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.). We are willing to
train individuals whose interests lie astride or between disciplines. 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 or 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 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.
One day/week: This clinic meets all day, five days per week.
The hematology/oncology fellow is assigned one oncology clinic day per week
throughout his/her fellowship and has primary responsibility for a dedicated
panel of oncology, bone marrow failure, and stem cell transplant patients. The
fellow provides direct, hands-on care for his/her patients that are undergoing
therapy, for those who are being evaluated for complications of therapy or
disease, and for patients followed off-therapy. In general, the fellow spends
about six hours per week in this clinic. Each clinic includes a conference
where all patients are discussed with a team of attending physicians.
1/2 day/twice monthly for fellows who are not on the
ambulatory hematology rotation. This clinic has three half-day sessions per
week. Fellows follow their hematology patients in one of these clinic sessions.
On average, they see two to four patients twice monthly and fellows have a
panel of hematology patients for whom they serve as the primary physician.
A clinical mentor is assigned to each first-year fellow. The
two meet about every three months to discuss any issues that may arise during
that time. In addition, the mentor receives copies of the performance reviews
done by the attending at the end of each rotation. Should problems be detected,
the clinical mentor will work with the fellow and the rest of the clinical
staff as appropriate to address the issues. The clinical mentor remains
assigned to the fellow throughout his/her fellowship. The fellowship
leaders also meet twice a year with each fellow to discuss goals, performance,
and personal issues and provide overall guidance for the fellow during all
three years of fellowship.
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 Conference,
Oncology Lecture Series, Pediatric Oncology Conference, and Tumor Board) are
regularly attended by most or all fellows.
Bone Tumor (Musculoskeletal) Conference (Tuesdays, 11:00
a.m.-12:00 p.m., every other week) - Interdisciplinary conference
involving surgeons, oncologists, and radiologists. Active patients with
musculoskeletal tumors are presented, and diagnostic and management issues
Brain Tumor Clinic Conference (Wednesdays, 12:00-1:00
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, 12:00-1:00
Hematologic Malignancy Conference (Wednesdays, 4:00-5:00
p.m.) - A review of data, including bone marrows and 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, 1:00-2:00
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, 4:00-5:00
p.m.) - Boston Children's Hospital and Dana-Farber Cancer Institute
investigators present their research. Fellows are encouraged to attend.
Solid Tumor Meeting (Fridays, 8:00-9:00 a.m.) – Clinical
conference to review solid tumor inpatients and new diagnoses and discuss
relevant journal articles.
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, 2:00-3:00 p.m.) - New patients referred to the transplant
service are reviewed.
Neuroradiology Conference (Thursdays, 11:15 a.m.-12:15
p.m.) - Patients with brain tumors are discussed during this
Oncology Post-Clinic Conference (Daily, 12:00-1:00 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
Pediatric Oncology Conference (Mondays, 4:00-5:00 p.m.) –
Presentation of clinical research and practice updates by local and invited
Solid Tumor/Lymphoma Conference (Tuesdays, 12:00-1:00
p.m.) - Active patients with solid tumors and lymphomas are reviewed,
and diagnosis and management issues are discussed in this multidisciplinary radiology
conference (radiology, radiation oncology, oncology, surgery).
Translational Research Conference (selected Tuesdays, 11:00
a.m.-12:00 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.
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 this is relatively uncommon. In 2019-20, the call schedule format
changed substantially compared to previous years. While call has educational
value for fellows, heavy nighttime coverage can undermine quality of life for fellows
and cause fatigue. The new call schedule has first-year fellows working 36 hour
weekend shifts (including Saturday morning through Sunday evening) once per
month along with scattered holiday coverage on-call. The remainder of overnight
calls (both weeknights and weekdays) is shared by second- and third-year
fellows as well as early career faculty and hospitalists. We work hard to limit
on-call duties in the second and third year of the program so as to protect
research focus and productivity for these fellows. We anticipate that our call
schedule will again be modified in the 2020-21 year as we hire new staff who
will be specifically oriented toward night and weekend coverage of our clinical
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