Listen to our Medical Oncology Podcast Episode
In Career Conversations, Dr Kayani explains the differences between Medical and Clinical Oncology and shares his experience of training in this fascinating area of medicine.
Medical Oncology
Definition
Oncology is a division of medicine that provides treatment for cancer. In the UK it is divided into Medical and Clinical Oncology. Medical Oncology is focused on the provision of systemic treatments e.g. chemotherapy, immunotherapy, endocrine and other treatments.
Medical Oncology is a truly exciting speciality- it is a mixture of clinical work, research and teaching. All with patient care at the centre and is ever changing!
It involves managing patients across a wide age range (Paedatrics Oncology is a separate speciality) in both curative and palliative settings. A Medical Oncologist’s job involves diagnosing, communicating, prescribing and monitoring patients with an array of different malignancies.
Medical Oncology involves working in a Multi-Disciplinary Team (MDT) with a broad range of healthcare professionals- providing opportunities to learn and teach each other regularly
In the UK, 1 in 2 people born after 1960 will develop cancer in their lifetime and as life expectancy continues to increase the demand for Medical Oncology services will continue to increase.
How is Medical Oncology different and why did I choose it?
I was drawn to Medical Oncology due to the opportunities to help patients and their loved ones- receiving a diagnosis of cancer is life changing and brings much stress and anxiety. To be able to meet a patient, discuss their journey and form an individual, research-based treatment plan to meet their needs is very rewarding. To be able to answer patients’ questions and provide them reassurance- letting them know we are here and with them every step of the way is something patients are very grateful for.
Pros
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The opportunity to care for patients as part of a diverse MDT, ensuring each patients’ individual needs are addressed
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The ability to manage patients with the most up-to-date, evidence-based treatments in an ever-changing environment with regular clinical developments- every day is a school day!
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Caring for patients in a very difficult period of their lives- although this can be very challenging it can also be very rewarding
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The variety of clinical work across multiple hospital sites, reviewing inpatients and outpatients and being involved in complex and challenging cases.
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A lot for opportunity for teaching as many healthcare professionals are unfamiliar with treatment regimens and side-effects and research developments.
Cons
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Little procedural work
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Needing to find time to keep up-to-date with the latest research and clinical developments alongside clinical demands (never seems enough time!)
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Can be a steep learning curve at the beginning of training due to the unfamiliarity of many medications, treatment regimens and side-effects
Article Author
Dr Anna Chisholm - ST3.
"Although all specialities aim to help patients, Medical Oncology is a unique blend of research, communication, MDT working and teaching which makes every day varied and exciting!"
My top tips for applications in Medical Oncology
As with any speciality- getting involved and making sure it is the right speciality for you is key. Early engagement demonstrates interest and allows increased familiarity with the speciality as a whole. Many potential applicants may not have much experience in Medical Oncology prior to applying and that is acceptable as Oncology is often based at tertiary hospitals therefore less Foundation/ IMT placement opportunities.
Nonetheless, arranging taster weeks, completing Oncology-themed quality improvement projects and research then presenting at a regional or national conference, being involved in leadership and attending Oncology conferences and events will all help towards an application to Medical Oncology.
Healthcare professionals working in Oncology are normally very friendly therefore do get in contact and get involved!
Day in the Life of a Medical Oncology Registrar
Everyday can be very varied and can often involve working across multiple hospital sites. It can include:
- Ward review of any Medical Oncology inpatients
- Outpatient clinics sub-divided by tumour site e.g. breast
- Attending Multi-Disciplinary Team (MDT) meetings with healthcare professionals including: Surgeons, Clinical Oncologists, Medical Specialities (e.g. Respiratory/ Renal etc.) and Radiology
- Chemotherapy Unit Reviews of outpatients
- Involvement in teaching, quality improvement projects and research
In addition to above, on-call commitments can include: addressing queries from other specialities and other hospital sites, answering queries from community teams e.g. GPs and reviewing unwell Oncology patients. Often on-call commitments involve managing both Medical and Clinical Oncology patients.
Training Programme Overview
The curriculum for Higher Speciality Training in Medical Oncology was updated in 2021 with the Introduction of Internal Medicine Training (IMT). It is a 4-year programme, but less-than-full-time work is common meaning the duration of the programme is often extended.
Medical Oncology is a Group 2 speciality and therefore training is not combined with Internal Medicine, meaning on completion trainees are single accredited. This is in contrast to other medical specialities which are in Group 1 e.g. Cardiology, Respiratory etc. which result in dual accreditation.
In the first year, Medical and Clinical Oncology has a common stem training programme to allow trainees to gain experience of both specialities. After this, training focuses on Medical Oncology.
Trainees will rotate through tumour sites every x4-6 months (can vary depending on deanery) across different hospitals. During this time, trainees will become familiar with treatment regimens, guidelines, complications, side-effects and future research. Trainees are supervised throughout my experienced clinicians.
Trainees can take time out of programme for a range of reasons following discussion with their Clinical and Educational Supervisors and Training Programme Directors. This may be for, but not limited to: research opportunities, other clinical work or career breaks.
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Applicants would normally be in current employment nearing successful completion or have completed Internal Medicine Training (IMT) Stage One (2 years). Medical Oncology is a Group 2 speciality therefore does not require completion of the 3 year Internal Medicine Training. Applicants must have completed IMT Stage One training by the start date of commencement of Medical Oncology training.
Alternative approved routes include completion of: UK Acute Care Common Stem (ACCS), UK Broad Base Training (medicine route), UK Core Medical Training, Irish Basic Speciality Training in Medicine or Joint Royal Colleges of Physicians Training Board (JRCPTB) internationally level 3 accredited equivalent Internal Medicine Stage 1 Training programme.
Applicants may also be eligible with evidence of achievement of the capabilities required by completion of year 2 of the Internal Medicine Stage 1 at time of application via the Alternative Certificate pathway.
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Applicants must have passed MRCP Part One at time of their application and have full MRCP(UK) diploma by offer date.
Alternatively, applicants would have completed MRCP(I) diploma by offer date.
During training, trainees will need to pass MRCP(UK) Speciality Certificate Examination (SCE) in Medical Oncology.
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- Throughout, trainees will be expected to keep an ePortfolio detailing Supervised Clinical Events (SLEs) as well as other activities such as teaching and quality improvement involvement to meet the learning objectives set out in the Medical Oncology curriculum.
- This is the same portfolio used in IMT with similar SLEs such as Mini-CEXs and Case-Based Discussions. In addition, there re further requirements such as Direct Observation of Systemic Therapy (DOST) and Direct Observation of Radiotherapy Planning Skills (DORPS).
- Trainees will also be required to obtain anonymous feedback from members of MDT, including consultants yearly and patients twice during the training programme.
- Trainees will also need to show evidence of keeping up-to-date with clinical practice and involvement in research and clinical trials.
- Similar to other training programmes, yearly trainees ePortfiolos will be reviewed by an Annual review of Competence Progression (ARCP) panel to review trainees progress and help guide further development.
- Requirements of training
- Medical Oncology Curriculum
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Medical Oncology has a close link with academic research. Many trainees’ will take time out of their training to be involved in research, known as Time Out of Programme for Dedicated Research (OOPR) however this is not a requirement and will extend training length.
There are many research opportunities available and higher qualifications (Masters’ Degree or PhD) can often be achieved during this time.
