Pediatric hematology and oncology fellows train within the Pediatric Hematology and Oncology Division of Spectrum Health Helen DeVos Children’s Hospital (HDVCH). HDVCH is a freestanding 120 bed children’s hospital with comprehensive primary care and specialty services. We are the primary center for tertiary pediatric care for over 2 million patients from the greater Grand Rapids, but our referral base extends to the far reaches of Western-Northern-and Central Michigan. HDVCH is the only site for inpatient pediatric hematology and oncology and stem cell transplantation care for our program; our PHO clinic is also situated on the 10th floor of HDVCH, but we have outreach clinics twice monthly at Munson Medical Center in Traverse City. The Pediatric Hematology and Oncology Program at HDVCH is one of the largest in the Midwest and includes the only pediatric bone marrow and stem cell transplant program on the western side of Michigan. Additional information about HDVCH can be found at www.helendevoschildrens.org.
Under the leadership of board-certified pediatric hematologists/oncologists, the program offers comprehensive, multidisciplinary specialty care for infants, children, teens and young adults. Care is provided for a wide range of hematologic, coagulation and oncologic disorders on an inpatient, outpatient and/or consultative basis. Services are distinguished by membership in the national Children’s Oncology Group (COG) and by a federally funded comprehensive hemophilia treatment center, the Helen DeVos Children’s Hospital Coagulation Disorders Program.
While gaining important clinical skills through patient care at HDVCH, fellows are invited to explore the many laboratory research opportunities at the Van Andel Institute (VAI), located adjacent to the Children’s Hospital. VAI is a private research and education institute founded by Jay and Betty Van Andel in 1996. VAI conducts biomedical research focused on cancer and Parkinson disease with a particular goal of translating scientific research into clinical applications. Interested fellows may even pursue a Ph.D. in Cell and Molecular Genetics through the VAI Graduate School. Additional information about VAI can be found at www.vai.org.
Alternatively, opportunities for clinical research projects at HDVCH are also available. Fellows may additionally choose to pursue advanced degree training in epidemiology, biostatistics and the conduct of clinical research through Michigan State University.
First Year Fellowship Overview
The first year of fellowship consists of clinical rotations on the inpatient and outpatient Hematology/Oncology Service, the Bone Marrow Transplant Service, and a clinical hematopathology laboratory experience. Other electives may include but are not limited to: Palliative Care, Radiation Oncology, Anatomic Pathology, Blood Banking, Pediatric Radiology, Orthopedic Oncology, Pediatric Hematology and Oncology Consult Rotation, Pediatric Critical Care, Advanced Bone Marrow Transplantation, and Bone Marrow Processing Lab. Six weeks of research time are built in to the first year rotations to give fellows time to explore research opportunities and prepare a research proposal by the completion of the first year of fellowship training.
During the first year, the fellow will acquire a group of patients for whom he/she has responsibility as the primary hematologist/oncologist. The fellow maintains a continuity clinic two half days of clinic per week, with an emphasis on continuing care of their primary patients and general experience in pediatric hematology and oncology.
Toward the end of the first year, the fellow will choose either a clinical- or laboratory-based research experience. Those choosing to pursue clinical research will be encouraged to obtain formal training in epidemiology, biostatistics, and the conduct of clinical research. Fellows choosing laboratory research will select an investigator at the Van Andel Institute or Spectrum Health as primary research mentor. All fellows will work with a Scholarship Oversight Committee to monitor their research progress.
A sample first year schedule is given below:
|January||Elective: Orthopedic Oncology|
|March||Bone Marrow Transplant|
To complement the training received on clinical rotations, fellows are also encouraged to regularly attend scheduled conferences, journal conferences, and lectures given by faculty and invited speakers.
Mornings – Inpatient and Outpatient Team Rounds
8:00-9:00 – Pediatric Stem Cell Transplant Conference
7:30-8:00 – Fellow Core Lecture
8:00-9:00 – Pediatric Grand Rounds
8:00-9:00 – Hematopathology Conference
8:00-8:45 – Journal Conference
7:30-9:00 – Tumor Board
Exposure to and participation in research begins early on 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 guidelines.
In addition, fellows will have six weeks during the first year exclusively devoted to exploration of several basic science, translational and clinical research opportunities. This time is set aside to allow the fellow to begin thinking about their particular research interests, identify research mentors, and formulate a research proposal. Those choosing to pursue clinical research will be encouraged to obtain formal training in epidemiology, biostatistics, and the conduct of clinical research. Fellows choosing laboratory research will select an investigator at the Van Andel Institute, the NMTRC at Spectrum Health, or Michigan State University as primary research mentor.
For fellows interested in pursuing a laboratory research career, an exciting 5-6 year program combining the pediatric hematology and oncology fellowship with a Ph.D. degree is also available. This joint endeavor with the Van Andel Institute provides both in-depth clinical training with patient care and doctoral training in Cell and Molecular Genetics to prepare the next generation of physician-scientists. More information about the combined fellowship-Ph.D. program is available here.
We also have a plethora of clinical research activities that are available including a 1 or 2 year Masters in Public Health clinical research program in conjunction with Michigan State University for motivated fellows.
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.
The GRMEP Research Department provides support to residents and faculty in all areas of research and scholarly activity (e.g., quality, educational, surveys). To access more details, including templates (e.g., study protocol, poster), help request forms and other contact information, visit GRMEP Research.
Special Clinical Opportunities
The Division of Pediatric Hematology, Oncology and Bone Marrow Transplant at Spectrum Health Helen DeVos Children’s Hospital offers an abundance of specialty programs with the goal of providing excellence in patient care. These specialty programs augment the clinical education of PHO fellows. Some of our services and activities include:
The Children’s Oncology Group
HDVCH has been a member of the Children’s Oncology Group (COG) since the beginning of the Pediatric Oncology Program in 1989. COG clinical trials define the standard of care for children with cancer. Through the Grand Rapids Clinical Oncology Program, patients at HDVCH 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, HDVCH 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. Dr. David Dickens is the Prinicpal Investigator for COG activities at HDVCH.
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 HDVCH. Under the directorship of Dr. Giselle Sholler, children and adolescents from around the world are offered the opportunity to enroll on phase I and phase II clinical trials. Dr. Sholler is also the Chair of the Neuroblastoma and Medulloblastoma Translational Research Consortium (NMTRC), which is a group of universities and children’s hospitals headquartered at HDVCH that offer a nationwide 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.
The After-Care and Transition (ACT) Program
The After-Care and Transition (ACT) Clinic 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.
A binder of general and individualized educational materials pertaining to late effects of cancer therapy is given to each survivor/family. 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 physician, consulting physicians and the survivor/family. The ACT Program is directed by Drs. Deanna Mitchell and Beth Kurt.
The Pediatric Early Care and Pediatric Hospice Program through Hospice of Michigan
The 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 his/her family to enhance the child’s quality of life when a cure in unlikely. Hospice of Michigan also offers a Perinatal Program for families anticipating life-threatening conditions for their unborn child, and the Pediatric Early Care (PEC) Program for children who meet some but not all criteria for hospice. The PEC Program provides education, family support and community resources for approximately 20 children per year. Dr. David Dickens is the Medical Director of the Pediatric Hospice Program.
The 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. We provide 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. We participate in the National Marrow Donor Program (NMDP). Aly Abdel-Mageed, MD is the Medical Director of the Blood and Bone Marrow Transplantation Program.
The Palliative Care Program
The Sickle Cell Anemia Program
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 Sickle Cell Anemia Program also features a successful program to reward adherence to hydroxyurea therapy. Dr. Richard Axtell is the Medical Director of the Sickle Cell Anemia Program.
The Comprehensive Coagulation Disorders Program
The Helen DeVos Children’s 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 Coagulation Disorders 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. Comprehensive Hemophilia Clinics are offered monthly and include 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 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. Dr. Deanna Mitchell is the Medical Director of the Coagulation Disorders Program.
The Neuro-Oncology Long-term Follow-up Clinic
The Neuro-Oncology Long-term Follow-up Clinic, directed by Dr. Sharon H. Smith at Helen DeVos Children’s Hospital 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 helps patients optimize life skills. A pediatric endocrinologist is able to assess 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.
More information about Helen DeVos Children’s Hospital and the services available can be found at www.helendevoschildrens.org.
The Vascular Malformations Clinic
The Vascular Malformations Clinic, directed by Dr. Kristen Snyder at Helen DeVos Children’s Hospital provides a comprehensive multi-disciplinary approach for the diagnosis and treatment of children with vascular anomalies including hemangiomas, venous malformations and lymphatic malformations. In addition to seeing Dr. Snyder, patients have the opportunity to 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, education about associated syndromes, and treat the many medical issues that accompany vascular anomalies.