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Research and Training
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.