Fellows do one year of clinical training and rotate through six
core experiences: inpatient hematology, hematologic malignancy, solid tumor,
stem cell transplantation, ambulatory hematology, ambulatory oncology and
neuro-oncology. They also have one elective block to pursue additional clinical
experiences in areas of particular interest. There is a high degree of
"hands-on" clinical responsibility. A queue system is used to be sure
that fellows longitudinally care for patients with a broad distribution of
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 always
willing to discuss unique arrangements and to try to accommodate our fellows’
interests, including those whose interests lie astride or between disciplines,
because we believe such individuals enrich the program with new views,
expertise, and experiences.
Fellows spend one day per week in the outpatient pediatric
oncology clinic where each fellow 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.
Fellows see outpatient hematology patients half a day twice
monthly. On average, fellows see two to four patients twice monthly and fellows
have a panel of hematology patients for whom they serve as the primary
A clinical advisor is assigned to each first year fellow at
the start of fellowship and remains available to fellows throughout their
training. Fellows and advisors meet informally about every three months to talk
about the transition to fellowship, to discuss issues fellows face in and out
of the hospital, and to provide an extra layer of support and mentoring. In
addition, the advisor receives copies of formative evaluations and clinical
feedback and is available to work with fellows to address personal learning
goals or areas of improvement. The fellowship directors and division leadership
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 Conference (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 Clinic Conference (Daily, 2:30-3:30 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 home calls for the hematology,
oncology, and stem cell transplant services. 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. All night calls end at
midnight, ensuring that the educational value of taking night calls is retained
while limiting undue fatigue. Weekend call duties take two forms: fellows may
take home night calls from 6:00 p.m.-midnight on either Friday or Sunday evenings,
with the remainder of the weekend free, or they may be assigned to weekend
coverage (Saturday, 8:00 a.m.-6:00 p.m., in the hospital with home calls until midnight,
and Sunday, 8:00 a.m.-6:00 p.m., in the hospital). Dedicated hospitalists oversee care
of inpatient hematology, oncology and stem cell transplant patients seven nights
a week. The hematology/oncology hospitalist also covers all outpatient phone
calls that arrive after midnight. Limiting on-call duties in the second and third
year of the program is another way that we support research training for our
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