Fellowship
Training
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Program Goals & Objectives The goal of the Medical Oncology fellowship program is to train oncologists for academically oriented careers. The program is designed to incorporate training in the diagnosis and management of a broad spectrum of neoplastic diseases. At the end of two years of training, each fellow is expected to be familiar with the natural history of the major and common human malignancies and to be knowledgeable about appropriate diagnostic and therapeutic approaches. By then, each fellow will have had exposure to a variety of research programs and will be expected to have demonstrated his/her ability to complete an independent research project in the laboratory or clinic. At the end of a third year of training, the fellow is expected to be competent, skilled oncologist able to assume a position as an independent investigator in either a laboratory-based or clinically oriented research program. Fellows who complete the training should be proficient in the following procedures: serial measurement of palpable tumor masses, bone marrow aspiration and biopsy, administration of chemotherapeutic agents and biological response modifiers through all therapeutic routes, and management and care of indwelling venous access catheters. First Year During the first year, each fellow is assigned two or three two-month rotations and six one-month rotations. These include rotations in both solid tumors and hematologic malignancies. On those services such as acute leukemia and bone marrow transplantation, where the primary activity is inpatient care, the fellow coordinates care for hospitalized patients. On other services (lymphoma and solid tumors) the fellow's primary assignment is in the clinic. Under the supervision of an attending physician, the fellow attends outpatients referred to the institution and a small number of inpatients. The fellow also is involved in the clinical research program for each service or section and is encouraged to develop a research program of his own. A typical first year of training consists of three two-month rotations on the hematology services (i.e., leukemia, lymphoma/myeloma, bone marrow transplantation) and six one-month rotations on solid tumor services (i.e., melanoma/sarcoma, breast, genitourinary, thoracic/head and neck, gastrointestinal and gynecological medical oncology). Upon fellows' completion of the first year of study, Division of Medicine faculty selects by ballot one outstanding fellow to receive the Clifton D. Howe Award for Clinical Excellence. Second and Third Years During the second and third years, a fellow may choose to devote his/her training to either a clinical or laboratory based research project. The fellow's project is supervised by an experienced faculty member who serves as a mentor. Projects are reviewed by a committee of advisors on a regular basis, and a formal report is presented annually. The advisors assess the project, evaluate the fellow's methods and findings, and provide advice. Clinician-Investigator The clinician-investigator program provides an opportunity to understand new drug development and evaluation in depth as well as to understand the phonotypic heterogeneity of human cancer. Emphasis will be placed not only on protocol design, protocol implementation and biostatistics, but also on the biology of human cancer. One or more protocols will be developed in collaboration with a faculty mentor. Didactic course work can be completed at the U.T. Graduate School of Biological Science at the School of Public Health. Externships of 2-12 weeks will be conducted at government agencies and in private sector companies for fellows to better understand different perspectives on drug development. From these experiences, a fellow on the clinician-investigator tract should better understand how drugs are chosen for development, the time frame for pre-clinical and clinical evaluation, the impact of market analysis, regulatory policies and procedures, and the role of the NCI in facilitating discovery, scale up and evaluation of new drugs. Physician-Scientist The physician-scientist program permits fellows to work in the laboratory for two years under the direction of one of our mentors. Fellows who excel during this interval will be eligible to compete for the junior faculty physician scientist awards that have recently been established at M.D. Anderson and that permits 80% protected time for an additional 3-5 years for faculty at the Assistant Professor level. Consequently, come 5-7 years of support could be made available for a young investigator to develop the expertise, credibility and publication record to complete successfully for peer reviewed funding. This interval would permit formal course work and the completion of requirements for a Ph.D. degree in the U.T. Graduate School of Biological Sciences. Over the last 10 years two Medical Oncology fellows have completed fellowship training in oncology while pursuing a Ph.D. Both have joined the M.D. Anderson faculty. The laboratory projects of fellows will be reviewed semi-annually by a "thesis" committee that will include the fellow's mentor and at least two other knowledgeable faculty members. Community-Based Research/M.P.H. The community-based research program will take advantage of our institution's extensive program in cancer control research and chemoprevention. Each fellow will complete two projects with mentors in the program. In addition there will be the option to obtain an M.P.H. degree at The University of Texas School of Public Health during this two year period. The Executive Committee evaluates the training of all fellows and oversees research progress during the last two years. Second and third year fellows meet periodically with Drs. Bast and Pazdur. Projects are presented annually with the entire group of fellows and mentor in attendance. Bioimmunotherapy The goal of this training program is to provide a curriculum that will lead to the development of independent clinician/scientists capable of translating new advances in basic immunobiology into the clinical area. Candidates that have these goals will be accepted into the program. The Bioimmunotherapy training program provides exposure to a broad range of topics including biostatistics, clinical trial design, genetics, cell biology, immunobiology, molecular biology and biochemistry. Through the Graduate School of Biomedical Sciences, fellows will have access to structured courses in different disciplines, which will be recommended by the sponsoring committee on an individual basis. Continuity Clinic For the duration of the training, a fellow must participate in at least one continuity clinic per week (for at least one half-day) either at M. D. Anderson Cancer Center or L. B. Johnson Harris County Hospital where the fellow sees at least one new patient per week and establishes his/her own patient base to be seen in follow-up visits. Six to eight patients per week are seen in follow up visits. The clinic and/or attending physician with whom the fellow works in the continuity setting is chosen by the fellow with the approval of the program director. The recommended choice should integrate the individual fellow's career objectives with the fellowship program's goals. A fellow may elect to participate in more than one continuity clinic. Scientific Writing In addition
to meeting American Board of Internal Medicine requirements, M.
D. Anderson Cancer Center expects all of its medical oncology/hematology
fellows to complete a manuscript suitable for publication before
graduation from the program. This requirement is met when a fellow
authors a manuscript that is published or in press in a scientific
journal (preferably peer-reviewed) or textbook. To prepare fellows
to meet the goal of scholarly writing, the program offers:
In 1993, the program's scientific writing support
efforts culminated in the publication of a comprehensive medical
oncology textbook whose chapters were exclusively first-authored
by M. D. Anderson's medical oncology/hematology fellows. Based on
customer demand and requests by the publisher for subsequent editions,
this project has become a permanent part of the fellowship program.
Courses & Lectures Each fellow is expected to attend weekly conferences and lectures specifically scheduled for fellows, i.e., weekly clinical case presentations, core lectures, chiefs; rounds, expanded medical grand rounds, biostatistics, communication skills, and journal club. First-year fellows are expected to attend Morning Report with the medical housestaff. Fellows are encouraged to attend lectures sponsored by the departments and divisions of the institution. Options With the approval of the program director, fellows fellows may choose to pursue concurrently with their fellowship:
Additionally, qualified fellows who have the fellowship program director's approval may enter M. D. Anderson's Physician-Scientist Postdoctoral Program. Physicians entering this program can expect an increased stipend and a faculty associate appointment. The purpose of this program is for physician scientists, through an fourth and fifth year of training, to prepare for full participation on the faculty and to obtain peer-reviewed funding. Fellows accepted into this program are expected to take courses in such topics as ethics, biostatistics, grant writing and molecular studies. Publications and presentations at national and international meetings are expected at this level of training. Accreditation The University of Texas M. D. Anderson Cancer Center Medical Oncology Fellowship program is approved by the Accreditation Council for Graduate Medical Education. Fellows who successfully complete this three-year training program are eligible to sit for the American Board of Internal Medicine (ABIM) Certifying Examination in the subspecialty of Medical Oncology. If, during their three-year training, fellows elect to complete proscribed rotations in classical Hematology at either The University of Texas Medical School at Houston or at the Baylor College of Medicine, they will be eligible to sit for the ABIM certifying examinations in the dual subspecialties of Hematology and Medical Oncology. |