CONTENTS

Departments Page

Surgical Oncology 1

Medical Oncology 2 – 6

Radiation Oncology 7 - 8

Oncologic Imaging 9 - 12

Palliative Medicine 13 - 14

FELLOWSHIPS FOR SURGICAL ONCOLOGY

Introduction: T he Department of Surgical Oncology

The Department of Surgical Oncology was formed in 1999 as one of the key clinical pillars of the National Cancer Centre of Singapore (NCCS).

Staff members include 8 full time NCCS surgical oncologists as well as more than 25 visiting sub-specialty consultants from the various public and private institutions. The surgical subspecialties available in the department include active programmes in breast cancer surgery, colorectal surgery, gynae-oncology surgery, head and neck surgery, hepatobiliary and pancreatic surgery, neuro-oncologic surgery, thoracic surgery, upper gastrointestinal surgery and uro-oncologic surgery.

The NCCS operates on a model of integrated multidisciplinary care and the Department of Surgical Oncology plays an active role towards achieving this practice. Weekly programme-specific tumour boards, journal clubs, radiology meetings and other CME activities ensure that academia and teaching are part of the service provision by the department.

Although primarily an outpatient facility, the NCCS is part of the Outram Campus complex of medical institutions that also houses the 1,600-bed Singapore General Hospital Complex. In conjunction with the Department of General Surgery, Singapore General Hospital (SGH), the Department of Surgical Oncology operates the in-patient facility within this complex for surgical oncology patients requiring operating theatre facilities and in-patient care.

Fellowship positions are available within the Department of Surgical Oncology in any of the sub-specialties listed above. The NCCS provides two funded fellowships every year in Surgical Oncology for 6 months each. Self-funded fellowships are also acceptable. As the fellowship programme is very heavily consultant-based, the fellowship programmes available at any point of time depends on the positions vacant and the training opportunities accessible then. The opportunity for hands-on training depends on skill level and training opportunities within each sub-specialty.

Minimum Entry Requirement

FRCS or equivalent Surgery qualifications.

Number of Places (each 6 months in duration) Available per Year

Four

Hands on Training

Yes

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FELLOWSHIP FOR MEDICAL ONCOLOGY

Introduction: T he Department of Medical Oncology

Since its inception in the early 1990s, the Department of Medical Oncology at the NCCS has been a dynamic group, with strength in clinical practice, peer-reviewed research, undergraduate and postgraduate teaching, and hospital, university and community service. Our department is the largest medical oncology unit in Singapore and sees more than 2000 new cases of cancer each year. Apart from the high volume of outpatient visits, we have also witnessed a significant increase in the number of bone marrow transplantations (both autologous and reduced intensity alllogenic transplantations) performed at our centre over the years. At the same time, the department is also actively involved in a substantial number of international as well as investigator-initiated trials with accompanying translational research protocols, thus bringing innovative treatment strategies and therapeutic reagents to our patients.

With more than 20 fully accredited medical oncologists and seven advanced medical oncology trainees, the department is able to develop each oncology specialty fully. Our laboratories and clinical teams involved in the management of lung cancer and nasopharyngeal cancers are constantly investigating new anticancer drug development and novel immunotherapeutic approaches, and have secured regional and international recognition as one of the top groups in these areas. Dr. Toh Han Chong continues his major role in the development of immunotherapeutic strategies, with an excellent track record of funding and a focus on innovative adjuvant therapies for malignancies such as nasopharyngeal cancers, hepatobiliary cancers and colorectal cancers. Dr. Donald Poon, who has recently returned from training in the United States, has secured grant support for setting up the first geriatric oncology service in the region. The lymphoma team has set-up the largest lymphoma database in Singapore, which has and continues to contribute to both clinical and epidemiological research efforts. The team is also committed in developing new approaches to fatal lymphomas such as peripheral T cell lymphoma and NK cell lymphomas through collaboration with basic scientists and molecular pathologists. Our breast oncologists have collaborated with the Department of Pathology and Medical Sciences in developing predictive models for high-risk breast and ovarian cancer families and new paradigms for breast cancer biology. We are also proud that our colleague, Dr Simon Ong, has successfully gained funding for developing innovative phase I studies in colorectal cancer.

Several members of the department have been involved in leadership roles in the community. Dr Koo Wen Hsin, apart from being the Head of the department, is also the Chairman of the Singapore Cancer Society, while Dr. Darren Lim, a lung oncologist by training, is also the director of a community hospital facility committed to providing intermediary oncology care and support to patients. Consultants from our department have also been elected as the presidents of the Singapore Society of Oncology for the last five years. Finally, members of the Division have participated in undergraduate and post-graduate teaching activities, as well as lecturing in several international forums in Europe and Asia.

The collaboration between our department and the division of surgical oncology, radiation oncology and basic scientists in our centre has strengthened the fellowship program substantially, leading to the training of clinical practice and academic oncologists and the winning of several awards by our trainees.

The Medical Oncology Fellowship Program at the NCCS

A) Overview

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The NCCS offers a three-year Oncology Fellowship program. Acceptance to the program is competitive and only fellows who have fulfilled the criteria stipulated by the Joint Committee on Specialist Training. Fellowship training activities included involvement in the design and conduct of clinical trials, basic science research, protocol writing, writing of manuscripts, bedside teaching at the SGH, outpatient exposure at the NCCS, and a series of multidisciplinary tumour boards and conferences designed to illustrate principles of the biology of cancer and its management. A weekly meeting reviewed difficult and challenging cases encountered by members of the faculty during the course of the week. A series of didactic lectures, journal clubs, and informal tutorial and case presentation provided instruction regarding the basic principles and biology of cancer.

B) Specific Aims of Training

Registrar training in Medical Oncology in the NCCS will aim to achieve the following objectives: 1. Basic Scientific Principles; including cancer biology and genetics, cancer etiology,

tumour immunology, and epidemiology

2. Basic Principles in pathology, surgical oncology and radiation oncology and pharmacology (chemotherapy, biologic therapy, and hormonal therapy).

3. Clinical Research; including design of clinical trials

4. Management of individual cancer types

5. Management of oncological emergencies

6. Principles of bone marrow transplantation

7. Complications; including infections and other complications of treatment

8. Supportive Care; including pain management, hematopoietic growth factors, transfusion therapy, nutritional support, sexual problems, end-of-life care, complementary and alternative medicine, and unproven methods of treatment

9. Survivorship; including follow-up care at end of treatment, prevention of second malignancies, employment and insurance, information and education, and advocacy

10. Psychosocial Aspects of Cancer; including psychological stages of cancer, cultural issues, spirituality, adaptive and maladaptive behavior, coping, and the use of psychotropic drugs

11. Bioethics, Legal, and Economic Issues; including informed consent, research ethics, conflict of interest

In order to achieve these objectives, the following programs and activities are incorporated into the 3-year of registrar training:

Inpatient and outpatient management of patients Education activities Exposure and involvement in basic science research Involvement in clinical trials Involvement in clinical research

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Writing of original articles Exposure and involvement in the cancer support groups and activities

C) Components of the Fellowship Program

I) Inpatient and Outpatient Management of Patients

Registrars will be supervised closely in both the inpatient and outpatient management of patients:

Inpatient Management Registrars will be rotated through the major inpatient teams on a three monthly

basis except for the months that they are involved in laboratory research. The attending consultant will review all cases seen by the registrars in the ward.

Registrars will also provide inpatient consultation services under the supervision of the attending consultant on a rotational basis, except for the months that the trainee in laboratory research.

Outpatient Services Registrars will be expected to perform outpatient clinic duties and will be

rotated through the major specific-specific clinics on a three monthly basis. In the months that the registrar is involved in laboratory research, they will only be involved in the running of one clinic session.

First year registrars will be expected to run three sessions (half-day) each week under supervision.

Second and third year registrars will be expected to run two to three sessions (half-day) each week under supervision.

Registrars’ Continuation Clinics Second and third year registrars running their personal continuation clinics

need to have all cases presented to their clinical mentor by the end of the working week.

II) Education Activities

Weekly Didactic Lectures (11/2 hrs) The aim of the didactic lectures will be to cover the curriculum as detailed in

appendix A. There will be a weekly didactic lecture each lasting about one to one and a half hours. The list of lectures, topics covered and attendance will be recorded.

Weekly Discussion on Landmark papers (11/2 hr) The aim of these sessions is to ensure that trainees are familiar with the major

landmark papers on which treatment recommendations for the management of the various tumours are made. These sessions are informal and will typically involve a discussion on 4 to 6 landmark papers. These sessions will also aim to address some of the controversial issues surrounding certain current recommendations. A list of the papers discussed each week, the discussant involved and attendance will be recorded.

Weekly Tutorial (1 hr). A minimum of two clinical cases will be discussed in these sessions. These sessions will typically involve discussion on approaches to clinical problems, practical management issues and review of radiological scans as well as interpretation of laboratory results. The cases discussed each week, the discussant involved and attendance will be recorded.

Weekly Journal Club (1 hr)

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A trainee will be scheduled to critically review a paper each week. A detailed discussion on methodology, including statistical methods, will be required. A list of the papers will be recorded.

Weekly Tumour Board (2hrs) A trainee will be required to attend at least one tumour board discussion a

week. A trainee in a specific tumour type rotation should attend the tumour board of the particular tumour type.

Weekly Medical Oncology Grand Rounds (1hrs) These sessions aim to discuss complex and difficult management issues

encountered in the clinics or the wards each week. A trainee will be questioned on the management on these cases and will have to present his/her arguments before the faculty.

III) Training in Basic Science Research

As part of the basic training, registrars will be given the opportunity to spend six months of their training attached to a research laboratory in NCCS, Singapore Health Services (SingHealth) or with the university. In these six months, they will not have clinical responsibilities. They are, however, expected to attend educational activities as far as possible and would still be expected to run one clinical session each week (applicable to registrars personal continuation clinics).

For eligible fellows, the option of pursuing a full time PhD program will be offered at the end of their second training. Eligible trainees will spend 18 months at the Van Andel Institute at Michigan, USA. The remaining of the training will be conducted at the NCCS-Van Andel research laboratory at the NCCS.

IV) Training in Clinical Trials

Registrars will be given the opportunity to participate in the design and conduct of clinical trials.

Each registrar would be assigned to participate in the running and conduct of at least one clinical trial during the period of their training.

Each registrar is also entitled to attend an external course on the design and conduct of clinical trial.

V) Training in Clinical Research other than Clinical Trials

All registrars will be given protected time each week (one half-day session) to participate in clinical research.

These clinical research projects may include retrospective reviews or prospective clinical studies.

All registrars will be required to be involved in at least one clinical research project in their period of training.

All registrars will be required to publish a minimum of one original clinical research paper (as first author) during the period of their training.

VI) Training in Cancer Support Activities

All registrars will be required to be involved in the organization and conduct of at least one project relating to cancer survivorship and cancer support. These projects may include involvement in any of the existing programs in NCCS:

o Living your best support group programo Steer programo EnReach

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o The revival connectiono Can survive

D) Mentoring and Feedback

Mentors will also individually meet with trainees to discuss their progress on monthly. The aims of these meetings will be to discuss the trainee’s progress at the above specific aims. The dates of the meetings will have to be registered in appendix B.

There were also be a monthly meeting with the head of department or a senior staff to discuss miscellaneous topics, including difficulties encountered at work as well as to share each other’s progress in clinical research as well as other relevant projects. This session will be held at the last Wednesday of the month.

E) Leave and Conferences (Not applicable to short-term fellows)

Three days of study leave every 6 months One overseas conference every 6 months The Harvard Oncology or Washington Oncology review course

For more details, please contact program director: Dr. Lim Soon Thye, dmoahl@nccs.com.sg

FELLOWSHIPS FOR RADIATION ONCOLOGY

Introduction: T he Department of Radiation Oncology

The Department of Radiation Oncology or Radiotherapy Department is headed by Dr VK Sethi with a team of 7 Consultants. It manages about 2000 new cases of cancer patients requiring radiation treatment and is equipped with 7 linear accelerators, two conventional and a CT simulator. It is equipped with the state of the art technology in radiotherapy including Intensity Modulated Radiotherapy (IMRT), radiosurgery, brachytherapy and Gammaknife treatment. There is also on going research in nasopharyngeal cancers, both clinical and laboratory.

Teaching Activities

The Department offers primarily clinical training in radiotherapy. The Department is divided into sub-specialty teams including breast, head and neck, lung, gynaecological tumours etc and are involved in these various tumour boards to co-manage with surgeons and medical oncologists.

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It also conducts basic science tutorials including physics and radiobiology. There are weekly presentation of journal articles and Quality Assurance rounds.

Consultant Staff

Head : Dr VK SethiDeputy Head : Dr Chua Eu TiongConsultants : Dr Joseph Wee

Dr Fong Kum WengDr Khoo Tan Hoon SengDr Terrence TanDr Susan Loong

TRAINING ATTACHMENT IN RADIOTHERAPY

Objectives

To provide all round training in radiotherapy with special interest fields such as gynaecological tumours and brachytherapy, brain tumours and radiosurgery/ Gammaknife treatment, Intensity Modulated Radiation treatment of nasopharyngeal cancers and head and neck tumours.

Structure/Content

Individualised to suit Fellow’s needs. Programme will allow short periods of attachment in various subspecialties according to the needs of the Fellow.

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Minimum Entry Requirement

Local degree in radiotherapy with two years experience in radiotherapy

Number of Places (each 6 months in duration) Available per Year

Two

Hands on Training

Yes

FELLOWSHIPS FOR ONCOLOGIC IMAGING

Introduction: T he Department of Oncologic Imaging

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The Oncologic Imaging Fellowship Program of the NCCS is developed with the aim of providing structured subspecialty post-qualification training in the following subspecialties:

1. Breast imaging and biopsy2. Hepatobiliary MRI3. Prostate MRI4. Head and Neck MRI and radiology.5. Oncologic Imaging.

A research fellowship is also available.

Structure/Content

A) Clinical Fellowship

The clinical fellowship program has 2 components:

1. Clinical competency2. Research

The training is structured. A skills checklist is provided for each subspecialty. The fellow is expected to acquire competency in all areas at the end of the training period. Any deficiency will be identified and corrected by library cases.

Clinical competencyThe fellow is expected to perform subspecialty duties. The fellow will not be called upon to perform general duties. All work and reporting done by the fellow will be fully supervised.

ResearchThe fellow will be given research time (20%) to complete at least one research project with the respective supervisors.

Training Objectives:

1. Subspecialty training in Oncologic Radiology

General Oncologic Radiology The trainee is expected to be

Familiar with the appearance and staging of tumours encountered in the chest, abdomen and pelvis.

Able to identify and correctly handle equivocal findings and not over or under-stage the patient

Appreciate the role and limitations of radiology in the oncologic patient, and the implications of positive or negative radiological findings

Able to conduct body tumour boards

Body imaging, including body CT and body MRI The trainee is expected to be

Able to interpret competently scans of the chest, abdomen and pelvis Able to understand body MR protocols and to tailor them for specific needs Able to perform prostate spectroscopy Participate in research activities

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Head and neck radiology The trainee is expected to be

Familiar with the appearance and staging of tumours of the head and neck Ability to perform and interpret brain spectroscopy Able to conduct head and neck tumour boards

Breast imaging The trainee is expected to be

Competent in interpretation of mammograms Competent in assignment of BIRADS scores Competence in breast ultrasound Able to perform US guided FNA, trucut and mammotome biopsies Able to perform stereotactic mammotome biopsy, trucut and wire localisation

procedures Able to perform and interpret breast MR Able to conduct breast tumour boards

Equipment:

GE LX 1.5T Signa MR ScannerSiemens Somatom PLUS 4 Spiral CT scanner (CT fluoroscopy enabled)GE 64 detector Multislice CTLORAD multicare prone biopsy table with Trex DSM digital mammographySiemens Mammomat 3000 Lorad M IV Platinum with StereoLoc IISequoia 512 Ultrasound Systems (Acuson)Logiq 700MR Expert Ultrasound Philips Optimus general radiography unit with linear tomography facility.Kodak Digital Science Computed Radiography System 400 PlusSiemens Virtuso WorkstationKodak Cemax-Icon PACS

Workload:

Body ImagingCT 11000 (examinations per year)MR 1460 MR Abdomen/MRCP 244MR/MRS prostate 90

Breast ImagingMammography (4617 per year)US (3194 per year)US guided FNA (50 per year)US guided Trucut biopsy (295 per year)US guided Mammotome biopsy (93 per year)US guided wire localization Stereotactic Mammotome biopsy (242 per year)Stereotactic wire localization (123 per year including US guided localizations)Stereotactic Trucut biopsyMR breast

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Head and Neck ImagingMR Neck and Nasopharynx 454 per year

Staff Radiologists:

Dr James KhooHead & Senior Consultant Subspecialty: Neuroradiology, Head and Neck RadiologyMinor Interest: Body Imaging.

Dr Jill WongSenior ConsultantSubspecialty: Breast ImagingMinor Interest: Neuroradiology, Chest Radiology.

Dr Thng Choon HuaSenior Consultant Subspecialty: Body Imaging with special interest in Liver MRI and Prostate MRI.Minor Interest: Breast Imaging

Dr Quek Swee TianSenior ConsultantSubspecialty: Musculoskeletal Radiology and Pelvic ImagingMinor Interest: Head and Neck Radiology.

Dr Juliana HoConsultantSubspecialty: Breast Imaging & Chest RadiologyMinor Interest: Musculoskeletal Radiology

Dr Fan Yoke FunSenior ConsultantSubspecialty: Head and NeckMinor Interest: Breast

Dr Ching Boon ChyeAssociate ConsultantSubspecialty: BreastMinor Interest: Head and Neck

Minimum Entry Requirements

FRCR or equivalent radiology board examinations.The program is suitable for recently qualified radiologists or radiologists who intend to sub-specialise. The program is not suitable for the general radiologist or for radiology trainees who have yet to pass their respective basic radiology board or fellowship examinations.

Duration:6 months. Renewable to one year.

Number of places (each 6 months in duration) available per yearOne every 6 months.

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Hands-on TrainingYes.

B) Research Fellowship

The research fellowship funds the fellow to assist in existing grants and research projects in the department. The research fellow is encouraged to propose his/her own research ideas. The research fellow will not be performing clinical duties and will not be receiving training in clinical work.

The department has grants on the following topics: Prostate MRI/MRS Angiogenesis imaging of breast cancers Automated tumour volume measurements

The department also intends to analyse and publish data from the on-going BreastScreen Singapore population-based mammographic breast-screening project.

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FELLOWSHIPS FOR PALLIATIVE MEDICINE

Introduction: T he Department of Palliative Medicine

NCCS is the first institution to establish a Department of Palliative Medicine in Southeast Asia. The department spearheaded formation of the Asia Pacific Hospice Palliative Care Network (APHN) comprising individuals and organisations working in palliative care from 18 regional countries to promote the development of the specialty in the region. The APHN secretariat is located in the department.

Palliative Medicine physicians conduct regular specialist clinics – thrice weekly at the NCCS and once weekly at KK Women’s and Children's Hospital (KKWCH). The department also provides consultative palliative care services to in-patients at the Singapore General Hospital and KKWCH. These services give care to patients with advanced cancer by optimising pain and symptom management, rehabilitation, nutritional and psychosocial support. The department works closely with NCCS’ Medical Social Services to ensure that NCCS patients receive holistic and empathetic care.

TRAINING ATTACHMENT IN PALLIATIVE MEDICINE

Objectives

The objective of the clinical fellowship attachment is to allow the trainee to experience working in a multidisciplinary tam providing palliative care in the hospital and cancer centre setting. The trainee will also be exposed to palliative care provision in the community, at in-patient hospices and the patient’s own home.

There will be opportunity to observe and attend clinics run by multidisciplinary pain service.

Structure/Content

Clinical Work Clinical Fellows are expected to work under the supervision of palliative medicine and

other consultants in the following areas: Outpatient clinics in various subspecialties Inpatient care of patients with cancer and advanced stages of other diseases Visits to hospice services and community hospital palliative care services

Research & Teaching Participate in research project that should be completed in 3 months Participate in monthly Journal Club meeting and teaching session

Participate in Tumour Boards Oncology Grandrounds Journal Clubs Subspecialties multidisciplinary tumour boards

Others Departmental activities as deemed appropriate by Head of Department or mentor

Minimum Entry Requirement

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General or Specialist qualifications

Number of Places (each 6 months in duration) Available per Year

Four

Hands on Training

Yes

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