We are committed to the training of fellows who will become world-class leaders in clinical, translational, basic science, or cross-cutting research. 
About 60 percent of our fellows choose to do laboratory research and 40 percent choose clinical investigation. We strongly support both pathways. We recognize that fellows come with varied prior research experiences, and our fellowship is designed to train those with extensive prior experience (including those with prior PhDs) as well as those with more limited prior experience.
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 ensure that, to the extent possible, a fellow's research work is not hampered by clinical responsibilities on days other than the assigned clinic day.
We are committed to funding three years of research training (beginning after the first year of fellowship) for all fellows. We provide each fellow and junior faculty member with the protected research time necessary for them to attain independence. This support is obtained through competitive federal training grants and nonfederal fellowships, supplemented by institutional resources. Additionally, a major strength of our program is the recognition that three years of fellowship is not usually sufficient to acquire the depth of scientific expertise needed for success in initial competitive grants, including career development awards and ultimately independence. Thus, we are fully committed to providing a “long runway” to support the research training of our fellows beyond the three years of formal fellowship training. This is accomplished by having trainees transition from a fellow to an instructor position at the end of the fellowship training period. Instructors are faculty-level positions that provide the opportunity to function as an attending physician clinically, with substantial protected research time to continue developing scientifically under exceptional mentorship until the fellow is ready to transition to an independent faculty position.
Identifying a research project and mentor ideally suited to
fostering each fellow’s passions and career interests is a major focus of our
program. We strongly recommend that this
process begin prior to the formal start of fellowship training. We provide guidance and advice regarding the
numerous potential clinical and laboratory mentors available in the Boston
area. Fellows are encouraged to begin reading
and discussing possibilities with potential mentors during the year before they
begin their clinical fellowship and to narrow the search to a small number of
possibilities by the time fellowship starts. In addition, fellows have the
opportunity to hear senior faculty members present their research at the weekly
division seminar series and at the annual fall retreat for which coverage is
provided to allow attendance by first-year fellows. In the fall, several evenings
are set aside for “Data Blitz,” during which faculty present five minute “hot
topics” of their research 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. Dr. Alejandro Gutierrez, one of the fellowship’s
Associate Program Directors, meets individually with fellows to help solidify
their research direction and mentorship plans. Research training is also a
standing agenda item during each fellow’s semi-annual review meeting with Dr. Jennifer C. Kesselheim and Dr. David A. Williams.
In addition to laboratories and mentors within pediatric
hematology/oncology at Dana-Farber/Boston Children's, 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 fellowship
program leadership. The opportunities include clinical and laboratory
researchers at Harvard Medical School, Harvard University, Massachusetts
Institute of Technology (MIT), the Whitehead Institute, the Broad Institute of
Harvard and MIT, the Koch Institute, the McGovern Institute, the Picower
Institute, Harvard School of Public Health, 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), Tufts University, Brandeis University, Boston University, the University
of Massachusetts Medical Center, and researchers outside the pediatric
hematology/oncology program at Boston Children’s Hospital or Dana-Farber Cancer
Institute. We view outside research experiences as particularly valuable since
it provides an opportunity to bring new skills and areas of research into our
program.
The
object of the training program is to provide 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, single-cell analyses, gene therapy/genome editing,
high-throughput chemical and genetic screens, and experimental therapeutics.
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 mentor and does not require that such mentors
be affiliated with the Division of Hematology/Oncology, Dana-Farber or Boston Children's. We
strongly believe that institutional funds for the training of research fellows
should be used solely to support the development of the trainees and not the
needs of the division or the broader program. 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 and international meetings. The overall laboratory research
experience approximates that of the intensity of a PhD research experience.
The goal of clinical research training for hematology/oncology
fellows is to produce leading clinical scientists in pediatric hematology/oncology.
Clinically-based research within the program is broadly defined as any research
that impacts on clinical outcomes and experiences of children with cancer,
hematologic diseases, or those diseases benefitting from stem cell transplant
or cellular therapies. The goal of the program is to create independent
investigators whose research will not only improve outcomes but also quality-of-life
for children with these diseases. In addition to “traditional” clinical
research (i.e. interventional clinical trials and outcomes research), the
current expertise of the faculty includes bioethics, improvement of
patient-parent-physician communication, decision-making, refinement of risk
stratification systems, evaluation and mitigation of late effects, and optimization
of palliative care. Several faculty are nationally recognized in medical
education leadership and scholarship.
To facilitate the clinical research within the
program, Dana-Farber/Boston Children's has established the Clinical and
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,
formal research training is encouraged, often with an intensive summer clinical
research training program. These are
often taken after the second year of fellowship so that the coursework
can focus on the fellow’s own research, but some fellows have elected to take
this after first year.
One option for core didactic training is the Program
in Clinical Effectiveness at Harvard School of Public Health (HSPH), which
provides a broad foundation for all types of clinical research. This intensive
seven-week, 15 credits program includes core courses in epidemiology and
biostatistics as well as two electives. Students who complete the Program in Clinical
Effectiveness may also 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 that will cover the cost
of the full master’s program and provide another source of mentoring for
fellows. Additional options for core didactic training are available through
Harvard Catalyst (The Harvard Clinical and Translational Science Center). The
Harvard Catalyst is a pan-Harvard University enterprise dedicated to improving
human health.
As with the selection of mentors, we also
support fellows who require additional training in cross-cutting areas and
have, for example, supported prior fellows in obtaining additional training
through the Harvard Medical School Master’s of Medical Education. We are very open to fellows with
non-traditional interests.
The division also sponsors
a weekly Children’s Hematology/Oncology Clinical Research works-in-progress
meeting, at which senior and junior faculty and fellows present their work on a
rotating basis. The intent of this 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.
In
addition to studies in basic and/or clinical research as outlined above, additional
training is available for fellows interested in translational research. This includes coursework available
at Boston Children’s Hospital through the Institutional Centers for
Clinical and Translational Research (ICCTR) led by Dr. Andy Place, one of our
oncology faculty, 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 (two week
course, offered annually in July) or the Introduction to Clinical Investigation
course (five-day course, offered three times per year) is encouraged for
fellows with relevant interests. Introduction to Statistical Genetics (CRP
Education core) and an overview of Clinical Pharmacology could also be valuable
for the fellow oriented toward translational research.
Learning to write a compelling grant
application and successfully competing for external funding is crucial for all
investigators; therefore, there are multiple supports in place to help fellows
hone their grant-writing skills. Fellows
who are developing a career in clinical, translational, or laboratory-based
research are expected to compete for external grants with advice and assistance
from their mentors. Typically, this includes foundation grants aimed at early postdoctoral fellows in the third year of fellowship or the first one to two years of instructorship. This is then followed
by submission for K08 and similar career development awards that can support
the last few years of postdoctoral training and the early transition to independence.
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. Our
program also has a designated faculty member with expertise in grant writing
for consultation on the grant writing process.