Pediatric Hematology/Oncology Fellowship

Inpatient service

Pediatric hematology/oncology and bone marrow transplant patients are admitted to the 9th floor of Helen DeVos Children’s Hospital. The inpatient hematology/oncology service consists of an attending physician, a first-year fellow, two advanced care providers, two nurse navigators, a chemotherapy pharmacist, a pediatric resident, and often medical students. First-year fellows spend approximately half of the year rotating on the inpatient unit in 4-week blocks. During this time, fellows develop expertise and confidence in managing patients admitted for chemotherapy or for complications related to treatment. In addition, the first year is involved with new patient consults as well as workup and evaluation for new diagnoses admitted to the service. Over time, the first year is expected to be able to oversee and run inpatient team rounds as the team leader. Call during the first year is typically one weeknight per week and one weekend per month. Overnight calls is home-based, however, fellows may need to return to the hospital for emergent patient situations or new patient diagnoses.

The goals for the first-year fellow on the inpatient unit are to learn how to:

Continuity clinic

Fellows are assigned to a continuity clinic during their first year. While rotating on the inpatient service, clinics are a half-day per week. While rotating on outpatient services, fellows have a full day of continuity clinic per week. A faculty member is paired with the fellow during the clinic and provides mentorship in the evaluation and treatment of the fellow’s patients. The goal is for the patients and their families to view the fellow as their primary hematologist/oncologist. Fellows are responsible for treatment planning including timely preparation of chemotherapy orders, holding important discussions, performing procedures, communicating with other providers and services, and planning surveillance imaging and follow-up. Fellows are encouraged to have a panel of primary patients with a variety of different diseases within pediatric oncology as well as bone marrow transplant, hematology, and neuro-oncology.

Bone marrow and stem cell transplant

First-year fellows spend one month rotating on the bone marrow transplant service. This experience provides time learning both in- and outpatient management for patients who receive blood and bone marrow transplants. Fellows spend time in new patient consultations, and bone marrow transplant rounds, and learn how to manage patients receiving cellular therapies such as CAR-T therapy. They also spend time with the bone marrow transplant coordinators learning about HLA typing and choosing the most appropriate donor.

The blood and bone marrow transplant program at Helen DeVos Children's Hospital is the only pediatric program in West Michigan and is fully FACT accredited for both autologous and allogeneic transplants. It provides marrow, peripheral blood, and umbilical cord blood transplants for a variety of malignant and nonmalignant disorders, including immune deficiencies, and metabolic diseases.

Fellows can elect to spend additional time with the Bone Marrow Transplant service if desired during their elective time in the first year.

Other rotations and electives

Additional education in thrombosis, hematopathology, blood bank/transfusion medicine, and palliative care is built into the first-year schedule. Fellows can choose to spend elective time in oncofertility, radiation oncology, ortho oncology, and surgical pathology.

Research planning

During the first year, fellows have six weeks of time to begin thinking about and preparing for the work they will do on their scholarly project. Fellows will meet with the program leadership and faculty to determine research interests and fellows select a research mentor and project before the end of their first year. Fellows have opportunities to choose a research project in a laboratory with a mentor at Van Andel Institute or Michigan State University or can work to pursue a project in clinical research, education, or quality improvement. Those choosing to pursue a non-laboratory-based project are encouraged to obtain formal training in the conduct of clinical research, biostatistics, and epidemiology.

Didactics

To complement the training received on clinical rotations, fellows also attend weekly multidisciplinary conferences, journal conferences, and lectures given by faculty and invited speakers. The conference schedule includes:

The second and third years of fellowship are dedicated mainly to the fellow’s scholarly project. Fellows continue developing clinical experience through their continuity clinics each week as well as through experiences in the subspecialty clinics. Second and third-year fellows take overnight and weekend calls, though the frequency is less than during the first year.

Second-year clinical subspecialty rotations include experiences in the comprehensive clinical of sickle cell disease, hemostasis/thrombosis, and hemophilia/coagulation disorders.

In the third year, fellows return to the inpatient service for approximately six weeks to sharpen their leadership skills by directing the multidisciplinary team prior to their graduation. Outpatient, third-year fellows rotate through the comprehensive survivorship, neuro-oncology long-term follow-up clinic, and vascular malformations clinics.

Scholarship oversight committee

All fellows will have a scholarship oversight committee (SOC) during their second and third year of fellowship. The SOC is composed of the primary research mentor, the program director and associate program director, and three experts in the field with at least one of these experts being outside the PHO department. Fellows provide regularly scheduled progress meetings to the SOC throughout their 2nd and 3rd years. The goal of the SOC is to provide useful guidance, critique, and direction to the fellow on their research project.

Exposure to and participation in research begins early in the fellowship program. While participating in direct patient care, fellows will learn to evaluate the eligibility of patients for clinical trials, lead consent discussions, and follow treatment protocols.

In addition, fellows have six weeks during the first year exclusively devoted to the exploration of several basic science, translational, and clinical research opportunities. This time is set aside to allow the fellow to begin thinking about their interests, identify research mentors, and formulate a research proposal.

Fellows are invited to explore the many laboratory research opportunities at Van Andel Institute and Michigan State University Grand Rapids Research Center, each of which is located adjacent to the hospital.

Opportunities for clinical research projects at Helen DeVos Children's Hospital are also available. Those choosing to pursue clinical research will be encouraged to obtain formal advanced degree training in epidemiology, biostatistics, and the conduct of clinical research through Michigan State University.

While fellows are encouraged to apply for grant funding to support their research, their position, salary, and benefits are guaranteed for all three years of fellowship training regardless of grant support.

After-care and transition clinic

The ACT program at Helen DeVos Children's Hospital is dedicated to the well-being of childhood cancer survivors. This comprehensive clinic is held twice monthly and is staffed by a physician, nurse practitioner, nurse, and social worker. All patients undergo a thorough review of the original illness and treatment, medical history since completing therapy, current health, and updated family history. Diagnostic laboratory and imaging studies are obtained to evaluate for late effects of childhood cancer treatment. General and individualized educational materials and other resources pertaining to the late effects of cancer therapy are given to each survivor and their family.

Comprehensive coagulation disorders program

The coagulation disorders program provides medical and psychosocial services to infants, children, and young adults with hemophilia and related bleeding disorders, and thrombotic disorders. On an annual basis, the program provides comprehensive services to approximately 300 pediatric patients with bleeding disorders and 100 patients with thrombophilia/thrombotic events. The program provides home infusion education and services, comprehensive diagnostic and therapeutic evaluations and treatment, anticoagulation monitoring, education, counseling, and advocacy.

The program is supported by federal grants from the Maternal Child Health Bureau and the Centers for Disease Control and Prevention. The program belongs to a national network of federally-funded hemophilia treatment centers and collaborates with centers across the country and the world to share research and standards of care. A comprehensive hemophilia clinic is offered monthly and includes services from the pediatric hematologist, hemophilia nurse specialists, medical social worker, child psychologist, physical therapist, and dental hygienist.

The program provides outreach services to children in western and northern Michigan, including collaborating with Munson Medical Center to provide a comprehensive clinic annually to patients in the northern areas. The program also collaborates with regional and national hemophilia organizations to participate in research and share resources to prevent complications from excessive bleeding and clotting.

Neuro-oncology long-term follow-up clinic

The neuro-oncology long-term follow-up clinic, held once a month, is dedicated to prolonging and improving the lives of patients with brain tumors both during and after therapy. Because survivors of brain tumors may have long-term issues, our multidisciplinary clinic is designed to address these problems with one visit. A pediatric psychologist is present to help with school performance and psychosocial issues and help patients optimize life skills. A pediatric endocrinologist addresses issues related to growth and other hormonal late effects of therapy. Medical treatment, psychological evaluation, education, counseling, and referral to specialty services are offered. Like the ACT Program, we also provide education about health promotion and disease prevention activities. A complete treatment summary letter, including a problem list and management recommendations, is sent to the primary and consulting physicians.

Sickle cell anemia comprehensive care clinic

The sickle cell anemia program is dedicated to prolonging and improving the lives of our patients with sickle cell disease. We offer comprehensive medical treatment, psychological evaluation, education, counseling, and referral to specialty services for children with this hematologic condition. Overall, we have about 85 active patients, many of whom are treated with hydroxyurea to reduce the frequency of complications such as acute chest syndrome or vaso-occlusive pain events. The multidisciplinary clinic meets once monthly and is staffed by a physician, nurse, and social worker.

Vascular malformations clinic

The vascular malformations clinic, staffed by a physician and advanced practice provider 3 times a month, provides a comprehensive multidisciplinary approach to the diagnosis and treatment of children with vascular anomalies including hemangiomas, venous malformations, and lymphatic malformations. In addition, patients can be cared for by a pediatric dermatologist, plastic surgeon, pediatric radiologist, and interventional radiologist. The aim of this collaborative team is to offer patients an accurate diagnosis, eand ducation about associated syndromes, and treat the many medical issues that accompany vascular anomalies.

Pediatric bone marrow and stem cell transplant program

The blood and bone marrow transplant program at Helen DeVos Children's Hospital is the only pediatric program located in West Michigan and is fully FACT accredited for both autologous and allogeneic transplants. It provides potentially life-saving marrow, peripheral blood, and umbilical cord blood transplants for a variety of malignant and nonmalignant disorders, including immune deficiencies and metabolic diseases. The program boasts recognition as an “over-performer” from the Center for International Blood and Marrow Transplant Research for excellent transplant outcomes. We participate in the National Marrow Donor Program.

Hospice of Michigan

The James B. Fahner Pediatric Hospice Program provides comfort and care to about 30 children annually, who are living with life-limiting conditions. The goal of the program is to work with the child and their family to enhance the child’s quality of life when a cure is unlikely. Hospice of Michigan also offers a perinatal program for families anticipating life-threatening conditions for their unborn child, and compass support services for children who meet some but not all criteria for hospice. The pediatric anchors programs provide education, family support, and community resources for numerous children each year.

Children’s Oncology Group

Helen DeVos Children's Hospital has been a member of the Children’s Oncology Group since the beginning of the pediatric oncology program in 1989. Children Oncology Group (COG) clinical trials define the standard of care for children with cancer. Through the Grand Rapids clinical oncology program, patients at Helen DeVos Children's Hospital have access to over 70 COG clinical trials. Available trials include phase 2 and 3 treatment trials as well as biology, supportive care, and epidemiology studies. All newly diagnosed patients are screened for eligibility and enrolled as appropriate. In 2009, Helen DeVos Children's Hospital was one of only eight hospitals nationwide to receive the Trials Award from the American Society of Clinical Oncology for its efforts to improve cancer care for children through clinical research. The program was specifically recognized for the large number of patients enrolled in clinical trials.

Haworth Family Innovative Therapeutics Clinic

Following a generous endowment gift from Dick and Ethie Haworth in 2011, the Haworth Family Innovative Therapeutics Clinic was established for the treatment of children with relapsed or refractory cancer at Helen DeVos Children's Hospital. Children and adolescents from around the world are offered the opportunity to enroll in phase 1 and phase 2 clinical trials.

Beat Childhood Cancer Research Consortium

Helen DeVos Children's Hospital has been a member of the Beat Childhood Cancer research consortium since its inception. Beat Childhood Cancer, directed by Dr. Giselle Sholler, is an international consortium of over 40 universities and children’s hospitals that offers a worldwide network of pediatric cancer clinical trials. These trials stem from the research of closely collaborating investigators and laboratory programs developing novel therapeutics for neuroblastoma and medulloblastoma, as well as other high-risk malignancies.

We participate in the National Resident Matching Program and use the Electronic Residency Application Service application process. We require the following information:

• A completed application/profile
• At least three letters of recommendation
• Curriculum vitae
• Medical school transcript and dean’s letter
• Personal statement describing career goals and reasons for selecting continued training in pediatric hematology oncology
• USMLE transcript
• For international medical graduates, an Educational Commission for Foreign Medical Graduates status report

For more information on our program, contact Mackenzie Mulrenin, program coordinator.

Corewell Health in West Michigan provides a comprehensive and very competitive benefits package for our residents, staff, and their families. In addition, our program provides educational monies to support your ongoing education. Download our salary and benefits document to learn more.