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Disclosures for Ellis Neufeld, MD, PhD. In compliance with ACCME policy, ASH requires the following disclosures to the session audience: . 51 st ASH Annual Meeting ♦ New Orleans, LA. Aiming for high-quality basic and translational research training for hematology fellows.

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Disclosures for Ellis Neufeld, MD, PhD

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Disclosures for Ellis Neufeld, MD, PhD

In compliance with ACCME policy, ASH requires the following disclosures to the session audience:

51st ASH Annual Meeting ♦ New Orleans, LA


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Aiming for high-quality basic and translational research training for hematology fellows

Ellis J. Neufeld MD, PhD

[email protected]

Children’s Hospital Boston

Dana Farber Cancer Institute

Harvard Medical School


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Lessons from Children’s/DFCI fellowship program

  • Start early

  • Offer highest quality opportunities, (not just divisional or departmental opportunities)

  • “Three years is not enough”

  • Scholarship oversight committee input must be both early and rigorous

  • No substitute for expert mentoring

  • Duty hours and high-quality lab training

  • What does it mean to train in “translational” research? Can a fellow really do this?

  • Recognize strengths and weaknesses. “What if basic science is not for me?”


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Start Early. No Earlier

  • Expose prospective fellows to breadth of opportunity. Work research training choices into fellowship interviews.

  • Focus on accepted fellows before they matriculate.

    • If local, invite to lab meetings, work on projects

  • “Data blitz” for first year fellows

    • 4 dinner sessions, 12 speakers per session, 5 slides/5 minutes each, 5 minutes for questions.

    • Basic and clinical investigators, all ranks, includes other hospitals and universities

  • Advisors encourage first year fellows to use elective time to investigate labs/opportunities


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Offer high-quality opportunities

  • If the best person at fellow’s topic of interest is across campus or across town, send the fellow.

  • Insist on highest level buy-in (chairs, deans) for high-quality research

  • Recruit best investigators (e.g. to data blitz)

    • Example 2009: new Program in Molecular Medicine at Children’s.


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“Three years is not enough*”

  • This is the mantra of our program.

  • Two T-32 grants available in Division, plus two more in sister departments. Use Clinical/hospital/GME funds for year 1.

  • Three-year T-32 support covers year four (first year instructors).

  • We do NOT guarantee year five automatically.

  • K12 opportunities, other scholarships/fellowships cover many for year 4/5.

  • K08, K23 cover several more years mentored research training

* Thanks to Sam Lux


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Scholarship Oversight Committee input should be early and rigorous

  • Set high expectations for fellow

  • Include senior external member(s) with broad view of field

  • Review need for scholarly work product

    • Paper or manuscript

    • Grant application approved or favorable review

    • “project write-up” acceptable in some cases

    • Remind lab mentor of the need for this activity.

    • The scholarly work product might NOT be the main lab focus. Small clinical reports acceptable.

  • Meet often enough to catch problems with focus or large technical glitches


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No substitute for expert mentoring

  • Mentor may or may not be the lab supervisor

  • Expertise in the relevant basic or translational field is essential. Expertise in the exact lab system is not essential.

  • Convene the mentors for all the fellows from time to time to review philosophy, best practices, challenges.

  • Mentors could serve on SOC or play complementary roles.


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Strive for K awards or equivalent

  • Few if any fellows could apply for R grants during third year.

  • Development of data for K application is a reasonable fellow goal.

  • K12 need few preliminary data. Increasingly, K08 and K23 need a lot!

  • Foundation/philanthropic equivalents are just as good (NHF-Baxter hemophilia grants)

  • The biggest gift in K grants is protected time


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Strive for K grants, continued

  • K08 most appropriate for basic research,

  • K23 can support any patient-oriented translational research

  • Training program should help with Career development plans for your K applicants

    • Faculty member or dean paying attention to CDP is invaluable for K applicants. Investment readily pays back


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Duty-hour limitations and high quality research training

  • According to most recent ACGME decisions, lab hours count in duty hours

  • Terrible implications for post-call fellows in research settings.

  • May require rethinking of coverage schemes

    • Night-float weeks on call to reduce interruptions of research for most fellows most of the time

    • Inevitable move toward hospitalists

    • FACULTY don’t have duty hour limitations

      • All kinds of bad potential implications if clinical duty is pushed back to first faculty year (i.e. our research fellows’ fourth year)

      • Possible division of labor among more-clinical vs more-lab-based researcher

  • If fellowship gets LONGER because of the duty hour conundrum, what happens to research time?


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What is “translational research training?”

  • This begs the question, “What is translational research?”

    • “Bench to bedside.”

      • New pathway discovered in the lab during a gene expression screen of MDS.

      • This leads to tests of pathway inhibitors in vitro. If successful, needs a clinical trial.

    • “Bedside to bench”

      • Fellow discovers an interesting patient with unknown genetic defect

      • Comes to lab to sequence candidate genes and learn pathophysiology.


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Can an applicant train in translational research?

  • Poll

    • Yes

    • No


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Training in translational research?

  • (Maybe) . Most translational researchers were trained to do something else

  • Traditional route A

    • Physician scientist trains in the lab, makes a discovery and learns how to translate it

  • Traditional route B

    • Physician investigator trains in clinical research methodology.

    • Collaborates with investigator A who has a new compound that needs testing

  • New route?

    • Formal training in methods for drug evaluation, IND submissions, statistics and methods for small scale phase I/2 trials, intellectual property issues, etc. Leads to masters degree

    • Harvard proposes such a pathway to complement traditional epidemiology/outcomes research for T1 researchers

    • (Neufeld skeptical)


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Recognize strengths and weaknesses

  • “What if I don’t really like to _____________

    • Write papers?”

    • Write grants or pay attention to lab budgets?”

    • Work in the lab, I like working with patients?”

  • “OK, fine.” Evaluate strengths, find training for the right alternative pathway

    • Regulatory/FDA

    • Clinical research?

    • Clinician pathway?


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Warning!

  • It is not appropriate to say to a fellow who is bailing out of the lab, “OK, then you’re a clinical researcher, ” and unleash the fellow on the clinical research unit without training in clinical research

  • But this actually happens all the time!


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“Real world” talk for second year fellows

  • Clinical and basic research leaders

    • Wine and cheese.

    • Last talk of a one week “consolidation course” September, year 2.

  • Cover some key concepts in aiming for academic career

    • Start up offers

    • Indirect costs

    • Protected time

    • K grants vs other pathways

    • Clinical vs. research pathways.

(REALLY? 70%???)


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DISCUSSION

  • Acknowledgments

    • Sam Lux

    • Stuart Orkin

    • David Nathan

    • David Williams

    • Tom Abshire


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