Learn more about the faculty's clinical expertise and research
The Medical Oncology/Hematology Fellowship Training Program at Memorial Sloan Kettering Cancer Center has a tradition of developing the careers of leading physician-scientists by providing rigorous training in the diagnosis and treatment of neoplastic disorders as well as in the conduct of clinical and/or laboratory investigation.
The Medical Oncology/Hematology Fellowship Training Program has two main objectives: 1) to provide comprehensive training in the evaluation and care of patients with cancer, leading to board eligibility in the subspecialties of medical oncology or both medical oncology and hematology; and 2) to develop highly qualified and productive investigators in clinical and/or laboratory-based cancer research.
The foundation of a successful cancer research training program is intensive subspecialty training in cancer medicine. This program is designed to meet all subspecialty training requirements and to provide insight into and perspective on the important problems and issues in cancer medicine. The first year of clinical training enables fellows to gain the fundamentals necessary to ask and pursue vital questions regarding the diagnosis and treatment of cancer.
In the first year of training, fellows are assigned to both inpatient and outpatient clinical rotations. The inpatient rotations constitute one-third of the year with rotations in genitourinary cancer, solid tumor consultation, stem cell transplantation, leukemia, and lymphoma/myeloma. During the inpatient rotations, fellows also participate in one half day per week of outpatient continuity clinic. Each first-year fellow spends two-thirds of the year training exclusively in outpatient subspecialty care. During the outpatient blocks, fellows are assigned to outpatient clinics with no inpatient responsibilities. This schedule provides first-year fellows with extensive ambulatory care experience in both hematologic and solid tumor oncology. The inpatient and outpatient rotations are disease oriented, resulting in in-depth, yet balanced exposure to patients with a wide variety of cancers. During the initial period of clinical training (12 months for medical oncology and 18 months for medical oncology/hematology certification), fellows are introduced to current clinical and laboratory research through a comprehensive one-year core curriculum provided by the Center's clinical and laboratory investigators.
Integration of clinical and laboratory research is a priority. All services within the divisions of Hematologic Oncology and Solid Tumor Oncology have members whose research is laboratory based. Presentations of both clinical and laboratory research are emphasized at divisional and departmental conferences, which research fellows are required to attend. Laboratory research pertaining to ongoing or proposed clinical research is presented at service/division conferences, and laboratory members actively participate in clinical service meetings.
In the first year of fellowship each fellow is assigned an advisor (who is also a member of the Fellowship Steering Committee) to aid in the selection of preceptors for the research training years. Faculty preceptors are chosen from Memorial Sloan Kettering Cancer Center, The Rockefeller University, and Weill Cornell Medical College. These faculty members are independent clinical and/or laboratory investigators with proven records of accomplishment. By the end of the first year, each fellow/preceptor pair proposes a research proposal that targets either intensive training in laboratory research or the design and execution of clinical trials during the second and third years of subspecialty training.
If a fellow elects to become board certified in hematology, an additional six months of benign hematology training, spread evenly throughout the second and third year, are required to complement the first year of clinical training. Hematology training includes rotations at both Memorial Sloan Kettering and NewYork-Presbyterian Hospital. Fellows participate in specific clinics with a focus on the diagnosis and management of hemoglobinopathies (sickle cell disease and thalassemia), hemophilia, and platelet disorders. In addition, fellows participate in the general hematology consultation service, affording the opportunity to manage emergent hematologic complications in the setting of pregnancy, general surgery, and trauma. Rotations include extensive training in blood banking and laboratory hematology. During the hematology consultation rotation, fellows perform bone marrow interpretation in joint sessions with members of the clinical services and members of the Department of Pathology, where aspirations, biopsies, and peripheral blood smears are reviewed in concert in order to discuss the differential diagnosis and eventual diagnosis.
Clinical Research Training
Full-time clinical trials research requires at least two years of formal training. During the research training period, the preceptor or mentor is responsible for ensuring that the fellow develops a focused hypothesis and works with a core facility biostatistician to develop the proper clinical trial methodology. The preceptor is responsible for the fellow's overall research training program, which includes oversight of trial design and conduct, data analysis and conclusions, presentation of research, and manuscript preparation. Together with the preceptor, the fellow writes and develops new studies, and ushers them through the review committees including the Institutional Review Board. The fellow meets regularly with the preceptor, biostatisticians, and research study assistant in order to oversee and analyze clinical trial data. Once sufficient data have been accrued, the fellow learns to draw conclusions, assess statistical validity, and present findings for review and critique. Collaboration with relevant basic scientists of the team and other clinician-scientists enhances the fellow's education and increases the breadth of research techniques. Such an approach is necessary for trainees interested in translational research projects that coordinate laboratory and clinical efforts. Clinical responsibilities for clinical research fellows include one full day of continuity clinic, typically under the guidance of the research preceptor, and two half days of elective clinics that change every four months.
The Department of Medicine provides strong support for clinical trials research training. Research nurses administer chemotherapy and monitor toxicity of patients on clinical trials. A single pharmacy controls all conventional and research drugs, and the process for review and safety of chemotherapy administration at Memorial Sloan Kettering is considered one of the most stringent in the nation. All clinical research data are maintained on the institution's clinical research database (CRDB) maintained by the Department of Biostatistics and Epidemiology. Research study assistants (RSAs) and biostatistical support are provided by the preceptor for data management and analysis for all protocols in the Department of Medicine. The Clinical Chemistry and Hematology laboratories are computerized; patient data are directly downloaded to the CRDB. Dedicated space and computer access to all clinical information and databases are provided for RSAs and trainees. The Memorial Hospital inpatient floors, Adult Day Hospital, and Outpatient Chemotherapy Units contain pharmacy satellite units, and provide full-time nursing, administrative and pharmacy staff, to create the ideal setting for the conduct of investigational protocols.
Laboratory Research Training
Fellows engaged in advanced laboratory research training work as active members of their mentor’s laboratory. The mentor meets regularly with the trainee to supervise ongoing work. The trainee is integrated into the larger research community, which includes the Louis V. Gerstner, Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center; the Weill Cornell Graduate School of Medical Sciences, conducted conjointly between Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; and the Tri-Institutional MD/PhD Program sponsored collectively by the Sloan Kettering Institute, The Rockefeller University, and Weill Cornell Medical College. Vigorous scientific dialogue among staff scientists and research trainees from Memorial Sloan Kettering and neighboring institutions is promoted through an active calendar of lectures, seminars, and visits by distinguished scientists. Training in research ethics, trial regulatory requirements, biostatistics, research methodology, and data computerization is provided both by the Tri-Institutional Ethics Program and Memorial Sloan Kettering programs.
The fellowship advisors meet regularly with the trainees to review progress. Research progress is gauged, in part, by submission of applications of support from internal and external funding sources during the second or later years of laboratory research, and submission of abstracts to national meetings. Intramural sources of funding include the T32s at both the Sloan Kettering Institute and Memorial Hospital. Extramural funding sources include the American Society of Hematology; the American Society of Clinical Oncology Young Investigator and Career Development Awards; the Leukemia Society Special Fellows Award; the American Cancer Society Junior Faculty Awards; K-series (K08/K23/K12) awards, and others. Salary support is guaranteed for three years of standard fellowship training or four years for those trainees who have selected the ABIM-Clinical Investigator Pathway after two years of Internal Medicine residency. Nonetheless, independent funding is regarded as the best evidence of future success. Fellows are encouraged to apply for internal and external funding and are supported in the grant-writing and application process. Trainees have been extremely successful in obtaining support for their research.
All laboratory research fellows attend one half-day outpatient session (four hours) per week related to patient care, which is an integral part of the research training program. This allows them to devote the required time to laboratory investigation while maintaining clinical skills. Fellows attend selected conferences (i.e., AACR/ASCO workshops, Keystone conferences, Cold Spring Harbor conferences) to interact with other fellows, investigators, and distinguished scientists from other institutions. Informal presentations of research occur regularly.
The Clinical Research Methodology Curriculum
The Clinical Research Methodology Curriculum is a one-year research training curriculum available for all fellows in the fellowship program. This didactic curriculum provides a fundamental core of didactic lectures, interactive seminars, Web-based programs, and workshops necessary for the training of future clinical investigators dedicated to academic careers in biomedical research. The one-year curriculum is conducted simultaneously with subspecialty clinical research training overseen by each fellow's mentor. In addition to Memorial Sloan Kettering faculty, the curriculum includes state-of-the-art seminars presented by outside speakers on related subjects in clinical research education. All participating faculty are experts in their respective fields and have distinguished records of accomplishment. The curriculum includes course work in each the following areas: Biostatistics in Clinical Research; Drug and Medical Device Development from Pre-Clinical Testing to FDA Approval; Clinical Research in Outcomes Analysis, Psychometric Measurements, Clinical Genetics, Biological Markers, Early Detection, Epidemiology, and Chemoprevention; Conducting Clinical Investigations: Ethical Conduct, Regulations Involving Human Subject Research, Data Management, Reporting Responsibilities, Institutional Oversight, and Conflict of Interest; and Institutional and Cooperative Group Clinical Trials: Trial Designs, Correlative Sciences, Ethical Considerations, and Regulatory Oversights.
Research opportunities for trainees in the Medical Oncology/Hematology Fellowship Program parallel the programmatic research areas at the Sloan Kettering Institute.
Core Curriculum and Conferences
Fellowship conferences have been designed to comprehensively address the biology and natural history of cancer, patient management, and research ethics. The core curriculum is composed of a series of didactic lectures concerning the pathophysiology and treatment of malignant disease, arranged by disease type. Additionally, a number of intensive mini courses have been developed to focus in greater detail on issues important to the fellow pursuing a career in medical oncology/hematology. Topics include the following: the biology of cancer, cancer genetics and immunology, communication skills training, and bone marrow review. In addition, fellows are required to participate in a chemotherapy administration course after which the fellow is credentialed in all aspects of preparation and administration of chemotherapeutic agents.
Fellows also attend weekly Department of Medicine meetings and divisional conferences for Solid Tumor Oncology and Hematologic Oncology. These conferences focus on research topics presented by internal and external speakers who are nationally and internationally renowned. Fellows also attend and participate in clinical case conferences specific to each service, which focus on case presentation and discussion of difficult management issues. Appropriate references to literature are made during the discussions, and key references are provided to enhance understanding of the specific area and support of clinical approaches.