- Craig Byersdorfer, M.D., Ph.D.
- Christen Ebens, M.D., M.P.H.
- Andrew Harris, M.D.
- George Hucks, M.D.
- Lauren Nicholls, M.D.
- Katherine Scott, M.D.
- Mark Vander Lugt, M.D.
- Kelly Walkovich, M.D.
Mission and Overview
Why consider Michigan for your Fellowship?
The University of Michigan Pediatric Hematology and Oncology (PHO) Fellowship is designed to train future leaders and provides outstanding opportunities in both clinical and research training. This three-year program is specifically oriented toward individuals who will pursue academic careers or assume leadership positions in clinical practice. Clinical activities occur in one of the leading children’s hospitals in the United States as well as a leading Comprehensive Cancer Center. The extraordinarily rich research environment, with faculty from departments and institutes throughout the university, provides virtually unlimited opportunities for young scholars in this discipline. The PHO training program lays the foundation for outstanding future careers, and its graduates become division chiefs, department chairs, leaders in national societies and pioneers who advance both clinical and basic research.
Division of Pediatric Hematology and Oncology
The PHO staff currently consists of 13 medical faculty members, all of who engage in clinical and/or basic research, and 2 research scientists. Other staff includes 7 nurse practitioners, 3 outpatient chemotherapy nurses, 1 pediatric social worker, and several child life workers with specific interests in PHO patients. The Division of PHO is affiliated with the Children's Oncology Group (COG), the result of a merger between the CCG and POG cooperative groups. Approximately 90-110 new pediatric oncology patients are diagnosed at The University of Michigan each year. All patients are treated according to COG guidelines, 50% on active COG protocols. 85-90% of patients eligible for active protocols are successfully enrolled. Most of the protocols require multidisciplinary input involving pediatric surgeons, pathologists, radiologists and radiotherapists. Each year, 600 patients are admitted to the PHO inpatient ward on the 7th floor of the C.S. Mott Children’s Hospital, which can accommodate up to 25 patients. The average daily census is 12-15 patients under the PHO service and 6-8 patients under the Bone Marrow Transplantation service. The number of PHO outpatient visits per year exceeds 5,000. Four full day clinics are held per week, with approximately 100-125 patients seen per week. In general, two attending physicians and 1-2 fellows and nurse practitioners are assigned to each clinic. Although the majority of outpatient visits are by oncology patients, sizeable populations of patients with various hematological disorders including nutritional anemias and neutrophil disorders are followed as well. In addition, two specialty multidisciplinary clinics are devoted entirely to red cell disorders (Pediatric Sickle Cell Program) and bleeding and clotting disorders (Hemophilia and Coagulation Disorders Program). All facets of the Pediatric Hematology/Oncology outpatient clinic operate out of the Comprehensive Cancer Center facility. The University of Michigan serves as a referral center for much of the state of Michigan, as well as northwestern Ohio.
Pediatric Blood and Marrow Transplant Program
The multidisciplinary Pediatric Blood and Marrow Transplant (PBMT) Program is internationally recognized for its translational and clinical research, with referrals from across the United States and abroad. The program is focused on developing safer and more effective strategies for patients who require hematopoietic cell transplants for the treatment of both malignant and non-malignant conditions. One of the largest PBMT services in the country, each year 35-50 transplants are performed annually for infants, children, and young adults in the specially designed eight bed unit in C.S. Mott Children's Hospital. Almost all patients participate in clinical trials ranging from novel disease-specific therapies and experimental approaches to prevent or treat transplant complications to biological studies aimed at determining laboratory and clinical factors that will predict for treatment-related effects and relapse. The faculty hold national and international leadership positions within COG, Pediatric Blood and Marrow Transplantation Consortium, and NIH Blood and Marrow Transplantation Clinical Trials Network. All PBMT faculty receive external grant support. Five Pediatric Hematology/Oncology attending physicians specialize exclusively in PBMT care, together with two nurse practitioners, a nurse coordinator and a clerical coordinator. Major diseases treated include acute and chronic leukemias, lymphomas (Hodgkin's Disease and NHL), solid tumors (advanced stage neuroblastomas, brain tumors and sarcomas), hemoglobinopathies (thalassemia and sickle cell disease), marrow failure states and severe immunodeficiencies. Donor sources include autologous, allogeneic, matched unrelated donor (MUD) and umbilical cord blood. A multidisciplinary team, including physicians, nurse practitioners, nurses, a clinical pharmacist, a nutrition specialist, a clinical social worker, child life workers and data managers, meets regularly to discuss care of patients. A unique feature of the PBMT program is its integration with the adult BMT program (approximately 200 transplants per year) for purposes of clinical and translational research. The PBMT and adult BMT facilities will be adjacent in the new Children’s and Women’s Hospital, where both inpatient and outpatient BMT facilities will adjoin the PHO facilities. Our program highlights include:
- Ranked by US News as tied for best in nation for BMT mortality (first year rankings given: 2007)
- Determination that early increases in TNF post-transplant predict for graft-versus-host disease and survival
- TNF-inhibition to prevent or treat acute graft-versus-host disease
- Radiopharmaceuticals combined with autologous transplant to treat high risk neuroblastoma
- Tumor lysate pulsed dendritic cell cancer vaccine for patients with high risk sarcoma, neuroblastoma, or Wilm's tumor
- Most experience in the US with allogeneic transplantation for congenital neutropenia (Kostmann's syndrome)
- Alternative donor transplantation for sickle cell disease
- Extracorporeal photopheresis for acute and chronic graft-versus-host disease in children and young adults
During the first year of training, fellows gain expertise in the management of children and young adults with wide ranging problems in hematology, oncology, issues related to bone marrow transplantation and immunology. During the 5-6 months spent on the PHO inpatient rotation, the fellow is responsible for supervision of three pediatric residents/interns assigned to the PHO service. While on the inpatient service, the fellow is also responsible for providing consultations regarding patients admitted to other sections of the pediatric department. 3-4 months are spent on the PBMT service, during which the fellow works together with PBMT attendings in caring for PBMT inpatients. 3-4 months of the first year are devoted to outpatient clinics to maximize exposure to patients seen in specialty clinics, including those dealing with PBMT, brain tumors, coagulation disorders, sickle cell disease, late effects of treatment and cancer genetics. These outpatient blocks also include rotations on the Pathology service (where the fellow is exposed to immunologic evaluation of malignant cells using the fluorescent activated cell sorter, histopathology of pediatric leukemias and solid tumors, and cytogenetics), in the Blood Bank (where the fellow becomes familiar with techniques and complications of blood product transfusions), and in Radiation Oncology (where the fellow learns first-hand about delivery of radiation therapy). Finally, one month of vacation is usually divided into two two-week blocks. Throughout the inpatient experience, trainees directly interact with other pediatric and adult specialty services, including pediatric surgery, pediatric critical care, pathology, radiology, and radiation oncology. The fellow will be assigned to one weekly outpatient clinic during which time he/she is responsible for seeing continuity patients, and for supervising medical students and residents who are present in that clinic. Beginning in the third fellowship year, the fellow’s continuity clinic is held every other week; during alternate weeks, the fellow attends specialty clinics to gain further outpatient experience in the above-described areas.
Fellows will become proficient at performance of spinal taps, bone marrow aspirations and bone marrow biopsies during the first year of training. These procedures are done under the supervision of attending physicians or nurse practitioners, either in treatment rooms or in the operating room. In addition, the fellows are responsible for reviewing and reporting all bone marrow specimens from patients managed on the inpatient service with monthly attending physicians.
Teaching of fellows is given high priority by members of the Division of PHO. A weekly course on review of normal and abnormal bone marrow smears directed at the first year fellows begins in the summer, and extends through early fall. In addition to ward attending rounds, several regular teaching conferences provide instruction in a variety of clinical and research topics related to PHO and PBMT issues: a didactic PHO conference and an interactive PHO Case Conference are held weekly; a multidisciplinary PHO Tumor Board is held bi-weekly alternating with a joint Adult and Pediatric Hematology Educational Conference, and a PHO Journal Club occurs monthly. Fellows, faculty and invited speakers make presentations at these conferences on a regular basis. In addition, a wealth of conferences sponsored by the University of Michigan Comprehensive Cancer Center (UMCCC), the Department of Pediatrics, and the Divisions of Adult Hematology/Oncology and Blood and Marrow Transplantation take place on a regular basis.
Second and Third Years: Research Training
In years two and three of the fellowship, the focus is on laboratory investigation, research meetings, and conferences and courses which will enhance the fellow’s basic research experience. During the two research years clinical responsibilities are limited to several weekends of inpatient coverage and one outpatient clinic per week; there are no inpatient rotations during this time, maximally protecting time for the research experience. During the second half of the first year, fellows have an opportunity to visit and interview potential faculty research preceptors in order to explore the potential options for training research projects. Our fellows have access to research laboratories throughout the medical school and basic science departments at the University of Michigan providing unlimited opportunities to launch their research careers. Fellows begin the second year with a three-month-long research scientist training program provided by renowned University of Michigan faculty. This course, offered from July-September of the second year, is designed to provide an overview of current concepts and methods in cellular and molecular biology. In addition to didactic sessions, the course provides hands-on experience in a laboratory setting of commonly used techniques. Although the course is designed for individuals with limited prior research experience, even seasoned researchers can benefit from the excellent instruction provided.
Expectations for postgraduate training during years two and three are high, as fellows develop independent research projects. Two years of salary support is guaranteed from one of the few Pediatric Hematology Training Grants in the United States (renewed in 2007). Fellows choose a research mentor from eighteen program faculty in six different departments throughout the University. During this time, fellows are expected to give two or three seminars related to both research and clinical interests. As part of academic training in PHO, it is essential for the trainee to learn how to prepare a research proposal. By the third year of training, under the guidance and supervision of their research mentor, the fellow is encouraged to submit a grant for extramural funding to support his or her ongoing research. Under some circumstances, the tenure of the fellowship may be extended by a year to enable further development as a research scientist. In addition to learning how to prepare grants and deliver both clinical and research talks, it is expected that the fellow will present an abstract at a national meeting, as well as write a first author paper. This ensures that the fellow will qualify for the specialty board examination in Pediatric Hematology/Oncology through the American Board of Pediatrics.
Other Training Opportunities
Pediatric Coagulation Specialist Training Program
The Hemophilia and Coagulation Disorders Program at the University of Michigan, with support from the National Hemophilia Foundation Clinical Fellowship Grant Program, has made a commitment to provide a unique training experience to prepare hematology fellows for a career in hemostasis and thrombosis. The U of M Hemophilia and Coagulation Disorders Program includes 2 Medical Directors (1 Adult and 1 Pediatric), 3 nurse specialists, comprehensive paramedical support staff (physical therapist, dental hygienist, social worker) a full-time clinic coordinators and a research coordinator. It receives funding from the Centers for Disease Control and the Maternal Child Health Bureau and currently serves over 1100 patients with bleeding and thrombotic disorders. Clinical and research faculty members at the U of M (including Paula Bockenstedt, MD, David Ginsburg, MD, Randal J. Kaufman, PhD, Steven Pipe, MD) have made major contributions to the molecular understanding of hemostasis and thrombosis. These individuals have the skills and complimentary interests to provide a superb training environment. Tracks with two different emphases are available: (1) On the Clinical Emphasis Track, under the supervision of the Pediatric and/or Adult Medical Director, the trainee will participate in inpatient and outpatient consultations for coagulation issues in both adult and pediatric patients, will spend 2 days/week in the outpatient clinics within the hemophilia treatment center, will become familiar with the day-to-day activities of the clinical coagulation laboratory (observing, performing and interpreting assays under supervision of the clinical laboratory director), and will develop a clinical research project in coagulation disorders or participate in an existing project. (2) Fellows may also select a Basic Research Track, making a one- or preferably two-year commitment to a basic science lab under the mentoring of one of the research faculty involved in hemostasis and thrombosis research. This would be a full-time commitment to the laboratory, except for participation in outpatient coagulation clinics (no more than 1 day per week). Eligible candidates include physicians who have completed training from an accredited residency program who have either (a) completed one year of clinical training in PHO at The University of Michigan and wish to fulfill research training requirements with an emphasis on coagulation research, (b) completed at least 1 year of clinical training in either Pediatric or Adult Hematology-Oncology from an accredited fellowship program and desire further coagulation training, or (c) completed all fellowship training requirements but wish to obtain additional training as a coagulation specialist. Although U.S. citizenship is not a requirement, appropriate immigration status for post-graduate training would be necessary.
Fellowship in Pediatric Health Services Research
This is a two-year training program funded by the National Institute of Child Health and Human Development (NICHD). Offered by the Division of General Pediatrics at the University of Michigan, the program is structured to provide Fellows with rigorous health services research training, knowledge of issues of contemporary health services, and a specific research program to guide their future work.
The goal of the Fellowship Program is to produce physician-investigators who excel in health services research and will become leaders in academic medicine. To accomplish this, the program will:
- provide fellows with a sound academic background, research training, and socialization in health services and health services research;
- create opportunities for independent and collaborative multidisciplinary research;
- emphasize skills for grant proposal preparation, manuscript publication, and presentation of scientific data in local and national symposia
The Divison of General Pediatrics at the University of Michigan includes over 50 faculty members organized into four sections: primary care, adolescent medicine, child abuse/neglect and child psychology. The primary care faculty (36) is located at 10 single and multi-specialty clinical sites in the greater Ann Arbor area. This placement of faculty provides an ideal opportunity for their collaboration with clinically oriented research conducted by Fellows. Several division faculty have fellowship training and advanced degrees in public health or sociology and conduct research in many different areas.
The Division also houses the multidisciplinary Child Health Evaluation and Research (CHEAR) Unit. The CHEAR Unit provides a mechanism and structure for the timely review and evaluation of local, state, and national children’s programs. Through the CHEAR Unit, Fellows will have opportunities to participate in multidisciplinary research studies relevant to current issues in child health policy. Linkages are in place with state agencies as well as with faculty from Schools of Medicine, Public Health, Social Work, Nursing, Pharmacy, Dentistry, Business Law, and Public Policy.
The Division of General Pediatrics also contains a working laboratory of research support personnel and services. The research infrastructure includes Ph.D-level data and policy analysts, masters-trained research associates, programmer/analysts, and research assistants. Support services available through the Division of General Pediatrics include: literature searching, data collection, statistical analysis, and manuscript editing.
Master’s Program in Clinical Research Design and Statistical Analysis
Our fellows have an opportunity to earn either a M.S. or M.P.H. degree during the second and third year of their fellowship training.
The University of Michigan School Of Public Health offers a 2 year course in Clinical Research Design and Statistical Analysis with an opportunity for the participants to earn a masters degree (M.S.) at the end of the course. The On Job/On Campus Program was developed in 1985 to provide a means for physicians, dentists, pharmacists, pharmacologists and others who are involved in clinical research to develop expertise in research design and statistical analysis while remaining in their existing employment. Course curriculum is presented over 4 days each month over 18-20 months. Fellows will complete a prospective clinical project which will be supervised by a mentor and an advisory team. For further information about the program’s eligibility and tuition requirements click here.
For our triumphs are not in research alone,
Nor in the hands of a single doctor,
But rather in the rewards realized from working together.
That’s the Michigan Difference.
University of Michigan Graduate Medical Education (GME) Scholars Program
The GME Scholars Program consists of 2 tracks, a Medical Education Track and a Healthcare Administration Track. Interested house officers may choose to participate in one of the scholar program tracks during their training. This innovative program will provide participants with a longitudinal training (a 20-month mini-fellowship) experience in one of the above two areas of concentration. This training will be incorporated into their current GME training program, and is open to all University of Michigan house officers (residents and fellows). The primary goal of the GME Scholars Program is to better prepare graduates to assume and succeed in academic positions with a focus in either medical education or healthcare administration at leading academic medical centers. Additionally, the program will allow participants to establish strong mentoring relationships in their chosen area of study, a network for future collaboration, and might serve as a stepping stone to pursue further graduate study if desired. Program participants will begin to develop the knowledge base and skill set required for them to be successful as the next generation of physician leaders. For additional details, please visit the Web site:
Pediatric Hematology/Oncology adheres to the Graduate Medical Education policy of House Officer Selection. To view the policy, please click here.
Pediatric Hematology/Oncology complies with the University of Michigan Graduate Medical Education supervision policy. To view the policy, please click here.