SUBSPECIALIST TRAINING PROGRAMME in GYNAECOLOGICAL ONCOLOGY

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Ilene Crawford
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EUROPEAN SOCIETY OF GYNAECOLOGICAL ONCOLOGY SUBSPECIALIST TRAINING PROGRAMME in GYNAECOLOGICAL ONCOLOGY Sme 50% f cancers that affect wmen are lcated in the breast r in the genital rgans.

1 EUROPEAN SOCIETY OF GYNAECOLOGICAL ONCOLOGY SUBSPECIALIST TRAINING PROGRAMME in GYNAECOLOGICAL ONCOLOGY Sme 50% f cancers that affect wmen are lcated in the breast r in the genital rgans. Gynaeclgical and breast cancer treatment is inter-disciplinary and requires a gd surgical training as well as knwledge abut raditherapy, chemtherapy, hrmne therapy, immuntherapy and genetics. ESGO recgnizes the develpment f subspecialty practices in a number f cuntries, in particular the USA and certain Eurpean cuntries and cnsiders that Gynaeclgical Onclgy shuld be recgnized as a subspecialty in Eurpe. In several Eurpean cuntries, breast cancer is nt treated by gynaeclgical nclgists. In these cuntries, fellws d nt have t include this cmpnent in their training prgramme, but it is recmmended that they becme familiar with the principles and practice f the management f breast diseases. The ESGO accreditatin and certificatin prgramme nly evaluates the training in gynaeclgic nclgy WITHOUT breast cancer. Educatinal bjectives and requirements fr training in these subspecialist areas have been defined in cnjunctin with acknwledged experts frm the Eurpean Sciety f Gynaeclgical Onclgy and are defined in the syllabus (Annex I). The rle f such a subspecialist is cmplementary t, and nt in cmpetitin with, that f a specialist in Obstetrics and Gynaeclgy. Training in the subspecialty f gynaeclgical nclgy 1. Definitin The gynaeclgical nclgist is a specialist in Obstetrics and Gynaeclgy but in additin, is able t:

2 prvide cnsultatin n, and the cmprehensive management f patients with, gynaeclgical cancer; manage the medical and /r surgical treatment f malignant diseases f the female genital tract which may invlve relevant surgery f abdminal rgans; practice gynaeclgical nclgy in an institutinal setting where all effective frms f cancer therapy are available. This includes cmprehensive management f gynaeclgical cancer including screening, diagnstic, therapeutic prcedures and fllw up. In the EU, the gynaeclgical nclgist usually takes charge f breast diseases except in Denmark, Finland, Ireland, Netherlands and the UK. The practice f gynaeclgical nclgy excludes the subspecialist frm certificatin in anther subspecialty. 2. The aim f the training T imprve the care f patients with gynaeclgical malignancies, in cllabratin with ther care prviders. 3. The bjectives f the training T train a subspecialist t be capable f: imprving knwledge, practice, teaching, research and auditing; c-rdinating and prmting cllabratin in rganizing the service; prviding leadership in develpment and research within the subspecialty. 4. The rganizatin f training The number f training psts shuld be strictly regulated, preferably by the relevant natinal bdy in rder t prvide sufficient expertise. The training prgrammes shuld be based in a multidisciplinary centre f Obstetrics and Gynaeclgy and shuld be rganized by a subspecialist r an accredited subspecialist (2). Centres shuld use guidelines and prtcls which are finalized by natinal prfessinal bdies and are reviewed at regular intervals. These guidelines will define the cases in which it is necessary t refer a patient t a subspecialist. Training as a subspecialist in gynaeclgical nclgy des nt imply that a subspecialist cannt practice in the general field f Obstetrics and Gynaeclgy. (2) Initially there will be a transitinal perid when accreditatin fr training will be given by the natinal appinting authrity r if nt by a prfessinal r scientific bdy t a Specialist in Obstetrics and Gynaeclgy with prven scientific and clinical expertise in Gynaeclgical Onclgy (s-called grand-father principle ). Subsequently, nly individuals with training in the subspecialty shuld hld such a psitin.

3 5. The means f training 5.1 Entry requirements: a recgnized specialist qualificatin in Obstetrics and Gynaeclgy r having cmpleted a minimum f fur years in an apprved training prgramme in Obstetrics and Gynaeclgy; the availability f a recgnized training pst. 5.2 An adequately remunerated pst in a recgnized training prgramme is a basic cnditin. Each trainee must be allcated a tutr t prvide guidance and advice. 5.3 Fr each cuntry, the estimated number f training psts shuld reflect the natinal need fr subspecialists in gynaeclgical nclgy, as well as the facilities and finances available fr training. 5.4 Trainees shuld participate in all relevant activities f the training unit such as the care f ut-patients and in-patients, n call duties during bth day and night, perfrming gynaeclgical nclgy peratins and participating in educatinal activities, including the teaching f ther health prfessinals. Participatin in audit and clinical r basic research is essential. 5.5 Arrangements fr pstgraduate training must be cmpatible with natinal emplyment and teaching legislatin in relatin t remuneratin, hurs f wrk and rights f emplyees in such matters as sick leave, maternal and paternal leave and cmpulsry military service. 5.6 The duratin f subspecialty training shuld include a minimum f tw years in an apprved prgramme and shuld cver the clinical and research aspects f the fllwing areas: Surgical training in a gynaeclgical nclgy unit; General surgical training; Urlgy; Raditherapy; Medical nclgy; Cytlgical diagnsis and pathlgy; Psych-nclgy; Tumur bilgy. Training in each f these areas will be dne in cllabratin with and preferably at least partly take place in the relevant units. 5.7 Training shuld be structured thrughut with clearly defined targets t be met after specified intervals. An educatinal plan shuld be drawn up in cnsultatin with the trainee at the beginning f each attachment and prgress shuld be mnitred regularly, by means f the Lg bk. 5.8 A trainee may spend sme training time in anther (1 r 2) centre(s) as lng as regulatins are being met.

4 6. Assessment f training 6.1 In all Eurpean cuntries, apprval f training and trainers shuld be the respnsibility f a natinal r reginal authrity which has the pwer t withdraw recgnitin, if necessary. Centres in cuntries where n natinal apprval f subspecialist training exists may apply fr ESGO accreditatin. 6.2 Apprval f institutins as training centres shuld be based n: annual statistics; internal quality cntrl and audit; rganized teaching sessins; the availability f: Raditherapy unit; Chemtherapy unit; Cyt-pathlgy unit; Multidisciplinary team regularly invlved in the management f gynaeclgical cancer; fulfilment f defined criteria fr minimum activity: 150 new genital cancer cases per year and 100 radical surgery cases per year (all cancers), 100 mre radical surgery cases fr a secnd fellw etc. wuld be the minimum number necessary t prvide quality care, fellwship training and research; Additinally, minimum f 60 new cases f breast cancer are recmmended in cuntries where breast cancers are treated by gynaeclgical nclgists. 6.3 Assessment f the trainee shuld be carried ut by a natinal cmmittee f experts, r else by the ESGO FAC and shuld take int cnsideratin: participatin in Gynaeclgical Onclgy curses, particularly thse recgnized by ESGO in agreement with cmpletin f a lg bk f clinical experience in Gynaeclgical Onclgy; peer review publicatins in a natinally recgnized jurnal. 6.4 ESGO is willing t rganize an evaluatin visit t a subspecialist unit, if requested.

5 Annex I. Syllabus 1. Definitins: Knwledge: basic understanding f all tpics cmmnly used in the clinical practice f gynaeclgical nclgy. Detailed knwledge: an understanding f imprtant aspects f tpics which may be mre cmprehensively understd by a specialist in anther discipline, such as a geneticist. Cmprehensive knwledge: a cmplete understanding f tpics which are imprtant in the clinical practice f gynaeclgical nclgy. 2. Basic sciences 2.1 Anatmy Cmprehensive knwledge f the reginal anatmy f the pelvis, abdmen, thrax, breast, thigh, endcrine glands, particularly in relatin t surgical prcedures undertaken by the gynaeclgical nclgist. Detailed knwledge f the grss anatmy and histlgy f relevant bnes, jints, muscles, bld vessels, lymphatics and nerve supply. Cmprehensive knwledge f the histlgy f the pelvic rgans and breast. Knwledge f cell structure. 2.2 Onclgy Cmprehensive knwledge f carcingenesis, invasin and metastasis. Detailed knwledge f cellular and mlecular bilgy. 2.3 Genetics Detailed knwledge f cancer genetics included inherited risk factrs. 2.4 Pathlgy Detailed knwledge f the cytlgy and histlgy f gynaeclgical and breast cancers and pre-cancer states. 2.5 Statistics and epidemilgy Detailed knwledge f statistical analysis and the cllectin f data in gynaeclgical nclgy. Detailed knwledge f setting up and interpreting clinical trials. Detailed knwledge f envirnmental factrs in relatin t gynaeclgical nclgy. 2.6 Micrbilgy Cmprehensive knwledge f the rle f infective agents in carcingenesis. 2.7 Bichemistry Detailed knwledge f nutritin in relatin t gynaeclgical nclgy.

6 2.8 Biphysics Knwledge f the physical principles and bilgical effects underlying imaging and therapeutic techniques invlving heat, light, sund and electrmagnetism. 2.9 Immunlgy Knwledge f immune mechanisms invlved in hst defense in cancer Pharmaclgy Cmprehensive knwledge f the prperties, pharmacdynamics, actins, interactins and hazards f pharmaclgical agents which are used in gynaeclgical nclgy. 3. Clinical sciences 3.1 Gynaeclgical Onclgy Cmprehensive knwledge f epidemilgy, aetilgy, preventin, screening, diagnstic techniques, prgnstic factrs and staging f gynaeclgical tumurs and their management including primary and secndary preventin. 3.2 Breast cancer Passive knwledge f epidemilgy, aetilgy, preventin and management f breast cancer. 3.3 Imaging Detailed knwledge f all imaging techniques including cmputer assisted tmgraphy, ultrasund, magnetic resnance imaging (MRI) used in gynaeclgical nclgy including indicatins and interpretatin. 3.4 Surgical management Cmprehensive knwledge and skill in all surgical prcedures used in gynaeclgical nclgy Detailed knwledge and skill in all recnstructive surgical prcedures, including the breast, used in gynaeclgical nclgy. Cmprehensive knwledge f the cmplicatins f surgery in gynaeclgical nclgy and f pst-perative care. Knwledge f the applicatins, techniques and cmplicatins f anaesthesia and intensive care and expertise in the practice f adult resuscitatin. Cmprehensive knwledge and experience in preperative assessment and preparatin fr surgery. (5) Minimal surgical prcedures t be perfrmed by the fellw per year: Surgery f endmetrial, varian and tubal cancer 30 cases Radical hysterectmy 15 cases Other pelvic malignancies 5 cases Vulvectmy and grin dissectin 5 cases

7 Nn surgical management Detailed knwledge and experience in the use in gynaeclgical nclgy f chemtherapy, hrmntherapy, raditherapy, immuntherapy and gene therapy. Detailed knwledge f the causes and management (including surgical) f chrnic pelvic pain. 3.5 Psychlgy Cmprehensive knwledge and experience f the psychlgical management f patients treated fr a gynaeclgical r breast cancer. -Detailed knwledge f the principles and management f sexual dysfunctin f patients treated fr a gynaeclgical r breast cancer. 3.6 Palliative and Terminal care Cmprehensive knwledge and experience in palliative care and the management f terminal care f patients treated fr a gynaeclgical r breast cancer.

SUBSPECIALIST TRAINING PROGRAMME

EUROPEAN BOARD AND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS (EBCOG) AND EUROPEAN SOCIETY OF GYNAECOLOGICAL ONCOLOGY (ESGO) SUBSPECIALIST TRAINING PROGRAMME IN GYNAECOLOGICAL ONCOLOGY This Programme