Advice for Away Rotations

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Apr 27, 2006
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Any advice before starting away rotations? I have only rotated through my home department during which expectations were low, and I was essentially an observer...

-What can I do to be best prepared for Rad Onc rotations?
-What books would you recommend reading?
-What types of questions did attendings ask you?
-What was your role as a medical student?
-Anything you else you which you knew/had done before your electives??

Thanks for the help!

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p-indecise said:
-What can I do to be best prepared for Rad Onc rotations?

I would recommend a small, introductory text suited for students. Either the Red Book by Coia or try the Newer Evidence-Based Text by Hansen/Roach. I would become familiar with basic radonc physics and biology. Also before you see a pt with a specific type of cancer read the appropriate section in the text. If you're strapped for cash UptoDate (if your institution pays for a subscription) was also recommended for site-specific information.

-What types of questions did attendings ask you?
Be sure you know the pt's history inside and out. And go crazy on the physical exam (e.g. full neuro exam for brain tumors), the attendings like to see that you are thorough. Also know the most common "pearls" for each tumor site which can be gleaned from the above texts or UptoDate. If the attending has published extensively, it could be worthwile to scan a few of his latest review articles. All attending questions are related to the above issues for the most part.

-What was your role as a medical student?
Generally students play the biggest role in the physical exam/history. You will likely be sent in first as an initial "screen." Therefore the more releveant history and physical exam findings you find, the better off you'll be. If you are aggressive you will be included in all aspects of radonc from planning, "sims", follow-up care, on-treatment exams, etc.

-Anything you else you which you knew/had done before your electives??
Treat your fellow students w/ respect and kindness, the residents are watching. If the chief resident or other resident asks you if you'd like to attend a different clinic at the last minute due to manpower shortage, jump at the opportunity. Try not to be overbearing or "over-friendly."
All good ideas ...

Be very assertive and aggressive, but not in an annoying way. Get all the data you can, and be cunning if you need to be. At UT-SW, I did not have computer access during the first few days and because of that I didn't get a great H&P on a patient. Dr. Choy (a really great guy who intimidates the bejeezus out of me), the chairman, pretty much tore me a new one - he said I needed to be crafty, and should have asked the nurses to log me in (there were no residents at the time) or should have figured out a way to get logged in. Find out about new consults the day before. Look up their medical records, lab data, imaging. If there are films, review them beforehand, maybe even with a radiologist over the phone. Then, look up UpToDate and make sure you know the current therapy. Learn from a resident how to present a "cancer history" rather than a "medicine history".

Schedule time with the program director and/or the chairman. Let them tell you what programs they think are great, and let them sell theirs. Do this mid rotation, so you can also use it as an evaluation for what you can improve on.

I don't know how friendly you should get with people. I was very big on that, and I became friends with many residents and joked around a lot with attendings, went out with them, etc. I was pretty much myself the entire time. I think it made me look too casual the first year I applied, and I got neg'd for interviews at the two places I rotated at: Beaumont and UChicago. This is coming from a guy who brought a treat for a patient's grand-daughter today, mentioned the previous night's intoxication to my attending during rounds this AM, and still plays pranks on the nurses and other residents. Once you have the job, you can be yourself. Until then, be serious. Radiation oncologists are very serious people.

Present a one hour talk at the end of the rotation. Kick absolute a s s on it. And do something challenging. I came at Hak with his specialty - Non-Small Cell Lung Cancer, and he appreciated that I did a great job.

Well ... it's tough. I don't envy you. Most of you will make a great impression. It's so hard for the faculty to decide who to interview and who to actually hire. Stand out in a good way. Be assertive. Show a deep interest in the field. Be yourself, but if you are too extreme, i.e. a goofball like me or stiff as a corpse, try to go to midline.

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I agree with everyone else that your job as a medical student is to do a kick-ass job on H+P and then doing dictations. Find out who you are going to see the next day and do your reading ahead of time. It would be nice if you can read a Perez or Leibel chapter, but realistically it's very hard and too long for one night. When I was rotating, I used the Red Book by Coia, which is more concise. However, now that I know a bit more, I am realizing that it is very out-dated. Therefore, I actually would NOT recommend Coia. Same thing with Baby Perez, (the blue book edited by Chao) it's full of pearls and bullet points, but, in my opinion, not very helpful for beginners.

My recommendation is to read the NCCN clinical practice guideline, which can be found at You can even log on and request a free CD to be sent home! It'll tell you how to stage a patient and how you would work-up, treat, and follow-up that patient; most practical questions you will be asked. It's concise enough for one night (at least the part that pertains to your patient). It is much more up-to-date than any textbook you will find. For natural history and epidemiology, though, you will have to go back to your favorite textbook.

One advice, when you are discussing with an attending (and when dictating), try quoting one study that provides evidence for your therapy approach. It's not that hard to find if you read the NCCN guideline (remember you don't really have to read the whole article to quote it), and, boy, it's very impressive.

In addition to doing H+P and dictating, some attendings may invite you to do the contouring. If they don't, I would be proactive and ask if you can participate in planning even if it's just watching over their shoulder. I didn't do this because, frankly, I didn't know that treatment planning was such a large part of what rad oncs do. Not only will it show your enthusiasm, it will make your day much more interesting.

Unless you are paired with an attending one-on-one, do NOT kill yourself trying to see many patients. Instead, see one, maybe two, patient a day and do a good job. Attendings don't know you are working your butt off to see four patients a day, they just remember you didn't do such a good job on that one patient of his/hers. If you have some free time on your hand, DO NOT sit and read; reading is for when you get home. The last thing you want to do is to look bored. Instead, I recommend spending time with non-physicians such as physicists, rad biologists, dosimetrists and therapists to get more rounded exposure to the field. Advertise you are doing this ("I want to spend some time today with therapists to see how they set up patients."). I believe this actually reflects positively... unless you use it everyday to slack off.

Lastly, for the most part, you will be doing just H+P and dictation day-in-and-day-out. There is much more to rad onc than that! Don't be turned off by your rotation experience and think this is a boring field. Unless you really need adrenaline rush to get you going, this really is a fantastically interesting specialty.

Good luck.
all very good advice (i highly recommend uptodate and nccn- uptodate will let you know the importan articles and current thinking on a topic and nccn gives you algorhythms). Also kudos to simuld for his post- very honest post and very good insight into important personal factors. That will help someone a lot I'm sure.
Physics and radiobiology sections of coia are still OK, although the rest is outdated. I think it is helpful to try to read a bit about physics and radiobiology either before or during the first 1-2 days of your rotation. At least in my case, I felt that I learned much more after I understood some of the basics.
For a good review of epi/natural history of the malignancies, what to look for on physical examination, as well as basic management, I found the following to be very helpful:

It's a multi-d cancer handbook (available from that site in PDF format) that gives perspectives from med/surg/rad onc and is nicely divided into systems. It's written at an entry-level and even gives some citations for further reading. Coia is one of the authors, and it seems to be updated pretty frequently.