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Clinical Training |
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The object of the training program is to provide the highest quality clinical and research training in hematology/oncology, so that our fellows become excellent clinicians and independent investigators making substantive contributions to biomedical research. The goals of the program are focused on this objective. The principal features of the program include the following:
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| Fellows follow their own patients and have the major responsibility for them. |
Clinical Training
Fellows do one year of clinical training and rotate through six services: hematology, oncology, stem cell transplantation, ambulatory hematology, neuro-oncology and off-service (consultative) oncology. They also receive training in transfusion medicine and laboratory medicine. There is a high degree of "hands-on" clinical responsibility. Fellows follow 20-25 oncology patients, 5-10 stem cell transplant patients and 30-40 hematology patients, on average, for all three years of fellowship (and beyond), and function as their primary caregiver. A queue system is used to be sure that fellows have patients with a broad distribution of diseases. The program is similar for most fellows, but is big enough that it is possible to vary the clinical experience for fellows who need a special program or want additional training in other specialties (e.g. ID, immunology, nuclear medicine, genetics/metabolism, etc.) Although most fellows are pediatricians or med-peds residents, the program has also trained 14 internists since 1965. In general, these were individuals with a particular interest in laboratory research who wanted a broad training experience, and who participated in a customized, combination program with the Brigham and Women's Hospital and Dana-Farber Cancer Institute leading to subspecialty boards in medical hematology and/or oncology.
We are also willing to train individuals whose interests lie astride or between disciplines. For example, we provided training for a physician who wanted to bring the disciplines of oncology and radiation therapy closer together by receiving training in both fields. Similarly, we have supported two fellows who combined training in infectious diseases and hematology/oncology, five who combined immunology training with hematology/oncology, one who linked metabolism, genetics, and hematology, and one who combined heme/onc with extra training in neuro-oncology, three who also became certified in transfusion medicine, and one who also completed training in hematopathology. This year we are funding a fellow to become board certified in hematopathology. We are always willing to discuss unique arrangements because we believe such hybrid individuals enrich the program with new views and experiences.
Research
It is our expectation that all fellows will receive extensive research training.
- Fellows who are particularly intent on a career in basic science research should receive training equivalent to a PhD with some postdoctoral experience in one of the major basic science disciplines: cell biology, structural biology, stem cell and developmental biology, genetics, systems biology, genomics, immunology, molecular biology, neuroscience or protein chemistry. The chosen research project should permit the fellow to use many of the different techniques of a particular discipline.
- Fellows interested in clinical research that does not require a laboratory experience should be broadly trained in biostatistics, clinical trials, clinical epidemiology, ethics, experimental design, and/or health services research, and may wish to obtain an MPH. Four different tracks leading to the Masters degree are available.
- Fellows interested in translational research should generally train first in a basic laboratory field, since translational research, as we define it, is essentially an extension of laboratory work.
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During the past 10 years, the period of research training has averaged 5.8 years. This is the time required for fellows to achieve independent status (tenure track appointment, independent space, funded R01 or other grant). The length of training varies widely from individual to individual (range three to eight years), but is almost always longer than the traditional two years of research training required by MD fellowships.
Flexibility
The training program should be individualized for each fellow, since fellows come to the program with very different goals and experiences in research. A strong effort is made to maintain maximum flexibility. For example:
- Though most fellows chose to do their clinical work first, some prefer to begin in the laboratory to avoid clinical distractions.
- The program allows the fellow to pick his or her research sponsor and does not require that such sponsors be members of the Division of Hematology/Oncology.
The general philosophy is that training monies are available solely to support the needs of the fellows and not the needs of the Division. In our experience, this view is not universal. Some programs restrict training grant funds to fellows who work for members of their program. Fellows who work outside the program must raise their own funds. We do not believe that such a philosophy is in the best interest of fellows.
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| Like Dr. Silverman, who now directs the Jimmy Fund Clinic, most Children's/Dana Farber faculty were trained in our program. |
Commitment
Fellows who are destined to have an academic research career need to be supported until they are able to obtain independent research funding. As noted earlier, the average fellow requires five to six years of research training before full independence is achieved. We believe this is a crucial point. Once chosen, a program must stick with a fellow who seeks a research career until the fellow becomes independent or it is clear that a research career will not be successful. We have had fellows whose first projects were a failure but who subsequently were successful. The need to support such individuals for an extended period is one of the principal functions of our training program. We make every effort to meet this obligation.
We approach each fellow with the expectation that they will join the tenure track faculty (independent Assistant Professor) of the hematology/oncology program (and Harvard Medical School) following their training period. In fact, many do so. Our approach provides an additional buffer zone for fledgling investigators to become firmly established before leaving "the nest," and we believe it contributes to the success of our program. However, it also emphasizes the need to train fellows in diverse areas and to allow fellows who study within the Division to develop their own areas of specialization.
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