The 18 months of clinical rotations that comprise the surgical oncology fellowship provide extensive exposure to all areas of general surgical oncology. The faculty has expertise in treating patients afflicted with a wide range of malignancies, and the fellows reap the benefits of this experience. This is the cornerstone of surgical oncology fellowship. The Louisville fellows will encounter and treat many patients with complex malignancies in a close, personal setting and develop one-on-one relationships with the faculty. It is these relationships and autonomy that foster growth in judgment and clinical excellence. Each fellow gains extensive operative experience in breast, melanoma, sarcoma, liver, pancreas, esophagus, and other GI cancers while at the University of Louisville.

Following the completion of an initial 6-month period of intense basic science research, each fellow rotates through the three SSO-required rotations in medical oncology, radiation oncology, and surgical pathology. The purpose of these rotations is to provide intense exposure of the surgical fellow to the disciplines of oncology that he or she will work with during the multidisciplinary care of patients. When properly assembled, the multidisciplinary oncology team affords each patient with the best chances for a satisfactory outcome. Having each fellow rotate through these disciplines expands their repertoire, teaches them about the utilities of various chemotherapeutic agents and radiation techniques, and exposes them to the diagnostic challenges posed to the pathologist.

The remaining portion of the first year is relegated to a rotation on head and neck surgery, where the fellow will be exposed to cancers of the pharynx, mouth, tongue, and neck, as well as participate in the care of these patients. this experience is critical to the overall education of the surgical oncologist. Following this, a rotation on the endocrine surgery service exposes the fellow to a vast array of patients afflicted with endocrine diseases. Each fellow will become proficient in surgery of the thyroid and parathyroid glands, as well as treat many patients with adrenal and pancreatic endocrine tumors.

The second year of the fellowship consists of block rotations in the core general surgical oncology disciplines. Each block is designed to pair one fellow with one attending. This close relationship is unique among the surgical oncology fellowships, and it fosters a life-long relationship between the fellow and attending.

The experience gained on each rotation is unique. While on Dr Martin's service, the fellow will be exposed to a vast array of gastrointestinal, hepatic, pancreatic, and esophageal cancers. Dr. Chagpar directs the breast cancer effort at the University of Louisville, and the fellow on her service will become a master of modern breast oncology, including stereotactic breast biopsy, skin-sparring mastectomy, and the like. While on Dr. McMasters' service, the fellow will participate in the melanoma clinic, as well as operate on a vast array of GI and hepatobiliary cancer patients. Dr. Scoggins' service will provide the fellow with additional experience with liver and pancreatic cancers, GI cancers, melanoma, and sarcoma.

Since the fellow is paired with one attending, the fellow's day mirrors the attending's activities. If the attending is in clinic, so is the fellow. When operating, the fellow is doing the case. Attending research and academic days are also the fellow's research and academic days. This system instills excellence in each fellow and is the core of the fellowship.

Operative Experience
The surgical oncology fellows are exposed to a huge amount of cases while at U of L. Below is a sample of the cases performed by the Division of Surgical Oncology in one year.

Fellow's Clinic
The Division of Surgical Oncology at the University of Louisville believes in the value of early clinical independence. To that end, the division established the surgical oncology fellow's clinic. This clinic is a weekly clinic completely run and staffed by the second-year fellow.

The educational benefits provided by this clinic are unique and invaluable. The fellows independently evaluate and treat patients afflicted with cancer, while the attending staff is available for consultation and assistance. The clinic is fully functional, complete with nurses, medical attendants, equipment, and clinic space. This clinical effort has the full support of the Department of Surgery, the James Graham Brown Cancer Center, and the University itself.

The clinic is held weekly, and the fellow is completely in charge. The Friday afternoon timeslot is dedicated to this clinic, and each attending supports the fellow's clinical efforts fully. This is truly a unique opportunity, and one that the fellows cherish and learn from. The educational benefits are not limited to the direct care of these patients; the fellows also gain a knowledge of billing and coding, and medical systems management that most residency programs simply cannot provide, yet every practicing physician must know (and unfortunately, has to learn on-the-job).