Several training models for hematologists currently exist in the field of sickle cell disease (SCD), including
- American Society of Pediatric Hematology/Oncology mentoring program,
- American Society of Hematology Clinical Research Training Institute,
- Program to Increase Diversity Among Individuals Engaged in Health-Related Research,
- American Society of Hematology Committee on Promoting Diversity,
- Johns Hopkins Hematology/Medical Oncology program,
- Medical College of Wisconsin benign hematology curriculum,
- T32 Training,
- European Hematology Association European Hematology Curriculum, and
- systems-based clinical hematologist.
AMERICAN SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY MENTORING PROGRAM
New training models have emerged that include “team mentoring” or participation in a “mentoring network.” Other models that pair mentors and mentees include the American Society of Pediatric Hematology/Oncology mentoring program that was developed to support early career members. Within this program, mentors and mentees are matched based on mutual
agreement with career development and research planning as the most commonly planned goals. Mentorship occurs by phone, e-mail, or in person at annual meetings. Most mentors and mentees are satisfied with the program and perceive a benefit from their participation (Badawy et al., 2017).
AMERICAN SOCIETY OF HEMATOLOGY CLINICAL RESEARCH TRAINING INSTITUTE
Another program with the goal to improve mentorship opportunities is the American Society of Hematology (ASH) Clinical Research Training Institute (CRTI), which is a 1-year experience for senior fellows and junior faculty intent on a career in hematology. The program began in 2003 and begins with a week-long workshop held in August and during the annual ASH meeting. The ASH CRTI is supported by a National Institutes of Health R25 training award (1R25CA168526-01A1) (Sung et al., 2015). Each participant is matched with a faculty member and the summer workshop includes 20 established clinical researchers, 5 or 6 biostatisticians, a library scientist, and representatives from key funding agencies including the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute. Although the program has had success, with most participants remaining in academic hematology, the diversity of participants is low; only 3 percent identify as black/African American or Hispanic. Steps taken to increase the participation of under-represented minorities to 15 percent include adding participants and collaborating with the ASH Committee on Promoting Diversity on the CRTI Oversight Committee to disseminate information about CRTI to more diverse members. Additionally, faculty in the program have presented to the Committee on Training to reach training program directors, and they have contacted diverse alumni to recommend CRTI to diverse fellows and junior faculty (King et al., 2016).
PROGRAM TO INCREASE DIVERSITY AMONG INDIVIDUALS ENGAGED IN HEALTH-RELATED RESEARCH
A program with a specific aim of increasing diversity is PRIDE (i.e., Program to Increase Diversity Among Individuals Engaged in Health-Related Research). PRIDE aims to provide intense research and career development mentorship coordinated through a central PRIDE Coordination Core at seven academic sites, each focused on a specific research area. PRIDE at Augusta University in Georgia is focused on “Functional and Translational Genomics of Blood Disorders” and has been funded by NHLBI since 2006. Summer institutes at Augusta University last 2 to 3 weeks and include 3 cohorts of 6–10 mentees. Mentees have monthly contact with mentors
with goals focused on grant writing skills. The majority of participants identify as black/African American (80 percent), and the majority of mentees (91.2 percent) conduct SCD research that involves clinical/translation studies. A significant success of the program has been the percentage of extramural grant submissions (75 percent) within 2 years following training completion. Of those participants who submitted grants, 64 percent obtained federal funding (Pace et al., 2017). Furthermore, participants in this mentor and mentee program are exposed to discussions regarding teaching and work–life balance, clinical care, and career plans (Starlard-Davenport et al., 2018).
AMERICAN SOCIETY OF HEMATOLOGY COMMITTEE ON PROMOTING DIVERSITY
Other efforts to increase diversity include the Committee on Promoting Diversity, which is responsible for advising ASH in its efforts to improve minority recruitment into hematology research and practice, attract minority hematologists to become members of the Society, and help develop minority hematologists so they can obtain leadership roles. The committee oversees the selection of applicants for participation and identifies potential mentors. Specific programs include the Medical Student Award Program, the Minority Graduate Student Abstract Achievement Award, the Minority Resident Hematology Award Program, and the ASH-AMFDP, which is a partnership between ASH and the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation (ASH, 2020).
JOHNS HOPKINS HEMATOLOGY/MEDICAL ONCOLOGY PROGRAM
There are some existing hematology training models in the United States that have been successful in creating opportunities for individuals who want to pursue a career in benign hematology through structured clinical and research programs that meet the Accreditation Council for Graduate Medical Education (ACGME) requirements. Established in 2005, Johns Hopkins has a Hematology/Medical Oncology program that has a 3-year ACGME accredited single board hematology track that has demonstrated a high retention rate of fellows who remain in clinical and research settings. In 2017, Johns Hopkins formalized its application procedure to allow candidates to apply to the hematology and/or medical oncology tracks. Of the 414 applications, 8 percent of candidates applied to the hematology track only, with half of those candidates expressing a specific interest in benign hematology. Having a hematology track appears to cultivate interest,
provide needed role models, and allow fellows to envision a career in the specialty (Naik et al., 2018).
MEDICAL COLLEGE OF WISCONSIN BENIGN HEMATOLOGY CURRICULUM
The benign hematology curriculum at the Medical College of Wisconsin is another example of a training program to increase the number of providers. The development of the curriculum was supported by funding from the ASH Alternative Training Pathway Grant. Specialized features of the program include that the curriculum has a clinical focus on training in benign hematology while still allowing the fellow to be board-eligible for hematology, clinic experiences have an emphasis in non-malignant hematology, and there is a strong foundation for additional (non-ACGME required) research training (Abshire, 2009).
T32 TRAINING GRANT
A multidisciplinary training model for individuals interested in careers in academic hematology research is a T32 Training Grant. The Ruth L. Kirschstein National Research Service Award (T32) supports grants to institutions to develop or enhance research training opportunities. One example is the long-standing Hematology T32 Training Grant at the University of North Carolina at Chapel Hill that trains both M.D. and Ph.D. scientists as adult and pediatric hematology fellows. The 2-year program has tracks in both basic bench and clinical research with scientific and educational interactions between M.D. and Ph.D. trainees in the form of conferences, journal clubs, and symposia. These regular interactions between M.D. and Ph.D. trainees creates an understanding of the goals of biomedical research in hematologic disorders. The foundations of training also include a mentored research project, focused seminars, didactic coursework in clinical research, laboratory methodology, grantsmanship, and navigating academia (UNC School of Medicine, 2020). Improving opportunities and access to T32 grants through additional grant funding would be one step in increasing the workforce in hematology and expanding the knowledge base of providers.
EUROPEAN HEMATOLOGY ASSOCIATION EUROPEAN HEMATOLOGY CURRICULUM
The European Hematology Association also provides a cooperative model for training hematologists that could be adapted in the United
States as their 27 national societies decided to develop a unified curriculum for European hematologists in 2003. The European Hematology Curriculum includes recommendations on minimum levels of competence, knowledge, and skills in hematology. A panel of European experts periodically updates versions to ensure that the curriculum is in line with the new developments in technology, diagnostic methods, and treatment modalities (Ossenkoppele et al., 2012). Of particular importance, they developed an online Curriculum Passport, which is a self-assessment tool that enables continuous survey of competence at individual, national, and European levels. The passport can be used as an educational tool to identify gaps in competence that can then be targeted by attending specific educational events or scientific conferences (Strivens et al., 2013).
SYSTEMS-BASED CLINICAL HEMATOLOGIST
Beyond clinical and research training in hematology, Wallace et al. (2015) have identified opportunities for hematologists to design new models for care delivery. They suggest a role for a “systems-based clinical hematologist,” which would be a specialty-trained physician who optimizes individual patient care and the overall health care delivery for patients with blood disorders by creating guidelines for other physicians within the practice to follow. The systems-based hematologist needs to be adaptable and have multiple commitments that could include identifying hematologic issues, developing care pathways, providing input into the appropriate use and interpretation of genomic testing, and counseling of patients with hematologic malignancy.
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