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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

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

51st ASH Annual Meeting ♦ New Orleans, LA

aiming for high quality basic and translational research training for hematology fellows

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

lessons from children s dfci fellowship program
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?”
start early no earlier
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
offer high quality opportunities
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.
three years is not enough
“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

scholarship oversight committee input should be early and rigorous
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
no substitute for expert mentoring
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.
strive for k awards or equivalent
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
strive for k grants continued
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
duty hour limitations and high quality research training
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?
what is translational research training
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.
training in translational research
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)
recognize strengths and weaknesses
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?
  • 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!
real world talk for second year fellows
“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%???)

  • Acknowledgments
    • Sam Lux
    • Stuart Orkin
    • David Nathan
    • David Williams
    • Tom Abshire