FRCR Part 2B (Oncology) - CO2B - assessment blueprint

Ability to communicate effectively with patients, eg, through:  

• Demonstrating effective communication with a patient via verbal and non-verbal interpersonal skills 
• Effectively gathering information through listening, exploration and follow-up questioning 
• Interaction to explain and deliver information, giving consideration to patient wishes and values/priorities 

Ability to communicate effectively with colleagues, eg, through:  

• Clear and concise presentation of cases and information 
• Communicating views and recommendations effectively; eg, as in a multidisciplinary team (MDT) situation 

A1. GENERAL COMMUNICATION: Verbal and listening skills, communication style, able to adjust behaviour and language as appropriate to the situation and able to gather information    

Definite pass: Clear, empathetic, patient-centred explanation. An appropriate level of confidence. Develops rapport. Active listening and responding to the patient. Appropriate non-verbal communication. Structured approach. 

Just pass: Clear explanation, appropriate language and body language/eye contact. Adequate communication but could be more concise. Some issues with confidence and rapport with patient/could engage with the patient more. 

Just fail: Does not introduce self or explain the role. Poor listening to the patient. Ineffective communication and salient points are not clear. May be over-confident and no rapport is established. Does not address all patient questions/concerns, limited ability to be flexible with discussion.  

Definite fail: Poor communication leading to misunderstanding. Talking over patient or arguing with patient. Poor non-verbal language. Unprofessional manner. Inappropriate or over-confident. Ignores patient questions/concerns. Uses jargon. 

A2. MANAGING CONCERNS: Explores patient concerns, demonstrates an understanding of patient wishes/values/priorities and addresses concerns within communication of information/plan. 

Definite pass: Fully addresses patient concerns, appropriate and realistic follow-up plan. Evidence of consideration of patient wishes/values/priorities without need for prompting. Active listening and displays interest. Checks knowledge and understanding. Displays empathy.  

Just pass: Listens to the patient and adequately addresses concerns raised with an appropriate management plan. Patient wishes/values/priorities are considered with some minimal prompting. Some attempt to identify concerns, some empathy. Minimal checking of knowledge 

Just fail: Inadequate, unsympathetic response, false reassurance. Patient wishes/values/priorities are considered after significant prompting. Does not attempt to identify concerns. Works to own agenda and does not show empathy. Cursory attempts to clarify knowledge.  

Definite fail: Argues with the patient. Promises something that they cannot deliver. Does not consider patient wishes/values/priorities. No attempt to identify concerns. No ability to show empathy. Didactic in approach. 

A3. EFFECTIVELY COMMUNICATING AN APPROPRIATE MANAGEMENT PLAN FOR THE SITUATION: Adopt language and behaviour appropriate to the situation, be able to assimilate information, identify the important elements and relay this in a concise and clear way. This includes conveying medical information correctly and appropriately to the patient in the scenario. 

Definite pass: Holistic patient-centred approach, adapts pace, amount and level of detail to patient’s needs. Able to explain and deliver information effectively and concisely. Use of appropriate language for the situation. Able to assimilate information. Allows opportunity for others to speak. 

Just pass: Considers patient needs and adapts information given accordingly. Able to explain and deliver information effectively, but not concisely. Mostly uses appropriate language. Not able to assimilate all information and may leave out some important aspects. Some interruption. 

Just fail: Provides an inappropriate level of detail and does not take into consideration the patient’s level of understanding. Use of medical jargon when speaking with the patient. Only occasional use of appropriate language. Does not adapt the information to the situation and misses cues. 

Definite fail: No attempt to adapt information given to the patient’s needs. Poor communication leading to misunderstanding. Not able to assimilate information and does not seek clarification. Frequently interrupts. Omits information, and/or gives inaccurate information. 

Ability to formulate an appropriate personalised management plan / strategy, eg, through:  

• Knowledge of current guidelines 
• Application of knowledge to the clinical context 
• Consideration of previous treatment 

Definite pass: Provides a comprehensive, clear, safe management plan which is appropriate to the patient balancing benefit and risk and taking account of factors such as co-morbidities, performance status, prior treatments etc. Good knowledge and application of current guidelines/SOC and able to adapt to the individual patient. 

Just pass: Appropriate, safe management plan. Mostly good knowledge of current guidelines/SOC but does not fully relate to patient’s co-morbidities or performance status. Considers previous treatment but requires some prompting to modify treatment.  

Just fail: Some aspects of clinical judgement are satisfactory but generally inadequate or unsafe management plan, misses important relevant points. Poor knowledge of current guidelines/SOC, needs prompting to consider individual patients. Not clear in reasoning. Considers previous treatment but does not modify proposed treatment sufficiently.  

Definite fail: Doesn’t provide a management plan at all. Poor/no knowledge of current guidelines/SOC and does not adapt to the individual patient. Treatment suggested unsafe. Does not take into account co-morbidities or performance status or prior treatments.  

Ability to safely and effectively plan, deliver and manage patients receiving a course of radiotherapy.

This covers three main themes:

1. Correct strategy – includes:

• Intent; eg, palliative / adjuvant / radical
• Modality; eg, electrons, superficial X-rays, standard MV photons
• Technique; eg, beam arrangement, VMAT
• patient set up / immobilisation; eg, couch position, bolus, vac bags, shells
• Imaging; eg, iv contrast
• Appropriate dose / fractionation
• Margins
• Nodal levels / regions to include

2. Target definition / drawing fields

• Uses diagnostic and planning imaging to correctly draw fields, target volumes and organs at risk (OARs).

3. Management of plan delivery – includes

• Alterations to patient positioning dependent on planning or patient factors (interaction with mould room team / radiographers)
• Planning scan problems (eg, rectal /, bladder volume)
• Assessment of planning statistics / DVHs / plan modification or selection
• On-set problems; eg, cone beam review, weight loss, poor patient compliance (eg, pain / anxiety)
• Toxicity review / management during treatment
• Managing gaps or modifying delivery due to patient factors

Most questions will test elements from all three of these themes and an overall domain score will be allocated using the guidance below.

(The ‘contouring station’ will focus specifically on the first two themes and candidates will receive separate marks for each)

See details below.

Strategy (C1)

Definite pass: Chooses suitable modality, set up and dose / fractionation with an appropriate description of technique (including aspects such as beam arrangement, electron energy or nodal levels to include).

Just pass: Overall strategy acceptable with only minor errors.

Just fail: Several errors that, when considered together, would lead to the possibility of inadequate treatment.

Definite fail: Major errors such as completely incorrect dose, modality or treatment plan that would not achieve the treatment goal.

Target definition / drawing fields (C2)

Definite pass: Outlines target and OAR volumes accurately. Has clear understanding and can justify decisions. Chooses appropriate beam arrangement and draws these correctly with suitable margins.

Just pass: Minor discrepancies but outlining broadly acceptable. Target and OAR volume definitions are acceptable but not ideal. Requires prompting to clearly justify/define volumes. Draws suitable beam arrangements but concern margins slightly wrong.

Just fail: Although the overall strategy is acceptable, sufficient errors in outlining to raise concern for confidence / competence in doing it in practice. Defines target or OAR volumes correctly up to a point but fails to complete. Limited knowledge of reasoning/justification for volumes. Beam arrangement that could be effective but where an alternative would be clearly better.

Definite fail: Major errors when defining target or OAR volumes. Inappropriate GTV/OAR coverage. Inappropriately defines target or OAR volumes or defines unsafe target or OAR volumes. Has no knowledge of reasoning or justification of the volumes.  Evidence of unsafe practice. Inappropriate beam arrangements.

Managing treatment delivery

Definite pass: Confidently manages issues related to treatment delivery with clear and effective advice to other staff groups (eg, planning team, mould room staff, radiographers) or patients. Knows when to modify treatment (eg, change patient position, re-plan) or how to manage toxicity.

Just pass: Unsure or hesitant but gets there with prompting. Small omissions in the candidate’s plan but overall decisions are correct.

Just fail: Several small errors or concerns about the ability to manage these issues.

Definite fail: Unsafe or clearly inadequate knowledge to make sensible decisions about a patient’s treatment. Making incorrect decisions about treatment delivery (eg, selects the wrong plan, continues when re-planning was necessary, risks treatment failure or unnecessary harm to the patient).

Ability to interpret data, eg.:  

• Clinical signs (from videos/photographs) 
• Bedside tests/Observations  
• Blood tests  
• Imaging (radiographs, CT scans, MRI scans, NM scans), including evaluation of digitally reconstructed radiographs and on-line portal imaging 
• Dose volume histograms (DVH) 
• Dose constraints, including colour washes and dose gradients. 

Definite pass: Clear, comprehensive and logical interpretation of a plan/DVH. Can justify why a plan is acceptable or not and identify how to improve. No prompting is required for image interpretation or clinical signs. Able to form a coherent, appropriate and comprehensive management plan with confidence.  

Just pass: Can interpret imaging and identify clinical signs with some prompting. Able to describe a DVH and can justify why a plan is acceptable or not. Able to form a management plan but some information missing. Lacks confidence in decision-making.  

Just fail: Unable to interpret imaging or identify clinical signs, despite prompting. Cannot clearly explain why a plan is acceptable or not. Assimilates information but is unable to clarify relevance. Cannot form a clear management plan.  

Definite fail: Unable to interpret imaging despite prompting. Repetitive incorrect identification of salient clinical signs. Misses significant OARs out of tolerance, hot spots or poor PTV coverage. Makes inappropriate or unsafe management plan leading to under/overtreatment.  

Ability to choose the right treatment, taking into account the holistic needs of individuals, giving consideration to patient values and priorities, eg, through:

• Taking into account modifications relating to patient factors (comorbidity, previous treatment etc)

• Considering patient preferences in the choice of treatment
• Recognising the need for tailored support for specific and/or vulnerable groups
• Understanding and showing sensitivity to issues of equality and diversity.

Definite pass: Holistic, empathic approach. Adapts communication and management plan accordingly. Confidently able to choose the right treatment taking into account the needs of the individual, giving consideration to patient values/priorities. Appropriate adjustment/modification and explanation of management plans

Just pass: Considers patient’s needs/wishes appropriately. Able to choose the right treatment but some hesitation or no / poor explanation of decision. Does not fully assess patient needs or fully relate management plan to patient/carer.

Just fail: Does not listen to the patient or take into consideration important issues (eg, performance status/co-morbidities/patient wishes). Chooses unacceptable treatment.

Definite fail: Suggests unsafe, inappropriate or unethical management plan. Doesn’t adapt to the patient at all. Chooses unacceptable treatment, does not explore holistic needs of individuals. Or ignores the holistic needs of individuals.

Ability to effectively prescribe, and manage patients receiving, SACT, eg, through:  

• Selecting the most appropriate SACT regimen 
• Prescribing SACT safely and accurately  
• Evaluating toxicity and response and adapting SACT accordingly. 

Definite pass: Knowledgeable of SACT protocols. Confidently able to prescribe for and manage patients receiving SACT. Able to apply appropriate modifications for co-morbidities, performance status and tolerance to treatment. Manages toxicity appropriately and understands potential serious complications. 

Just pass: Has knowledge of SACT protocols but knowledge not secure. Able to prescribe for and manage patients receiving SACT but with some hesitation. Able to modify regimens according to co-morbidities and performance status but lacks confidence or in-depth knowledge or requires some prompting. Gaps in knowledge of toxicity and management. Misses some minor points 

Just fail: Significant gaps in knowledge of common SACT regimens. Able to prescribe SACT for the patient but fails to modify SACT leading to unsafe dosing. Inadequate management of toxicity, does not adjust dose correctly. Fails to recognise significant toxicity. 

Definite fail: Minimal knowledge of SACT regimens. Fails to recognise required modifications for co-morbidities or performance status. Unsafe and makes dangerous decisions. Poor knowledge of toxicity and management.