The pediatric hematology-oncology fellowship at UT Southwestern and Children’s Medical Center Dallas was first established in 1984. Since that time 60 fellows have graduated and 11 are in training. Based on a comprehensive review over the last five years, almost 50% of fellows and fellow graduates were successful in securing research funding, more than 50% have first authored publications, and 65% have abstract presentations at a national meeting. The fellowship program is currently under the direction of Dr. Patrick Leavey.
Duration of Fellowship
A minimum of three years, as required by the Pediatric Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME). Fellows have the option to do a fourth fellowship year to focus on and complete their research projects. This strategy has been very successful and is supported by the fellowship program as a way to enhance future career development. Fellows staying for a 4th year must apply for grants to support their stipend and research expenses. A number of mechanisms are available to assist with these activities.
Funding for our fellowship program is derived primarily from the following sources:
- Children's Medical Center Dallas
- Two local fundraising organizations:
Children's Cancer Fund
Wipe Out Kids Cancer
Other national and regional agencies that have supported fellows during the past five years include:
- The Pediatric Scientist Development Program
- The American Society of Clinical Oncology
- St. Baldrick’s Foundation
- The Sickle Cell Scholar Program of the NHLBI administered through the Southwestern Comprehensive Sickle Cell Center (2003 - 2008)
- The North and Central Texas Clinical and Translational Science Initiative
- A T32 NRSA fellowship training grant
- The UT Southwestern Physician Scientist Training Program
The first fellowship year is focused almost exclusively on clinical training. Fellows begin with a short orientation block allowing new trainees to familiarize themselves with both the inpatient and outpatient departments. During this time the program hosts a series of introductory lectures on important hematology-oncology topics prior to fellows starting to take call. Fellows rotate for approximately three months each on hematology, oncology, and stem cell transplant services. The new patient rotation is a wonderful opportunity to see hematology and oncology patients before anyone else, allowing the fellow to develop differential diagnoses, appropriate workups, and treatment plans. Each fellow also has two weeks with the late effects team toward the end of the first year.
Each fellow has four weeks of research elective within the first six months to allow time to plan a research project, and a second research elective for two weeks to finalize outstanding issues before August, when second-year fellows start their research projects.
Second and Third Years
While second- and third-year fellows continue to spend one day weekly in continuity outpatient clinic and remain on the schedule for periodic night and weekend call, these two years are focused almost exclusively on research. Fellows deciding to do clinical research are expected to audit classes in the NIH-funded Clinical Science Training Curriculum at UT Southwestern. Fellows doing basic science are encouraged to audit classes offered through this program as necessary for their project development and completion. All fellows are assigned a Scholarship Oversight Committee for the second and third years.
Clinical experience in all areas of pediatric hematology-oncology is ensured by a large patient population. The outpatient department at the Center for Cancer and Blood Disorders is the largest medical specialty clinic at Children’s Medical Center Dallas and is second only to orthopedic surgery in the number of annual visits (15,000 per year). Growth in new patient referral has been sustained with greater than 250 new oncology patients, 500 new miscellaneous benign hematology patients, 650 active sickle cell patients, and 250 active hemophilia patients. Subspecialty programs have been developed in thrombosis, ITP, chronic transfusion, sickle cell disease, hemophilia, bone marrow failure syndromes, acute leukemia, neuro-oncology, orthopedic oncology, neurofibromatosis, cancer survivorship, and neuroblastoma. This has allowed disease specific groups to establish standards and oversee critical components of care, and has allowed development of research in a wide variety of areas.
In June 2010 the faculty and fellows were asked to assess three areas of strength and three areas for improvement in the fellowship program. Almost unanimous agreement was obvious between fellows and faculty:
Hematology training and research opportunities
Areas for Improvement
Clarity of academic expectations
Hematology, neuro-oncology, and stem cell transplant teaching
Specific program improvement activities have been developed in response to each and will be assessed for success in the summer of 2011.
The Department of Pediatrics has established a curriculum and program that provides a forum for fellows to share research ideas with each other and develop both clinical and academic collaborations. The core curriculum outlined in the American Board of Pediatrics Guidelines for Subspecialty Training is provided by:
- The departmental fellows’ lecture series
- The Division’s fellowship program lecture series
- Support to attend institutional and national courses, seminars, and scientific meetings
The disease specific curriculum also outlined by the ACGME and ABP are incorporated into the teaching syllabus, and clinical exposure is provided by the fellowship program.
First-year fellows are evaluated after each inpatient rotation by the faculty with whom they work. Every six months the Program Director has a private meeting with each fellow to review progress and problems. A similar mechanism is in place for second- and third-year fellows, and the latter also receive regular feedback from their clinical or laboratory research mentors. Fellows are evaluated by 360-degree evaluations, parent evaluations, and evaluations of presentations. At the end of each academic year the fellows have the opportunity to evaluate the hematology-oncology faculty and the fellowship program through a process that maintains confidentiality.
Night and Weekend Call
First-year fellows take one to two nights of call each week. Weekends are usually off during inpatient rotations. Night call is very infrequent during the week for second- and third-year fellows. All fellows share weekend and holiday call.
Call schedule improvements designed by fellows involve a second fellow on call from home each weekend to take outside parent calls from 8 a.m. to 3 p.m. This allows the primary on-call fellow to round with the attendings during weekends without the distraction of outside calls. The fellow at home then takes primary call on Sunday evening to allow both fellows adequate rest prior to the start of the work week on Monday morning.