Clinical oncology is the non-surgical management of malignant disease, using both radiotherapy and systemic therapy (chemotherapy, hormone therapy and biological agents). Managing cancer in all its various forms requires an enquiring mind, a secure general medical background, good practical skills and a real commitment to patient care.
There is a uniqueness about patients with malignant disease that is powerfully motivating to cancer specialists. Training has never been better or more closely supervised and the potential for effective and enlightened management of cancer is enormous at a time when research is at last helping us to understand the biology of malignant disease and develop novel effective treatments.
Clinical oncology specialty training begins after Core Medical Training (CMT) and MRCP Part 1 is an essential requirement for entry; MRCP Part 2 is desirable. Applicants are advised to obtain some experience in clinical or medical oncology or palliative care during their pre-specialty training but this is not mandatory.
There are 13 clinical oncology training schemes in England, as well as schemes in Wales, Scotland and Northern Ireland. All follow the same curriculum and deliver structured training in cancer basic sciences and the management of malignant disease. During training, most trainees rotate from the main (base) hospital to other hospitals in order to gain a wide experience of practice.
Clinical oncology is a very clinically focused specialty, with much of the working week spent in direct patient contact in outpatient clinics, in the radiotherapy department, and on the wards. In addition, at least one session per week is spent in the technical planning of radiotherapy for individual patients. However, the challenging nature of malignant disease means that referencing and contributing to research through clinical trials or translational research is integral to patient management. A period of time in research during training is encouraged and may lead to a higher degree. Teamwork is very important; most clinical oncologists work as part of a multidisciplinary team of specialty nurses, radiographers, physicists, surgeons and other clinicians, all of whom must integrate and communicate effectively. Good communication skills are vital, both to patient management and to teamworking.
During specialty training, the Fellowship Examination of The Royal College of Radiologists (FRCR) must be attained. The First FRCR Examination covers the cancer basic sciences of medical physics, medical statistics, radiobiology, cell biology and clinical pharmacology. It is usually taken after a year of specialty training. Most trainees are ready to sit the Final FRCR Examination two years later having learnt the basic management of most common and some less common malignant diseases. The final phase of training after the FRCR Examination allows the trainee to broaden and deepen his or her experience, and also provides time for research and gaining the management skills that are integral to a career as an NHS consultant. The indicative total duration of training is five years (or the whole-time equivalent if training is undertaken on a less than full-time basis).
Competition for clinical oncology training posts is similar to that for most medical specialties. Prospective trainees are advised to:
- Get a good CV as a medical student
- Consider taking an intercalated BSc to learn research and laboratory skills
- Gain a good grounding in general medicine and surgery during the Foundation Programme
- Get a place on a Core Medical Training (CMT) rotation, possibly including a placement in medical or clinical oncology or palliative medicine
- Do some clinical or medical audits
- Spend some time finding out about how the cancer services work in the UK
- Pass the MRCP examination.
Prospective trainees are encouraged to make contact with local clinical oncology trainees for further information and first-hand advice. Current trainees are also able to access the Oncology Registrars' Forum (ORF) web pages on the RCR website as a useful resource, containing information such as the 'Ideal Training Timetable' and 'Trainee Induction Pack'.