We are committed to the training of fellows who will become world-class researchers in clinical, translational or basic research. About 60 percent of our fellows choose to do laboratory research and 40 percent choose clinical investigation. We strongly support both pathways. Most fellows remain with the same research mentor until the fellow assumes independent faculty status (i.e., usually Assistant Professor) at Dana-Farber/Boston Children's Cancer and Blood Disorders Center (or elsewhere). Although the NIH only allows a maximum of three years postdoctoral research support on NIH Training Grants (T32s), we have in the past and will continue to try and support fellows for as long as necessary for them to attain independence. This support is obtained through vigorous pursuit of competitive federal and nonfederal fellowships, supplemented by institutional resources.
At the beginning of the research training period, most fellows have completed a year of intensive clinical training in hematology/oncology. During that year, the fellow's stipend is derived from institutional funds. Once this year is completed, the fellow enters a nearly full time research training program supported by two institutional training grants (a total of 18 slots). The fellow's time is carefully protected to permit at least 80% time for research. Clinical work is limited to an average of one clinic day per week. A comprehensive program of cross coverage has been instituted to insure that, to the extent possible, a fellow's research work is not hampered by clinical responsibilities on days other than the assigned clinic day.
Fellows are asked to begin investigating research projects and mentors during the year before they begin their clinical fellowship and to narrow the search to a small number of possibilities by the time they begin fellowship. We provide listings of many laboratory and clinical researchers in the Boston area and ask the fellows to read about specific research areas and begin to identify potential mentors. In addition, during the fellows’ first year, senior faculty members present their research at the division seminar series and at the annual Fall retreat for which coverage is provided to allow attendance by first year fellows. In late fall, four evenings are set aside for “Data Blitz” in which up to 40 faculty present 5 minute “vignettes” of their research focus for the benefit of the first year fellows. To aid the selection process, fellows meet with selected faculty in the broad area of the fellow’s research interest. The meetings occur early in the first year. This process continues throughout the first half of the year, with the goal that all fellows will have secured a research position by January.
In addition to laboratories within pediatric hematology/oncology, during the past 42 years many fellows have trained in outstanding laboratories throughout the Boston area. Fellows are able to work with any of the thousands of experienced researchers in the Boston area, as long as the outside research sponsor is acceptable to an oversight committee composed of Drs. Williams, Orkin and Pellman (laboratory research) and Sallan (clinical research), Mack and Diller. The opportunities include clinical and laboratory researchers at Harvard Medical School, Harvard School of Public Health, Harvard University, Harvard Business School, the Kennedy School of Government, the various Harvard hospitals (Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center), Massachusetts Institute of Technology (MIT), the Whitehead Institute, the Broad Institute of Harvard and MIT, the McGovern Institute, the Picower Institute, Tufts University, Brandeis University, Boston University, the University of Massachusetts Medical Center, and researchers outside the pediatric hematology/oncology program at Children’s Hospital Boston or Dana-Farber Cancer Institute. We view outside research experiences as particularly valuable since, if fellows rejoin the program as faculty, they bring new skills and areas of research.
The object of the training program is to provide PhD and PhD-postdoctoral research experiences and scholarly research training in hematology/oncology, so as to render trainees independent investigators making substantive contributions to biomedical research. The primary goal is to teach fellows how to formulate and answer important research questions.
Trainees will be broadly trained in one of the major basic science disciplines: protein chemistry, molecular biology, developmental biology, genetics, immunology, neuroscience or cell biology. Newer areas of focus within the division include embryonic stem cells, somatic cell reprogramming, gene transfer technology, zebrafish, genomics, and high-throughput chemical and shRNA screening. Hematopoiesis research techniques are particularly noteworthy.
The chosen research project should permit the candidate to use many of the different techniques of a particular discipline. The program allows the trainee 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 trainees and not the needs of the division. In our experience this view is not universal. Fellows typically present their work at lab meetings and once or twice per year at floor-wide research meetings. In addition, fellows frequently present their work at national meetings. The overall laboratory research experience approximates that of the intensity of a PhD research experience.
The Clinical Research Fellowship Track aims to produce leading clinical scientists in pediatric oncology and hematology. Fellows in this track will accomplish these key signposts of clinical research expertise:
- Expertise in a specific area of interest (in a disease, a therapeutic modality, or in relevant fields of risk reduction, outcomes research or cancer control) that will lead to national recognition.
- Proficiency in the methods necessary to independently carry out clinical research.
- A portfolio of research that demonstrates competency in various aspects of clinical research.
- Completion of a grant to support of his/her research.
The following "roadmap" provides fellows and their mentors a suggested schedule of milestones for clinical research over the course of fellowship training at Dana-Farber/Boston Children's Cancer and Blood Disorders Center.
Clinically-based research within the Program is broadly defined as any research that impacts on clinical outcomes and experiences of children with cancer, genetic and hematologic diseases. The goal of the program is to create independent investigators whose research will not only improve the outcome but also the quality of life for children with these and transplant-related diseases. In addition to “traditional” clinical research: i.e. clinical trial design and evaluation, the current expertise of the faculty includes bioethics, medical education, improvement of patient-parent-physician communication, refinement of risk stratification systems, evaluation and mitigation of late effects and optimization of palliative care.
To facilitate the clinical research within the program, the Dana-Farber/Boston Children's has established the Clinical Translational Investigational Program (CTIP). CTIP includes protocol specialists, who are available to advise on the development and submission of protocols for clinical research, as well as statisticians with expertise in study design, data collection and evaluation, clinical research associates and clinical research nurses. CTIP will augment the fellow’s research experience through this readily-available expert support.
Fellows choose a research mentor during the first year of fellowship and will develop a portfolio of possible research topics. For fellows who come without substantial research methods training, the core didactic training is the Clinical Effectiveness Program at Harvard School of Public Health (HSPH) which is typically taken the summer after the first or second year of fellowship training. Tuition for this course is fully funded by the training program. This intensive 7-week, 15 credit program includes core courses in epidemiology and biostatistics as well as 2 electives. For students with prior experience, higher level courses are offered in Analytic Issues of Clinical Epidemiology, Principles of Clinical Trials, and Survival Methods in Clinical Research. One important goal of the summer course is to develop a complete clinical research proposal, including background, objectives, methods, statistical analysis, with input from both the clinical research mentor as well as the HSPH faculty. This project will serve as the blueprint for at least one of the projects the fellow intends to complete during the subsequent year(s) of fellowship.
Students who complete the Clinical Effectiveness Program can apply for a degree-granting program at the Harvard School of Public Health (either Master of Science or Master of Public Health). There are several training grants available at Harvard (see table below) that will cover the cost of the full master’s program and provide another source of mentoring for fellows. Current training programs include: the Cancer Prevention Fellowship at Harvard School of Public Health, the Clinical Investigator Training Program at Beth Israel Deaconess Medical Center, the Harvard Pediatric Health Services Research Fellowship Program at Children’s Hospital Boston, and the Program in Cancer Outcomes Research Training at the Massachusetts General Hospital. Fellows in the program may also take advantage of the training and research opportunities made available through the Harvard Catalyst. The Harvard Clinical and Translational Science Center is a pan-Harvard University enterprise dedicated to improving human health. It is a shared enterprise of Harvard University, its ten schools and 18 affiliated academic healthcare centers (AHCs), the Boston College School of Nursing, MIT, the Cambridge Health Alliance, Harvard Pilgrim Health Care, and numerous community partners.
Masters programs are combined under the auspices of Harvard Catalyst, including the Scholars in Clinical Sciences Program and the more translational Clinical Investigation Training Program.
The division also sponsors a weekly Children’s Hematology/Oncology Clinical Research Seminar Series (CHOCRS), at which senior and junior faculty, and fellows, present their work on a rotating basis. The intent of the seminar series is to simulate a “lab meeting atmosphere” in which the work presented is mostly work-in-progress that will benefit from the comments and criticisms of colleagues.
Fellows working towards a career in clinical research are encouraged to apply for grant funding, either from a private foundation or for a National Institute of Health Career Development award (K series) near the end of their fellowship. In addition to support from their mentor, fellows receive comprehensive support and guidance throughout the grant application process as the program recognizes this as an important component to becoming an independent researcher. Fellows have access to a designated faculty member with expertise in grant writing for consultation on the grant writing process.
The Global Health in Hematology/Oncology Fellowship Track offers a unique opportunity to train in aspects of global health as they relate to hematology and oncology health care in developing countries. For fellows interested in global health a 4-year fellowship is offered. Mentored clinical and clinical research training will take place in one of the Dana-Farber/Boston Children's partner institutions in a low or middle income country. Currently the sites that are available to fellows include any of the member institutions of AHOPCA (La Asociacion de Hemato-Oncologia Pediatrica de Centroamerica y Republica Dominicana), a pediatric oncology association that has a designated pediatric oncology facility in every country in Central America and the Dominican Republic. In addition, the Dana-Farber/Boston Children's program is developing a pediatric oncology program at the Black Lion Hospital in Addis Ababa, Ethiopia and has current efforts in Egypt (Children’s Cancer Hospital ‘57357’ in Cairo), Sub-Saharan Africa, South East Asia, and South America. Fellows will spend a minimum of one month and up to three months per year at one of these sites during their second, third and fourth year of their fellowship training. Since this requires additional time to be spent off-site during the fellowship we extend training to four years for most fellows.
Global health fellows will develop clinical research projects at these sites which will be co-mentored by Dana-Farber/Boston Children's faculty and on-site mentors. Ongoing collaboration when the fellow is not in residence at the site will be facilitated with interactive information technology, such as the Cure4Kids website. For fellows who come without substantial research methods training, the core didactic training is the Clinical Effectiveness Program at Harvard School of Public Health (HSPH) which is typically taken the summer after the first or second year of fellowship training. Tuition for this course is fully funded by the training program. This intensive 7-week, 15 credit program includes core courses in epidemiology and biostatistics as well as 2 electives. For students with prior experience, higher level courses are offered in Analytic Issues of Clinical Epidemiology, Principles of Clinical Trials, and Survival Methods in Clinical Research. The overarching project for the summer course is to develop a complete clinical research proposal, including background, objectives, methods, statistical analysis, with input from both the clinical research mentor as well as the HSPH faculty. This project will serve as the blueprint for the project the fellow will work on at the international site.
In addition to studies in basic and or clinical research as outlined above, training for fellows who choose to pursue a focus in translational research should include coursework (available at BCH through the Clinical Research Program (CRP) and the Translational Research Program (TRP) as well as through Harvard Catalyst) that introduces and educates the fellow in the following topics:
- The IND/IDE regulatory process
- Investigator responsibilities in FDA-regulated research
- Biomarker development in the clinical trial setting
- Data and safety monitoring boards vs. plans
- Delegation of responsibility/building a study team
- Negotiating relationships with industry: Conflict of interest, technology transfer, IP issues, contracts/budgets
Participation in an intensive clinical trial or clinical investigation course such as the Harvard Catalyst Intensive Training in Translational Medicine course (2 week course, offered annually in July) or the Introduction to Clinical Investigation course (5 day course), offered three times per year should be encouraged. Introduction to Statistical Genetics (CRP Education core), and an overview of Clinical Pharmacology could also be valuable for the fellow oriented towards translational research.