Fellows do one year of clinical training and rotate through six services: hematology, hematologic malignancy, solid tumor, stem cell transplantation, ambulatory hematology, and neuro-oncology. They also receive training in transfusion medicine and laboratory medicine. There is a high degree of "hands-on" clinical responsibility. 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 the Dana-Farber Cancer Institute leading to subspecialty boards in medical hematology and/or oncology.
Pediatric and Adult Training in Hematology (PATHway) is a shared program between the Hematology/Oncology Division at Dana-Farber/Boston Children's Cancer and Blood Disorders Center and the Hematology Program at Brigham and Women’s Hospital. Fellows interested in careers in non-malignant hematology, survivorship care for the formerly lethal pediatric malignancies; or trainees interested in transitional care for the “pediatric” disorders, e.g. thalassemia and marrow failure are able to gain training in this combined pediatric/adult program.
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 several 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, one who combined hematology with extra training in neuro-oncology, three who have also become certified in transfusion medicine, two who have completed additional training in pediatric palliative care, and one who also completed training in hematopathology. We are always willing to discuss unique arrangements and to try to accommodate our fellows’ interests, even when out of the ordinary, because we believe such individuals enrich the program with new views and experiences.
There are a large number of weekly conferences and rounds on a variety of topics. Fellows are expected to attend conferences that are specific to a service during their rotations on that service and are invited to attend at other times. A few conferences (Hematology Teaching Conf., Oncology Lecture Series, Pediatric Oncology Conf., and Tumor Board) are regularly attended by most or all fellows.
Bone Tumor (Musculoskeletal) Conference (Tuesdays, 11 a.m.-12 p.m., every other week) - Interdisciplinary conference involving surgeons, oncologists and radiologists. Active patients with musculoskeletal tumors are presented, and diagnostic and management issues discussed.
Brain Tumor Clinic Conference (Wednesdays, 2-3 p.m.) - Patients to be seen that day are discussed by a multidisciplinary team, including neuro-oncologists, neurosurgeons, radiation oncologists, psychosocial clinicians, neuropsychologists and physical therapists. Fellows are urged to participate if one of their patients is attending the clinic that day.
Children's Hospital Medical Grand Rounds (Wednesdays, 12-1 p.m.)
Hematologic Malignancy Conference (every other Thursday, 3-4 p.m.) - A review of data, including bone marrows, other pathology and radiographic information, that relates to active patients with hematologic malignancies, with discussion about their course and decision-making.
Hematology Ambulatory Conference (Thursdays, 1-2 p.m.) - Hematology care providers, including the first year fellow during his/her hematology rotations, present patients seen during the prior week in hematology clinic.
Hematology Grand Rounds (Fridays, 8:15-9:15 a.m.) - A review and discussion of the patients followed by the hematology service is led by the fellow on the inpatient hematology rotation. Many upper year fellows also attend. Current articles from the hematology literature are also reviewed.
Hematology/Oncology Research Conference (Thursdays, 4-5 p.m.) - Boston Children's Hospital and Dana-Farber Cancer Institute investigators present their research. Fellows are encouraged to attend.
Hematology/Oncology Teaching Conference (Mondays and Wednesdays, 5-6 p.m.) - A case-based seminar on a wide range of hematology and oncology topics. For all first year fellows. Includes a series of sessions at the beginning of the year on the analysis of peripheral blood and bone marrow slides.
Hematopoietic Stem Cell Transplantation Conference (Thursdays, 8:30-9:30 a.m.) - Issues in transplantation are presented by experts in the field.
Hematopoietic Stem Cell Transplantation Intake Rounds (Mondays, 2-3 p.m.) - New patients referred to the transplant service are reviewed.
Oncology Post-Clinic Conference (Daily, 1-2 p.m.) - Each oncology care provider presents for review the patients seen by him/her that day. Fellows attend weekly on their assigned day for outpatient oncology clinic.
Pediatric Oncology Conference (Mondays, 4-5 p.m.) - Protocols, staff, institution and patient care issues are discussed.
Solid Tumor/Lymphoma Conference (Tuesdays, 12-1 p.m.) - Active patients with solid tumors and lymphomas are reviewed, and diagnosis and management issues discussed, in this multidisciplinary radiology conference.
Translational Research Conference (selected Tuesdays, 11 a.m.-12 p.m.) - Lab scientists and clinicians from the program review recent publications, discuss current studies within the department, and/or discuss upcoming therapeutic protocols, with the goal of bringing basic science and clinical practice together.
Tumor Board (selected Mondays, 5-6 p.m.) - First year fellows conduct a review of the literature, and lead a multidisciplinary discussion, on a topic of clinical oncology. Usually, this conference is inspired by one of the presenter's patients or clinical experiences. In general, all first year fellows attend. Upper-year fellows and oncology staff also attend.
Beginning in 2010 and again in 2011-12, the call schedule format changed substantially compared to previous years, with the goals of maximizing fellow education and quality of life, resident education, and patient care. The new call schedule includes the addition of hospitalists who cover the Stem Cell Transplant (BMT service) call in-house from 5 pm to 8 am on Saturday through Thursday nights.
Fellows from all years take phone calls for the Hematology, Oncology and Stem Cell Transplant services overnight, including both in-hospital and outside calls. In some circumstances (for example, a new patient with leukemia), fellows may be asked to return to the hospital from home, but they are no longer obligated to stay in house every night. This change relieved fellows of overnight in-house Stem Cell Transplant call Saturday through Thursday of each week, allowing for adherence to duty hours and lessened fatigue. On the weekends, fellows cover all services.
One fellow takes in-house call for the BMT service on Friday night, and a separate fellow is on call during the daytime on Saturday and Sunday. The Hematology and Oncology services are covered by one fellow from Friday 5 pm until Sunday 5 pm. On Sunday night a different fellow assumes call, covering the Hematology and Oncology services from home from 5 pm to 8 am.
This new system has resulted in a significant decrease in fellow call, including a major reduction in in-house fellow call. This change constituted a major undertaking by the program, in order to maximize fellow education and productive research time.
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