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Musculoskeletal Oncology Fellowship

The Orthopaedic Oncology Fellowship at Vanderbilt University Medical Center began in August, 2006. The program will have one fellow per year. The fellowship lasts for one year. It occurs at a single institution, which is the parent institution, Vanderbilt. Ginger E. Holt, MD is the Program Director with Herbert S. Schwartz, MD and Jennifer L. Halpern, MD as additional program faculty.

The educational goals of the Musculoskeletal Oncology Fellowship are to expose the fellow to a diverse experience of musculoskeletal neoplasia clinically, operatively and in the laboratory. The goal is to create an academic orthopaedic oncologist. Our goal is not to create an orthopaedic surgeon who has a minor interest in orthopaedic oncology. The fellowship may not take a fellow each year. The fellow will be selected through the fellowship match application process.

The fellowship contains five critical components within the educational experience:

The surgical exposure to all aspects of musculoskeletal neoplasia and bone disorders. This includes the group of entities of skeletal sarcomas, soft tissue sarcomas, benign soft tissue tumors, benign bone tumors, metastatic disease to the bone and soft tissues, and metabolic bone disease. The surgical exposure deals with the pathologies listed above and involves a wide range of patient ages. Approximately 20% of the orthopaedic oncology practice at Vanderbilt involves children. There exists a free-standing children’s hospital on campus at which almost all children less than 18 years of age are operated upon and are hospitalized. Ages of patients operated upon range from infants to nanogenerians. Traditionally all sites of the body are operated upon. These include the sites of the axial skeleton and appendicular skeleton. They also involve the retroperitoneum and extra compartmental areas of the axilla, groin and popliteal fossa. Surgeries also include the chest wall and abdominal wall. 

The second area of clinical exposure is the clinical venue. This involves seeing patients in the outpatient setting as well as rounding on inpatients. Typical inpatient census is 10-12. Radiograph and image interpretation is a regular feature and educational interaction that occurs in the outpatient setting. All x-rays are brought to the operating room. 

The third area involves laboratory research. This involves clinical and pre-clinical studies as well as basic science research. One day of each week will be allocated for protected time in these academic pursuits. 

The fourth area of educational experience involves pathology interpretation. At least one time per week, current and past pathology glass slides are reviewed. We are thus able to correlate images of a particular patient with surgical anatomy and histopathology. This cements the conceptual and biological behavior of the tumor. 

The fifth area of education experience involves teaching. The fellow is responsible for giving a portion of the annual tumor course which may consist of a couple of lectures. Approximately, two grand rounds are given each year by the fellow. There are probably book chapters that require writing assigned to the fellow during the course of the fellowship year. 

The educational methodology is the classic apprenticeship model. There are three full-time orthopaedic oncologists at Vanderbilt whose practice is at least 90% devoted to the specialty. The fellow is with one of those physicians at all times. Direct supervision of the fellow is a regular and prominent feature.

Current Fellow:

Nathan Mesko, M.D.Nathan Mesko M.D.
August 1, 2013 to July 31, 2014

Dr. Mesko comes to us from the Cleveland Clinic Foundation for a fellowship in Musculoskeletal Oncology after he completed his residency in 2013.
 
 

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