Educating the next generation of clinical investigators

In 2011, Steven Grossman, M.D., Ph.D., moved from Massachusetts to Richmond to become the chair of the Division of Hematology, Oncology and Palliative Care, and tasked J. Christian Barrett, M.D., with directing the Hematology-Oncology Fellowship Program. Together, they set out to grow the three-year program from six fellows to 12 and, eventually, 15. 

“In addition to meeting the increased need for hematology-oncology providers, we wanted to create flexibility for fellows seeking careers as investigators wishing to take advantage of the array of resources at the institution and the Massey Cancer Center,” Barrett says. “We decided the most effective and cost-efficient means of identifying and hiring the next generation of investigators was to leverage the fellowship and develop talented physician scientists and investigators ourselves.”

The initial planning phase took time as the program set out to delineate the knowledge, skills, and attitudes essential for a successful clinician investigator. This phase spanned a few years. Progress accelerated when the training program partnered with the newly created division research committee chaired by Bhaumik Patel, M.D. This partnership culminated in the development of an eight-week clinical research course positioned in the late winter of the first year. The timing of the course allows the fellows to take a break from the otherwise clinically heavy year and sets them up for success during their later two years of training by generating clinical research questions and projects that might serve as the basis for their scholarly efforts. 

The course is divided into two distinct modules: population science and general research methods, and clinical translational research.

Brian Cassell, Ph.D., directs the first four weeks of the course, which focuses on generating research questions; understanding the research environment, resources and processes at Massey; accessing internal and external databases for health services research and implementation science; and conducting systematic review. To promote learning retention, the section employs practical experiential learning activities. They also gain an increased exposure to biostatistics during the course, an addition made in response to learner feedback. 

“The fellows conduct each of the steps of a systematic review as a team, with guidance from a research librarian and research mentors,” Cassell says. “The components of a systematic review — such as comprehensive searches using multiple databases, and evaluation of studies’ biases — are useful for the fellows for any career track, whether clinical or research.”

research image2Armed with basic knowledge of research methods, the fellows are ready for the next phase of the training in clinical translational research. Drs. Larisa Litovchick, M.D., Ph.D., and Patel co-direct the four-week section during which the fellows are introduced to the process of grant writing and the state-of-the art resources for conducting translational research available at VCU and Massey Cancer Center.

The course offers interactive small-group presentations from VCU School of Medicine graduate faculty with expertise in RNA sequencing, proteomics, metabolomics, cancer mouse models and other research tools. Interactive group discussions and journal club presentations facilitate the fellows’ understanding of the pre-clinical cancer research literature and prepare them for the future practice of personalized medicine.

To develop a research proposal, the participants work individually or in small groups — and often in collaboration with School of Medicine translational cancer researcher — to first identify a research question. They then develop a research plan and pilot grant application,  including specific aims, that is presented at the end of the course. To develop their proposals, fellows apply the tools learned throughout the entire course.

“This module was designed with a goal to promote confidence in the future generation oncologists,” Litovchick and Patel say. “We believe that by demystifying the process of grant writing and applying modern research tools the course promotes the fellow’s interest and confidence in conducting research in their future careers.”

The course has been a labor of love for all involved. After three years, the course continues to evolve with incremental modifications to optimize the content and the hands-on activities to achieve the curricular goals while affording the learners the needed balance to meet their diverse career aspirations. As the fellows move into their second and third year of training, the program expansion allows fellows to differentiate their training to meet their individual professional development needs.

Throughout his first year in the program, Ian Bouligny worked tirelessly during evenings and weekends designing and programming a RedCap database to address dozens of research questions he generated relevant to his intellectual passion, acute leukemia.

“The course was remarkably useful because I was exposed to faculty and mentors in informatics, programming, database building and statistics, allowing for what I was doing at the time to line up perfectly with what I was being exposed to,” Bouligny says. “Now, as a second-year fellow, I am using the instrument I created to prepare several abstracts for submission to our national conference this year, with the assistance and mentorship of Dr. Keri Maher.”  

Meanwhile, his classmate, Eziafa Oduah, has secured space in the lab of her mentor, Litovchick. As she begins her second year, Eziafa is exploring her novel ideas regarding p53 as a therapeutic target in cancer while simultaneously pursuing her Ph.D.

“Although I came in with some research experiences, the course equipped me with more tools and exposed me to the resources available here at VCU,” she says. “With the help of my mentors, I was also able to develop and refine my research hypotheses in preparation for a grant submission. I now look forward to developing my ideas and career as a clinician and scientist.”

Regardless of their ultimate career goals, the course is designed for all fellows to benefit from the material.

Logan Rhea, a second-year fellow, appreciated the hands-on approach the course took in turning clinical questions into research questions to pursue later in his training. “I certainly feel more comfortable reading and interpreting earlier phase and basic research studies,” he says, “with a better understanding of unique charting methods and presentations of data.”

The effort of last 10 years has paid dividends with some graduates taking jobs in private practices across the country while others have pursued academic careers at the Mayo Clinic Rochester, Moffitt Cancer Center, University of Oklahoma, VCU, Wake Forest and Washington University-Barnes Hospital.

“While continuing to produce physicians with exceptional clinical skills, we can now showcase our ability to train exceptional investigators as well,” Barrett says. “If our graduates choose to pursue an academic career on faculty at VCU, that is awesome. If they ultimately take positions at other institutions, they serve as our ambassadors. Either way, it is a win for our graduates and for the training program.”