Musculoskeletal Oncology Fellowship

The Musculoskeletal Oncology Fellowship at Vanderbilt University Medical Center began in August 2006. The year-long fellowship, based entirely at Vanderbilt University Medical Center, is designed for one fellow – to best maximize her or his educational opportunities and professional growth. Teaching faculty include Program Director Ginger E. Holt, MD, Herbert S. Schwartz, MD, Jennifer L. Halpern, MD and Joshua M. Lawrenz, MD. 

The overriding goal of the program is to foster the evolution of the academic musculoskeletal oncologist – a physician armed with the surgical confidence and clinical acumen to deliver the best care in a thoughtful, evidence-guided manner. That goal mandates that the fellow’s experience is shaped by the following components: 1) high surgical volume and high complexity of cases in which the fellow plays an integral technical role, 2) clinical experience that emphasizes thorough and meticulous history taking, physical examination, multi-disciplinary analysis (radiology/pathology) of patients, 3) research opportunities centered around support of innovation and of evidence-based approaches, and 4) leadership roles – teaching residents and organizing multi-disciplinary panels to generate treatment algorithms for patients.

We encourage interested applicants to apply to the fellowship through the ACGME Fellowship Match process. We take pride in educating the future leaders in our field. 

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Left to right: Joshua M. Lawrenz, MD; Ginger E. Holt, MD (Program Director); Herbert S. Schwartz, MD; and, Jennifer L. Halpern, MD.

  • The fellowship contains four critical components within the educational experience:

    Surgical Intelligence. One of our most common observations is that we have never seen the same case twice. A musculoskeletal oncologist requires expertise in anatomy, understanding of tumor biology, creativity in consideration of post-resection reconstruction options, and humility. Those characteristics can only be fostered through exposure to a significant volume of complex cases. The Vanderbilt Musculoskeletal Oncology Group is the 4th busiest orthopaedic oncology group in the country. We operate on extremities, the pelvis, retroperitoneum, spine and chest wall. We operate on children and adults. We surgically treat both bone and soft tissue sarcomas, metastatic bone and soft tissue disease, pathologic fractures, and metabolic bone disease. In the operating room, the fellow typically works directly with an attending, thereby gaining firsthand technical experience and mentoring.

    Clinical Acumen. While some clinical decisions are mandated by a given diagnosis, there are many instances in which deciding who needs surgery and who does not is a difficult dilemma. In the clinic, a robust assessment of each patient is a critical part of delivering excellent care. The patient’s story often illuminates a diagnosis. Critical analysis of radiographic imaging and pathology slides (tissue analysis) is required to generate a reasonable differential diagnosis.  Delivery of hard news in an empathetic and kind manner is an art. Clinic is a time to learn about disease processes and how they present, but perhaps more importantly to understand the personal impact they have on patients and their families. 

    Research. Fellows are encouraged to translate clinical questions that arise into scientific studies. In addition, there are ongoing projects run by the faculty that the fellow is encouraged to join, including clinical and pre-clinical studies and basic science laboratory research. Evidence based treatment decisions are based upon a careful review of the literature. The fellow has dedicated weekly time to focus on research pursuits.  

    Leadership. A critical part of the fellow’s education revolves around the concepts of leadership – as a teacher, a coordinator, and an advocate. As a teacher, the fellow gives formal educational lectures to the residents. She or he learns to mentor and guide residents as they develop their own surgical and clinical skills set. The role of teacher is also an inherent part of a practice that centers around delivering profound diagnoses that impact one’s life and livelihood in a way that patients can comprehend. The fellow is asked to be the point person for our multi-disciplinary sarcoma working group which includes experts in medical oncology, surgical oncology, radiology, pathology, radiation oncology and plastic surgery. Specifically, the fellow coordinates the weekly and vital Sarcoma Tumor Board, where cases are presented and best practices formally recommended. In that setting, the fellow learns to advocate for her or his patients in a group of esteemed peers.

  • Duties

    • Sarcoma Tumor Board Conference: Coordinate weekly patient list/documentation
    • Clinical: Prepare daily written pre-operative plans for surgical cases
    • Education: Give 2-3 lectures to residency during oncology academic block
    • Administrative: Log cases/duty hours
    • Research: minimum 1 abstract/publishable project

    Benefits

    • Office with computer and work space
    • 24/7 exercise facility (free weight/aerobics) within orthopaedic surgery department
    • Readily available orthopaedic anatomy cadaver lab on medical campus
    • Courses (1): Stryker MSKL Oncology course in August
    • Conferences (2): MSTS in fall, AAOS in spring

  • Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Children’s OR AM

     

    Clinic PM

    Clinic

    Adult OR

    Adult OR AM

     

    Admin/Research PM

    Adult OR

    • Approximately 400 cases / year
      • Adult 85%, Pediatrics 15%
    • Clinical spectrum
      • 1/3: Sarcoma (2/3 soft tissue, 1/3 bone)
      • 1/3: Benign tumors (2/3 soft tissue, 1/3 bone)
      • 1/3: Metastatic disease/arthroplasty/infection

    **At Vanderbilt, bone and soft tissue sarcomas of the extremity, pelvis, trunk, chest wall, sacrum and spine are treated by the musculoskeletal oncology service.

  • Recent Publications

    • Wilson RJ, Freeman TH Jr, Halpern JL, Schwartz HS, Holt GE. Surgical Outcomes After Limb-Sparing Resection and Reconstruction for Pelvic Sarcoma: A Systematic Review. JBJS Rev. 2018 Apr;6(4):e10. PMID: 29688908
    • Nguyen JQM, McWade M, Thomas G, Beddard BT, Herington JL, Paria BC, Schwartz HS, Halpern JL, Holt GE, Mahadevan-Jansen A. Development of a modular fluorescence overlay tissue imaging system for wide-field intraoperative surgical guidance. J Med Imaging (Bellingham). 2018 Apr;5(2):021220. PMID: 29531968
    • Mesko NW, Wilson RJ, Lawrenz JM, Mathieu JL, Ghiam MK, Mathis SL, Halpern JL, Schwartz HS, Holt GE. Pre-operative evaluation prior to soft tissue sarcoma excision – Why can’t we get it right? Eur J Surg Oncol. 2018 Feb;44(2):243-250. PMID: 29269109
    • Intraoperative Raman spectroscopy of soft tissue sarcomas. Nguyen JQ, Gowani ZS, O'Connor M, Pence IJ, Nguyen TQ, Holt GE, Schwartz HS, Halpern JL, Mahadevan-Jansen A. Lasers Surg Med. 2016 Oct;48(8):774-781. doi: 10.1002/lsm.22564. Epub 2016 Jul 25. PMID: 27454580