Curriculum

Pediatric Hematology Oncology Fellowship Program

Curriculum

Year 1

The first year of the program is focused on clinical training and includes rotations on the inpatient oncology service, outpatient hematology and oncology services, and inpatient and outpatient bone marrow transplant services. Sites of clinical rotations include Seattle Children’s hospital, the Seattle Cancer Care Alliance (outpatient transplant), UW medical center (radiation oncology) and the Odessa Brown children’s clinic (sickle cell disease clinic). Fellows maintain an ongoing continuity clinic one half day a week where they develop a cohort of patients for which they are primarily responsible. Fellows also have a one month elective rotation; options include gaining additional training in laboratory medicine, radiation oncology or gain exposure to opportunities for research with a local biotechnology group. During this block fellows have flexibility to meet with potential mentors for their scholarly work in years 2 and 3.

Years 2-3

The second and third years of the program are devoted to scholarly work, with reduced clinical responsibilities. Fellows maintain their continuity clinic throughout their fellowship. They also spend one month as a ‘junior attending’ in their 3rd year, either on the inpatient transplant or hematology-oncology services, designed to facilitate their transition to the responsibilities of attending.

Didactic program

Learning throughout fellowship blends didactics with interactive teaching and self study. Regularly occurring conferences include:

  • Pediatric hematology oncology meeting (weekly): presentations include both clinically focused and research presentations.
  • Standard practice meeting (monthly)- review and update policies related to standard clinical management pathways.
  • General tumor board (weekly)
  • Neurooncology tumor board (weekly)
  • Discipline-oriented conferences (solid tumor, leukemia, hematology; weekly)
  • Fred Hutchinson Cancer research center grand rounds (weekly)
  • Hematopathology conference (monthly): Review of benign and malignant hematology cases
  • Hemschool (monthly): Fellow organized didactic review of hematology topics
  • Board preparation- Fellow organized review of materials for the pediatric hematology oncology subspecialty boards.
  • Hemoglobinopathy conference (quarterly)- laboratory based review of complex hemoglobinopathy cases.
  • Journal club (6 times/year)- fellow organized meeting focused on critical review of selected literature
  • Humanism curriculum (4 times/year)- topics include wellness, communication skills.
  • Fellows college

On-Call

Fellows take call from home with decreasing frequency from years 1 to years 2 and 3. Fellows are on call approximately 5 times a month in their first year, 3-4 times/month in year 2 and twice a month in year 3. There is no in-house call, however fellows are expected to return to the hospital to evaluate and direct management of patients with suspected new cancer diagnoses. Fellows take calls from the families of our patients as well as referring community physicians who seek consultation after 5 pm or on weekends. We have an inpatient hospitalist service that provides in-house management of inpatients and transplant patients and supervises the on call pediatric residents.

Clinical program

Seattle Children’s Hospital serves as the pediatric and adolescent academic medical referral center for Washington, Wyoming, Alaska, Montana and Idaho. Seattle Children’s Hospital has partnered with the Fred Hutchinson Cancer Research Center and the University of Washington to form the Seattle Cancer Care Alliance (SCCA) to offer a full range of services for children with hematologic and oncologic disorders.

We diagnose about 250 pediatric patients with oncologic disorders and perform approximately 75 HSCT each year. Our inpatient oncology unit has 60 beds. U.S. News & World Report magazine has ranked Seattle Children’s Hospital among the nation’s top children’s hospitals for 19 consecutive years.

Seattle Children’s hospital participates in a number of research consortiums including the Children’s Oncology Group COG), Phase I consortium, New Approaches to Neuroblastoma (NANT), Therapeutic Advances in Childhood Leukemia (TACL), Pediatric Brain Tumor Consortium (PBTC) and Pediatric Oncology Experimental Therapeutics Investigators Consortium (POETIC). Investigator initiated research studies include cell immunotherapy and tumor paint studies. Seattle children’s hospital consistently ranks in the top 5 for patient enrollment in clinical trials.

Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. Medical students and residents regularly rotate on the hematology oncology service.

We offer a variety of specialized programs to provide multidisciplinary care for our complex patients.

  • Hemophilia treatment center/ Bloodworks Northwest (Amanda Blair MD). We diagnose and manage bleeding disorders including hemophilia, von Willebrand disease, platelet function disorders and rare coagulopathies.
  • Bone marrow failure program (Amy Geddis MD PhD). We diagnose and manage a variety of acquired and inherited bone marrow failure syndromes. We collaborate closely with our colleagues at the SCCA who perform non-malignant bone marrow transplant.
  • Sickle cell disease at Odessa Brown (Michael Bender MD PhD). We diagnose and provide comprehensive care for children with sickle cell disease and related sickling disorders in a community setting.
  • High risk leukemia program (Todd Cooper DO). We coordinate care for children and adolescents with high risk leukemia including ALL and AML. We offer several trials in immunotherapy and work closely with our colleagues at the SCCA who perform bone marrow transplant.
  • Brain tumor program (Sarah Leary MD). This is a multidisciplinary clinic where patients can see oncology, radiation oncology, neurosurgery and supportive services.
  • Bone tumor clinic (Katie Albert MD). This is a multidisciplinary clinic where patients can see oncology, orthopedic surgery and supportive services
  • HSCT program (Scott Baker MD). The SCCA consistently has amongst the highest one-year survival rates for hematopoietic stem cell transplants of any treatment center in the country and performs transplant for both malignant and non-malignant disorders.
  • Bone marrow transplant transition clinic (Ann Dahlberg MD). This clinic manages patients who are more than 100 days past their bone marrow transplant.
  • Survivorship clinic (Eric Chow MD PhD). SCH is recognized as a Center of Excellence for survivorship by the Livestrong foundation.

Research opportunities

In order to meet our fellows’ unique career development goals, we develop an individualized research program for each, this includes ongoing mentorship regarding research projects, timelines for manuscript and grant development, as well as targeted career development seminars. All fellows participate in regular works-in-progress presentations within their laboratory or clinical research teams.

Fellows participate in at least 2 years of scholarly work. The fellowship program offers a diverse array of research opportunities. Our trainees have the option to pursue research projects with mentors from the Seattle Clinical Research Institute, the Fred Hutchinson Cancer Research Center and the University of Washington. Each fellow will have a Scholarship Oversight Committee to guide them through their research project. Fellows are encouraged to present their work at meetings and to apply for grant funding to support continuation of their research beyond their fellowship.

Examples of research opportunities Seattle Children’s Research Institute:

  • The Ben Towne Cancer Research Center is home to the world-renown SCRI immunotherapy research program. Cutting edge science in Chimeric Antigen Receptor (CAR) T-Cell regimens includes translational research programs for leukemias and solid tumors.
  • The Center for Clinical and Translational Research (CCTR) is home to multiple basic science laboratories focused on the development of treatments that transform the health of children. The CCTR is home to more than 400 research faculty and staff members from over 30 subdivisions and is the hub for clinical investigation and therapeutic development at Seattle Children’s Research Institute.
  • The Center for Immunity and Immunotherapies brings together a dynamic group of experts across multiple disciplines to solve some of the immune system’s most complex problems. Many of the researchers treat patients in the ImmunologyRheumatology and other clinics at Seattle Children’s Hospital. The center’s research evolves from clinical questions to laboratory-based investigation and back to patients in the form of improved diagnostic tools for primary immune deficiency and autoimmune diseases, advanced therapies for genetic disorders, innovative vaccine strategies and enhanced immune monitoring techniques.

Other centers at SCRI include:

At Fred Hutch, five unique divisions offer a unique environment for career development:

  • The Basic Sciences Division is comprised of >30 independent and highly interactive laboratories pursuing different, yet related, areas of molecular and cellular biology and utilizing a broad range of approaches and experimental systems.
  • The Clinical Research Division works to develop and analyze new treatments for cancers and other diseases and translate investigational new agents from the bench to the bedside.
  • The Human Biology Division aims to cultivate interdisciplinary research to advance understanding of human biology and the complex problems of neoplasia and other human diseases. The division is structured to foster laboratory-based and computational research at the interface of basic, clinical, and population sciences.
  • The Public Health Sciences Division identifies strategies that would ultimately reduce the incidence of and mortality from cancer and other diseases. Using large populations as their "laboratory," researchers look for links between cancer and its possible triggers, from diet and lifestyle to environmental and genetic factors. Identifying such cancer causes can lead to better cancer-detection methods and new ways to help people adopt healthier lifestyles to minimize or avoid their risk of getting the disease in the first place.
  • The Vaccine and Infectious Disease Division, VIDD, aims to develop novel vaccines for infectious diseases that threaten global health, to shed light on the workings of the human immune system, and to develop novel treatment and prevention strategies to lessen the burden of infectious diseases and cancers caused by infection, particularly in the immunocompromised host. The international HIV Vaccine Trials Network (HVTN) is headquartered at VIDD. Nested within VIDD is Fred Hutch’s Global Oncology Program aimed at addressing the worldwide cancer epidemic by translating four decades of scientific exploration into new prevention and treatment strategies.

The University of Washington Medical Center also offers a full slate of basic science research opportunities.

  • UW faculty members have been responsible for many basic science and technological advances in medicine and have been pioneers in numerous areas, including transgenic animal technology, cell replication and signal transduction research, as well as the development of medical ultrasound, renal dialysis and technology critical to protein science, and they are international leaders in genome sciences. International recognition of UW faculty scientific achievements include:
  • When the National Institutes of Health created the first three National Centers of Excellence in Genomic Sciences, the UW received two of the three awards – one in the School of Medicine and one in the College of Engineering.
  • Ten UW Medicine faculty are recognized by the Gairdner Foundation for their seminal contributions to scientific advances worldwide.
  • UW biomedical research programs have been ranked consistently among the top schools in receipt of National Institutes of Health (NIH) grant funding in U.S. News & World Report surveys.

Clinical investigator pathway

For fellows interested in clinical or outcomes research, fellows may pursue careers in epidemiology and public health, survivorship and outcomes, global health, bioethics, and palliative care. Our clinical research track (CR track) is well-established and includes specialized mentorship from research leaders in these fields. Fellows on the CR track are encouraged to enroll in Master’s Degree programs at the University of Washington (e.g., in the School of Public Health). Just as with the laboratory research opportunities, the CR track includes a wealth of focused research training opportunities from Fred Hutch, The University of Washington, and SCRI.

  • Population Health: The Public Health Sciences Division of the Fred Hutch aims to aim to identify strategies that would ultimately reduce the incidence of and mortality from cancer and other diseases.
  • The Survivorship and Outcomes program: The Survivorship Program team is dedicated to conducting research to learn more about the long-term and late effects of cancer treatment and to improve the quality of life for survivors. Researchers are involved in projects ranging from studying the long-term cardiovascular effects of cancer treatment, to examining the factors that determine emotional adjustment and quality of life.
  • Global Health: Seattle is a hub for Global Health, home to the Bill & Melinda Gates FoundationPATHHealth Alliance InternationalI-TECH, and the UW Global Health Department. Seattle also houses national leaders in Global Oncology, with several experts at the Fred Hutchinson Cancer Research Center and the University of Washington. From infectious disease related cancer research, to cancer advocacy, to capacity building efforts, each focus is represented in Seattle. The Fred Hutch partnership with the Uganda Cancer Institute is a great example of a winning partnership between a cancer center in a low resource setting and a center of excellence here in the USA.
  • The Treuman Katz Center for Pediatric Bioethics is housed in the SCRI Center for Clinical and Translational Research. It serves as a national resource for addressing the complex bioethical issues affecting families, healthcare institutions and society.
  • Seattle is also home to the University of Was hington Cambia Palliative Care Center of Excellence(PCCE). The PCCE is home to an internationally-renowned research center dedicated to improving the quality of palliative and end-of-life care. The collaborative, inter-professional faculty of the center received over $6 million in 2016 from 20 on-going NIH and foundation-funded grants. These faculty members provide diverse expertise, mentorship, and resources for those interested in palliative care oncology research.