Oncology as a career Managing and treating patients with cancer Two distinct career pathways – medical and clinical oncology Medical oncology – use of chemotherapy and targeted agents + involvement clinical trials Clinical oncology – radiotherapy mainly but also some chemotherapy and trial involvement Don’t forget other specialties: haem/surgery/pall care

Good points to the job High degree of patient involvement and management Interesting and changing medical field – new developments occurring continually Many opportunities to be involved in research Rewarding

Advanced NSCLC Lung cancer: 1995 Platinum doublet chemotherapy 1 Best supportive care Median survival 7.9 months 1

Lung cancer: 2009 and beyond Advanced NSCLC gefitinib 5 Mutant EGFR NSCLC Median survival 24.3 months 6 Wild-type EGFR NSCLC Platinum doublet Chemo: not pem or bev 1 Pemetrexed 4 monotherapy Erlotinib 3 monotherapy Best supportive care Docetaxel 2 monotherapy Erlotinib 3 monotherapy Squamous NSCLC Non-Squamous NSCLC Pem-cisplatin doublet Chemo 7 / carbo/taxol± bev 8 Maintenance

Difficult points to the job High degree of patient involvement and management – can be intense! Can be emotionally stressful Hard work

Personal qualities which make it enjoyable Good communication skills Interest in academic medicine Enjoyment of working in multi-disciplinary teams Commitment to the specialty including hard work, both clinically and academically An ability to delegate and influence decisions as well as to make sound clinical judgements under difficult, emotional pressure

Average day as an oncology registrar Outpatient clinic – seeing new patients and patients undergoing treatment Prescribing and planning new chemotherapy / radiotherapy Ward based work – junior team + ward rounds / family discussions Managing queries on patients and treatment from day unit On-call overnight (from home)

My week MondayTuesdayWednesdayThursdayFriday Ward roundJournal club Lower GI clinic Upper GI MDM Upper GI clinic Course/adminWard round HPB clinicLower GI clinic Ward roundCourseAdmin

Medical oncology training pathway

Competition Consider carefully the likely levels of competition involved and to be prepared to be flexible about choices 2011: CLINICAL ONCOLOGY – ST3 national training numbers TOTAL:39951:2.4

Competition 2011: MEDICAL ONCOLOGY – ST3 national training numbers TOTAL:33921:2.8

Academic Clinical Fellowships 2013 in London/KSS Medical Oncology ST3+: – 3 posts: Imperial College London at Hammersmith Hospital (1 post) ICR and Royal Marsden (2 posts); UCL (1 post) Clinical Oncology ST3+: – 1 post: ICR and Royal Marsden

The chart above shows an expansion in the workforce since 1997, at an increasing rate of change during the past five years, and the supply of Medical Oncology consultants is forecast to increase during the next decade The Good News MEDICAL SPECIALTY WORKFORCE FACTSHEET

Academic training 2 pathways -Most medical oncology trainees complete PhD degrees -MSc. In oncology also during registrar years (everyone) -2 pathways -‘normal’ training number, OOP for MD/PhD -NIHR Academic Clinical Fellowship (ST3 onwards for medical oncology)

Academic Pathway Academic foundation programme in oncology FY 1 & 2 c c Core medical training + MRCP ST 1 & 2 Specialist training in oncology + specialist exam ST 3, 4 & 5 PhD or completion of training Not required for entry into later academic programme but an advantage N.B in some deaneries run-through programmes are available + Cambridge integrated system

Academic Training Academic training available in oncology in foundation years (FY1 and 2) Then can continue from ST3 after completing core medical training Designed to allow doctors to gain experience of research (though some already have experience Involves one block of 4months research in foundation years Then 3 months each year during specialist oncology training - (~3 available in London/yr) Designed to work up to starting a PhD (though most non-academics also complete PhD’s)

Building CV… FY/ST job in oncology/haematology Case reports Audit Poster presentations Clinics MRCP Trust oncology post

Our pathways Research degree prior to medicine, then academic medical oncology training ACF medical oncology ‘Normal’ registrar, taken time out for PhD Further info on academic programmes at programme-recruitment programme-recruitment cademic-training/vacancies/medical-oncology-st3- acf cademic-training/vacancies/medical-oncology-st3- acf-2001

Related links – Joint Royal Colleges of Physicians Training Board SpR/Pages/Oncology.aspx – London Deanery schools/medicine-and-medical-specialties – Association of Cancer Physicians – Academic training