The Melanoma Oncology Fellowship Program at MD Anderson Cancer Center is approved by the Graduate Medical Education Committee (GMEC) and the Texas Medical Board (TMB). The creation of our program is due to an excellent track record of training fellows in the Hematology/Oncology Program, which is measured by superior feedback from our trainees.
This is a one-year fellowship program with a second optional year, consisting of one year of clinical training and a second optional year of either clinical or translational research, or a basic science experience.
All trainee candidates must hold an M.D. degree with prior residency training in Dermatology, Internal Medicine or Medical Oncology. Fellows that have prior residency training in Dermatology will focus on didactics and outpatient melanoma/dermatology clinics. These fellows will not take call or cover the inpatient service overnight. Fellows with prior residency training in Internal Medicine or Medical Oncology may take call and cover the inpatient service on nights under the supervision of the inpatient attending.
Candidates must have the following documents* in place prior to being considered for the Melanoma Oncology Fellowship Program:
- Completed Application for Educational Appointment
- Three letters of recommendation
- Copy of doctoral diploma
- Credentials evaluation for all credentials received outside the United States
- Research Proposal
* All documents in a foreign language must be accompanied by certified English translation
The University of Texas MD Anderson Cancer Center is an equal opportunity employer and maintains a smoke-free environment. The Melanoma Oncology Fellowship Program strongly encourages applications from women and minorities.
The Melanoma Oncology Fellowship helps develop highly qualified melanoma clinicians and clinical researchers who will become a significant resource to medical care worldwide. Applicants will contribute to specific research projects while becoming outstanding melanoma oncologists and leaders in the field. The training program also provides opportunities that extend from “bench research,” to clinical training resulting in translational efforts that will ultimately result in improvements in routine patient care.
First-year fellows will rotate through clinics daily in the outpatient center and inpatient service and will assume clinical responsibility of the patients they see along with the attending physician and in coordination with the APP. All inpatient and outpatient care will be supervised by the attending physician.
Fellows completing our program must be capable of meeting the educational objectives listed below:
- Manage patients with advanced melanoma
- Perform Lumbar puncture, Ommaya puncture procedures
- Administration of intrathecal chemotherapy or immunotherapy via LP or Ommaya
- Perform intratumoral oncolytic administration
- Understand basic tumor immunology/cytokine/vaccine therapy
- Understand the tumor biology and natural history of melanoma and integrate this data with knowledge of multi-modal therapy to effectively diagnose and treat patients with this disease
- Understand melanoma biology signal transduction pathways and how this relates to targeted therapy approaches
- Assess the need for and effectively perform complex oncology therapy in the treatment of patients with melanoma.
- Become an innovative physician-scientist or clinical investigator who can effectively translate laboratory discoveries into improvements in patient care.
- Be an inspired teacher to instruct others in the principles of multi-disciplinary patient care and research at all levels - basic, translational, and clinical.
At the completion of this clinical rotation, fellows should be able to:
- Understand the pathology and epidemiology of melanoma
- Understand the staging system for melanoma, AJCC 8th edition
- Comprehend the role of surgical treatment of melanoma
- Assess the risks and benefits of standard and experimental treatment regimens for melanoma
- Manage melanoma cytokine therapy and immune therapy an targeted therapy
- Have a clear understanding of basic tumor immunology and cancer vaccines as well as targeted therapy
- Understand the rationale and process of translating research from the lab to the clinic
- Utilize laboratory endpoints to aid in the evaluation of experimental therapies used in clinical trials
- Interpret the results and understand the significance of publications describing translational research trials
All training rotations are performed at MD Anderson.
Second-year fellows are expected to focus on clinical, translational or basic science research and will be supervised by the appropriate clinical or research faculty, depending on which avenue the fellow pursues.
The Melanoma Fellowship Program offers an unprecedented opportunity for clinical fellows to get training in laboratory-based research in the immunology and molecular biology of melanoma. The program offers both extensive hands-on laboratory training, as well as training on the theoretical aspects of cancer cell biology and tumor immunology related to melanoma.
Fellows interested in laboratory research will be patterned after the Physician/Scientist Program (80% laboratory and 20% patient care). Laboratory projects include analysis of human melanoma specimens and conduct to murine tumor models performing studies that can easily be translated to the clinic.
Fellows that are more clinically oriented will perform 60% clinical research and 40% patient care. Clinical research can include participating in prospective clinical trials of novel agents, design and execution of clinical trials, coordinating studies of biomarkers and performing retrospective reviews of melanoma patients.
These areas include:
- Sterile techniques in the culture of tumor cell lines and lymphocytes isolated from patients.
- Characterization of lymphocyte responses against melanoma antigens in human and murine systems.
- DNA/RNA isolation and gene expression analysis by RT-PCR and microarray.
- Protein analysis techniques (electrophoresis and reverse-phase protein chip arrays).
- Development of melanoma tumor animal models to test the effects of different therapeutic agents.
- Development of skills in experimental planning, trouble-shooting and acquisition of up-to-date knowledge on the state-of -the-art in melanoma tumor immunology and cell biology research.
- Gain experience in developing and participating in IRB-approved lab or clinical protocols.
- Anti-tumor vaccination strategies and monitoring of the anti-tumor immune response.
- Functional analysis of tumor-infiltrating leukocytes and vaccine-induced anti-tumor T cell responses.
Lecture Series Topics are as follows:
- “Adjuvant Therapy” – Sapna Patel, M.D.
- “Adoptive Cell Therapy” – Adi Diab, M.D.
- “Brain Mets/Leptomeningeal Disease – Isabella Glitza Oliva, M.D., Ph.D.
- “Combination Checkpoint Blockade” – Adi Diab, M.D.
- “Development of Targeted Therapy for Melanoma” – Michael Davies, M.D., Ph.D.
- “Melanoma Overview” – Rodabe Amaria, M.D.
- “Rotation Overview” – Sapna Patel, M.D.
- “Immunotoxicity: The Diagnosis and Management” – Adi Diab, M.D.
Participant’s supervisory and teaching responsibilities
Melanoma Oncology fellows do not have supervisory responsibilities. The melanoma oncology fellows provide extensive patient care and teaching services to MD Anderson. The fellows participate in the training of University of Texas Medical Center residents and medical students, and in the consultative education of MD Anderson faculty physicians of other disciplines. Significant emergency room and outpatient services are provided to the institution by the fellows, which includes afterhours and weekend service availability.
In this program, fellows rotate through the outpatient center, the inpatient melanoma service, including ICU, and the consultative service.
The outpatient melanoma clinic begins at 8 a.m. Fellow(s) are expected to see outpatients in the Melanoma and Skin Center, review relevant scans and reports and present each case to the faculty physician. Fellows are encouraged to maximize the interaction with the faculty by actively participating in the formulation of the plan of care. Fellows are required to participate in chemotherapy planning for the patients they have seen and work closely with the mid-level providers, clinic and research nurses. It is the responsibility of the fellow to dictate the full history and physical note on each patient they have seen in accordance with institutional documentation and billing guidelines. Clinic and research nurses, pharmacists, and the faculty are available to help with chemotherapy planning, orders, protocol requirements and instructions, and teaching. The primary care nurse and the mid-level provider will help with patient flow as well as clinical and radiograph assessment.
The inpatient service rounds with the attending physician begin between 7:30 a.m. and 9:30 a.m., depending on the attending covering. Fellow(s) on the inpatient service take primary medical responsibility of the inpatients and are expected to pre-round on inpatients with the MLP prior to the formal attending/team rounds every morning. The morning rounds focus on efficiently identifying problems and formulating a plan of care for each patient. Morning rounds are meant to be educational and encourage the fellow to be proactive in learning from the attending physician. The fellow will share the responsibility of dictating the admission and discharge note with the APP. The fellow will be responsible for communicating with consulting physicians and other ancillary services to ensure patient care is delivered in an efficient manner so that the hospital stay is appropriate to the medical needs of the patient.
Fellows may be required to take home call. A call schedule will be drafted and distributed to the fellow(s) indicating the dates of call coverage. The fellow covering is responsible for all inpatient and emergency room admissions. The number of patients is variable and often determined by the patient census. Trainees average approximately 47 hours a week, not including call assignments and other research activities. During holidays and weekends, only the actual hours spent in the hospital providing patient care are to be counted by the fellow towards the working hours.
Moonlighting is not approved for the Melanoma Oncology Fellowship Program.
Conferences are scheduled around fellowship clinical responsibilities and activities. Critical developments in patients require that the fellow fulfill their clinical obligations that may preclude attendance at scheduled meetings or conferences.
Conferences and seminars
The fellowship trainees are expected to attend the following scheduled meetings:
|DoCM Grand Rounds
||Division of Cancer Medicine
|Melanoma Q & A
||Weekly||Mandatory||Melanoma Medical Oncology|
|Melanoma Multidisciplinary Conference Meeting||Weekly||Mandatory||Melanoma Medical Oncology|
|Melanoma Protocol Meeting||Monthly||Mandatory||Melanoma Medical Oncology|
|Melco||Weekly||Mandatory||Melanoma Medical Oncology|
|Melanoma Oncology Weekly Lab meeting||Weekly||Optional||Melanoma Medical Oncology|
(Fellow required to present once quarterly)
|Melanoma Medical Oncology|
Progression in responsibilities
During the first year of fellowship, the Program Director and Co-Director will assign rotations. Assignments will be determined with the goal of maximizing the learning experience of the fellow. In general, the first year rotation will be evenly distributed over the inpatient and outpatient areas. However, there may be circumstances when one setting or the other may provide a better learning experience for the trainee.
During the second year, the fellow(s) will spend the entire year conducting clinical, translational or basic science research under the direction of one or more faculty. The fellow is responsible for conducting the necessary background research and for the design of the clinical protocol, project or actual bench research investigation under the guidance of a faculty mentor. The fellow will be required to present findings at weekly laboratory meetings or Melanoma Grand Rounds. Furthermore, the fellow is expected to prepare abstracts for submission and presentation at national meetings, as well as final manuscript preparation. Fellows may also continue clinical research projects under faculty supervision during the second year. Fellows who desire to conduct basic science research are expected to already possess the skills and experience in research to successfully complete their project and should identify a mentor during the first year of training.
Formal review of trainees occurs semi-annually with the Program Director and Co-Director. However, informal review of the trainees also occurs on an ongoing basis through daily interactions with the faculty. Anonymous evaluations of the training program and individual faculty by the fellows are provided to critique and provide feedback for quality assurance and improvement. Separate annual evaluations are provided to the Educational Office. Fellows are required to report duty hours to the GME office using an online mechanism coordinated by the GME office.
Trainees are given the opportunity to voice concerns during formal meetings with the Program Director and Co-Director., or informally on an ongoing basis. Trainee signatures on the evaluation are optional so to preserve anonymity.
Applicants must provide a personal statement, biographical sketch, certified copy of doctoral diploma, certified transcript of medical school grades, and three letters of recommendation (usually including one from the director of residency training program). Graduates of foreign medical schools must also supply a certified copy of a valid ECFMG certificate, proof of foreign licensure, a certified undergraduate college grade transcript, a certified medical school Dean’s letter and a completed IAP 66 form. Other documents may be required in keeping with the recommendation of the Trainee Support Services. Application materials are then reviewed among the principal Fellowship Training Personnel.
After review of the provisionally acceptable application, a decision to interview the applicant is made, and a 1-2 day interview itinerary is arranged, which includes appointments with the Program Training Director, Department Chairman, principal fellowship training faculty personnel and selected other clinical and research faculty from the Department of Melanoma Medical Oncology. A tour of the relevant facilities is also provided. Evaluations are obtained from each interviewing representative.
Based on the supplied application materials, evaluations, and any necessary personal, professional or solicited references, a decision is made to either provide an informal offer, to reject a candidate, or postpone the fellowship application for one year.
Each accepted applicant is supplied a copy of the Melanoma Oncology fellowship orientation manual, conference schedules, general fellowship guideline brochure, and MD Anderson Trainee Survival Guide.
The overall quality of the fellow applicants ranges widely, with approximately 40% being of quality to warrant an official interview. Approximately, 10-15% are highly desirable applicants. Approximately 6-8 completed applications are anticipated each year.
Terms and Conditions of Appointment
Prior to or contemporaneously with the making of a recommendation for offer of appointment, GME programs must inform applicants in writing of the terms and conditions of appointment, and benefits including financial support, paid time off, professional liability, insurance benefits, and the conditions under which living quarters, meals, and other services or their equivalent are provided. This information should also be provided on the internet website.
Appointment is contingent upon successful completion of all requirements of the TSBME, the institution and any requirements specified in this program description. The trainee may practice under an institutional permit or with an individual Texas Medical License. Trainees holding a permit or medical license assume the responsibility of maintaining a valid permit or license. Current written proof or a valid license or written proof of a valid permit must be submitted to the Office of Graduate Medical Education before a trainee may start a program. Further, trainees are required to maintain currently valid documents indicating evidence of their authorization to work in the United States in order to participate in a clinical training program. The appointment contract term is 12 months or less, generally commencing on July 1 of a calendar year and ending on June 30 of the following year.
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MD Anderson Cancer Center is committed to encouraging good health and staying true to our mission to end cancer. If you are applying for a GME fellowship or residency program starting on or after July 1, 2016, please be advised that MD Anderson will have instituted a tobacco-free hiring process as part of its efforts to achieve these goals. If you are offered an appointment, you will be subject to a Pre-Employment Drug Screen for tobacco compounds in compliance with applicable state laws. If you do not pass the urine drug screening which includes testing for tobacco compounds, you CANNOT be appointed at MD Anderson. Should you fail to meet this contingency, MD Anderson will withdraw your offer of appointment for the academic year. You may reapply for the following academic year, but there are no guarantees that you will be offered a position as many of our programs are already filled for several years out.