pediatric oncology curriculum
DESCRIPTION
TRANSCRIPT
Pediatric Oncology
Curriculum
Preface
T he Egyptian Fellowship Board and the Pediatric Oncology scientific council worked collabo-
ratively to make this curriculum available for trainees’ guidance and support.
Postgraduate medical education world wide are now governed by sets of academic standards that
describe the qualities and abilities of graduates. In addition, there are standards for the training
processes , trainers’ selection and methods of assessment. standards ensure transparency and
clarify expectations.
The Egyptian fellowship board had defined and published its standards for the general and profes-
sional competencies expected from our graduates in different specialties upon successful comple-
tion of training. These expectations has been reflected in the pediatric oncology curriculum.
The curriculum describes what trainees will know and be able to do upon completion of training.
In additions, methods of teaching and learning needed to deliver the curriculum are listed . The
curriculum also describes in details, expectations from trainees during their rotations in “The
training rules and regulations section”. Methods of assessment and examination regulations are
also available in the last section of the curriculum.
All topics covered during practical and theoretical studies are outlined. This will help trainees to
guide their readings and their choice of learning activities. The scientific council also recommends
that trainees and trainers refer frequently to the logbook, where they will find requested clinical
cases and practical procedures. The logbook will also serve as the source of evidence that pediat-
ric oncology trainees have attended required rotations and achieved requested competencies.
The trainees, trainers and Educational supervisors will get significant benefits from regular check-
ing of the Egyptian Board website. All announcements related to training and exam will be avail-
able there. In addition, you will find many useful electronic resources that we hope it will be bene-
ficial in your preparation for the exam and continuous professional development.
Esmat Ahmed Sheba
Secretary General
The Higher Committee of Medical Specialties
Acknowledgement
This curriculum has been created through collaboration between The Pediatric Oncology
Scientific Council and The Egyptian Fellowship Curriculum Committee. The following mem-
bers of the Pediatric Oncology Scientific Council have made substantial contribution to the
curriculum development as subject matter experts
The Egyptian Fellowship Curriculum Committee has made significant contribution to the cur-
riculum through Collaboration with the council in the design and formulation of the educa-
tional structure. The member who participated in the work is
The Committees consulted international and national curricula in pediatric oncology.
The external references for the development of this curriculum are:
1. The pediatric oncology curriculum approved by the Royal College of child health
and PMETB 2007
2. The previous Egyptian Board curriculum in pediatric oncology
3. The Egyptian Board Guidelines for curriculum development 2007
4. Postgraduate Medical Education and Training Board UK (Guidelines for curricu-
lum development 2006)
Professor Dr Alaa El Haddad, Professor of pediatric oncology and Chair of the Pe-
diatric Oncology department at the National Cancer institute, Cairo University
Associate Professor Dr Hany Abd El Rahman, Associate Professor of pediatric on-
cology, National Cancer Institute. Cairo University
Professor Dr Eman Abd El Raouf Mohammed ,Professor of pediatric hematology,
Cairo University and the educational advisor of the Egyptian Fellowship Board
Pediatric Oncology Curriculum Egyptian Fellowship 7
7
CONTENTS………………….
The structure and regulations of Pediatric Oncology training…... 9
Curriculum aim ……………………………………………………. 13
General intended learning outcomes………………………………. 14
Module I……………………………………………………………... 17
Module II …………………………………………………………… 22
Module III ………………………………………………………….. 27
Module IV…………………………………………………………... 33
Methods of assessment …………………………………………….. 37
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The Structure and regulations of
Pediatric Oncology training
The Egyptian Board of pediatric oncology requires two years of supervised
training program that must be conducted in accredited pediatric oncology hospitals
and centers before sitting for the final examination. The board publish an updated
list of accredited centers at its website. Entry to the pediatric oncology-training
program has the following requirements for trainees who are affiliated to MOHP:
1. Graduation from medical school and successful completion of the pre-
registration house officers' year
2. Successful completion of the Egyptian Fellowship in Pediatrics or equiva-
lents (e.g. MRCPCH) with evidence of practical training.
Trainees, who finished their master degree in pediatrics within five
years must join the pediatric fellowship training for two years and pass
successfully the final certifying exam before joining the pediatric on-
cology training program
During the entire program, the candidate must work as a full time residents in the
training center. He or she must get gradually increasing responsibilities for patient
care according to the stage of training and available supervision.
1.Pediatric-Oncology trainees must spent their training period in the following
services:
a. Pediatric Hematological malignancies services (10 months)
b.Pediatric Solid tumor services (10 months)
c. Bone marrow transplantation service (3 months).
d. In addition, attendance to radiotherapy services, oncology surgery wards,
clinical pharmacy and clinical pathology department will be organized by
the educational supervisor on part-time basis to allow for the attainment
of required intended learning outcomes
2.The first two modules of the curriculum must be completed by the end of the first
year of training. However only module one will be the subject for assessment in
the first part exam.
3.The third and fourth modules must be covered by theoretical and practical studies
during the second year of training and the whole curriculum is a subject for the
final exam
Any changes to this guidelines would be announced at the board website and
we advise trainees to regularly visit the site for announcements and updates
Training rotations
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1. Trainees must attend at least 75% of lectures on pediatric oncology subjects.
2. They should pass successfully through the first part exam before being eligible
for the final exam. Trainees who failed the first part exam twice may be asked
for additional period of training up to one year and successful pass of the first
part exam before being allowed to sit for the final certifying exam
3. Trainees should be actively involved and responsible for patient care including
sharing in making decisions about diagnosis and management under supervi-
sion of the consultants.
4. They must attend 75% of weekly meetings including clinical rounds, tutorials
and journal clubs
5. Their performance will be monitored and evaluated by trainers and a report
made of their performance on monthly basis to the Egyptian Fellowship
Board.
6. All trainees will work as residents in the training specialty and they must ful-
fill all residents jobs defined by supervisors and trainers
7. They should be responsible under supervision for outpatient and in patients'
routine work.
8. They must take supervised shifts according to the hospitals requirements and
regulation.
Important notice
Trainees must pass successfully all the seven foundation courses before
being promoted to the second year of training. Full information about
foundation courses is available at the EF website and administration office.
Trainees who finished their foundation courses during their pediatric fellow-
ship will not repeat the courses.
Trainees duties and obligations
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Specific requirements and obligations
The trainees will be responsible for supervised admission of patients from the out-
patient department or emergency.
They will share in the completion of the following documents under supervision
Complete history and physical examination form.
Investigation requests, (laboratory, radiology, pathology, etc.).
Reporting and documenting the results of the investigations
Writing the plan of management after consultation and approval from supervi-
sors
Daily progress notes.
Order and medication sheets
Orders of the necessary diagnostic procedures
Discharge summaries.
Sick leaves and medical reports
The Trainee should inform the senior staff of any high-risk patient admission.
The trainees should attend various pediatric oncology outpatient clinics and clinics
related to the rotation in radiotherapy, nuclear medicine and surgical oncology as
requested by trainers and supervisory staff. They should participate in different pa-
tients' interviews and share in management under supervision.
The trainees must attend and participate in the mandatory academic and clinical
activities of the department. Attendance and participation should not be less than
75% of the total number of activities within any training rotation / period including.
Daily morning patients' rounds and meetings
Clinical round and staff round presentation
Journal club meeting
Interdepartmental Meetings/ morbidity and mortality meetings
Grand staff rounds
1- Obligations towards the Admitted Patients
2- Obligations in the outpatient Clinics
3- Mandatory Clinical and Academic Activities
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The trainees must keep and update their logbook where they record all activities
and skills performed and learned during the training program. The activities
should be dated and categorized to whether been performed by the trainee him/
herself or as an assistant or participant. The trainer and finally the educational
supervisor should counter sign activities registered in the logbook. The Trainer
and educational supervisor must sign the completed Log Book. Trainers must
revise the logbook weekly. Educational supervisors must revise the logbook and
provide feedback on monthly basis.
The trainees shall undertake at least one research or audit project during the
training program under the guidance and supervision of their trainers. Such pro-
ject should be written and presented to a committee from the scientific council
before the trainee is accepted for admission to the final certifying examination.
The scientific council will announce topics and themes for the research or audit
projects.
Before the completion of the training program, the trainee should have com-
pleted satisfactorily the rotations described in the structure of the program, per-
formed him/herself, and assisted in the various requested procedures.
According to Ministry of Health and Population regulation
Performance of the trainee must be evaluated on regular and continuous basis.
The evaluation process should involve all aspects of the training including theo-
retical, clinical and investigative procedures skills as well as the attendance and
participation.
The trainers who are required to write confidential reports on the performance of
each trainee should evaluate the trainee periodically. The trainee should not be
allowed to proceed in the training program and move to the next year unless he/
she attains a satisfactory level of performance acceptable to the responsible
trainer and educational supervisor.
4. The Log Book
5. The Research project
General rules and regulations
1.Holidays and on call duties
2.Evaluation Procedures:
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Interruption of training
It is not permissible to interrupt such a structural training program except in major
unavoidable circumstances. Such circumstances should be convincing and approved
by the Secretary General. The Interruption once approved should not be for more
than one year. Interruption of the training program for more than one year shall re-
sult in dismissal from the program and cancellation of the preceding training period.
Curriculum aim
The aim of this curriculum is equip Egyptian fellowship trainees in the specialty of
pediatric oncology with knowledge, skills and attitudes necessary for efficient, inde-
pendent and safe practice as pediatric oncology specialists. It gives you - as a fellow-
ship trainee - a clear picture of what you have to achieve by the end of this fellow-
ship program. Therefore, when it comes to your assessment at the end of the train-
ing, we will want to know how well you have achieved the program objectives and
be confident that you are fit to practice as a pediatric oncology specialist with com-
petence.
Rational Statement
The purpose of this curriculum is to describe the competencies expected
from pediatric oncologists upon completion of training . The curriculum also
describes the methods of teaching and learning that will be used to facilitate
the delivery of the curriculum. In addition, it highlights the different methods
of trainee's performance evaluation. The curriculum contents have been for-
mulated through the following methods:
1. Revision of previous Fellowship pediatric oncology curriculum
2. Revision and benchmarking of international curricula for postgraduate
training in pediatric oncology.
3. Consultation of experts in the field of pediatric oncology.
Representatives from the pediatric oncology scientific council have partici-
pated in the process of curriculum development in collaboration with repre-
sentatives from the Egyptian Board curriculum Committee. The curriculum
was finally approved by the council in July 2008
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General intended learning outcomes
By the end of training in Pediatric Oncology, trainees should have acquired the
following knowledge, skills, attitudes and be able to:
1. Describe the Incidence and mortality rates for various childhood cancers with
emphasis on ethnic and geographical variabilities.
2. Explain the etiological background of childhood cancer both the facts and
theories.
3. Distinguish between national , regional and international cancer registration
policies.
4. Explain the role of clinical trials in pediatric oncology and recall the history
of evolution of current clinical trials and treatment outcomes.
5. Discuss the normal and abnormal mechanisms of cellular growth control.
6. Explain the genetic basis of malignant disease.
7. Discuss the features and clinical presentations of different childhood malig-
nancy.
8. Discuss the role of biological factors as diagnostic and prognostic aids.
9. Describe the indications and techniques of biopsy and optimal methods for
tissue handling for diagnosis and biological studies.
10. Discuss the principles and strategies of various modalities of treatment for all
stages of solid tumors and hematological malignancies that affect children.
11. Discuss the principles of cancer treatment with chemotherapy and the ration-
ale of combination chemotherapy regimens.
12. Discuss the principles and applications of high dose therapy and the rationale
for bone marrow transplantation in various childhood malignancies.
13. Discuss various techniques for bone marrow support including the use of
growth factors.
14. Summarize the basics of radiobiology and different planning techniques used
in the delivery of radiotherapy to children.
15. Recall the principles of less commonly used radiotherapy techniques, includ-
ing brachytherapy and targeted therapy.
16. Outline the role of onco surgery in the diagnosis and management of various
childhood cancers.
17. Discuss the acute toxicities of cancer treatment (individual drugs and radio-
therapy).
18. Discuss the late side effects and consequences of therapy, including effect on
learning, endocrine consequences, major organ toxicities and their causative
agent.
Knowledge and understanding
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19. Outline the importance of tumor and DNA banking for future research.
20. Outline the basic principles of biological and novel therapies for the management
of pediatric malignancy.
21. Explain the working structure, aims and functions of the pediatric oncology ser-
vices in the country.
22 Take full and focused clinical history and perform complete and organ targeted
clinical examination for children presented with various malignancies.
23 Request appropriate diagnostic studies and formulate a rational differential diag-
nosis.
24 Interpret the results of investigations correctly (laboratory, radiological imaging
and pathology) and modify his differential diagnosis list accordingly.
25 Timely recognize and manage various oncological emergencies such as septic
shock, tumor lysis, SVC obstruction, spinal cord compression, and raised ICP.
26 Perform independently bone marrow aspiration and trephine biopsy.
27 Prescribe and administer safely intrathecal drugs according to local and national
policies.
28 Prescribe, handle and administer chemotherapy safely
29 Timely recognize and manage acute drug reactions to chemotherapy and manage
the extravasation of chemotherapy agents appropriately.
30 Manage competently fever with neutropenia , including management after the
failure of first line antibiotic therapy.
31 Investigate and manage fungal and viral infections in the immune-compromised
child.
32 Organize and participate in long-term follow up programs for children with vari-
ous malignancies.
33 Participate as a team member in surveillance of survivors using national guide-
lines.
34 Manage pain related to cancer appropriately and recognize the different patterns
of pain and their different therapeutic interventions including non pharmaceutical
approaches.
35 Identify and control other symptom such as breathlessness and bowel obstruc-
tion.
36 Perform complete nutritional assessment for children with cancer and prescribe.
appropriate nutritional support during and after chemotherapy.
37 Consult appropriately nutrition specialists and seek their advice when indicated.
Skills
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Communication skills, ethics and
professional attitudes
38 Appreciate the concept of ‘Good Clinical Practice'
39 Communicate effectively and empathetically with children and families and
be able to convey bad news in appropriate manner
40 Discuss the concept of phase I, II and III trial and be able to explain this to
patients and parents
41 Discuss with patients and care givers various treatment options and gain in-
formed consent for treatment and for enrollment in clinical trial
42 Be confident in discussing these issues with adolescents and their families
and in making appropriate referrals
43 Educate families and patients about fertility preservation techniques for ado-
lescents who will receive treatment that may impair fertility in the long term
44 Work within multidisciplinary teams to manage various oncological prob-
lems
45 Collaborate with neuropsychiatric specialists in the management of learning
and psychological consequences of cancer treatment
46 Communicate both verbally and in written concerning the impact of treat-
ment on learning, patients school education and other possible short and long
term effects.
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Module I
This module aims to equip trainees with essential knowledge and problem solving
skills in the following domains:
Cancer biology
Pathology & molecular biology
Clinical Pharmacology
Chemotherapeutic agents
Epidemiology & Biostatistics
Basics of Surgical Oncology
Basics of Radiation Oncology
Radio-diagnosis
Basics of Cancer
Intended learning outcomes
By The end of the module, trainees will be able to:
1.Discuss the principles of cancer biology, genomics & proteomics, molecular
targets and explain the processes of invasion, metastasis, angiogenesis & cancer
immunology.
2.Describe the Molecular and genetic characteristics of normal & malignant cells
(Genomics & proteogenomics).
4.Describe the principles of various epidemiologic studies , types of re-
search designs and principles of biostatistics including survival analysis
and mortality indices.
5.Discuss the indications for and role of surgery in diagnosis, staging and
management in different types of childhood malignancies.
6.Discuss the indications for and role of radiation oncology in the manage-
ment of childhood cancer. In addition, they must identify and initiate man-
agement for its expected side effects.
7.Recognize the indications for and interpret the results of different imaging
modalities including radiography, Ultrasound, CT, MRI, PET scan and
nuclear medicine (these include their use for the diagnosis, staging and
follow up of pediatric cancers).
8.Discuss the Classification, mode of action, toxicities, basis of combination
therapy and precautions of the use of chemotherapeutic agents including
late effects and teratogenicity.
9.Prescribe judiciously various chemotherapeutic agents through various
routes of administration.
10.Monitor children on chemotherapy, recognize the toxicities of chemo-
therapeutic agents and manage it appropriately.
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Caner biology Topics Method Of
Learning
Method
Of
Expected
Year Of
Achievement
Normal chromosomal structure & func-
tion, gene transcription, DNA repair
mechanisms
Lectu
res an
d se
lf-stud
y
First p
art ex
am
1st y
ear
Molecular basis of Cancer
Transformation of normal cells into
cancer cells
Chromosomal & genetic changes in
malignancy, point mutation, transloca-
tions, deletions, gene amplification &
over-expression
Mechanism of spread, invasion
migration & metastasis
Tumor markers
Basics of caner virology
Oncogenic viruses
Laboratory diagnosis of
viral infection
Micro array
Surgical Oncology Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Role of surgery in diagnosis and
staging of pediatric tumors
Lectu
res an
d ro
tatio
ns in
Su
rgica
l On
colo
gy
First p
art ex
am
1st y
ear
Different types of surgery
Role of surgery in management of
disease complications
Role of surgery in Palliation
Common post operative
complications
Venous access, management and
maintenance
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19
Pathology Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement L
ectures
S
elf stud
y
p
ractica
l atten
da
nce o
f pa
tholo
gy
lab
First p
art ex
am
1st y
ear
Introduction to general pathology
Morphologic criteria of malignancy
The range of tumors that can
develop from normal tissue
components
Classification of malignant tumors
Morphology of common tumors
(macro & micro), grading &
differentiation of tumors
The natural history of malignant dis-
eases, presentations, characteristics
of their growth & spread
Principles and application of ad-
vanced techniques in tumor
diagnosis
Use of specialized pathology tech-
niques e.g. Immuno-histochemistry,
phenotype, cluster of differentiation
( CD) classifications, FISH & CISH,
micro array & gene print
Use of clinic-pathological data within
multidisciplinary approach for pa-
tients management
Pediatric Oncology curriculum Egyptian Fellowship Board
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20
Pharmacology Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Classification and mode of action of cyto-
toxic drugs
Lectu
res
First p
art ex
am
1st y
ear
Drug resistance, doses &
administration
Phases of drug development & screen-
ing at pre-clinical levels
Pharmacokinetics & pharmacodynam-
ics: general principles, plasma concen-
tration, AUC
Protein & tissue binding, drug concen-
tration at the target site
Principle of clinical use: dose intensity,
combination therapy, new adjuvant
therapy
High dose chemotherapy
Cancer Chemotherapy Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Mode of action of cytotoxic drugs ,
phases of the cell cycle,
Lectu
res an
d o
n jo
b tra
inin
g ro
tatio
ns in
Clin
ical P
ha
rma
colo
gy
First p
art ex
am
1st y
ear
Mechanisms of intrinsic & acquired
The indications & goals of chemo-
therapy, adjuvant & neoadjuvant
Clinical use of cytotoxic drugs
Principles of adverse effects of cy-
totoxic drugs & their management
Antiemetics and targeted therapy
( monoclonal antibodies, TKI, tu-
mor vaccines, cellular therapy,
antiangiogenesis, cytokines)
Dose intensification: indications,
complications & adverse effects
Pediatric Oncology Curriculum Egyptian Fellowship Board
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21
Radiation Oncology Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Principles of radiation biology &
normal tissue tolerance Lectu
res an
d
rota
tion
s in
Ra
dia
tion
On
colo
gy
First p
art ex
am
1st y
ear
Principles of radiation physics,
fractionation & dosing
Clinical aspects of radiation oncol-
ogy & toxicity, interaction with
chemotherapy, potentiation &
protectors
Diagnostic Radiology Topics Method Of
Learning
Method
Of
Expected
Year Of
Achievement
Imaging modalities: indications
and cost/benefit
Lectu
res an
d sm
all g
rou
p
sessio
ns o
n
Rad
iolo
gic film
First p
art ex
am
1st y
ear
Radiography, U/S CT & PET MRI
nuclear medicine: indications
intervention radiology
Interpretation exercises
Biostatistics Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Introduction to epidemiology Lectu
res with
ha
nd
s on
train
ing
First p
art
exa
m
1st y
ear
Measuring occurrence of disease
Surveillance and overview
Study designs
Basic statistics
Pediatric Oncology curriculum Egyptian Fellowship Board
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22
Module II
This module aims to equip trainees with comprehensive knowledge , problem
solving and patients' management skills in the following domains:
1. Oncologic Emergencies
2. Infectious diseases
3. Clinical pathology and blood banking
4. Hematologic Malignancies:
Acute Lymphoblastic Leukemia (ALL)
Acute Myeloid Leukemia (AML)
Chronic Myeloid Leukemia (CML)
Myelodysplastic Syndrome (MDS)
Non-Hodgkin's Lymphoma (NHL)
Hodgkin's disease (HD).
Intended learning outcomes
1. Discuss emergency situation related to cancer development, treatment side ef-
fects or organ dysfunction.
2. Discuss the Principles of antimicrobial treatment in febrile neutropenic cancer
patients.
3. Identify the role of clinical pathologists in diagnosing hematological malig-
nancies and in supporting the transfusion management of cancer patients.
4. Discuss the indications for, precautions and procedures of blood product trans-
fusion in children with cancer.
5. Discuss the etiology, Incidence, epidemiology, clinical presentation, prognostic
factors, differential diagnosis and different strategies of management of child-
hood hematologic malignancies.
Knowledge
Pediatric Oncology Curriculum Egyptian Fellowship Board
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23
Skills
1. Timely recognize and properly manage various types of oncological emergencies
e.g. tumor lysis syndrome, cord compression, septic shock, fever and neutropenia,
bleeding ….etc
2. Prevent, anticipate and competently management febrile neutropenic cancer
patients, with emphasis on diagnostic work up, early wide spectrum antibiotics
coverage and proper introduction of antifungal and antiviral treatment
3. Classify malignant hematologic disorders using different investigations and for-
mulate a rationale differential diagnosis and reach a final correct diagnosis
4. Use blood product transfusion judiciously in the management of hematological
malignancies
5. Anticipate, prevent and manage reactions related to blood product transfusions
6. Make appropriate evidence based decision-making regarding the choice of
treatment strategy, dealing with treatment complication, follow up during chemo-
therapy and early identification of relapsing and/or resistant cases needing second
line chemotherapy or BMT.
Oncological emergencies Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Identification of causes, clinical
presentation, and management of
oncologic emergencies
L
ectures
A
ttend
an
ce of o
utp
atien
ts
A
ttend
an
ce of in
patien
ts
Seco
nd
part ex
am
1st y
ear
Septic Shock, bleeding, coagulation
disorders
Tumor lysis syndrome
Cord Compression, increased intrac-
ranial tension, encephalopathy
Dyspnea, massive effusion, ascites
Fever and neutropenia
SVC syndrome, cardiac tamponade
Pediatric Oncology curriculum Egyptian Fellowship Board
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24
Infectious diseases Topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Epidemiology, strategies for
managing of infectious diseases in
pediatric oncology patients
L
ectures
A
ttend
an
ce of o
utp
atien
ts
A
ttend
an
ce of in
patien
ts
Seco
nd
pa
rt ex
am
1st y
ear
Risk assessment and clinical
manifestations of fever
in children with and neutropenia
cancer
Prevention of infections in children
with cancer
Antibacterial treatment of febrile
neutropenic patients
Antifungal agents
Antiviral agents
Clinical pathology and blood
banking Topics
Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Classification of malignant
hematologic disorders
L
ectures
A
ttend
an
ce of o
utp
atien
ts
A
ttend
an
ce of in
patien
ts
Seco
nd
pa
rt ex
am
1st y
ear
IPT
Cytogenetics in acute leukemia
Molecular biology
HLA typing
Uses of blood components in
hematologic malignancies
Management of transfusion reaction
Pediatric Oncology Curriculum Egyptian Fellowship Board
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25
Acute leukemia Topic
Topics
Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Epidemiology of infant and child-
hood acute leukemia
Lectu
res an
d o
n jo
b tra
inin
g in
hem
ato
logica
l malig
nan
cy w
ard
s
Seco
nd
part ex
am
1st y
ear
Etiology and genetic associations
incidence, clinical presentations of
ALL, AML
Diagnostic investigations, prognos-
tic factors and risk stratification.
Treatment protocols and monitoring
the response
Minimal residual disease
Role and indications for bone
marrow transplant
Role and indication of radiotherapy
management of rarer forms of
childhood leukemia
management of testicular, CNS and
bone marrow relapse
Chronic myeloid leukemia and
myelodysplastic syndromes
Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Epidemiology; incidence and
molecular abnormalities of
childhood CML and MDS Lectu
res an
d o
n jo
b tra
inin
g in
hem
ato
logica
l malig
nan
cy w
ard
s
Seco
nd
pa
rt ex
am
1st y
ear
Classification, clinical presentations
Laboratory and prognostic features
of CML, and MDS
Chemotherapy for CML, MDS
Monitoring of response and
treatment outcome
Role of bone marrow transplant in
the treatment of myelodysplasia and
chronic myeloid leukemia in
Pediatric Oncology curriculum Egyptian Fellowship Board
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26
Hodgkin’s Lymphoma
Topics
Method Of
Learning
Method
Of
Expected
Year Of
Achievement
Epidemiology, clinical presentation,
and laboratory features Lectu
res an
d o
n jo
b tra
inin
g in
hem
ato
log
ical m
alig
nan
cy
ward
s
Seco
nd
pa
rt ex
am
1st y
ear
Histological subtypes and their ef-
fects on prognosis
Ann-Arbor staging system
Diagnostic work up
current treatment strategies includ-
ing the role of radiotherapy
FDG-PET scan
complications and late effects of
chemotherapy and radiotherapy
Non-Hodgkin's Lymphoma
Topics
Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Histological subtypes of NHL in chil-
dren and adolescents
Lectu
res an
d o
n jo
b tra
inin
g in
hem
ato
log
ical m
alig
nan
cy w
ard
s
Seco
nd
pa
rt ex
am
1st y
ear
Clinical presentation
Cytogenetic and molecular genetic
Association of EBV and HIV with NHL
investigations and diagnostic work up
Prognostic features
Current treatment strategies accord-
ing to immunophenotype and patho-
Management of the acute presenta-
tions: SVC obstruction, airway
compression, spinal cord compres-
Indications and role of BMT in
Management of relapsed NHL
Pediatric Oncology Curriculum Egyptian Fellowship Board
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27
Module III
This module aims to equip trainees with comprehensive knowledge , problem
solving and patients' management skills in the following themes:
1-Solid Tumors:
Renal Tumors.
Neuroblastoma.
Germ cell Tumors.
Hepatic Tumors.
Retinoblastoma
Bone Tumors.
Soft Tissue Sarcoma.
Central Nervous System Tumors.
2-Practical Procedures & Investigations
3-Therapeutic Procedures:
Lumbar Puncture
Bone Marrow Aspiration & Biopsy
IV Fluids
Infusion pumps
1. Discuss the etiology, incidence, clinical presentation, differential diagnosis,
pathological subtypes and management guidelines of pediatric solid tumors
2. Discuss the indications and steps of performance for different practical proce-
dures used during the course of diagnosis or treatment of cancer patient e.g.; col-
lection of blood sample, LP, BM aspiration& biopsy and tapping of ascetic fluid
3. Outline the contraindications and expected complications of various procedures
Intended learning outcomes
Knowledge
Pediatric Oncology curriculum Egyptian Fellowship Board
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28
Take appropriate evidence based decisions regarding treatment strategy,
Discuss the indication of surgery and/or radiotherapy
Deal with treatment complication appropriately
Follow solid tumor pediatric patients during chemotherapy and early identify
relapsing and/or resistant cases needing 2nd line chemotherapy and/or
autologous BMT
Communicate effectively and in a simple way to patients the indications and
techniques of invasive procedures and be able to take informed consent
Perform the following therapeutic procedures independently and safely:
Lumbar puncture, BM aspiration and biopsy, needle thoracocentesis for
pleural effusion or pneumothorax, tapping of ascetic fluids.
Interpret results of investigations requested and respond appropriately
Record results and document procedures legibly and accurately
Explain the investigation results to parents and/or the child
Recognize complications of procedures and be able to respond appropriately
Supervise and teach junior colleagues the performance of the above
mentioned procedures
Skills
Hepatic tumors topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Congenital conditions associated with
hepatoblastoma
Lectu
res an
d o
n th
e job
train
ing
du
rin
g so
lid tu
mo
r rota
tion
s
Fin
al w
ritten , clin
ical a
nd
ora
l exa
mi-
na
tion
2n
d y
ear
Differential diagnosis of right upper quadrant
masses, anatomy and histology of the liver
Tumor markers in primary liver tumors
Pre-treatment staging system
Prognosis of hepatoblastoma and hepatocellular
carcinoma and factors that determine it
Surgical resection of primary tumor
Role of liver transplantation in the management
of hepatic tumors
Late effects of treatment
Pediatric Oncology Curriculum Egyptian Fellowship Board
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29
Renal tumors topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Classification and pathological subtypes
of renal tumors including incidence of
Wilms tumor L
ectures
O
utp
atien
t rota
tion
s In
patien
t rota
tion
s
Fin
al w
ritten , clin
ical a
nd
ora
l exa
min
atio
n
2n
d y
ear
Clinical presentation and differential
diagnosis of a renal mass
Prognostic significance of histology
Staging Wilms tumor
pre- and post-surgery
Principles of treatment for all stages of
tumor according to different patients’
groups
Principles of treating bilateral Wilms
tumor
management of a patient with recurrent
Wilms tumor
Role of surgery and radiotherapy
Complications and late effects of
treatment
Retinoblastoma topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Epidemiology, genetic, and clinical
features of unilateral and bilateral
retinoblastoma
Lectu
res an
d o
n jo
b tra
inin
g
du
ring
solid
tum
or ro
tatio
ns
Fin
al w
ritten , clin
ical a
nd
ora
l exa
mi-
na
tion
2n
d y
ear
Clinical presentation of retinoblastoma
Trilateral retinoblastoma
Imaging modalities to determine extent and
metastatic spread
Staging of retinoblastoma
Treatment modalities: surgery, irradiation,
chemotherapy and photocoagulation
Screening and follow-up for patients and
siblings
Complications, rehabilitation and late
effects
Pediatric Oncology curriculum Egyptian Fellowship Board
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Neuroblastoma topics Method Of
Learning
Method
Of
Assessment
Expected
Year Of
Achievement
Etiology and clinical presentation by age
Lectu
res an
d o
n jo
b tra
inin
g
du
ring
solid
tum
or ro
tatio
n
Fin
al w
ritten , clin
ical a
nd
ora
l exa
min
atio
n
2n
d y
ear
Management of common clinical problems
associated at presentation: hypertension,
spinal cord compression, Horner's
Radiological investigations for diagnosis
and staging
International staging system (INSS)
Prognostic factors and prognosis according
to age and stage, histology and MYCN
Laboratory findings: VMA, NSE, ferritin,
LDH, MIBG
Treatment strategies according to risk
stratification, role of surgery and
Principles of managing relapsed NBL
Germ cell tumors topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Embryogenesis and histogenesis of Lectu
res an
d o
n jo
b tra
inin
g
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Genetic Characteristics of Adolescent
Testicular Tumors
Clinical presentation
Diagnostic work up
Pathological subtypes
Clinical markers: H-CG,AFP, LDH
Principles of treatment:
Treatment complication,
Late effects and follow up after end of
Pediatric Oncology Curriculum Egyptian Fellowship Board
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Bone tumors topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Epidemiology, predisposing factors and genetic
predispositions L
ectures a
nd
on
job
train
ing
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Pathological subtypes
Ewing family of tumors and their effect on
prognosis
Clinical presentations and potential metastatic
sites
Differential diagnoses for plain x-ray
appearances
Imaging modalities and their indication
Neoadjuvant and adjuvant chemotherapy in the
management of bone tumors
Role and limitations of surgery
Rehabilitation for limb sparing, joint sparing
and amputation
Late effects of bone tumor
Soft tissue sarcoma topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Epidemiology, predisposing factors and
Lectu
res an
d o
n jo
b tra
inin
g
du
ring
solid
tum
or ro
tatio
n
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Classification of STS: RMS /Non RMS
Cytogenetic and molecular genetic
abnormalities associated with soft tissue
sarcomas
Histological subtypes and patterns of
Clinical presentation
Staging of soft tissue sarcomas
Role of surgery, chemotherapy and
radiotherapy
Pediatric Oncology curriculum Egyptian Fellowship Board
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Central nervous system tumors topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Epidemiology, predisposing factors and
Lectu
res an
d o
n jo
b tra
inin
g
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Classification, pathological subtypes and
Clinical presentations
Types and interpretation of neuro-images
Planning of treatment through neuro-
Role of surgery, irradiation and
chemotherapy in the treatment of CNS
Monitoring the response to treatment
Complications and late effects of CNS
Rehabilitation
Practical Procedures and investigations Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Appropriate indications for practical
procedures and investigations
Lectu
res an
d o
n jo
b tra
inin
g
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Local and national guidelines for obtaining
informed consent for investigations or
Contraindications and complications of
Anatomical markers for invasive
The principles for the practice of
The steps of performance of various
techniques
Pediatric Oncology Curriculum Egyptian Fellowship Board
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33
Requested procedures
1. Administer SC, IM & IV injections
2. Tapping of ascites
3. Thoracocentesis for pleural effusion or pneumothorax
4. Lumbar puncture and intrathecal administration of chemotherapy
5. BM aspiration and biopsy
6. Arterial blood gas analysis
Module IV
This module aims to equip trainees with essential knowledge , problem solving and
patients' management skills in the following themes:
1. Endocrine Malignancies
2. Rare Tumors
3. Hematopoietic Stem Cell Transplantation (HSCT)
4. Pain Management
5. Late Effects of Chemotherapy
1. Outline the physiological background, Incidence, classification, and associated
syndromes of the commonly seen endocrine malignancies
2. Discuss the clinical presentation, staging and treatment strategy for different en-
docrine malignancies
3. Explain the importance of consultation with colleagues in adult oncology
4. Outline the role of high dose therapy with autologous stem cell rescue in the
management of malignant disorders in children and young adults
5. Discuss the indications and role of allogeneic hemopoietic stem cell transplanta-
tion (HSCT) in children, including the indications for HSCT from other than a
matched sibling donor
6. Explain the principles of HLA (human leucocyte antigen) typing and donor se-
lection, including the different potential sources of HSCT, and HSCT collection
and cryopreservation
7. Describe the complications of HSCT and their management, including graft-vs.-
host disease, veno-occlusive disease and graft failure
8. Outline the late effects of HCST in children, including growth, fertility and sec-
ond malignancy
9. Discuss the Pathophysiology of pain in cancer patient
10.Explain the drug treatment of pain and the analgesic ladder
11.Describe different Pain syndromes
12.Outline practice guidelines for providing sedation and pain relief for practical
procedures
Intended learning outcomes
Knowledge
Pediatric Oncology curriculum Egyptian Fellowship Board
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34
Skills
1. Recognize, diagnose and manage late effects of malignancy, chemotherapy
and radiotherapy toxicity
2. Develop follow-up plans for cancer survivors and counsel them appropri-
ately
3. Manage patients with neuro endocrine tumors as a member within multidis-
ciplinary team
4. Participate as a team member in HSCT for children with hematological ma-
lignancies
5. Clinically assess, and identify patients who are not fit for further active can-
cer treatment, or at the terminal stage of life
6. Attend to Quality of life issues and provide psychological support to the pa-
tients and their family
7. Assess the patients pain score, stratify the different types of pain and measure
their intensity
8. Choose treatment modality and use appropriately non-pharmacological treat-
ments
9. Identify and manage side effects of pain treatment
Neuroendocrine malignancies topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Classification of Neuro-endocrine tumors
Lectu
res an
d o
n jo
b tra
inin
g
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Clinical presentations and methods of
diagnosis
Staging and prognostic factors
Role of surgery in localized & advanced
disease
Role of chemotherapy & radiation therapy
for different disease stages
side effects of treatment
The principles of follow up
The management of relapsed disease
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35
Hemopoietic stem cell transplantation
(HSCT) Topics
Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Role of high dose therapy with autologous
stem cell rescue in the management of malig-
nant disorders in children and young adults
Lectu
res an
d o
n jo
b tra
inin
g
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Indications for allogeneic HSCT
in children
Advantages of allogeneic HSCT and donor
lymphocyte infusion in some non-malignant
disorders
Role and indications of allogeneic HSCT in
the treatment of leukemia in children and
young adults
Principles of HLA typing and donor
selection
Complications of HSCT and their
management
Conditioning regimens used in HSCT and
their side effects
Role and complications of TBI in HSCT
Principles and types of
immunosuppression used in HSCT
Infectious complication
Late effects of HCST in children
Rare tumors topics Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Types of adult malignancies that could occur in
children
Lectu
res an
d o
n jo
b
train
ing
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
The role of adult oncologists in the manage-
ment of rare childhood tumors
the diagnosis, staging, treatment & relation to
adults' protocols
The Clinical presentation and diagnosis of rare
tumors
Role of Chemotherapy, Surgery and radiother-
apy
Pediatric Oncology curriculum Egyptian Fellowship Board
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36
Pain management and palliative care
Topics
Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Principles of palliative care and
quality of life
Lectu
res an
d o
n jo
b
train
ing
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Pathophysiology of pain in cancer patient
Drug treatment of pain and
the analgesic ladder
Pain syndromes
Evidence based practice guidelines for the
management of pain in cancer patients
Complications and side effects
of pain management
Late effects of Chemotherapy
Topics
Method Of
Learning
Method
Of
Assessment
Expected Year
Of
Achievement
Delivering survivorship care Lectu
res an
d o
n jo
b
train
ing
Fin
al w
ritten , clin
ical
an
d o
ral ex
am
ina
tion
2n
d y
ear
Growth and neurocognitive sequelae of
chemotherapy
Systemic function abnormalities
Second malignant neoplasms
Hormonal function abnormalities
Late mortality among childhood
cancer survivors
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37
Methods of assessment
Regulations
The general rules and regulations of assessment approved by the Egyptian fellow-
ship board and published at the training handbook and the board web site applies
for the pediatric oncology specialty. In addition to the successful completion of the
training program, all candidates must successfully pass three exams in order to get
the fellowship certificate.
First part Exam
The first part exam is a written exam. Trainees will sit for the first part exam after
completion of the first year of training. Each candidate has two chances to pass the
exam. Failure for two times or more in the first part will result in request for repeti-
tion of a specific period of training. The scientific council will determine the dura-
tion of training extension.
Candidates will not sit for the final certifying exam unless they pass successfully
the first part exam and completed the required period of training
Second part exam
The second part exam is a written exam. Trainees are allowed to sit for the second
part exam after passing successfully the first part and after completion of the train-
ing period. In addition, each candidate must submit his logbook for final assess-
ment. The logbook requirements must all be completed and signed by the trainer
and educational supervisor.
Each candidate has three chances to pass the exam and one more additional chance
may be granted in special approved circumstances.
Clinical Exam (third part)
The third part exam is a clinical and oral exam. Candidates who pass successfully
the second part are allowed to sit for the third part. Again, each candidate has three
chances to pass the clinical exam and an additional fourth chance may be granted in
special approved circumstances.
Pre-requisite for entering the first part exam
Trainees should pass the following courses in order to be eligible for the first part exam
1. Local TOEFEL with a score of at least 500
2. Computer courses in word processing, PowerPoint and internet
Trainees who passed these courses during their pediatric
fellowship training are not required to repeat it
Pediatric Oncology curriculum Egyptian Fellowship Board
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38
Components and structure of examination
The first part exam aims to test trainee's knowledge in module one of their cur-
riculum. The following themes are subject for the first part examination
1. Cancer biology
2. Pathology & molecular biology
3. Chemotherapeutic agents
4. Clinical Pharmacology
5. Epidemiology & Biostatistics
6. Basics of Surgical Oncology
7. Basics of Radiation Oncology
8. Radio-diagnosis
9. Basics of Cancer
Please revise the curriculum for details of topics and required learning outcomes
PART I examination consists of two papers:
Paper I (2 hours): Multiple choice questions with a single best answer format.
Paper II (2 hours): short answer and /or problem solving questions
Both papers will ensure coverage of the above-mentioned themes
The second part exam aims to test trainees' knowledge and skills in the whole
curriculum of pediatric oncology. In this exam, the scientific council will ensure
coverage of the whole curriculum.
Part II examination consists of four papers:
1- Two MCQ papers each two hours in duration
In both papers, facts, problem solving and management skills are going to
be assessed. You will choose one best answer in each question
2- Two short assay papers each two hours in duration
Questions will assess Trainees' knowledge about various pediatric oncol-
ogy problems and their management. In addition, it will test trainees' diag-
nostic and problem solving skills.
The structure of the first part exam
The structure of the second part exam
Pediatric Oncology Curriculum Egyptian Fellowship Board
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39
part III exam is a clinical and oral exam and is composed of the following compo-
nents:
Clinical exam
The clinical exam remains the most important part of the examination as the long
case evaluate the potential performance of the candidate in clinical practice while
short cases assess clinical examination skills in various system. Passing this compo-
nent of the exam independently is essential for certification.
Long Clinical Case : the candidate is observed in silence for the first part of the
examination by two examiners where he/she is taking the history from the parent
or the child and performing a physical examination and then The examiner asks
him to present his findings in the history and examination and discuss the manage-
ment of the case . Examiners give marks according to a predetermined weighting
of the components of the exam.
Short case examination: Each candidate examines 2-3 patients. The examiners
evaluate his abilities to correctly elicit and interpret physical signs or his abilities
to take focused clinical history. An agreed marking system is used to ensure objec-
tivity and fairness of the exam.
OSPE: A 10-20 station examination including radiological imaging/ laboratory
data results / photographs / cytogenetics or pathology slides, simulated patients
and procedural stations. Each station is five minutes and they test candidate diag-
nostic, interpretative, procedural, management and communication skills
VIVA: The oral exam is composed of two oral examination stations. Each station
is a committee of two examiners who will spend 20 minutes with the candidate (10
minutes for each examiner). They will test the candidates’ ability to manage vari-
ous pediatric oncological problems and explores his/her abilities for making sound
differential diagnosis. They will also assess his attitudes and interpersonal commu-
nication skills. the exam is based on a set of topics with opening and supplemen-
tary questions. The questions cards are prepared in advance together with the ex-
pected ideal answer and allocated marks. This allows a good objective basis for
marking.
The structure of the third part exam