The second and third year hematology and oncology fellowship is tailored to the fellow's intended career path.
Curriculum for 2nd and 3rd Year Fellows
The second phase of fellowship education is tailored to the career goals of the individual trainee. Our curriculum is specifically designed to permit the trainee 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. Additionally, there are some clinical responsibilities expected during these years of training:
On this rotation, the fellows concentrate on the evaluation and management of patients with new oncologic diagnoses (or patients with unknown diagnoses for whom a malignancy is part of the differential diagnosis). The aims are for the fellow to gain an understanding of disease processes, the past histories and the choices of chemotherapy regimens. Consults will be staffed by a dedicated oncology consult attending physician who is also responsible for daily rounds and teaching.
The programs purpose is to provide a sophisticated and comprehensive experience in the diagnosis and management of oncologic diseases, under the direct supervision of attending physicians.
- Principal teaching methods:
Inpatient patient 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 a variety of solid tumors and their complications, including breast cancer, aero-digestive cancer, melanoma and sarcoma, lymphomas, brain tumors, and genitourinary cancers.
- Mix of diseases:
A wide array of solid tumor oncologic problems, as well as new lymphadenopathy, hypercalcemia, workup of new masses or 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.
Bone marrow aspiration and biopsies, chemotherapy infusion, stem cell and bone marrow infusion, intrathecal/intraventricular chemotherapy administration.
- Educational resources:
As previously described.
All fellows must spend two weeks attending the outpatient clinics in gynecologic oncology. Because this surgical subspecialty of oncology is managed exclusively by the obstetrics and gynecology service at Penn, including chemotherapy administration, fellows obtain experience in this field by rotating through these clinics for at least one 2-week block during their 2nd or 3rd years of training.
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.
- With another appropriate scientist at the Abramson Cancer Center, the University of Pennsylvania, the Children's Hospital of Philadelphia, or the Wistar Institute. Investigators across campus work in diverse aspects of cancer genetics and genomics, proteomics, cell and developmental biology, signal transduction, stem cell biology, structural biology, immunobiology, vaccine and cellular therapy, gene therapy and virology.
The laboratory experience is structured to provide the fellow with sufficient training to build a career as an independent investigator. Support for those individuals wishing to obtain a doctorate as part of this experience can be arranged through the Clinical Investigator Graduate Degree Program.
Upper-year fellows attend a variety of formal and informal research venues to become aware of potential mentors. The scientific mentor is chosen no later than the spring of the first year after formal and informal consultation with various faculty members.
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
For those desiring more in-depth methodological research training, there are several programs available through the Perelman School of Medicine, including:
- 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.
- The summer courses offered by the ASBMT, AACR/ASCO and ASH.
A master's degree in clinical epidemiology offered through the Department of Biostatistics and Epidemiology.
A master's degree in experimental medicine and translational research offered through the Institute for Translational Medicine and Therapeutics.
- A master's degree in health services and policy, which can be done as part of the Robert Wood Johnson Foundation.
- A master's degree in public health.
- For those already prepared with master's degrees, certificate programs in both clinical epidemiology and translational research are available through the sites above.
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 consists of the fellow working closely with one or two of the many basic, clinical, or translational investigators in the hematology/oncology division. The fellow is assigned mentors after consultation with Dr. Loren and other divisional leadership. The process of identifying and meeting with potential mentors culminates in the spring of the first year of fellowship.
Each fellow develops, writes, submits to the IRB, and executes one or more clinical research protocols. During this time, the fellow may also seek additional formal instruction in the design, execution and interpretation of clinical trials. For example, those individuals with particular professional interests in cancer epidemiology may complement clinical research training with master's degree training in clinical epidemiology and biostatistics, as noted above.
Whether participating in either the bench research or the clinical/translational research pathway, each fellow maintains a weekly continuity clinic throughout his or her fellowship. This allows fellows to deepen their experience in clinical hematology/oncology and develop their breadth of clinical experience.
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 participate in any of the several multidisciplinary subspecialty tumor boards, particularly those related to their research projects.
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 develop their professional careers following completion of their formal fellowship training, as senior research associates or instructors in the division.