A Graduate Medical Education Curriculum to Introduce the Concept of Cancer Survivorship.

Introduction: The growing number of cancer survivors has expanded the need for physicians familiar with survivorship care outside the subspecialty of oncology. However, primary care providers have historically not been comfortable managing the growing number of cancer survivors and their long-term sequela. To date, there is no current ambulatory curriculum designed as a workshop to discuss general concepts of cancer survivorship with internal medicine resident physicians. Methods: This was a 3-day workshop series given over 5 weeks. Residents were given a simulated case following a geriatric breast cancer survivor. Session 1 consisted of creating a survivorship care plan and discussing secondary cancer screening. Session 2 included a discussion on primary tumor recurrence and short-term side effects of cancer treatments. Finally, Session 3 incorporated mental health adjustment and long-term side effects of various cancer treatments. Knowledge and attitude assessments were administered during Sessions 1 and 3. Results: Eighty-seven residents participated, with 59 completing the survey on Session 1, and 36 completing the same survey on Session 3. Prior to the curriculum, two residents reported comfort in creating a survivorship care plan compared to 23 after the curriculum. Similarly, comfort in screening for excess mortality increased from three residents to 19. General knowledge of common side effects from cancer treatment modalities was well known prior to the curriculum. Discussion: Survivorship care heavily incorporates the basics of primary care. This curriculum successfully raised awareness among resident physicians regarding survivorship terminology, which, in turn, improved their comfort in the long-term management of the cancer survivor.

rugose (rg), a Drosophila A kinase anchor protein, is required for retinal pattern formation and interacts genetically with multiple signaling pathways.

In the developing Drosophila eye, cell fate determination and pattern formation are directed by cell-cell interactions mediated by signal transduction cascades. Mutations at the rugose locus (rg) result in a rough eye phenotype due to a disorganized retina and aberrant cone cell differentiation, which leads to reduction or complete loss of cone cells. The cone cell phenotype is sensitive to the level of rugose gene function. Molecular analyses show that rugose encodes a Drosophila A kinase anchor protein (DAKAP 550). Genetic interaction studies show that rugose interacts with the components of the EGFR- and Notch-mediated signaling pathways. Our results suggest that rg is required for correct retinal pattern formation and may function in cell fate determination through its interactions with the EGFR and Notch signaling pathways.