Clinical rotations are arranged on a 3-month block schedule. Each clinical rotation pairs the resident with one (rarely two) attending who has a team including a designated nurse and an administrative assistant. Each attending has a primary disease-site focus, but sees a small number of patients with other types of cancer as well. The resident focuses their reading and clinical learning, as well as their end of rotation oral exam, on the designated disease-site. Residents enjoy the depth and focused learning, while keeping up their skills in treating other disease sites.
The resident's activities include attending tumor boards, reviewing medical records and ensuring proper work-up has been completed, deciding the plan for treatment with the patient, and prescribing radiation. Starting the first day of residency, the resident is involved in treatment planning, from ensuring proper simulation, to contouring, and reviewing radiation plans. Residents work with the attending's team to provide continuity of care for their patients throughout treatment and follow-up.
Below is a sample clinical block schedule for an incoming resident.
Details of clinical experience by disease-site:
Our breast service includes patients with early stage patients post-lumpectomy, as well as post-mastectomy and a growing number of patients that have completed neoadjuvant chemotherapy. We deliver EBRT utilizing multiple options for cardiac avoidance including prone setup, DIBH, and heart blocks. We also have an interstitial brachytherapy program for partial breast piloted by Dr. Yashar, as well as a new Accuboost program.
Our GU service includes primarily prostate (definitive and post-op), bladder, and testicular cancer, with rare cases of penile and urethral cancer. Dr. Einck specializes in LDR seed brachytherapy, as well as HDR brachytherapy as a boost for select patients. Our prostate EBRT is exclusively IMRT. Our attendings and residents also play a critical role in deciding appropriateness of androgen deprivation therapy (ADT).
Our gynecologic service includes primarily cervical and endometrial cancer, but also vulvar and vaginal cancer. Our brachytherapy is HDR and includes both intracavitary and interstitial implants, done either in our clinic or the OR with the gyn onc surgeon. Our attendings pioneered IMRT for gyn cancer, which is our preferred modality for pelvic RT. Depending on their level of training and experience, residents are expected to run moderate sedation as well as the procedure, with close oversight from attendings.
Our lung/thoracic service includes primarily lung cancer (both NSCLC and SCLC), as well as thymoma and occasionally mesothelioma. Spearheaded by Dr. Sandhu, our department's lung SBRT program began in 2007, and is now a significant part of our treatment paradigm in early stage lung cancer, as well as oligometastatic disease, when appropriate and often on our institutional protocols. We utilize a frameless technique with 4D-CT imaging and gating when indicated.
Our GI service treats a substantial number of patients with esophageal, gastric, pancreatic, liver, and colorectal and anal cancers using 3D-CRT, IMRT, and SBRT as appropriate. San Diego has a particularly large HCC population, so in addition to GI tumor board, residents attend a special liver tumor board led by hepatology.
Our lymphoma service is one of the largest lymphoma programs in the country, due in large part to collaborations with medical oncology led by Dr. Sanghvi, including establishing tumor boards and survivorship programs at UCSD for these patients. We utilize primarily involved-site radiotherapy (ISRT) with DIBH to mazimize heart avoidance, but also have active programs in total skin electron therapy and TBI.
Our CNS service includes a variety of both malignant and benign tumors of the brain and spine. There is an emphasis on an understanding of imaging techniques, and their interpretation and use in planning. Techniques covered include hypofractionated therapy and SRS, when appropriate. Dr. Hattangadi's clinical research focus is in imaging, neurocognitive function and quality of life. Residents are exposed to multidisciplinary approaches including neurosurgery, neuropathology, neuropsychology and will work closely with our neuro-oncology colleagues.
Our head and neck service includes a variety of patients with tumors of the oropharynx, nasopharynx, larynx, hypopharynx, salivary gland, and thyroid. Clinical experience on this rotation includes regular nasopharyngoscopic exams to evaluate tumor at presentation and response to therapy.
Our pediatrics rotation was recently combined with proton therapy, given that the majority of our pediatrics patients now have access to protons for treatment, if indicated. This rotation includes attending tumor board at Rady Children's Hospital, and seeing children with a variety of malignancies, including leukemia, medulloblastoma and other tumors of the CNS, Wilms, neuroblastoma, Ewing's sarcoma, and lymphoma.
In San Diego there is a particularly high volume of skin cancer, allowing one of our research track attendings, Dr. Sharabi, to dedicate his primary clinical focus to this disease (including primarily BCC, SCC, melanoma and Merkel cell), which pairs with his research focus in immunotherapy and its interaction with radiotherapy.
UCSD has 3 satellite clinics, with residents routinely spending one block at either Encinitas or South Bay in their last year. This provides a more general, community approach to radiation therapy that enables more resident autonomy. Our clinic in South Bay is equipped with Xoft electronic brachytherapy due to their high volume of skin cancer.