Course Director                                                                  David Brenin, MD

Surgical Oncology/Breast/.

Faculty                             Primary Specialty           Secondary

Dr. Craig Slingluff          Melanoma                      Clinical Trials, Cancer Immunotherapy

Dr. David Brenin            Breast Surgery

Dr. Anneke Schroen      Breast Surgery  General Surgery

Dr. Shayna Showalter    Breast Surgery

Learning Objectives

Upon completion of this rotation all medical students are expected to be able to:

1. Develop a comprehensive pattern of complete care of the surgical patient.
2. Discuss the pathophysiology of benign and malignant breast problems
3. Execute the work-up of the suspicious breast lesion.
4. Understand treatment options for patients with invasive and non-invasive breast cancer. 
5. Discuss the rationale for adjunctive therapy, and how it varies with stage, histologic type, and patient factors.

 6.   Develop an understanding of the importance of the multidisciplinary approach.   A critical part of this experience is participation in the Breast Team conference on Friday afternoons at 1:30 PM.

7. Discuss the identification, staging, and treatment options for melanoma.
8. Describe the rational for lymphoscintigraphy, the role of experimental clinical trials in adjuvant therapy and the role of interferon in this disease.  A critical part of this experience is participation in the Gold Book Conference at 10 AM on Thursdays at 5:00 pm.
9.  Perform a focused history and examination in a patient with breast disease and melanoma, or other malignancy.
10. Develop a plan of care for all in-house surgical patients with whom they come in contact. This includes data collection, ordering and interpreting appropriate diagnostic tests, and working to provide a patient centered plan consistent with the resident’s level of training

  Responsibilities

1. Participate in general surgery call and management of general surgical oncology consults and surgical procedures. 
2. Outpatient care:  This clinical service involves a strong and long-term relationship between the patient and surgeon.  There will be a substantial outpatient experience, including outpatient clinics and outpatient surgery.  This will provide particularly useful opportunities to provide patient-focused care, to develop a therapeutic relationship with patients and families.
3. Screening for new and recurrent cancers:  Cancer patients return regularly for routine follow-up visits, and patients with high risk of breast cancer are seen regularly for screening evaluations.  As these are critical aspects of clinical decision-making, this rotation will provide excellent opportunities to gather data, to order diagnostic tests, to interpret data, and to make decisions.  Biopsies are often needed in the clinic, and opportunities to perform them will be available.
4. Multidisciplinary care:  Care of patients with cancer, especially Breast, Melanoma, Sarcoma and Endocrine cancers, routinely require multidisciplinary management.  Attendance at the weekly Breast and Melanoma conferences are required.  This rotation will provide opportunities to work as a team member, to act in the best interest of the patient; and to observe and to work with interdisciplinary teams to improve patient care.
5. Clinical Research:  There will be opportunities for motivated residents to analyze practice performance and to recommend needed improvements; to locate and to apply scientific evidence to the care of patients; to critically appraise the scientific literature; and to perform independent, mentored clinical research.
6. Professionalism:  Patients with cancer are particularly vulnerable.  Conversations with these patients, thus, can be stressful and difficult.  Great attention is placed on demonstrating integrity and honesty; accepting responsibility; and demonstrating sensitivity to patients' concerns and needs.