cases needing 2nd line chemotherapy and/or

autologous BMT

Communicate effectively and in a simple way to patients the indications and

techniques of invasive procedures and be able to take informed consent

Perform the following therapeutic procedures independently and safely:

Lumbar puncture, BM aspiration and biopsy, needle thoracocentesis for

pleural effusion or pneumothorax, tapping of ascetic fluids.

Interpret results of investigations requested and respond appropriately

Record results and document procedures legibly and accurately

Explain the investigation results to parents and/or the child

Recognize complications of procedures and be able to respond appropriately

Supervise and teach junior colleagues the performance of the above

mentioned procedures

Skills

Hepatic tumors topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Congenital conditions associated with

hepatoblastoma

Lectu

res an

d o

n th

e job

train

ing

du

rin

g so

lid tu

mo

r rota

tion

s

Fin

al w

ritten , clin

ical a

nd

ora

l exa

mi-

na

tion

2n

d y

ear

Differential diagnosis of right upper quadrant

masses, anatomy and histology of the liver

Tumor markers in primary liver tumors

Pre-treatment staging system

Prognosis of hepatoblastoma and hepatocellular

carcinoma and factors that determine it

Surgical resection of primary tumor

Role of liver transplantation in the management

of hepatic tumors

Late effects of treatment


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29

Renal tumors topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Classification and pathological subtypes

of renal tumors including incidence of

Wilms tumor L

ectures

O

utp

atien

t rota

tion

s In

patien

t rota

tion

s

Fin

al w

ritten , clin

ical a

nd

ora

l exa

min

atio

n

2n

d y

ear

Clinical presentation and differential

diagnosis of a renal mass

Prognostic significance of histology

Staging Wilms tumor

pre- and post-surgery

Principles of treatment for all stages of

tumor according to different patients’

groups

Principles of treating bilateral Wilms

tumor

management of a patient with recurrent

Wilms tumor

Role of surgery and radiotherapy

Complications and late effects of

treatment

Retinoblastoma topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Epidemiology, genetic, and clinical

features of unilateral and bilateral

retinoblastoma

Lectu

res an

d o

n jo

b tra

inin

g

du

ring

solid

tum

or ro

tatio

ns

Fin

al w

ritten , clin

ical a

nd

ora

l exa

mi-

na

tion

2n

d y

ear

Clinical presentation of retinoblastoma

Trilateral retinoblastoma

Imaging modalities to determine extent and

metastatic spread

Staging of retinoblastoma

Treatment modalities: surgery, irradiation,

chemotherapy and photocoagulation

Screening and follow-up for patients and

siblings

Complications, rehabilitation and late

effects


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30

Neuroblastoma topics Method Of

Learning

Method

Of

Assessment

Expected

Year Of

Achievement

Etiology and clinical presentation by age

Lectu

res an

d o

n jo

b tra

inin

g

du

ring

solid

tum

or ro

tatio

n

Fin

al w

ritten , clin

ical a

nd

ora

l exa

min

atio

n

2n

d y

ear

Management of common clinical problems

associated at presentation: hypertension,

spinal cord compression, Horner's

Radiological investigations for diagnosis

and staging

International staging system (INSS)

Prognostic factors and prognosis according

to age and stage, histology and MYCN

Laboratory findings: VMA, NSE, ferritin,

LDH, MIBG

Treatment strategies according to risk

stratification, role of surgery and

Principles of managing relapsed NBL

Germ cell tumors topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Embryogenesis and histogenesis of Lectu

res an

d o

n jo

b tra

inin

g

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Genetic Characteristics of Adolescent

Testicular Tumors


Diagnostic work up

Pathological subtypes

Clinical markers: H-CG,AFP, LDH

Principles of treatment:

Treatment complication,

Late effects and follow up after end of


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31

Bone tumors topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Epidemiology, predisposing factors and genetic

predispositions L

ectures a

nd

on

job

train

ing

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Pathological subtypes

Ewing family of tumors and their effect on

prognosis

Clinical presentations and potential metastatic

sites

Differential diagnoses for plain x-ray

appearances

Imaging modalities and their indication

Neoadjuvant and adjuvant chemotherapy in the

management of bone tumors

Role and limitations of surgery

Rehabilitation for limb sparing, joint sparing

and amputation

Late effects of bone tumor

Soft tissue sarcoma topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Epidemiology, predisposing factors and

Lectu

res an

d o

n jo

b tra

inin

g

du

ring

solid

tum

or ro

tatio

n

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Classification of STS: RMS /Non RMS

Cytogenetic and molecular genetic

abnormalities associated with soft tissue

sarcomas

Histological subtypes and patterns of


Staging of soft tissue sarcomas

Role of surgery, chemotherapy and

radiotherapy


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32

Central nervous system tumors topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Epidemiology, predisposing factors and

Lectu

res an

d o

n jo

b tra

inin

g

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Classification, pathological subtypes and

Clinical presentations

Types and interpretation of neuro-images

Planning of treatment through neuro-

Role of surgery, irradiation and

chemotherapy in the treatment of CNS

Monitoring the response to treatment

Complications and late effects of CNS

Rehabilitation

Practical Procedures and investigations Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Appropriate indications for practical

procedures and investigations

Lectu

res an

d o

n jo

b tra

inin

g

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Local and national guidelines for obtaining

informed consent for investigations or

Contraindications and complications of

Anatomical markers for invasive

The principles for the practice of

The steps of performance of various

techniques


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33

Requested procedures

1. Administer SC, IM & IV injections

2. Tapping of ascites

3. Thoracocentesis for pleural effusion or pneumothorax

4. Lumbar puncture and intrathecal administration of chemotherapy

5. BM aspiration and biopsy

6. Arterial blood gas analysis

Module IV

This module aims to equip trainees with essential knowledge , problem solving and

patients' management skills in the following themes:

1. Endocrine Malignancies

2. Rare Tumors

3. Hematopoietic Stem Cell Transplantation (HSCT)

4. Pain Management

5. Late Effects of Chemotherapy

1. Outline the physiological background, Incidence, classification, and associated

syndromes of the commonly seen endocrine malignancies

2. Discuss the clinical presentation, staging and treatment strategy for different en-

docrine malignancies

3. Explain the importance of consultation with colleagues in adult oncology

4. Outline the role of high dose therapy with autologous stem cell rescue in the

management of malignant disorders in children and young adults

5. Discuss the indications and role of allogeneic hemopoietic stem cell transplanta-

tion (HSCT) in children, including the indications for HSCT from other than a

matched sibling donor

6. Explain the principles of HLA (human leucocyte antigen) typing and donor se-

lection, including the different potential sources of HSCT, and HSCT collection

and cryopreservation

7. Describe the complications of HSCT and their management, including graft-vs.-

host disease, veno-occlusive disease and graft failure

8. Outline the late effects of HCST in children, including growth, fertility and sec-

ond malignancy

9. Discuss the Pathophysiology of pain in cancer patient

10.Explain the drug treatment of pain and the analgesic ladder

11.Describe different Pain syndromes

12.Outline practice guidelines for providing sedation and pain relief for practical

procedures


Knowledge


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34

Skills

1. Recognize, diagnose and manage late effects of malignancy, chemotherapy

and radiotherapy toxicity

2. Develop follow-up plans for cancer survivors and counsel them appropri-

ately

3. Manage patients with neuro endocrine tumors as a member within multidis-

ciplinary team

4. Participate as a team member in HSCT for children with hematological ma-

lignancies

5. Clinically assess, and identify patients who are not fit for further active can-

cer treatment, or at the terminal stage of life

6. Attend to Quality of life issues and provide psychological support to the pa-

tients and their family

7. Assess the patients pain score, stratify the different types of pain and measure

their intensity

8. Choose treatment modality and use appropriately non-pharmacological treat-

ments

9. Identify and manage side effects of pain treatment

Neuroendocrine malignancies topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Classification of Neuro-endocrine tumors

Lectu

res an

d o

n jo

b tra

inin

g

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Clinical presentations and methods of

diagnosis

Staging and prognostic factors

Role of surgery in localized & advanced

disease

Role of chemotherapy & radiation therapy

for different disease stages

side effects of treatment

The principles of follow up

The management of relapsed disease


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35

Hemopoietic stem cell transplantation

(HSCT) Topics

Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Role of high dose therapy with autologous

stem cell rescue in the management of malig-

nant disorders in children and young adults

Lectu

res an

d o

n jo

b tra

inin

g

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Indications for allogeneic HSCT

in children

Advantages of allogeneic HSCT and donor

lymphocyte infusion in some non-malignant

disorders

Role and indications of allogeneic HSCT in

the treatment of leukemia in children and

young adults

Principles of HLA typing and donor

selection

Complications of HSCT and their

management

Conditioning regimens used in HSCT and

their side effects

Role and complications of TBI in HSCT

Principles and types of

immunosuppression used in HSCT

Infectious complication

Late effects of HCST in children

Rare tumors topics Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Types of adult malignancies that could occur in

children

Lectu

res an

d o

n jo

b

train

ing

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

The role of adult oncologists in the manage-

ment of rare childhood tumors

the diagnosis, staging, treatment & relation to

adults' protocols

The Clinical presentation and diagnosis of rare

tumors

Role of Chemotherapy, Surgery and radiother-

apy


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36

Pain management and palliative care

Topics

Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Principles of palliative care and

quality of life

Lectu

res an

d o

n jo

b

train

ing

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Pathophysiology of pain in cancer patient

Drug treatment of pain and

the analgesic ladder

Pain syndromes

Evidence based practice guidelines for the

management of pain in cancer patients

Complications and side effects

of pain management

Late effects of Chemotherapy

Topics

Method Of

Learning

Method

Of

Assessment

Expected Year

Of

Achievement

Delivering survivorship care Lectu

res an

d o

n jo

b

train

ing

Fin

al w

ritten , clin

ical

an

d o

ral ex

am

ina

tion

2n

d y

ear

Growth and neurocognitive sequelae of

chemotherapy

Systemic function abnormalities

Second malignant neoplasms

Hormonal function abnormalities

Late mortality among childhood

cancer survivors


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37

Methods of assessment

Regulations

The general rules and regulations of assessment approved by the Egyptian fellow-

ship board and published at the training handbook and the board web site applies

for the pediatric oncology specialty. In addition to the successful completion of the

training program, all candidates must successfully pass three exams in order to get

the fellowship certificate.

First part Exam

The first part exam is a written exam. Trainees will sit for the first part exam after

completion of the first year of training. Each candidate has two chances to pass the

exam. Failure for two times or more in the first part will result in request for repeti-

tion of a specific period of training. The scientific council will determine the dura-

tion of training extension.

Candidates will not sit for the final certifying exam unless they pass successfully

the first part exam and completed the required period of training

Second part exam

The second part exam is a written exam. Trainees are allowed to sit for the second

part exam after passing successfully the first part and after completion of the train-

ing period. In addition, each candidate must submit his logbook for final assess-

ment. The logbook requirements must all be completed and signed by the trainer

and educational supervisor.

Each candidate has three chances to pass the exam and one more additional chance

may be granted in special approved circumstances.

Clinical Exam (third part)

The third part exam is a clinical and oral exam. Candidates who pass successfully

the second part are allowed to sit for the third part. Again, each candidate has three

chances to pass the clinical exam and an additional fourth chance may be granted in

special approved circumstances.

Pre-requisite for entering the first part exam

Trainees should pass the following courses in order to be eligible for the first part exam

1. Local TOEFEL with a score of at least 500

2. Computer courses in word processing, PowerPoint and internet

Trainees who passed these courses during their pediatric

fellowship training are not required to repeat it


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38

Components and structure of examination

The first part exam aims to test trainee's knowledge in module one of their cur-

riculum. The following themes are subject for the first part examination

1. Cancer biology

2. Pathology & molecular biology

3. Chemotherapeutic agents

4. Clinical Pharmacology

5. Epidemiology & Biostatistics

6. Basics of Surgical Oncology

7. Basics of Radiation Oncology

8. Radio-diagnosis

9. Basics of Cancer

Please revise the curriculum for details of topics and required learning outcomes

PART I examination consists of two papers:

Paper I (2 hours): Multiple choice questions with a single best answer format.

Paper II (2 hours): short answer and /or problem solving questions

Both papers will ensure coverage of the above-mentioned themes

The second part exam aims to test trainees' knowledge and skills in the whole

curriculum of pediatric oncology. In this exam, the scientific council will ensure

coverage of the whole curriculum.

Part II examination consists of four papers:

1- Two MCQ papers each two hours in duration

In both papers, facts, problem solving and management skills are going to

be assessed. You will choose one best answer in each question

2- Two short assay papers each two hours in duration

Questions will assess Trainees' knowledge about various pediatric oncol-

ogy problems and their management. In addition, it will test trainees' diag-

nostic and problem solving skills.

The structure of the first part exam

The structure of the second part exam


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39

part III exam is a clinical and oral exam and is composed of the following compo-

nents:

Clinical exam

The clinical exam remains the most important part of the examination as the long

case evaluate the potential performance of the candidate in clinical practice while

short cases assess clinical examination skills in various system. Passing this compo-

nent of the exam independently is essential for certification.

Long Clinical Case : the candidate is observed in silence for the first part of the

examination by two examiners where he/she is taking the history from the parent

or the child and performing a physical examination and then The examiner asks

him to present his findings in the history and examination and discuss the manage-

ment of the case . Examiners give marks according to a predetermined weighting

of the components of the exam.

Short case examination: Each candidate examines 2-3 patients. The examiners

evaluate his abilities to correctly elicit and interpret physical signs or his abilities

to take focused clinical history. An agreed marking system is used to ensure objec-

tivity and fairness of the exam.

OSPE: A 10-20 station examination including radiological imaging/ laboratory

data results / photographs / cytogenetics or pathology slides, simulated patients

and procedural stations. Each station is five minutes and they test candidate diag-

nostic, interpretative, procedural, management and communication skills

VIVA: The oral exam is composed of two oral examination stations. Each station

is a committee of two examiners who will spend 20 minutes with the candidate (10

minutes for each examiner). They will test the candidates’ ability to manage vari-

ous pediatric oncological problems and explores his/her abilities for making sound

differential diagnosis. They will also assess his attitudes and interpersonal commu-

nication skills. the exam is based on a set of topics with opening and supplemen-

tary questions. The questions cards are prepared in advance together with the ex-

pected ideal answer and allocated marks. This allows a good objective basis for

marking.

The structure of the third part exam

pediatric oncology curriculum

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