Curriculum for 2nd and 3rd Year Fellows
The upper years of hematology-oncology fellowship education at HUP are tailored to the career goals of the individual trainee. Our curriculum is specifically designed to permit our fellows to identify and pursue a specific investigative path, whether in the traditional laboratory-based sciences, or in population science, health services, epidemiology, or developmental therapeutics. There are some ongoing limited clinical responsibilities expected during these years of training to ensure that our fellows also become expert physician sub-specialists.
Oncology Consults
On this rotation, the fellows focus on the evaluation and management of hospitalized patients with new cancer diagnoses (or patients with unknown diagnoses in whom a malignancy is part of the differential diagnosis). The aims are for the fellow to gain an understanding of disease processes, the interactions of cancer and its treatment with co-morbid medical conditions, and the selection of chemotherapy regimens. Consults are staffed by a dedicated oncology consult attending physician who is also responsible for daily rounds and teaching.
- Principal teaching methods:
Inpatient management, consultation, teaching, clinical conferences and case reviews, literature reviews.
- Educational content:
Explication of the biology and pathogenesis of a variety of solid tumors and participation in the diagnosis and treatment of these diseases and their complications, including breast, GI, GU, and aero-digestive cancers, melanoma and sarcoma, lymphomas, brain tumors.
- Mix of diseases:
A wide array of solid tumor oncologic problems, as well as new lymphadenopathy, hypercalcemia, workup of new masses and lytic bony lesions.
- Patient characteristics:
Men and women, adults and adolescents, including geriatric populations.
- Types of clinical encounters:
Interviews and examinations in the inpatient setting.
- Procedures:
Bone marrow aspiration and biopsies, chemotherapy infusion, intrathecal/intraventricular chemotherapy administration.
- Educational resources:
As previously described.
Gynecologic Oncology
All fellows spend two weeks attending the outpatient clinics in gynecologic oncology under the direction of the obstetrics and gynecology surgery service at Penn, and a medical oncology attending physician with special expertise and interest in gynecologic medical oncology, including clinical trials for this patient population.
Laboratory-Based Research
Those individuals planning careers in basic research spend the remainder of their fellowship either:
- As a mentored trainee with one of the many physician-scientists in the Division or,
- With another scientist at the Abramson Cancer Center, the Abramson Family Cancer Research Institute, the Perelman School of Medicine at the University of Pennsylvania, the Children's Hospital of Philadelphia, or the Wistar Institute. Investigators across our campus work on all aspects of hematology and cancer, including genetics and genomics, proteomics, cell and developmental biology, signal transduction, stem cell biology, structural biology, computational biology, immunobiology, vaccine and cellular therapy, gene therapy and virology.
The laboratory experience is structured to provide the fellow with training to establish the foundation for a successful career as an independent investigator. Support for trainees wishing to obtain a doctorate as part of this experience can be arranged through the Clinical Investigator Graduate Degree Program.
First-year fellows are encouraged to attend a variety of formal and informal research venues to become aware of potential laboratory mentors. The scientific mentor is chosen in the spring of the first year just prior to the start of the 2nd fellowship year.
Clinical/Translational Research
Fellows who wish to pursue careers in clinical research undertake a structured clinical research program that formally begins with the second year of fellowship training. This includes the following:
- In-Depth Methodological Research training that may include:
- A year-long course led by Emma Meagher, MD, (Center for Experimental Therapeutics), "Patient Oriented Research," that culminates in the fellow generating a grant proposal.
- Summer courses offered by the ASBMT, AACR/ASCO and ASH. A good example is the AACR/ASCO Methods in Clinical Cancer Research annual workshop in Vail, CO, in which many of our fellows have participated.
- A master's degree in clinical epidemiology (MSCE) offered through the Department of Biostatistics and Epidemiology.
- A master's degree in experimental medicine and translational research (MTR) offered through the Institute for Translational Medicine and Therapeutics.
- For those already prepared with master's degrees, the School of Medicine offers certificate programs in both clinical epidemiology and translational research through the sites listed above.
Each fellow interested in a career as a clinical investigator is expected to develop, write, submit to the IRB, and begin one or more clinical research protocols.
Core Curriculum in Clinical Research Methodology
This includes a course led by Angie DeMichele, MD, MSCE given in the summer of the second year, "Methods in Clinical and Translational Cancer Research" (EP815). Accompanying this introductory course are two additional monthly conferences:
- Fellows Clinical/Translational Research Conference (chaired by Dr. DeMichele). Enables fellows to present for discussion their developing and ongoing independent research projects.
- Fellows Journal Club. Provides a forum for critical review of the literature and further training in statistical methodology.
Both conferences are mandatory for all upper-level fellows and are widely attended by the clinical research faculty.
Formal Mentoring
Formal mentoring consists of the fellow working closely with one or more of the many basic, clinical, or translational investigators in the Hematology/Oncology Division or the Abramson Cancer Center. The fellow finds a mentor(s) after consultation with the Program Director, one of the Fellowship Program Associate or Assistant Directors and other members of the faculty. The process of identifying and meeting with potential mentors culminates with formal selection of a mentor(s) in the spring of the first year of fellowship. The Division is proud of a strong tradition and culture of mentoring our fellows and junior faculty.
Clinical Experience
Whether participating in bench research or the clinical/translational research pathway, each fellow maintains a weekly half-day continuity clinic throughout his or her fellowship. This allows fellows to deepen their experience in clinical hematology/oncology.
As in the first year, each fellow is supervised in the continuity practice by the clinical faculty with whom they see patients. All patients are seen with and under the direct supervision of an attending physician. The fellows' educational experience is further enhanced by continuing to attend clinical case conferences in hematology and oncology throughout the upper years.
In addition, fellows are encouraged to participate in one of the many multidisciplinary subspecialty tumor boards, particularly those related to their research projects and clinical interests.
The fellows' training during this individualized, senior research phase is designed to prepare the fellows to begin independent investigative careers as faculty members at an academic institution, in the pharmaceutical industry, or in government. Integral to this training process, along with specific research activities, is training in scientific writing and presentation.
In the spring of the second and third years, fellows are expected to make formal presentations of their research to the Division and they are encouraged and supported to present mature work at regional and national meetings of scholarly societies.
All fellows are mentored sufficiently to apply for and compete successfully for KO8, K23 awards or their equivalents. Many opportunities exist for fellows who successfully obtain such awards to continue their professional careers following completion of their formal fellowship training as senior research fellows or instructors in the Division.