What Does The U.S. Navy and Saint John’s Cancer Institute have in Common?
“The aircraft carrier [USS Dwight D. Eisenhower] houses 6,000 people. On this ship, as the only surgeon… the jets can’t take off without a surgeon [me] on board,” comments Laura Fluke, M.D., naval surgeon and future graduate of the 2024 class, Donald L. Morton Complex General Surgical Oncology Fellowship Program at Saint John’s Cancer Institute.
Among the 200 surgeons in the U.S. Navy on active duty, 5 are given the role of a general complex surgical oncologist, while even fewer are given the opportunity to pursue a Complex General Surgical Oncology (CGSO) Fellowship.
CGSO fellowship positions continue to be among the most competitive and sought-after in surgical fellowship training. An average of 74 applications were submitted to each CGSO training program in 2018, and the current demand for positions greatly exceeds the number of positions offered,” stated in the journal Annals of Surgical Oncology, 2019.1
Presently, there are 38 programs, according to the Society of Surgical Oncology.2 Saint John’s Cancer Institute admits 4 fellows per academic year for the Donald L. Morton Complex General Surgical Oncology Fellowship, and to date, has graduated over 170 surgical oncologists, many of which are in leadership positions around the country.
I ranked this fellowship program as my number one choice, so being able to come has been a great opportunity.
– Laura Fluke, MD
On top of the competitive nature of the program itself, according to Dr. Fluke, not many fellowship training programs are military friendly, and therefore, willing to train an active-duty surgeon. Though, according to Dr. Fluke, surgeons receiving CGSO training for the military at a civilian facility will typically be excluded from active military deployment until their training is completed. In 2023, two Donald L. Morton fellows will graduate and go back to active duty in the Army, Dr. Jessica Weiss, and Dr. Julia Greene.
In the summer of 2021, I was on an aircraft carrier in the Arabian sea, supporting the evacuation of Afghanistan. It was there that I found out I had matched here.
– Laura Fluke, MD
Dr. Fluke will be amidst the elite once she’s completed her surgical oncology training, and in the entire Navy too; she will run their surgical oncology tumor boards, in Portsmouth, Virginia. At Saint John’s Health Center, there are many tumor boards for each specialty, Melanoma, Breast, Gastrointestinal, Urology, Thoracic, and Endocrine. The fellows participate in many of them.
Laura Fluke, M.D., Talks Fellowship and Being a Top Gun Surgeon
Dr. Laura Fluke elucidates her surgical training as a naval surgeon and fellow at Saint John’s Cancer Institute, Donald L. Morton Complex Surgical Oncology Fellowship Program
Do Fellows Run Tumor Boards?
There are four, 3-month surgical rotations for each specialty in the first year. “While on these services, we run the tumor boards; they are multidisciplinary… where all these different oncologists discuss each patient individually. This is the tool that this facility is giving me, to take back to the Navy, to then go on and run the tumor boards in the Navy,” remarks a smiling Dr. Fluke.
The Navy does have tumor boards. Although here, I am very impressed; it is a major institution, and there are tumor boards for every specialty.
– Laura Fluke, MD
Not only is Dr. Fluke and her peers participating in the tumor boards and presenting patient cases with their attending surgical oncologist, fellows are conducting research projects with mentors, which later will be presented at a conference and then eventually published. “We have multiple research conferences each week. I have projects I am working on with Dr. Essner and Dr. Bilchik right now. The fellows have multiple research opportunities and working with big data banks.” She continues, “every Friday there is a conference where two fellows present cases of patients they are seeing, use recent literature to continue research, and to teach their peers. Educational time on Fridays is a real asset to this program.”
What can A Fellow Expect While Learning Under Each Specialist?
Dr. Fluke’s two-year fellowship is divided into multiple rotations. She recently completed her first 3-month rotation with, Dr. Richard Essner, Director of the Melanoma and Cutaneous Oncology Program at Saint John’s Cancer Institute. She is now on her second 3-month rotation with Dr. Anton Bilchik, Director of the Gastrointestinal and Hepatobiliary Tumors Program, at Saint John’s Cancer Institute. According to Dr. Fluke, “Dr. Bilchik is a general complex surgical oncologist, but specializes in [HPB and] GI [cancers]. The service is a knockout! In these few months, I’m in the trenches, and the patients are thankful, and really sick. This will be the most difficult 3 months here.”
Her third 3-month rotations will consist of one month of research, one month with both breast and endocrine, and one month of radiation oncology. She will spend time with other professors of oncology including Dr. Crystal Fancher, Dr. Janie Grumley, Dr. Melanie Goldfarb, and Dr. Robert Wollman.
“[the] last 3-month block will be a mixed service; anything goes with Dr. Foshag and Dr. Fischer.” In this rotation she could do breast surgery, then a colon, then liver, if those surgeries present themselves. Dr. Leland Foshag is the Program Director of the Donald L. Morton Complex General Surgical Oncology Fellowship. Dr. Trevan Fischer is Assistant Program Director of the Donald L. Morton Complex General Surgical Oncology Fellowship.
It’s in our second year that we get more minimally invasive procedures… where we get to be independent, and work with people to give us those complex procedures.
– Laura Fluke, MD
To Future Applicants From Laura Fluke, M.D.
“You will get the right cases, and enough of them, and a variety to become a general surgical oncologist. You get the independence to know when you graduate you will be able to do it in your own practice.”
The Complex General Surgical Oncology Fellowship is a two-year program approved by the Accreditation Council for Graduate Medical Education (ACGME) and by the Society for Surgical Oncology (SSO). It was started in 1991 when Dr. Donald Morton established the John Wayne Cancer Institute (now known as Saint John’s Cancer Institute) at Saint John’s Health Center.
Donald L. Morton Fellowship Facts
- Saint John’s Health Center will average between 1,700 cancer cases and 1,900 cancer cases per year.
- The 2018-2020 DLM graduating class averaged 346 cancer-related cases at Saint John’s Cancer Institute.
- Fellows will see an average of 40 percent more cases than required by ACGME.
- The case volume required by ACGME is 240 cancer-related cases per graduating class.
I am comfortable doing these procedures I have never done and taking them with me when I leave.
– Laura Fluke, MD
- A Survey of the Complex General Surgical Oncology Fellowship Programs Regarding Applicant Selection and Rank – PMC (nih.gov)
- Program List – Society of Surgical Oncology (surgonc.org)