Pediatric Hematology/Oncology Fellowship Program

The pediatric hematology fellowship at UT Southwestern and Children's Medical Center Dallas (CMC) was first established in 1983. Since that time 67 fellows have entered the program and based on a comprehensive review of graduates over the last 5 years 85% of remain in academic practice. Also over the last 5 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

Minimum 3 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.

Financial support

Funding of the pediatric hematology-oncology fellowship program at UT Southwestern is derived primarily from the following sources: (1) the current T32 NRSA grant, an NIH/NCI fellowship training grant; (2) the UT Southwestern Physician Scientist Training Program (which offers up to three years of research support to outstanding M.D. or M.D.-Ph.D. postdoctoral trainees); (3) operating funds from Children’s Medical Center Dallas; and (4) support from two local fundraising organizations, the Children's Cancer Fund and Wipe Out Kids Cancer. In addition, other national agencies that have supported senior fellows during the past five years have been the Pediatric Scientist Development Program, the American Society of Clinical Oncology, St. Baldrick’s Foundation, and the Sickle Cell Scholar Program of the NHLBI administered through the Southwestern Comprehensive Sickle Cell Center (from 2003 through 2008) and Basic and Translational Research Program (since April 2008). Fellows staying on for a 4th year must apply for grant support for part of their stipend and research expenses. A number of mechanisms are available to assist them with these activities.

Curriculum

First Year (2009-2010 Schedule at a Glance)

The first fellowship year is almost exclusively focused on clinical training. Most 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 ~ 3 months each on hematology, oncology and stem cell transplant services. The new patient rotation is a wonderful opportunity to see new 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 (After the Cancer Experience: ACE) toward the end of the first year. All clinical rotations and elective months have specific goals and objectives linked to educational resources and evaluations.

Each fellow has 4 weeks of research elective within the first 6 months to allow time to plan a research project, and a second research elective for 2 weeks to finalize any outstanding issues prior to August when second year fellows start their research projects. Also during the first year fellows are assigned an advisory committee of 3 faculty to guide their decision making regarding the choice of research projects and mentors. This is of course in addition to frequent meetings with Dr. Buchanan (Division Director) and Dr. Leavey (Program Director).

Second and Third Years

The second and third fellowship years are almost exclusively focused on research. Fellows deciding to do clinical research are expected to enroll 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 as outlined in the American Board of Pediatrics document on sub-specialty training. 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.

Core Curriculum

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 Sub-specialty Training, is provided by the departmental fellows lecture series, by the Pediatric Hematology-Oncology Fellowship Program Lecture Series, and by the support offered through the Pediatric Hematology-Oncology Fellowship Program 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 provided by the fellowship program.

Evaluation

First-year fellows are evaluated after each inpatient rotation by the faculty with whom they work. These evaluations are written and submitted to the fellowship office. 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 research mentor (either clinical or laboratory). At the end of each academic year the fellows have the opportunity to evaluate the hematology-oncology faculty and entire program by means of a process that maintains confidentiality.

Night and weekend call

First-year fellows take 1 to 2 nights of call each week. Weekends are usually off during inpatient rotations. Second- and third-year fellow’s night call is very infrequent during the week. All fellows share weekend call, and holiday call. Recent improvements to the call schedule (designed by fellows) involve a second fellow on-call each weekend from home to take outside parent calls from 8am to 3pm. 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. The program adheres to the ACGME guidelines regarding a maximum eighty-hour work week, and is aware of the Institute of Medicine recommendations for further adjustment of duty hours and awaits a final response from the ACGME in this regard, expected 2010.