Internship: Oncology

1. Admission – after the student has seen the case, discuss the case and plan with the student, meet the owners, revise the history and physical examination if needed, and discuss the plan and written cost estimate with the owners. You will also review your cases and plans with the senior faculty member on service prior to speaking with the owners.
2. Diagnostic evaluation and therapeutic management – perform all hands on procedures with which you are comfortable. Specific training and supervision are required for use of rigid and flexible endoscopic equipment. Perform daily complete physical examinations on all patients – do not rely on student information alone.
3. Owner communication – contact owners daily during hospitalization to relay the patient’s condition, test results, plan, and current bill/update of estimate (once to twice weekly for radiation patients). Students perform this duty whenever possible, but you are responsible for the accuracy of the discussions. All client communications must be recorded in the medical record. Review student records daily and provide constructive comments.
4.  Availability – all clinicians are expected to be available by pager or phone any time they have a case in the hospital (24 hours/day, 7 days/week). If you must be absent, another intern or resident must be responsible for your hospitalized cases. If you anticipate more than a few hours absence, notify the student and faculty member, and note the new clinician in the medical record (and ICU sheet if applicable). If more than a day is involved, the client must also be informed.
5. Unfinished business – keep an on ongoing record of loose ends, such as necropsy reports and mailed-out laboratory tests. Do not rely on the appearance of lab reports to remind you of these responsibilities.
   As described below in “Records”, it is essential that records be complete and helpful to other clinicians unfamiliar with the case. It is common for a client to call or appear unexpectedly when the original clinician is unavailable.
6. Professional Development Time – Time will be scheduled for release from clinical responsibilities (see Approximate Rotation Schedule). We expect you to maintain the continuity of the management of your patients by being reachable if there are questions regarding case management. Be sure the record is complete, and effectively communicate the transfer of patient care to the other clinician, the owner, and the referring veterinarian. We expect you to continue attendance at Cancer Class, Cytology Rounds,
7. Journal Club and House Officer seminars.

1. Call the referring veterinarian and record the content of your conversation in the medical record when:
   The diagnostic evaluation and/or initial treatment plan is completed. Usually this occurs near the time of discharge. Ensuring the discharge instructions convey the necessary information for follow-up care and faxing them to the rDVM is usually adequate. In more complex cases, particularly when the client will be discussing treatment options with the referring veterinarian, a phone call may be needed as well. This is extremely important, and insures appropriate care should a problem develop at home and to ensure the client is receiving accurate information. For animals hospitalized for more than 3 days, call the rDVM with a progress report.
   • A patient dies or is euthanized. This is to ensure that the rDVM knows about the adverse outcome.
   • Results of laboratory tests pending at the time of discharge are available, or if treatment plans are changed. This can be done through the CTs or included on the next discharge if the patient is currently undergoing a course of therapy (i.e. will be seen in a short time period).
   • He/she has called regarding patients referred previously. The CTs will place the medical record in the rounds room; return these calls as soon as possible.
2. Send a printed copy of the discharge summary to the rDVM when:
   • a hospitalized patient is discharged. These must be as complete as possible, including all prescribed drugs and dosages, and short and long-term plans for follow-up. Give these to the receptionist to fax.
   • if requested, a copy of the preliminary or final necropsy report.
3. In general, faculty will be responsible for returning consultation calls/fax consultations. House officers are responsible for returning the majority of client/rDVM calls on ongoing patients.

Interns – Be available to the intern rotating on the oncology service to provide consultation, assistance with special procedures and advice regarding patient care.

Students – Allow the student to present to you their findings, differential diagnoses, and diagnostic and treatment plans for each of their cases. Do not allow the students to act on their suggestions without your permission.
You are responsible for supervising all special procedures and providing suggestions and guidance to students. Encourage students to perform those procedures that are consistent with their abilities and that do not compromise the patient.
Students do not need to be involved in the management of every case. In general, if the students are overwhelmed with patient management responsibilities, you may see cases without students.
We expect the oncology intern to promptly attend morning rounds when on the New Patient service, provided attendance is not required at other rounds during this time.  We also expect you to actively contribute to student rounds.

• Check ICU orders and clinician order forms (in-patient wards) at least twice daily to assure accuracy, to sign and to note new observations or problems. Review the observations made by the ward and ICU technicians each morning. Review ICU orders and COFs with the students (when applicable) before 8:00 a.m. rounds begin.
• Review medical records daily. Edit SOAP entries thoughtfully to assist the student in problem-oriented thinking. Scrutinize records for accuracy and completeness of documentation. As a general rule, SOAPs should not be long narratives. Succinct explanations and short lists of major differentials and plans are expected. Each problem must be addressed individually (not the whole animal) and differential diagnoses must be prioritized. With radiation patients, the students should SOAP the patients’ individual problems once the first week. The second week, the SOAP can address the entire animal. Daily upgrades should be recorded as part of the SOAP.
• Complete medical records as soon as possible after patient discharge. Under no circumstances should records remain incomplete for longer than 3 weeks. Case summaries must be accurate. In ALL cases, provide written follow-up plans with contingency plans to insure continuity of patient care in the event that you are unavailable when follow-up of any kind is needed.
• Again, record all client and rDVM conversations (in person or by phone). Communication logs should include the date and time of any conversation and the person with whom you spoke.

We expect you to be a “gunner” – eager to receive new cases. Your best learning experiences and stimuli for reading and research all come from your own case material. It is impossible to accurately predict case outcome ahead of time, and it is very much to your advantage to be involved with the management of as many cases as possible.

The hospital oncology service consists of 1-2 faculty members, and 3-5 house officers. By 7:30 am every weekday morning, the resident and interns pick up cases admitted the previous evening or weekend and check their inpatients.

The clinic service is divided into two groups: a New Patient service and a Chemotherapy / Recheck service. The new patient service meets for morning rounds from 8:30 – 9:30 am. Between 4-5 new appointments are scheduled each day, Monday through Thursday. Emergency appointments are added on as necessary. The Chemotherapy / Recheck service begins receiving patients at 7:30 am and sees between 8-15 appointments each day Monday through Thursday. The oncology intern spends approximately equal time on each of these services (e.g., Monday and Wednesday on the New Patient service, Tuesday and Thursday on the Chemotherapy / Recheck service). Afternoon rounds are held from 2:30 – 3:30pm each afternoon and attendance by all members of both services is required. Fridays are teaching days for the oncology service. A boarded oncologist works independently seeing Chemotherapy / Recheck appointments on Fridays.

Emergency appointments and in-house consultations are handled as needed every day of the week.

You are required to attend the following weekly rounds and seminars:

• Surgery/Oncology Rounds
• Oncology Journal Club
• House Officer Rounds
• House Officer Seminar
• Critical Care/Cardiology/Neurology Rounds
• Other Hospital- and Service-related Rounds or Seminars, as assigned