How To Get the Most out of Your Fellowship

Only by the end of my first year of fellowship did I realize that beyond your fellowship experience there is a lot you can gain. Learning how to take care of our patients is definitely very important, but there is much more that we can gain from this period of our lives, specifically in terms of our learning. Whether you foresee a career in academia, private practice, or industry, there are opportunities available to you during this time period that will not be repeated.

It was after several conversations, looking over different curriculum vitaes, and spending endless hours surfing on the Internet that I learned most of the things I will share with you. Given my strong interest in breast cancer, my focus will be mainly on oncology, but similar opportunities are out there for those who are passionate about hematology or other solid malignancies as well.

Writing Your Own Letter of Intent

During your fellowship experience, an amazing opportunity is to participate in writing a study protocol from beginning to end. This includes beginning with a discussion of the idea, writing a letter of intent (LOI) and submitting it for peer review, receiving funding, writing the whole protocol, getting institutional review board (IRB) approval, opening the study, enrolling patients, and hopefully, beginning to see results before you graduate!

The most difficult step may be finding an original concept and the appropriate mentoring in your institution for helpful, guiding expertise. Behind that is writing your LOI and perhaps submitting it to a workshop where your idea can be further developed.

For fellows and junior faculty, one of the most amazing experiences in clinical cancer research is attending the ASCO/AACR Vail Workshop that occurs every year during the summer season. The workshop includes 100 “students” with diverse backgrounds (medical oncology, radiation oncology, hematology, gynecology oncology, neuro-oncology, surgical oncology, and pediatrics) and a world-class faculty devoted to the students for a whole week.

The faculty includes outstanding clinical and transla- tional researchers, phase 1 experts, past and current American Society of Clinical Oncology (ASCO) presidents, biostatisticians, and patient advocates. The workshop is quite competitive, and if you are considering the use of an investigational drug provided by a pharmaceutical company, you need a commitment letter, so start working on it early. It will be worth it!

The American Society of Hematology (ASH) also has opportunities such as the Translational Research Training in Hematology Program to help you develop your own protocol.

Funding

The National Institutes of Health has several fellowship (F) and Career Development (K) awards that are worth exploring (http://grants.nih.gov/training/extramural.htm or http://www.cancer.gov/researchandfunding/cancertraining).

These are highly competitive but very prestigious awards to start your career with.

Another possible funding source for a fellow is the ASCO organization. In response to a need to recruit promising investigators into academic medicine, ASCO created the Young Investigator Award (YIA). In 1984, ASCO provided $16,000 for research in melanoma to Dr Judith S. Kaur, the first young investigator awarded with a YIA. Since then, ASCO has launched the careers of more than 700 fellows through its YIA program and has provided $30 million of research funding. The term of the YIA is 1 year, and the award currently provides $50,000 in research funding to award winners.

Other options for funding are available through the American Cancer Society (ACS), ASH, the Leukemia and Lymphoma Society, the Komen Foundation, and the Department of Defense (DOD), among other organizations.

When selecting an appropriate funding opportunity, you will want to consider your focus of research, prior research experience, level of institutional commitment, and citizenship status. Something to be aware of before you begin your application is that most of the grants are exclusive for US citizens, noncitizen nationals, or permanent residents. Except for K99/R00, most of the K awards from NIH are only available to US citizens or permanent residents.

Present Your Results

For me, the best way to organize my projects is to have a deadline in my agenda. I suggest choosing a deadline to help keep you organized. It can be a deadline for a research workshop, abstract submission, or simply a date that you establish so that you have results before applying for jobs. This way, no matter how busy your fellowship is in terms of clinical responsibilities, you never lose sight of your goal.

Whether attending a scientific meeting for the learning experience or for presenting your own work, it is a great way to network with experts and meet fellows from other institutions. Getting to know fellows from other institutions has been one of the most valuable experiences during my training. It made me realize the strengths and weaknesses of my training, share experiences and available opportunities, and meet future colleagues with whom I will interact with for the rest of my professional life.

American Society of Clinical Oncology

There are several reasons why you want to be involved with ASCO beyond grant opportunities. ASCO provides exceptional learning material available through ASCO University. Examples include the ASCO-SEP question bank (an essen- tial tool for boards preparation), tumor boards, diverse courses, flashcards oriented toward first-year fellows with basic oncology concepts, slides, and reviews of oncology literature.

You may also consider volunteering with ASCO and serving on a committee. No matter what your background, area of interest, or institution from which you come, we all can contribute. The best way to do so is by registering on the ASCO website (http://www.asco.org/about-asco/volunteerserve- committee).

You may also approach ASCO committee members and ASCO staff during meetings to express your interest. It may take time to get a chance to participate, but if you show interest, your opportunity will come. Similar opportunities are available through ASH and the American Association for Cancer Research (AACR).

Complement Your Training

There are other opportunities during the fellowship experience that can enrich your learning experience. These are diverse, depending on the areas of interest.

If you foresee a career in clinical research, something you may want to consider is applying for an external fellowship at the Cancer Therapy Evaluation Program (CTEP)/ NCI in the Investigational Drug Branch. This experience provides exposure to the review of incoming LOIs and protocols, and provides the opportunity to attend internal meetings between CTEP and pharmaceutical companies, or between CTEP and the FDA in regard to the development of new agents.

Another option is to apply for a rotation at the FDA. This opportunity will train you in federal regulations and the principles and practices of FDA medical product review, such as the design of clinical trials, monitoring of trials, identification of biomarkers, and clinical pharmacology.

If you are more focused on basic research, don’t miss some of the workshops AACR has available, such as the Annual AACR Aspen Workshop on molecular biology in clinical oncology.

These Are the First Days of the Rest of Your Life

With all the available opportunities, it is important to confirm your initial decision that oncology is what you want to do for the rest of your life. Personally, I believe we are fortunate to have a very rewarding interaction with our patients and the privilege of sharing crucial moments in their lives. At the same time, we are part of a dynamic, evolving, ever changing and advancing field!

Filipa Lynce, MD, is a chief fellow in the hematology/oncology program at MedStar Georgetown University Hospital and MedStar Washington Hospital Center.