Resident Training Program
New York University Medical Center is a designated NCI Cancer Center comprised of New York University School of Medicine, The Tisch Hospital of New York University, The NYU Cancer Institute, and Bellevue Hospital. Tisch Hospital is a private voluntary hospital that opened in June 1963. Bellevue is the principal municipal hospital of the City of New York, located in a facility that opened in June 1976. The entire Medical Center complex stretches from 23rd to 34th Streets between First Avenue and the East River. It is close to Midtown Manhattan, including its theaters, museums, and department stores.
Approximately 1100 newly diagnosed cancer patients are seen annually in the Radiation Oncology Department by direct referral, and additional patients are seen at various interdepartmental conferences. The patient load provides a balanced and extensive experience in the management of malignant disease.
Why Two Hospitals?
Although located next to each other, Tisch Hospital and Bellevue Hospital attract different patient populations and thus provide the radiation oncology resident with a broader experience in the spectrum of malignant disease than is generally available at a single institution. All residents receive appointments to both hospitals and spend time at each institution. The patient population at Tisch Hospital reflects the population of a tertiary care medical center. Training includes a wide range of external-beam and brachytherapy techniques. Treatment planning is carried out with the aid of the department's two simulators: a conventional simulator with fluoroscopy and a CT-simulator. Both Tisch and Bellevue Hospital patients are simulated, planned and treated at the Tisch Hospital location. A full 3-dimensional reconstruction of the CT data set is loaded into our planning system, Eclipse, for virtual treatment planning. Additional imaging information such as MR may be registered with the CT and used in the planning process. There are 12 Eclipse stations located throughout the department and available for physician planning and review. The department has a varied treatment armamentarium including 3 linear accelerators (2 with variable photon energies and a range of electron energies) and a cobalt machine unit. An Eleckta Gamma Knife is used for stereotactic radiosurgery (SRS). (The Brainlab treatment planning system is used for both Linac-based SRS and fractionated stereotactic radiosurgery.) Brachytherpay, both low and high dose rate, is done with a range of isotopes, using both permanent and temporary techniques. Hyperthermia is available as well.
Bellevue provides both primary and tertiary care to a broad-based population. The Bellevue patient population tends to present with more advanced tumors that permit the resident to see the natural history of untreated disease and challenges the resident’s resourcefulness in terms of designing and implementing appropriate treatment plans. All treatment for Bellevue patients is given at Tisch Hospital. The proximity of the two hospitals enables the resident to move freely between the two.
Silvia Formenti, M.D., is Chairman of the Department of Radiation Oncology. The full-time attending staff physicians are Richard F. Cohen, M.D., Assistant Professor, Nelly Huppert, M.D., Assistant Professor, Stella Lymberis, M.D., Assistant Professor, Ashwatha Narayana, M.D., Professor and Residency Program Director, Nicholas Sanfilippo, M.D., Assistant Professor, Clinical Medical Director, Peter B. Schiff, M.D., Ph.D., Professor, Joshua S. Silverman, M.D., Instructor, Radiation Oncology, Mary Helen Barcellos-Hoff, Ph.D., Professor, Radiation Oncology and Cell Biology, Kevin Du, M.D., Ph.D., Instructor, Radiation Oncology, and Barry Rosenstein, Ph.D, Adjunct Professor; Radiation Oncology. The Physicists are Keith DeWyngaert, Ph.D., Associate Professor, Director of Physics, Associate Director of Technical Operations, Kerry Han, Ph.D., Gabor Jozsef, Ph.D, and Sunshine Osterman, Ph.D. The Radiation Biologist, Barry Rosenstein, Ph.D., Radiation Biology directs the radiobiology instruction. The attending staff has authored and co-authored a number of books and many articles dealing with cancer and radiotherapy. Since we accept a maximum of eight residents in all years of training, the ratio of attendings to house staff is high, and residents have the opportunity to work closely with the attendings.
The objective of the residency program in radiation oncology is to educate and train physicians to be skillful in the practice of radiation oncology and to be caring and compassionate in the treatment of patients. Residents spend 36 months in the clinical core curriculum of radiation oncology at NYU as well as one month in pediatrics and one month in brachytherapy at Memorial Sloan-Kettering Cancer Center. They receive exposure to oncologic pathology and are expected to engage in either laboratory or clinical research. Elective time is allotted to pursue subjects in depth. Residents master the necessary components of radiation physics and radiobiology, and they learn how to integrate radiation oncology into the multimodality approach to treatment.
At the start of each academic year, a series of didactic lectures attended by Radiation Oncology residents and Medical Oncology fellows introduces the basic concepts of oncology. These lectures are generally given from 1-2 PM during July and August. Attendance at these sessions is mandatory. The course covers major oncologic problems facing the oncologist and serves as an introduction to the natural history of various tumors as it pertains to the evaluation and treatment of patients. A broad overview of the role of radiation and chemotherapy in treating each of the tumors is presented. The talks also include practical information on the evaluation and treatment of common oncologic problems.
At the beginning of the academic year there is also a short series of lectures in medical physics, which serves to introduce the residents to this important aspect of training.
Physics Training (Faculty: Keith DeWyngaert, Ph.D.)
Satisfactory completion of a formal course in physics is expected of all residents. The physics staff conducts a series of lectures and laboratory experiences to give the resident an understanding of the physics of radiation oncology. Lecture notes are distributed and there are tests of residents’ performance during this course. There are homework assignments, and the residents’ performance during this course is evaluated. Residents take the RAPHEX exam annually.
Radiobiology (Faculty: Barry Rosenstein, Ph.D.)
Satisfactory completion of a formal course in radiobiology is required for all residents. Lecture notes are distributed, and there are tests of residents’ performance during this course.
Multidisciplinary Conferences & Tumor Boards
A variety of interdisciplinary clinical conferences of value to the resident are held at frequent intervals at the Medical Center. Attendance at these conferences aids the resident in learning the value of other treatment modalities in the care of the patient with cancer. To assure a broad and equitable exposure to these conferences, a schedule of mandatory attendance is created for the residents and distributed by the chief resident. During the full course of training, residents have the opportunity to attend each of the conferences.
The attending staff present didactic material to the residents throughout the academic year. Attendance is mandatory. Residents are also encouraged to utilize the "Practical Reviews in Oncology" for self study and self assessment. Review of these examinations in study groups organized by the residents is encouraged.
During the academic year, residents are assigned to prepare conferences. These cover a specific oncology problem, and residents are assigned a preceptor with whom they should review their topic outlines. The nature of the topic, site of disease and expected depth of the presentation are in keeping with the level of the residents training. The resident is required to discuss his/her topic during preparation of his/her presentation with members of the attending staff to gain guidance and advice about the material to be covered and format of the presentation. A formal evaluation of the presentation is done.
Time is available for electives in various oncology specialties, and additional time is available for rotations in medical physics. Residents are required to take 1-month "mandatory electives" in pediatrics and brachytherapy at Memorial Sloan-Kettering Cancer Center. Under some circumstances, residents may pursue other special training outside of the Medical Center. Such an elective must have a clearly defined educational goal that cannot be provided “in house.” All electives must be approved by the director of the program and the chairman of the Department.
The In-Service examination for residents in radiation oncology is given in March of each year. All residents are urged to take the test. The Department pays for each resident to do so and provides time during the course of the regular work week to take the test.
Each academic year, the chief resident coordinates a series of pathology rounds. These are held monthly, beginning at 7:30 AM, for the purpose of reviewing general oncologic pathology specimens. Residents also attend a monthly pathology lecture jointly with the Pathology residents. In addition, tumor specimen histology is presented by the Pathology staff at the various multi-disciplinary tumor boards. It is expected that the residents will review the individual specimens on each case they see with a member of the Pathology Department.
The American Committee on Graduate Medical Education (ACGME) requires residents in Radiation Oncology to engage in a research project during the course of training. The research project may involve a basic science or clinical study or may be directed to a physics or radiobiology question. Residents are encouraged to develop their own research proposal. Once the resident has selected his/her topic for research, the idea must be written out in the form of a proposal with accompanying supporting information: a summary of other work in the field, the relevance of the idea to oncology and a time table for completion. To allow sufficient time to complete the required project, residents are urged to select a topic during the first year of their training. This will allow time to conduct the research, analyze the data, prepare a manuscript and submit it for presentation at a national meeting and/or submit it for publication. Residents work closely with a faculty mentor during all steps of the research process.
The trainee is encouraged to participate in more than one research project although quality is stressed rather than quantity. The resident will be sent (with expenses paid by the program) to any meeting at which his/her work is accepted so that he/she may present the work.
Attendance at Meetings Outside of the Medical Center
During the course of the academic year a variety of oncology-related meetings are held in the New York metropolitan area. These include monthly meetings of the New York Roentgen Society, the New York Cancer Society and the Metropolitan Breast Society. Attendance at the monthly Monday evening meeting of the New York Roentgen Society is required. The Department pays for membership in this society. Residents are provided time to attend the Spring Meeting of the NYRS. Residents are sent to any meeting at which they have an abstract accepted. Residents in their last year of training are sent to the American Society for Therapeutic Radiology and Oncology meeting as a matter of course.