scholarly journals Opportunities for Maintenance of Certification to Better Reflect Scope of Practice Among Medical Oncologists

2020 ◽  
Vol 16 (8) ◽  
pp. e641-e648
Author(s):  
Jonathan L. Vandergrift ◽  
Bradley M. Gray ◽  
Brendan J. Barnhart ◽  
Lorna A. Lynn ◽  
Rebecca S. Lipner
Keyword(s):  
Breast Cancer ◽  
Internal Medicine ◽  
Solid Tumors ◽  
Medical Oncology ◽  
Hematologic Malignancies ◽  
Scope Of Practice ◽  
Certification Examination ◽  
Maintenance Of Certification ◽  
Narrow Scope ◽  
Medical Oncologists

PURPOSE: Critics argue that the American Board of Internal Medicine’s medical oncology Maintenance of Certification examination requires medical oncologists with a narrow scope of practice to spend time studying material that is no longer relevant to their practice. However, no data are available describing the scope of practice for medical oncologists. METHODS: Using Medicare claims, we examined the scope of practice for 9,985 medical oncologists who saw 8.6 million oncology conditions in 2016, each of which was assigned to 1 of 23 different condition groups. Scope of practice was then measured as the percentage of oncology conditions within each of the 23 groups. We grouped physicians with similar scopes of practice by applying K-means clustering to the percentage of conditions seen. The scope of practice for each physician cluster was determined from the cancers that encompassed the majority of average oncology conditions seen among physicians composing the cluster. RESULTS: We found 20 distinct scope-of-practice clusters. The largest (n = 6,479 [65.5%]) had a general oncology scope of practice. The remaining physicians focused on a narrow scope of cancers, including 22.6% focused on ≥ 1 solid tumors and 11.9% focused on hematologic malignancies. The largest focused cluster accounted for 7.7% of physicians focused on breast cancer. CONCLUSION: A single American Board of Internal Medicine Maintenance of Certification assessment in medical oncology is most appropriate for approximately 65% of certified medical oncologists’ practices. However, the addition of assessments focused on breast cancer and hematologic malignancies could increase this figure to upwards of 85% of certified medical oncologists.

Optimizing internal referrals within an academic breast oncology practice.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 48-48
Author(s):  
Jamie L Carroll ◽  
Stephanie L. Amundson ◽  
Tufia C. Haddad ◽  
Karthik Giridhar
Keyword(s):  
Breast Cancer ◽  
Internal Medicine ◽  
Review Process ◽  
Medical Oncology ◽  
Clinical Information ◽  
Breast Cancers ◽  
Breast Clinic ◽  
Medicine Clinic ◽  
Oncology Practice ◽  
Internal Medicine Clinic

48 Background: Improving new patient access to medical oncology clinics is a priority. Unlike external referrals which undergo a review process, internal referrals (from any Mayo department or community-based, affiliated health system) are scheduled directly. At times, these internal referrals lack necessary clinical information, or may be more appropriate for electronic consultation (e-consult). This impacts the patient experience, provider satisfaction, and access to new patient visits. A pilot program was implemented in the Medical Oncology breast clinic to review new internal referrals prior to scheduling. Methods: In 2018, all internally referred patients to Medical Oncology breast clinic were reviewed by an advanced practice provider in breast oncology. Electronic medical records were reviewed to collect diagnosis, pathology, radiology information and treatment to date. Internal referrals were either accepted directly to medical oncology breast clinic, triaged to an internal medicine clinic for workup of a new breast mass, converted to an e-consult, or declined as no medical oncology need was identified. Results: 52 patients were referred internally to Medical Oncology breast clinic. Of these, 29 (55.8%) were accepted directly as new consultations, 8 (15.4%) were triaged to the Internal Medicine clinic, 6 (11.5%) were converted to e-consults, and 6 (11.5%) were declined as not requiring breast medical oncology input. Of the 8 patients that started in the IM clinic, 6 eventually required Medical Oncology breast clinic consults for invasive breast cancers. The most common e-consult was for extending adjuvant endocrine therapy (3/6). 1/6 e-consults required a follow up consultation. The most common reason for declining a consult was no diagnosis of an invasive breast cancer (4/6). A total of 16/52 referrals (30.2%) did not require a breast oncology new consultation. Conclusions: Review of internal referrals improved the efficiency of new breast cancer medical oncology consultations. This review process has been implemented across the entire Medical Oncology practice.

Development and Implementation of a Medical Oncology Quality Improvement Tool for a Regional Community Oncology Network: The Fox Chase Cancer Center Partners Initiative

2007 ◽  
Vol 5 (9) ◽  
pp. 875-882 ◽  
Author(s):  
Margaret A. O'Grady ◽  
Elena Gitelson ◽  
Ramona F. Swaby ◽  
Lori J. Goldstein ◽  
Elaine Sein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Quality Assurance ◽  
Quality Improvement ◽  
Medical Oncology ◽  
Cancer Center ◽  
Community Oncology ◽  
Medical Oncologists ◽  
Disease Site ◽  
Mean Compliance

Fox Chase Cancer Center Partners (FCCCP) is a community hospital/academic partnership consisting of 25 hospitals in the Delaware Valley. Originally created in 1986, FCCCP promotes quality community cancer care through education, quality assurance, and access to clinical trial research. An important aspect of quality assurance is a yearly medical oncology audit that benchmarks quality indicators and guidelines and provides a roadmap for quality improvement initiatives in the community oncology clinical office setting. Each year, the FCCCP team and the Partner Medical Oncologists build disease site- and stage-specific indicators based on National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Concordance with multiple indicators is assessed on 20 charts from each community practice. A report for each FCCCP medical oncology practice summarizes documentation, screening recommendations, new drug use, and research trends in a particular disease site. Descriptive statistics reflect indicators met, number of new cases seen per year, number of disease site cases from tumor registry information, and clinical trial accrual total. Education and documentation tools are provided to physicians and oncology office nursing staff. The FCCCP Clinical Operations Team, consisting of medical oncologists and oncology-certified nurses, has conducted quality audits in medical oncology offices for 7 years using NCCN-derived indicators. Successful audits comprising gastric, colorectal, and breast cancer have been the focus of recent evaluations. For the 2005 stage II/III breast cancer evaluation, mean compliance per parameter was 88%, with 15 of 16 practices achieving mean compliance greater than 80%. A large-scale quality assurance audit in a community cancer partner network is feasible. Recent evaluation of localized breast cancer shows high compliance with guidelines and identifies areas for focused education. Partnership between academic and community oncologists produces a quality review process that is broadly applicable and adaptable to changing medical knowledge.

The Birth of the Subspecialty of Medical Oncology and Examples of Its Early Scientific Foundations

2010 ◽  
Vol 28 (22) ◽  
pp. 3653-3658 ◽  
Author(s):  
Pierre R. Band
Keyword(s):  
Breast Cancer ◽  
Internal Medicine ◽  
Acute Leukemia ◽  
Medical Oncology ◽  
Clinical Importance ◽  
Disease Free Survival ◽  
Clinical Program ◽  
American Society ◽  
Childhood Acute Leukemia ◽  
Short Time

“Passion is not accepting defeat.” —Emil Frei III In the early 1950s, an experimental and clinical program characterized by unique cross-fertilization was developed. The clinical importance of experimental animal models in drug screening and in establishing key chemotherapy concepts and the role of the pioneers of medical oncology in the design of the various phases of drug trials, using childhood acute leukemia and breast cancer as models, are discussed. Over a short time and with only a few drugs, principles of chemotherapy were laid out, which led to cures in such diseases as childhood acute leukemia and Hodgkin's disease and to improved disease-free survival in breast cancer. It is these and other achievements that paved the way to medical oncology. At the instigation of the American Society of Clinical Oncology (ASCO), the American Board of Internal Medicine made inquiries about a subspecialty in oncology. ASCO and B. J. Kennedy, MD, played key roles in the events leading to the official recognition of medical oncology as a new subspecialty of internal medicine in 1972.

Preparing for the ABIM Examination

2013 ◽  
pp. 1-8
Author(s):  
Robert D. Ficalora
Keyword(s):  
Internal Medicine ◽  
Certification Examination ◽  
Test Taking ◽  
Maintenance Of Certification

Since 2006, more than 7,000 individuals per year have taken the ABIM initial certification examination, and between 3,000 and 5,000 individuals per year have taken the Maintenance of Certification (MOC) examination. This chapter has the following goals: review the content and format of the American Board of Internal Medicine (ABIM) examination, provide strategies for preparation for the examination, and give suggestions on how to utilize techniques to improve test-taking skills.

scholarly journals Guide to diagnosis and treatment of breast cancer

2020 ◽  
Vol 3 (1) ◽  
pp. 8-16
Author(s):  
Alexandru C. Grigorescu ◽  
Silvia Moşoiu
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
National Health Insurance ◽  
Medical Oncology ◽  
Case Analysis ◽  
Tumor Board ◽  
Evidence Based ◽  
Medical Oncologists ◽  
Cancer Specialists ◽  
Therapeutic Possibilities

The guide is addressed to medical oncologists who, ac­cor­ding to the European Society of Medical Oncology (ESMO), are “cancer specialists” who follow the patient and the tra­jec­tory of his disease from diagnosis to the end of his life. Like any guide, it cannot cover all situations that arise in practice. Therefore, it does not replace the case analysis per­formed in the tumor board or in the clinical sections. The guide brings together evidence-based guidance re­com­mended by ASCO and ESMO. Medicines that have not yet been reimbursed in Romania are reported. The re­com­mendation is that, in order to establish the the­ra­peu­tic plan of a patient, the protocol of the National Health Insurance House should be consulted in order to reconcile the theoretical therapeutic possibilities with those possible in our country.

The Brigham Intensive Review of Internal Medicine

2014 ◽  
Keyword(s):  
Internal Medicine ◽  
Study Guide ◽  
Certification Examination ◽  
Maintenance Of Certification ◽  
Online Resource ◽  
Practice Review ◽  
Review Course ◽  
Board Review ◽  
Learning Points ◽  
Comprehensive Study

Based upon the popular review course from Harvard Medical School, this online resource is a comprehensive study guide for the American Board of Internal Medicine certification or maintenance of certification examination, as well as for general practice review by physicians and residents. Authoritative and thorough, it provides in-depth coverage across all specialties of internal medicine, including endocrinology, neurology, hepatology, rheumatology, gastroenterology, and more. It features numerous tables and figures, and detailed discussions with emphasis on essential learning points. It features over 350 board review questions, numerous tables and figures, detailed discussions with emphasis on essential learning points, and there is a further section dedicated to board simulation.

The Board Examination

2012 ◽  
Author(s):  
Amit K. Ghosh
Keyword(s):  
Internal Medicine ◽  
Diagnosis And Treatment ◽  
Certification Examination ◽  
Board Examination ◽  
Maintenance Of Certification ◽  
Broad Domain ◽  
Certifying Examination

This chapter is aimed primarily at candidates preparing for the American Board of Internal Medicine's (ABIM's) certifying or maintenance of certification examination in internal medicine. However, candidates preparing for non-ABIM examinations also may benefit from the information, which covers various aspects of preparation for an examination, strategies to answer the questions effectively, and avoidance of pitfalls. The ABIM has stated that the certifying examination tests the breadth and depth of a candidate's knowledge in internal medicine to ensure that a candidate has attained the necessary proficiency required for the practice of internal medicine. According to the ABIM, the examination has 2 goals: the first is to ensure competence in the diagnosis and treatment of common disorders that have important consequences for patients, and the second is to ensure excellence in the broad domain of internal medicine.

Nonhematologic neoplasia in biallelic BRCA2 mutated Fanconi anemia.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10041-10041
Author(s):  
Vasant Chinnabhandar ◽  
Todd E DeFor ◽  
Rebecca Tryon ◽  
John E Wagner ◽  
Margaret L MacMillan
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Solid Tumors ◽  
Fanconi Anemia ◽  
Malignant Tumors ◽  
Brca2 Mutation ◽  
Hematologic Malignancies ◽  
Cancer Surveillance ◽  
History Of ◽  
Brca2 Mutations

10041 Background: Fanconi anemia (FA) is a cancer predisposition disorder. Affected individuals do not tolerate conventional doses of chemotherapy or radiation well. Biallelic BRCA2 mutations cause a rare (̃3%) form of FA. Most patients with this subtype have a family history of breast cancer and die in early childhood. Optimal management remains uncertain. Herein, we report the world’s largest single center cohort of biallelic BRCA2 patients, with a focus on non-hematologic malignancies. Methods: The University of Minnesota’s prospectively maintained FA database was analyzed for data on biallelic BRCA2 mutated FA patients. IRB-approved consent was obtained for all subjects. Results: Twenty patients with biallelic BRCA2 were identified. Median age of FA diagnosis was 1.5 years (range: 0-16.2 years). All patients had a significant history of cancer in the family with breast cancer being particularly frequent (65%). Eight (40%) patients developed non-hematologic neoplasia before 18 years of age. These included 10 malignant tumors and 4 benign neoplastic lesions; 3 patients had more than one solid tumor (see Table). Surgical resection was attempted in all malignant tumors, dose reduced adjuvant chemotherapy was utilized in 5 cases and radiation in one case. Thirteen (65%) patients developed hematologic malignancies (AML=6, ALL=3, MDS=4), all without preceding marrow failure. Fourteen patients underwent allogeneic HCT. Eleven patients have died, 3 from solid tumors and 5 from leukemias. Nine patients are currently alive, of whom 3 are post-HCT. Only 4 (age range: 6.5-16.3 years) patients in the cohort remain free of any oncologic diagnoses. Conclusions: Patients with FA due to biallelic BRCA2 mutations have a unique phenotype with an extraordinarily high risk of early-onset de-novo acute leukemia and solid tumors, often both diagnosed in the same patient. They require extensive, lifelong cancer surveillance from an early age to optimize outcomes. Therapy for malignant diagnoses should aim to minimise exposure to genotoxic / crosslinking agents and radiation. BRCA2 mutation testing in family members and appropriate genetic counselling is essential. Additionally, a family history of BRCA2 mutated cancers should prompt FA testing in offspring with any relevant FA-related clinical findings. Nonhematologic neoplasia and therapy.[Table: see text]

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