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RESIDENT CORNER
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 552-553

Things I wish I had learned during residency-practical tips


Cancure Cancer Centre; Department of Medical Oncology, Narayana Multispeciality Hospital, Ahmedabad, Gujarat, India

Date of Submission04-Apr-2020
Date of Decision13-Apr-2020
Date of Acceptance10-May-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Rushabh Kothari
307, City Centre Arcade and Homes, Besides SRP Camp, Naroda Patiya Circle, Naroda, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_117_20

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How to cite this article:
Kothari R. Things I wish I had learned during residency-practical tips. Cancer Res Stat Treat 2020;3:552-3

How to cite this URL:
Kothari R. Things I wish I had learned during residency-practical tips. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 22];3:552-3. Available from: https://www.crstonline.com/text.asp?2020/3/3/552/295529



As a resident at any institute, one is protected by the established infrastructure, protocol, experienced consultants, and paramedical staff. The world outside the teaching institute is hardly the same. I took the leap from a resident to a consultant with a private hospital in August 2018, and feel lucky to have had 1 year of senior residency post DM.

At the time I joined the hospital, it did not have a Department of Medical Oncology. Therefore, my experiences may sound unfamiliar to those who have joined hospitals/institutes, where the department was already in place.

At my residency institute, peripherally inserted central catheter (PICC) line insertion was the norm for all infusional chemotherapy, as well as for many patients with hematological malignancies. PICC insertion and care would be performed by expert nursing staff. As residents, what we needed to do was to write “PICC counseling and insertion” on the green sheet of paper, and things would be done by the time we were back from the outpatient department (OPD). I hardly realized the importance of that precious intravenous (IV) access for oncology patients. It was during my periphery posting in the post-DM year that I realized its importance. Hence, during my last posting, I made sure that I was capable of inserting the PICC line myself.

Once I started practicing PICC line insertion routinely in the private hospital, I realized that PICC care was more important than insertions. I had struggled for 3 months and was disheartened at the sight of hanging PICCs, blocked PICCs, dirty dressings, irregular flushing, and the lack of sensitivity on the part of the patient as well as the nursing staff. At this point, I wished I had learned it earlier. Therefore, I first sensitized the nursing staff and anesthetists regarding the importance of IV access in oncology patients and the need to keep the PICC functional for months together. The next step was to counsel the patients and teach them the importance of PICC care, especially regular dressing and flushing. Another important step was to emphasize the importance of examining the chest X-ray after each PICC insertion. I am also planning to send three nursing staff for a month long training in PICC line insertion and care.

The second most ignored thing for me was arranging for social support for patients. I hardly remember any patients who were planned for curative intent therapy during my residency who missed out on treatment because of the lack of funds. There were ever-helpful social workers ready to cater to the patient's needs in each OPD. The situation in private practice, however, is very different. I had to refer out my first patient with acute promyelocytic leukemia because of the lack of funds. I knew that we could get funds from various trusts, corporate social responsibility programs, minister funds, etc., but I had conveniently ignored this process while in residency. I am yet to figure out how to approach this issue.

Multidisciplinary tumor board aka the “Joint Clinic (JC)” always fascinated me during residency. I am of the firm belief that multidisciplinary tumor boards are the best way to manage patients. Therefore, I, despite great resistance from other consultants, organized the first multidisciplinary tumor board at my institute. It was a very mixed experience. The first couple of cases went well, but later it appeared to me as if every specialty wanted to treat the same patient first, and there was some chaos about deciding the sequence of treatment. We then had tumor board meetings once or twice a month for 4–5 months, followed by a 6 months break for no bonafide reason. This made me realize that we needed an institute-specific protocol evolved through the combined efforts of all specialties for the management of each tumor. We also needed to shun egos and be adaptable and open-minded. We have now planned a biweekly tumor board beginning from the next month. My fingers are crossed.

Oncology is a fast-changing field, and treatment protocols keep changing often. The docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil perioperative chemotherapy was one of the changes which I found useful. I started this chemotherapeutic regimen in about five patients for 3 months. After their surgeries and follow-up, I considered it a good idea to compare the new treatments with the older protocols and analyze the outcomes. Then came the wakening ccall: we did not have the electronic medical records of the patients, and there was no way to retrieve even their basic data. I could only hope that all the five patients come for their follow-ups on time; fortunately, 4 out of 5 did, but the 5th one was lost to follow-up. Realizing that things could have been the other way round, I persuaded the authorities to appoint a coordinator to manage the patient data at least in Google sheets. Maintaining records for the basic demographics, staging, treatment pattern, response rate, progression-free survival, and overall survival is not difficult even in private practice. These data are most important for self-evaluation and better patient care.

To identify qualified personnel delivering ancillary services is a daunting task. Radiologists, pathologists, molecular pathologists, genetic counselors, palliative care physicians, psychiatric counselors, etc., are assets that are undervalued during the residency, but one realizes the vacuum outside. Delivering oncology services is easier than managing ancillary care, even in the metros.

I have tried to elaborate on the major hurdles I have faced during the past 18 months. I hope to prevent the next batch of residents from having the same regrets that I have.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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