A three-year medical oncology programme provides comprehensive teaching and experience in the field of Solid Tumor Oncology and Haematological Malignancies. All essential aspects are included in the training such as: staging, diagnosis, management options and supportive care. A comprehensive teaching ground is available for Fellowship Programme in Medical Oncology. Fellows are responsible in giving quality care to the patients admitted to the hospital, seen in clinics and while receiving chemotherapy, directly under the faculty supervision. They are encouraged to treat patients independently, especially in their senior years. They have separate rotations in haematology, paediatric oncology, radiation oncology, surgical oncology histopathology, radiology and infectious diseases. Specific schedule for each fellow is given at the beginning of each year. They are required to participate in the tumor boards, journal club, medical grand rounds and other educational meetings.
Our objective is to produce Medical Oncologist who knows all aspects of care of the patients with cancer including: diagnosis, staging, treatment, palliative and psychological care. They should have the expertise in medical treatment of patients with solid tumors and haematologic malignancies that includes chemotherapy, hormonal therapy, biological therapy, analgesic and supportive and end of life care. They should be able to comprehend and evaluate the merits and demerits of new therapies available, and to determine how these therapies can be incorporated into the care of cancer patients. They should have sound knowledge of the social, legal, and financial issues involved in the care of cancer patients, both during the active treatment phase and then at the terminal phase of care of these patients. They should be able to understand the principles of prevention and early detection of cancer including screening. A Medical Oncologist should also understand the principles and indications of autologous and allogeneic bone marrow transplantation.
Duration of Training:
The Medical Oncology Fellowship in the Department of Medicine at the Aga Khan University Hospital encompasses a minimum of 3 years’ time which includes separate rotations in radiation oncology, paediatric oncology, laboratory haematology, radiology and infectious diseases. Electives are also provided for research, breast surgery, histopathology, daycare oncology and bone marrow transplant. Specific schedule for each fellow is given at the beginning of each year.
• MBBS or equivalent degree approved by the PMDC
• FCPS-Part II in Internal Medicine, or MRCP-Part II, or Diplomate ABIM is required for entry.
Scope and Content:
a. Skills and Clinical Training:
Medical Oncology fellows should know how to infuse chemotherapy and be able to perform bone marrow aspiration and biopsy and paracentesis. They should have the knowledge in identifying and treating the toxicities associated with cancer treatment. They should understand the multidisciplinary approach required to optimise the cancer care. They should be able to interpret the radiological imaging and to coordinate that into cancer care. They are supposed to present in journal clubs held weekly, attend all multi-disciplinary tumor board meetings, and they are encouraged to start their fellows’ clinic in the last six months under the supervision of faculty to fine tune their skills attained over the previous years.
Fellows will have the opportunities to participate in laboratory or clinical research in all years of their training with supervision of faculty members. Some protected time will be provided to permit meaningful research experience. Proper experimental design, methodology and data analysis will be encouraged. Results of their research activities will be encouraged to be reported in various meetings.
Trainees are evaluated for clinical competence. Supervising faculty specifically evaluates clinical judgment, medical knowledge, clinical skills (history/ exam/ procedures), humanistic qualities, professional attitudes and behavior, medical care and overall competence as a subspecialist consultant. Faculty also regularly reviews medical records to assess the record keeping and written communication abilities of trainees. The supervising faculty provides verbal feedback to trainees regarding their performance prior to the end of each rotation. Records of evaluations are maintained in file for credentialing and are accessible to trainees for review on request.
Faculty evaluations by fellows are conducted periodically. Formal sessions are held between fellows and the faculty on regular basis to review their progress.
Terminal Objectives / Competencies achieved annually
At the end of the first year, the fellows should have the following competencies:
Know the workup, staging , identify the primary site, correct use of tumor markers and radiological investigations.
Know the risks and benefits of different therapies of cancer care.
Know that cancer care has a multidisciplinary approach and coordination is required.
Know the importance of doctor-patient relationship, education and counseling of the patient, identification of psychological issues and financial status.
Knows the management of oncological emergencies and end of life/palliative care.
Knows the correct method, dose and toxicities of chemotherapy, immunotherapy and hormonal therapy.
The second year offers further understanding the principles of medical oncology care as outlined in the objectives in the first year.
Trainee takes charge of weekly journal club activity in the second year.
They are rotated in radiology and radiation oncology, haematology and spend more time in research activities which also includes compulsory four weeks course of Epidemiology and Biostatistics offered by AKUH.
Fellow takes charge of weekly grand tumor board activity and is responsible for presenting literature search and updates on cases presented in the meeting.
Throughout their training period they are responsible for teaching/supervising undergraduates and residents and nursing staff rotating in medical oncology.
Fellows rotate in paediatric oncology, surgical oncology histopathology, infectious diseases, daycare oncology and bone marrow transplant unit.
They also complete their research projects and submit for publication.
They are encouraged to conduct fellows’ clinics especially during last six months of their fellowship to gain confidence and fine tune their skills attained over the previous years under the supervision of faculty.
Terminal Objectives / Competencies achieved at the end of the program
At the termination of the program, the individuals will be able to sit in the FCPS Part II Medical Oncology Examination offered by the College Of Physicians And Surgeons.
They should be confident to adequately stage, diagnose, treat and follow patients in Medical Oncology. They should know that cancer care is multidisciplinary; thereby they should be able to adequately coordinate and facilitate care with other modalities like Radiation and Surgical Oncology. They should know the principles of cancer screening and should continue to apply that in their practice. They should have the knowledge and the experience to conduct research activities. Essentially, the structure of the programme speaks for making of such highly competent consultants who should be able to join any institute as Consultant Medical Oncologist as soon as they pass out of the fellowship program.
Currently one candidate is selected annually. However we are anticipating increase in the number of seats to two per year.
There are five full-time and two part-time faculty members involved in teaching. Besides teaching, they also have administrative responsibilities. The Programme Director is Dr Nehal Masood, MD, Associate Professor, Department of Medicine.
Dr. Nehal Masood, MD
Section Head, Haematology/Oncology,
Director, Oncology Fellowship Programme
Dr. Adnan Abdul Jabbar
Haematology and Oncology
Dr. Munira Shabbir Moosajee
Haematology and Oncology
Dr. Yasmin Abdul Rashid
Dr. Tayyaba Z. Ansari
Dr. Azmina Vali Mohammad
Lecturer, Haematology and Oncology
Dr. Ghulam Haider
Lecturer, Medical Oncology
LEVEL OF COMPETENCE TO BE ACHIEVED EACH YEAR
Oncology & Haematology Fellow's Competency List
The level of competence to be achieved each year at our training programme is specified according to the key, as follows:
Level I = Can Perform procedure independently
Level II = Performs procedure under direct supervision of consultant
Level III = Assists and observes
PRIVILEGE FELLOWS MO SMO
Year 1 Year 2 Year 3 Approved without restrictions Approved without restrictions Approved without restrictions Approved without restrictions
Bone marrow Aspiration Level III Level II Level I
Bone marrow biopsy Level III Level II Level I
Chemotherapy limited to subspecialty areas Level III Level II Level I
Bone marrow biopsy Level III Level II Level I
Intrathecal chemotherapy Level III Level II Level I
Parcentessis Diagnostic + Therapeutic Level III Level II Level I
Diagnostic lumbar puncture + IT chemotherapy Level III Level II Level I
Thoracentesis, Diagnostic + therapeutic Level III Level II Level I
CURRENT DISTRIBUTION OF FELLOWS’ ROTATIONS IN THREE YEARS
Jan Feb Mar April May June July Aug Sep Oct Nov Dec
F1 Floor Floor Floor
Floor Floor Floor Floor
R Floor Clinic
1 day clinic
F3 Research Rotation
Rotation Research + Clinic Rotation Floor Rotation Research + 1 day Clinic E*
F1 Fellow I F2 Fellow II F3 Fellow III E* Elective R Rotation
Dr. Yasmin Abdul Rashid
Senior Instructor, Medical Oncology,
Fellowship Programme Coordinator
Dr Nehal Masood, MD
Department of Medicine,
Section Head, Haematology/Oncology
Director, Oncology Fellowship Program,
Aga Khan University Hospital, Karachi, Pakistan.
Tel: 92-21-3486-4603 / 4572
Fax: 92-21-493-4294 & 493-2095