Learn more about the faculty's clinical expertise and research
The Medical Oncology/Hematology Fellowship Training Program at Memorial Sloan Kettering has a tradition of developing the careers of leading physician-scientists by providing rigorous training in both the clinical management of neoplastic disorders as well as the conduct of clinical and/or laboratory investigation. The training program has two main objectives: 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 to develop highly qualified and productive investigators in clinical and/or laboratory-based cancer research.
Medical Oncology Training
The MSK Medical Oncology/Hematology Fellowship Training Program aims to provide fellows with comprehensive subspecialty training in clinical oncology while also developing their careers as future clinical investigators and/or laboratory researchers. These goals are achieved through direct clinical experience, both in the inpatient and outpatient setting, as well as a structured didactic curriculum designed to promote clinical and laboratory investigation.
Clinical subspecialty training at MSK is both diverse and comprehensive. In their first year of training, fellows are assigned to both inpatient and outpatient clinical rotations. Each first year fellow spends two-thirds of the year training exclusively in outpatient subspecialty care. During the outpatient blocks, fellows are assigned outpatient clinics and are protected from any inpatient responsibilities. This schedule provides first-year fellows with extensive exposure to a variety of disease-specific clinics in both hematologic and solid tumor oncology. Throughout their clinic experience, fellows will participate in both initial consultations and longitudinal follow-up visits. Additionally, they will play a critical role in the enrollment and management of patients on clinical trials.
The inpatient experience constitutes one-third of the year, with rotations in genitourinary cancer, solid tumor consultation, stem cell transplantation, leukemia, and lymphoma/myeloma. The purpose of the inpatient rotations is to provide fellows with experience in the management of acute complications due to both patients’ underlying malignancies and their treatments. During their inpatient rotations, fellows will be encouraged to assume a leadership role in managing the various members of the inpatient team. They will be protected from outpatient responsibilities with the exception of one half day per week of outpatient continuity clinic.
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 years, are required to complement the first year of clinical training. Hematology training includes rotations at both Memorial Sloan Kettering and New York-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 pathology departments.
Core Curriculum and Conferences
During their initial period of clinical training (12 months for medical oncology and 18 months for medical oncology/hematology certification), fellows’ direct clinical experiences are supplemented by a highly structured curriculum that focuses on core concepts in clinical oncology and exposes them to emerging avenues of study in both clinical and laboratory-based research. The curriculum features lectures delivered by many of MSK’s most highly regarded clinicians, service chiefs, and laboratory investigators. As part of their core curriculum, fellows are also given lectures in pharmacology, with particular attention to chemotherapeutic agents and palliative care. Fellows also attend various weekly lecture series and conferences including Medical and Solid Tumor/Hematologic Oncology Grand Grounds, service-specific case conferences, and multidisciplinary case conferences.
Additionally, a number of intensive “mini-courses” have been developed for first-year fellows to provide additional education in the fundamentals of disease management as well as an introduction to clinical and laboratory research initiatives and mentors. These mini-courses are given to first-year fellows on Monday afternoons, during which they are free of clinical responsibilities. Examples of the courses offered include:
- The New Visit Seminar Series, in which each first-year fellow, under the supervision of his or her continuity clinic mentor, provides a comprehensive review of the initial diagnosis and management of a particular disease
- The Cancer Biology Series, in which some of MSK’s most renowned physician-scientists speak with first-year fellows about emerging research initiatives in cancer biology, including epigenetics, immunotherapy, and developmental genetics
- The Pharmacology and Chemotherapy Practicum, in which first-year fellows are educated, and ultimately credentialed, in the preparation and administration of chemotherapeutic agents
- The Bone Marrow Review Course, in which fellows are given interactive lectures and didactics in the evaluation of peripheral blood and bone marrow smears (both in physiologic and diseased states)
- The Humanism Curriculum, during which fellows participate in interactive discussions on death and dying, work-life balance, patient-doctor relationships, and goals of care discussions
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, 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 submits 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.
Clinical Research Training
Fellows intending to pursue a career in clinical research begin a two-year period of formal training beginning in their second year. During this period, under the oversight of their clinical mentors, fellows develop a focused, testable hypothesis; accrue sufficient data; perform the appropriate data analysis (in combination with MSK’s core facility biostatisticians); and present their findings both at national meetings and in peer-reviewed publications. During their training, clinical research fellows also have the opportunity to write and develop new protocols and submit them for review by regulatory committees including the Institutional Review Board. Clinical research fellows are encouraged to collaborate with basic scientists to develop translational initiatives that attempt to provide laboratory correlates with clinically relevant outcomes. Once a clinical trial is instituted, the participating fellow meets regularly with the preceptor, biostatisticians, and research study assistant in order to oversee and analyze clinical trial data. During this two-year period, clinical research fellows are supported by intramural funding sources both at the Sloan Kettering Institute and MSK; they are also encouraged as part of the training process to apply for extramural sources of funding. All second-year fellows are enrolled in a grant writing course to facilitate the development of skills required to obtain grant funding as they transition to careers as independent investigators.
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 training in clinical research and the implementation of clinical trials. Patients on protocol are co-managed by research nurses, research study assistants, and pharmacists, who provide support for ongoing clinical trials. This team, in collaboration with the trainee, is responsible for administering chemotherapy, monitoring toxicities, providing biostatistical and data management support, and distributing study medications. All clinical research data are maintained on the institution’s electronic Clinical Research Database (CRDB), maintained by the Department of Biostatistics and Epidemiology. Dedicated space and computer access to all clinical information and databases are provided for research study associates and trainees. The Memorial Hospital inpatient floors, Adult Day Hospital, and Outpatient Chemotherapy Units contain pharmacy satellite units and full-time nursing, administrative, and pharmacy staff, and provide an ideal setting for the conduct of investigational protocols.
Laboratory Research Training
Each fellow intending to pursue a career in laboratory research begins a minimum two-year period in the laboratory of his or her mentor starting in the second year. During this time, mentors supervise implementation and completion of the goals outlined in their fellow’s research proposals. Research fellows collaborate closely with members of the larger tri-institutional research community, including the Louis V. Gerstner, Jr. Graduate School of Biomedical Sciences, the Graduate School of Medical Sciences conducted conjointly between Memorial Sloan Kettering 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. As part of their ongoing research education, fellows attend and participate in an active calendar of lectures, seminars, and research consortiums. They are also encouraged to attend selected conferences (e.g., AACR/ASCO workshops, Keystone conferences, Cold Spring Harbor conferences) to interact with other research investigators and further their scientific education. 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.
Throughout this research training period, fellows’ research initiatives may be supported by either the Sloan Kettering Institute and MSK T32 training grants or other funding sources. Salary support is guaranteed for three years of standard fellowship training and four to five years (depending on single- or dual-board eligibility) for those trainees who have selected the ABIM-Clinical Investigator Pathway after two years of Internal Medicine residency. Similar to clinical research fellows, laboratory research fellows are encouraged to apply for extramural sources of funding. Laboratory-based research fellows initially participate in a “level 1” grant writing workshop targeting Young Investigator Awards in order to develop skills required to secure funding. As more senior fellows, they participate in a “level 2” grant writing workshop targeting K Awards with the goal of establishing funding as independent investigators. Extramural funding sources include but are not limited to: 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; and K-series (K08/K23/K12/K99-R00) awards.
The Medical Oncology/Hematology Fellowship advisors meet regularly with trainees to review progress. Research progress is gauged, in part, by submission of applications for support from internal and external funding sources during the second or later years of laboratory research (as mentioned above), as well as submission of abstracts to national meetings and generation of manuscripts for publication in peer-reviewed journals.
Each laboratory research fellow continues to attend one half-day outpatient session in the disease specialty of his or her choice under the care of a clinical mentor. This level of protection allows fellows to devote the required time to laboratory investigation while maintaining clinical skills. Research time is truly protected: There are no weekend or on-call responsibilities during the research training years. Research fellows are encouraged to pursue translational initiatives that integrate their basic-science interests with clinical outcomes, particularly in the context of clinical trials.
The Certificate Program in Clinical Investigation (CPCI)
The Certificate Program in Clinical Investigation (CPCI) is a one-year research training curriculum available for all fellows in the fellowship program. This didactic curriculum provides a fundamental core of 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. The curriculum includes coursework in each of 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.