Gynaecological Oncology

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information

I About The Programme

Name of Programme

Gynaecological Oncology Clinical Fellowship Programme

Overview

The KK Gynaecological Cancer Centre/Colposcopy Suite is a tertiary referral center which serves over 450 new cases of gynaecological malignancy and over 500 new cases of gynaecological premalignancy each year. KKH has the largest colposcopy centre in Singapore offering screening, diagnostic and therapeutic management of patients with precancer of cervix and vulva diseases.

For more information about the KK Gynaecological Cancer Centre, click here.

Aim of Programme

The general aim of this Fellowship is to equip the trainees with the necessary knowledge and skills to attain the basic requirements to function as a gynaecologic oncologist.

Duration of Programme

6-12 months

Learning Outcomes

After completing the programme, Fellows will:

• be able to take:
  
• a comprehensive medical history and perform a general physical examination;
• a specific gynecologic history and perform a gynecologic examination;
• an oncologic history and perform an examination directed towards the evaluation of cancer.
• be able to select the appropriate diagnostic techniques needed to:
• establish the diagnosis;
• establish the extent of disease;
• evaluate co-existing disease which may have an important bearing on selection of therapy and response to therapy.
• be able to stage the cancer according to currently accepted guidelines;
• be familiar with the assessment and performance of the visual diagnostic techniques and tissue sampling, including an understanding of the indications, limitations and techniques of:
• colposcopy of vulva, vagina and cervix;
• hysteroscopy;
• cystoscopy.
• be familiar with diagnostic imaging including the indications, limitations and principles of interpretations;
• understand the current theories of carcinogenesis, including the effects of environment, family history and viral factors;
• demonstrate an understanding of oncogenes, tumor suppressor genes, DNA repair genes and oncogenesis, and be familiar with the influence of genetics on the clinical practice of gynecologic oncology. The Fellow should also know the essential components of the immune system as well as the current data cited as evidence that the immune system is involved with neoplastic processes;
• be able to discuss the available methods of evaluation and management of malignant disease in all groups of patients;
• be competent in clinical gynaecologic oncology and in surgical procedures for the treatment of gynaecologic cancers and precancers;
• be able to perform:
• simple vaginal and abdominal hysterectomies;
• radical hysterectomies;
• radical adnexal cytoreductions;
• lymphadenectomies of the inguinal, femoral, pelvic and para-aortic areas;
• vaginectomies that are simple or radical;
• vulvectomies that are skinning, simple or radical;
• omentectomies;
• insertions of intracavity radiation application;
• laser therapy;
• laparoscopic surgical approaches where applicable, including hysterectomies, salpingo-oophorectomies, lymphadenectomies and staging procedures;
• be familiar with pelvic exenterations that are anterior, posterior or total;
• be familiar with gastrointestinal procedures such as colectomies, anterior resections and colostomy, as well as urological procedures such as DJ stenting, ureteric repair, bladder repair and ileal conduits;
• be able to recognise and manage coagulopathies, injuries to bladder, ureters, vessels and bowels;
• be able to recognise and manage postoperative, such as
• bleeding;
• pulmonary embolisation;
• uretero/vesicovaginal or rectovaginal fistulas;
• wound problems including infection, dehiscence and evisceration;
• septic pelvic thrombophlebitis;
• bowel obstruction;
• metabolic abnormalities including hypercalcemia, hyponatremia and hypomagnesemia;
• sepsis including septic shock;
• hernias including ventral, perineal, and peristomal types;
• acute and chronic pain.
  

Content Areas

The Department endorses and follows the following training programme:

1. Teaching Programme

1. Pre-Invasive Disease Module
2. Training Syllabus:
• Chemotherapy of Gynaecological Tumours
• Therapeutic Principles
• Surgical Procedures
• Radiation Therapy
  
• Pain Relief & Palliative Care
3. Academic Presentations

2. Practical Programme

1. Tumour Board
2. Cancer Staging (clinical)
3. Cancer Surgery
4. Radiotherapy Attachment
5. Chemotherapy (inpatient & outpatient)
6. Combined Cancer Clinics
7. Hospice Care & Home Care
8. Colposcopy
9. Laser/LEEP Clinic
10. Ward Care
11. Cancer Ward Meeting
12. Living with Cancer Programme
13. Data Administration

3. Research Project

1. At least one original research project and thesis

4. Material Provided

1. Treatment Guidelines for Gynaecological Cancers
2. Chemotherapy for Gynaecological Cancers: Guidelines & Treatment information
3. Gynaecological Oncology Care Manual
4. Access to Resource Room & Reading and AV Material
5. Gynaecological Cancer Briefs 
   

Training Methods

The Fellow will be assigned an individual mentor throughout the programme. The mentor will be directly responsible for the activities that are assigned to the Fellow.

Past and Present Fellows

From 2002 to 2012, 12 doctors from Singapore, Malaysia, Middle East and Pakistan had undergone the 1-year hands-on training programme with the Department.

From 2002 to 2016, 14 doctors from China, Hong Kong, India, Malaysia and The Philipines had also joined the Department’s Clinical Observership Program.

Team of Experts

The Gynaecological Oncology Fellowship Programme is managed by the following experts:

II Assessment and Evaluation

Aims of Assessment

Fellows will need to demonstrate their proficiency level based on the following competencies:

(A) Patient Care

Fellows are expected to:

• demonstrate caring and respectful behaviours when interacting with patients and their families;
• gather essential information about patients by performing a complete and accurate medical history and physical examination;
• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment;
• develop, negotiate, and implement effective patient management plans;
• counsel and educate patients and their families;
• use information technology to support patient care decisions and patient education;
• perform competently all medical and invasive procedures considered essential for generalist practice in the discipline of obstetrics and gynaecology;
• provide health care services aimed at preventing health problems or maintaining health
  

(B) Medical Knowledge

Fellows must demonstrate knowledge of established and evolving biomedical, clinical, and cognate, e.g. epidemiological and social behavioral, sciences and apply this knowledge to patient care. They are expected to:

• demonstrate an investigatory and analytic thinking approach to clinical situations;
• demonstrate a sound understanding of the basic science background of women’s health and apply this knowledge to clinical problem solving, clinical decision making, and critical thinking.
  

(C) Practice-Based Learning and Improvement

Fellows must be able to use scientific evidence and methods to investigate, evaluate and improve patient care practices. Fellows are expected to:

• identify areas for personal and practice improvement and implement strategies to enhance knowledge, skills, attitudes, and processes of care;
• analyse and evaluate personal practice experience and implement strategies to continually improve the quality of patient care provided using a systematic methodology;
• locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems;
• demonstrate receptiveness to instruction and feedback;
• apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness;
• use information technology to manage information, access online medical information, and support their own education. 
  

(D) Interpersonal and Communication Skills

Fellows must be able to demonstrate interpersonal and communication skills that assist in effective information exchange and be able to team with patients, patients’ families, and professional associates. Fellows are expected to:

• sustain therapeutic and ethically sound relationships with patients, patients’ families, and colleagues;
• provide effective and professional consultation to other physicians and health care professionals;
• elicit and provide information using effective listening, non-verbal, explanatory, questioning, and writing skills;
• communicate effectively with patients in a language that is appropriate to their age and educational, cultural, and socioeconomic background;
• maintain comprehensive, timely, and legible medical records;
• communicate effectively with others as a member or leader of a health care team or other professional group.
  

(E) Professionalism

Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. Fellows are expected to:

• demonstrate respect, compassion, integrity, and responsiveness to the needs of patients and society that supersedes self-interest;
• demonstrate accountability to patients, society and the profession by
• demonstrating uncompromised honesty;
• developing and maintaining habits of punctuality and efficiency;
• maintaining a good work ethic, i.e. positive attitude and high level of initiative;
• demonstrate a commitment to excellence and ongoing professional development;
• demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care;
• describe basic ethical concepts such as autonomy, beneficence, justice and non-maleficence;
• maintain confidentiality of patient information by
• describing current standards of the protection of health-related patient information;
• listing potential sources of loss of privacy in the health care system;
• obtain informed consent and advanced directives;
• demonstrate sensitivity and responsiveness to the culture, age, sexual preferences, behaviors, socioeconomic status, beliefs and disabilities of patients and professional colleagues. 
  

(F) Systems-Based Practice

Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Fellows are expected to:

• understand how their patient care and other professional practices affect other health care professionals, the health care organisation, and the larger society, and how these elements of the system affect their own practices;
• describe how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources, by
• listing common systems of health care delivery, including various practice models;
• describing common methods of health care financing;
• discussing common business issues essential to running a medical practice;
• applying current procedural and diagnostic codes to reimbursement requests;
• practice cost-effective health care and resource allocation that does not compromise quality of care;
• advocate for quality patient care and assist patients in dealing with system complexities.
• acknowledge that patient safety is always the first concern of the physician by
• demonstrating the ability to discuss errors in management with peers and patients to improve patient safety;
• developing and maintaining a willingness to learn from errors and use errors to improve the system or process of care;
• show an understanding of risk management and professional liability by being able to
• list the major types and providers of insurance;
• describe the most common reasons for professional liability claims;
• describe a systematic plan for minimising the risk of professional liability claims in clinical practice;
• describe basic medical-legal concepts regarding a professional liability claim and list the steps in processing a claim.
  

Assessment Approaches

The Fellow will be required to submit a logbook of experience at the end of the posting. Fellows are also encouraged to keep a reflective log. The following are also necessary for completion of the programme:

• 1 accepted publication in a peer-review journal
• Attendance at an approved advanced laparoscopy/pelvic surgery workshop
• Completion of 6-monthly assessment report (form T3) from SMC

Fellows are encouraged to provide feedback to the supervisor, and vice-versa, whenever necessary.

Evaluation Process

General overall grading system

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competencies-based knowledge, skills and performance that Fellows must demonstrate throughout the programme.

III Target Audience and Eligibility Requirements

Target Audience

Gynaecologist who has a keen interest in gynaecology oncology work and surgeries, and would like to function as a gynaecology oncologist.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

• have at least 2 years after MRCOG, MRANZCOG, M.MED (O&G) or equivalent, preferably after at least 1 year attachment in a gynaecological oncology unit in their respective country;
• have adequate surgical dexterity appropriate for advanced pelvic surgery;
• be conversant in English;
• have accreditations approved by Ministry of Health Singapore, Singapore Medical Council and KK Women’s & Children’s Hospital;
• have the basic qualities of a good clinician – responsible, compassionate and high ethical value.

Candidates will be assessed within the first 3 months and will continue with the programme if deemed suitable.

IV Other Information

Course Fees

Course fees will be determined upon application.

Funding

Self-funded or sponsored by their parent country or institution. A written agreement must be submitted stating that prospective Fellows will return to their home country after completing the programme.

Certification

Certificate of fellowship will be awarded upon completion of the programme.