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
their 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 the late fall, four
evenings are set aside for “Data Blitz,” during which up to 40 faculty present five
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. Dr. Alejandro Gutierrez, one
of the fellowship’s Associate Program Directors, also meets with fellows to help solidify their research direction and
mentorship plans.
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. David A. Williams, Stuart H. Orkin, and David Pellman
(laboratory research), and Stephen E. Sallan, Jennifer W. Mack, and A. Lindsay Frazier
(clinical research). 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 Boston Children’s
Hospital 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,
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, 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 seven-week, 15 credits program includes
core courses in epidemiology and biostatistics as well as two 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, and 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 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 Boston Children’s Hospital, 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.
Master’s 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 toward a career in clinical research are
encouraged to apply for grant funding, either from a private foundation or through
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 four-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 the 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 seven-week, 15 credit program includes core courses in
epidemiology and biostatistics as well as two 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, and 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 Boston
Children’s Hospital 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 (two week course, offered annually in July) or
the Introduction to Clinical Investigation course (five-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.