1. Training should encompass experience with a broad range of malignancies and an understanding of the place of appropriate methods of investigation, assessment and management. Trained medical oncologists may take their place with radiation oncologists, surgeons, and other health care professionals in multidisciplinary programs to ensure optimal patient outcome.
    
2. Trainees are expected to understand:
   • the biology and natural history of malignant disease;
   • the management of all stages of common tumours;
   • the current specialist literature; relevant techniques of clinical research;
   • relevant techniques of clinical research.
     
3. Trainees shall:
   • gain an understanding of the importance of a multi-disciplinary approach to the management and treatment of malignant disease;
   • acquire knowledge of the nature, pathology, natural history and epidemiology, and genetics of human malignant disease;
   • gain experience in the methods of investigation and management of patients with potential or proven malignancy, including screening for early detection, and diagnosis by appropriate methods including clinical examination, pathological techniques and imaging procedures;
   • gain an adequate understanding of the pharmacology, pharmacokinetics, use and side effects of antineoplastic drugs (including cytotoxics, hormonal therapies and biological agents);
   • be proficient in the prevention and treatment of the complications of malignant disease;
   • obtain experience in the supportive management of cancer patients including rehabilitation and symptom palliation with particular emphasis on psychological and social support;
   • achieve a high level of communication skills;
   • gain an understanding of the role of radiotherapy in the management of patients with cancer;
   • gain an understanding of haematology practice with special reference to the haematological side effects of treatments, the management of haematological malignancies, and the use of high dose chemotherapy and marrow/stem cell rescue;
   • be familiar with the role of curative and palliative surgery in the management of patients with malignancy;
   • gain experience in the development of new agents including protocol development and implementation;
   • develop an understanding of the appropriate methods of statistical design and analysis. This should enable the trainee to evaluate research reports with an appropriate depth of understanding;
   • recognise the particular legal, ethical and moral circumstances surrounding the management of patients with malignant disease.
4. Trainees are strongly encouraged to undertake training in more than one institution to enable them to acquire a sufficient breadth of exposure and experience. In some instances it may not be possible to complete core training in a single institution. For example, some sites are only accredited for 12 months of core medical oncology training.
    
5. Trainees are required to spend a minimum of 12 months of core training at a site accredited for core medical oncology training in Australia or New Zealand. Proposals to undertake training overseas will be assessed prospectively on an individual basis.

Components of Training
Core Training
Core clinical training consists of 24 months in medical oncology and directly related areas.

Trainees are required to spend at least 18 months in approved medical oncology departments but the SAC would encourage longer periods if possible. During this time the trainee should be exposed to patients with a range of common tumours and be responsible for their management under supervision. It is expected that this should involve a mix of inpatients and outpatients. It is recognised that changes in medical practice may make experience in some of these sites difficult to obtain. However, experience can be obtained in situations such as privatised clinics and out reach programs to compensate for any deficiencies. A supervisor's report from an appropriate supervisor, indicating satisfactory completion of the medical oncology component, is required by the SAC.

The SAC may consider up to 6 months of core clinical training in related areas, including haematology, palliative medicine, or radiation oncology. Trainees should contact the Coordinator of Advanced Training for advice in advance of applying for approval of training if they are considering this option.

It is desirable for trainees to have sufficient understanding of radiotherapy to know its role and limitations in various clinical situations, including:

• an understanding of the basic principles of radiobiology;
• an understanding of the basic principles of radiation physics;
• an understanding of the simulation and planning process;
• an understanding of the clinical role for palliative radiotherapy;
• a knowledge of indications for radical radiotherapy;
• management of radiotherapy side effects;
• management of patients undergoing combined chemotherapy/radiotherapy (New Zealand).
  

Similar considerations apply to experience in haematology, especially with the development of protocols involving high dose chemotherapy with stem cell rescue.

Trainees should also obtain similar knowledge of and experience in palliative medicine including knowledge of the pathophysiology and pharmacology of pain, constipation, nausea and vomiting, and other common symptomatic problems. There should be an understanding of the role of the community team and hospice in the management of the terminally ill and the workings of the multi-disciplinary team.

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