Program Requirements

Surgical Oncology Training Program

The Society of Surgical Oncology is pleased to report that the Accreditation Council for Graduate Medical Education (ACGME) Board of Directors has approved the program requirements for Complex General Surgical Oncology. All fellowship programs based in the United States listed on the Program List are accredited by the ACGME. These programs are required to comply with the ACGME Program Requirements for Graduate Medical Education in Complex General Surgical Oncology.

The Society of Surgical Oncology has approved all three Canadian programs, which are also accredited by the Royal College of Physicians and Surgeons of Canada. Strict requirements outlined below must be met to be an SSO-approved training program. 


Knowledge, Skills, and Clinical Experiences | Cancer Research | Cancer Education | Leadership in Oncology | General Requirements | Clinical Training in Surgical Oncology | Additional Essential Training in Oncology | Research Training

Established by The Training Committee of the Society of Surgical Oncology - 2001

Training In Surgical Oncology

A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research.

A training program in surgical oncology should prepare its graduates to interact with other oncologic disciplines and to provide a leadership role in the surgical, medical, and lay communities in matters pertaining to cancer.

Program Description

1.0 OBJECTIVES

The fellowship should provide fellows with the following:

1.1 Knowledge, Skills, and Clinical Experiences

1.1.1 Clinical and technical skills for providing comprehensive care to cancer patients. An essential component of the fellowship is training in new techniques, to produce surgeons capable of providing state-of-the-art surgical care to cancer patients.

1.1.2
Skills in performing special and unusual operations for patients with complex or recurrent neoplasms.

1.1.3
Expertise in diagnosis and management of rare or unusual tumors, based on knowledge of the natural history of such cancers.

1.1.4
Knowledge and experience to determine disease stage and treatment options for individual cancer patients, at the time of diagnosis and throughout the disease course.

1.1.5
Broad knowledge of other cancer treatment modalities (including radiotherapy, chemotherapy, immunotherapy, and endocrine therapy). This requires an understanding of the fundamental biology of cancer, clinical pharmacology, tumor immunology, and endocrinology as well as an understanding of potential complications of multimodality therapy.

1.1.6
Expertise in the selection of patients for surgical therapy in combination with other forms of cancer treatment, as well as knowledge of the benefits and risks associated with a multidisciplinary approach.

1.1.7
Expertise in palliative techniques including proper selection of patients, proper performance of appropriate palliative surgical procedures, and knowledge of nonsurgical palliative treatments.

1.1.8
Knowledge of tumor biology, carcinogenesis, epidemiology, tumor markers, and tumor pathology.

1.2 Cancer Research

1.2.1 Knowledge to design and implement a prospective data base and to conduct clinical cancer research, especially prospective clinical trials.

1.2.2
Sufficient familiarity with statistical methods to properly evaluate results of published research studies.

1.2.3
Knowledge to guide a trainee or other personnel in laboratory or clinical oncology research.

1.2.4
Knowledge of the interface of basic science with clinical cancer care, to facilitate translational research.

1.3 Cancer Education

1.3.1 Educational knowledge and skills to train students and physicians in the multimodality management of cancer patients.

1.3.2
Knowledge and skills to train non-physicians (physician assistants, oncology nurses, enterostomal therapists, etc.) in specialized cancer care.

1.3.3
Skills to organize and conduct cancer-related public education programs.

1.4 Leadership in Oncology

Skills to develop and support:
• institutional programs relating to cancer, including a tumor registry;
• institutional policies regarding cancer programs and problems;
• interdisciplinary meetings and discussions on cancer topics, patient care, and oncology research program
• psychosocial and rehabilitative programs for cancer patients and their families.

2.0 PROGRAM REQUIREMENTS

2.1 General Requirements

The Surgical Oncology Fellowship consists of a minimum of two years of continuous education and training following completion of a general surgery residency. At least 12 months of this period must be devoted to training in clinical surgical oncology. The two years must include formal rotations on surgical and non-surgical oncology services. A portion of the program should be devoted to clinical or laboratory research, and fellows must have access to faculty who can mentor them in basic science research and have time for such an experience if desired.

2.1.1 There should be adequate opportunity to interact with surgeons in companion surgical specialties, primarily thoracic, gynecologic, and urologic surgery, and to gain surgical experience in these areas. Interaction with orthopedic, neurosurgical, and pediatric surgical specialists is also desirable. These experiences may be obtained by formal rotations on subspecialty services, participation in structured multidisciplinary conferences, attendance at subspecialty tumor clinics, or inclusion of subspecialty patients on a single surgical oncology service.

2.1.2
Initial outpatient assessment, preoperative decision making, perioperative management, and patient follow-up are essential to the training experience. To the greatest extent possible, fellows should participate in the preoperative evaluation, assessment, treatment planning, and postoperative ambulatory care of patients in whose surgery they participate. As a guide, fellows should see preoperative and postoperative ambulatory patients at least one full day out of five, or its equivalent.

2.1.3
Clinical experience alone is insufficient education in surgical oncology. The training program must develop a regularly scheduled didactic program consisting of conferences, lectures, debate series, and/or journal club, covering not only clinical surgical problems but also nonsurgical, basic science, clinical research, and ethical problems. Fellows must participate and program directors must be able to provide proof of fellow attendance at didactic conferences.

2.1.4
The surgical oncology fellowship program must not conflict with the regular surgical residency programs at any participating institution. Surgical oncology fellows' clinical responsibilities must be in accordance with the guidelines of governing residency review bodies. In institutions with Accreditation Council for Graduate Medical Education-approved surgical training programs, a fellow cannot be responsible for the same patients or for the same service as the chief resident. In other systems, the fellows' experience should not be diluted by, nor should it diminish, the experience of residents in their final year of training. Rather, a surgical oncology fellowship program should complement an institution's surgical residency program by developing a focus of excellence in cancer management that can be observed and experienced by all residents and attending staff.

2.1.5
The fellowship sponsoring institution must be accredited by the responsible national organization overseeing healthcare quality issues (Joint Commission on Accreditation of Healthcare Organizations or equivalent). The general surgery residency training program of the sponsoring institution (if applicable) must be fully accredited by the appropriate national governing body charged with oversight of surgical training programs.

2.1.6
The institution must provide an appropriate educational environment and ensure appropriate trainee supervision. Patient support services, work hours, and on-call schedules should be reasonable and allow fellows to participate in scholarly activities such as in-house didactic conferences; and local, regional, and national meetings. Access to a major library and on-site electronic literature retrieval capabilities are required.

2.1.7
The program director must be board certified (or equivalent) in general surgery and a member of the SSO. The faculty must demonstrate evidence of scholarly activity in surgical oncology, as evidenced by participation in basic science research; clinical research protocols; presentations at local, regional, or national meetings, and/or publications in peer-reviewed journals.

2.1.8
Each fellow's progress during the program must be formally evaluated in writing and feedback provided to the fellow at least semi-annually by the surgical oncology program director and faculty. The fellow should be advised of any deficiencies in time to correct problems prior to completion of the fellowship.

2.1.9
Fellows must be given the opportunity to evaluate the program overall, as well as all rotations, conferences, and faculty. These evaluations should be obtained in as confidential a manner as possible. The program director should regularly assess the post-training clinical and research activities of past surgical oncology fellows to determine whether the goals of the training programs are being achieved, namely, the production of effective academic and community-based surgical oncologists.

2.2 Clinical Training in Surgical Oncology

2.2.1 A minimum of 12 months of clinical training in surgical management of cancer cases is required.

2.2.2
Each surgical oncology fellow must perform a minimum of 240 cancer-related operative procedures (as surgeon or first assistant). Minimum numbers for specific anatomic or disease-site categories are listed below.

Oncologic area
Minimum case number
Multidisciplinary cases 
Breast 40 25 
Endocrine
15 15 
Gastrointestinal not HPB
50 25 
Hepatobiliary/pancreatic
35  25
Melanoma/soft tissue sarcoma
30 30
Total
170  120

70 additional cases in one or more of these oncologic areas
 
Total cases
240  120


 
Multidisciplinary management experiences
120 with subcategorization as shown above
Can have overlap of surgical cases and cases documenting multidisciplinary management

Presented at multidisciplinary conference 

The following conditions apply to these minimum case numbers:

2.2.2.1 Experience in all categories is highly desirable. Adequate operative experience (as defined by the above table) with breast cancer, colon and rectal cancer, melanoma, cancers of the upper gastrointestinal tract (stomach, liver, pancreas) and in sentinel lymph node biopsy and regional node dissection is required.

2.2.2.2
Surgical experience with endocrine, head and neck, soft tissue or bone, and thoracic cancers is highly desirable. For these disease sites, operative volume for a fellow is considered adequate if minimum numbers are met in three of the four categories.

2.2.2.3
In addition to open breast procedures, experience with stereotactic and ultrasound-guided breast biopsy is desirable.

2.2.3 Each fellow must gain experience in surgical management of patients undergoing predominantly medical therapy (no minimum number of cases required) including:

• staging for lymphoproliferative malignancies;
• management of distant metastatic disease, including resection;
• insertion of indwelling access devices for systemic or regional chemotherapy;
• endoscopic procedures of the aerodigestive tract and minimally invasive surgery, particularly as it applies to the staging of cancer.

2.2.4 Each training program must utilize the SSO Web-based operative log to document and record trainee operative experiences. Each fellow's operative log should be reviewed regularly. The program director must have a system to address and correct operative experience deficiencies promptly.

2.3 Additional Essential Training in Oncology

The fellowship must provide exposure to and experience in the multidisciplinary management of cancer. Rotations on nonsurgical services alone will not substitute for an understanding of the integration of multiple oncology-related specialties in the treatment of cancer patients. The fellowship must provide opportunities to participate in multidisciplinary clinics, tumor boards, or conferences. Required non-surgical experiences are specified below. Each program should have written objectives for these non-surgical experiences.

2.3.1 Radiation Oncology-A minimum of one month dedicated to learning the principles and practice of radiation oncology, as related to surgical patients.

2.3.2
Surgical Pathology-A minimum one-month rotation in the surgical pathology department or a documented equivalent exposure.

2.3.3
Medical Oncology-A minimum of one month dedicated to medical oncology. Fellows should gain experience in evaluating and managing patients receiving chemotherapy, hormonal therapy, and immunotherapy. The training should provide an understanding of the biologic, pharmacologic, and physiologic rationale for each form of therapy, as well as the indications, risks, and benefits of regional and systemic therapy in the adjuvant and advanced disease settings. At least 80% of the time spent in medical oncology should be outpatient-rather than inpatient-focused.

2.3.4
Supportive and Rehabilitative Care-Fellows must gain experience in providing supportive care to cancer patients, including pain management and parenteral and enteral alimentation, as well as rendering emergency surgical care. Fellows should also have an understanding of rehabilitative services in various settings, including reconstructive surgery and rehabilitation after extremity sarcoma surgery, mastectomy, and major head and neck surgery.

2.4 Research Training

2.4.1 Clinical research must be included in the training program. Fellows should have opportunities to design and implement clinical protocols, and each fellow should initiate or participate in an investigative project and should be sufficiently familiar with statistical methods to properly evaluate research results.

2.4.2
Each fellow must complete a course on clinical research on human subjects, such as the courses approved by the National Institutes of Health Office for Human Research Protections, or an institution-based equivalent. Ethics of research on human subjects must be included in the curriculum.

2.4.3
Each fellow should have the opportunity to participate in laboratory research. Fellows who desire this experience must have access to basic science research faculty mentors (on or off-site) and time for such research.

2.4.4
Clinical Investigation-Training in basic methodology for conducting clinical trials, including biostatistics, clinical research design, ethics, and implementation of computerized data bases must be provided.