The Fellowship Training Program in Adult Medical Oncology at the National Cancer Institute is a unified teaching experience in clinical oncology and research that is conducted at the National Cancer Institute (NCI) and the National Naval Medical Center (NNMC), Bethesda, Maryland. This Fellowship Program provides an unique opportunity for physicians interested in academic careers to develop and integrate both their clinical and basic research interests. The clinical portion of the Fellowship consists of primary responsibility for the clinical care of inpatients and outpatients with a board spectrum of adult malignancies. It introduces the participants to the process of designing and conducting clinical trials. During the first clinical year, there is an emphasis on exposing fellows to the basic science and clinical medicine of oncology. During the research years, the fellow will join one of the several hundred available investigators within the National Cancer Institute to acquire the skills necessary to become an independent biomedical investigator with emphasis on laboratory or clinical science. The NCI guarantees at least two years of protected research time to all of its medical oncology fellows. The goal of the Program is to foster the development of physician-scientists who have excellent clinical and research skills. During the first year of Medical Oncology training, Fellows devote 100% of their time to clinical training in inpatient and outpatient care. All first year fellows spend six months at the NIH Clinical Center (NIH-CC) and six months at the NNMC. In the second and third years, 20% of the fellows' time is spent in the care of outpatients in either the NIH-CC or NNMC. This continuity clinic ensures that fellows in the program extend their experience with a wide spectrum of human cancer. The remaining time in the second and third years is protected time for research in any of the NCI Clinical Teams or any NIH laboratory. The NIH-CC emphasizes the development of new approaches to the treatment of cancer and its complications. Current areas of clinical emphasis include prostate cancer, ovarian cancer, renal cell carcinoma, lymphomas, Hodgkin's disease, chronic leukemia, new drug testing, stem cell transplantation and AIDS, and its associated malignancies. Patients with AIDS and AIDS associated malignancies constitute approximately 15% of the total patient population; nearly all these patients are involved in studies of experimental antiretroviral compounds and chemotherapy. Training in clinical diagnostic procedures such as bone marrow examination, thoracentesis, and paracentesis is a routine part of the first-year experience. Collaboration with related clinical units in the Clinical Center such as Radiation Oncology, Surgery, and Critical Care Medicine is very close. The NNMC is located in Bethesda, adjacent to the NIH campus. It is a tertiary referral hospital that serves active duty military personnel and their families, retired military and their spouses, and some embassy, Congressional, and other non-military government personnel. Patients are referred from the military system around the world with all types of malignant disease, including solid tumors and hematological malignancies. There is a large population of young adults with malignant diseases characteristic of this age group (e.g. germ cell tumors). The program provides consultation in oncology and hematology to the NNMC and treatment for DOD patients with cancer. In addition, civilian patients who are eligible for NCI studies can be admitted to the program for care and study. The studies at NNMC have focused on breast cancer, prostate cancer and cancer vaccines. Roughly 8% of patients enrolled are on NCI clinical trials and 92% of patients are involved in standard oncologic management. The Medial Oncology Branch also has a joint Hematology/Oncology Training Program in collaboration with the Hematology Branch, National Heart, Lung, and Blood Institute, and the Hematology Department, Clinical Center, NIH. This program combines the separate training programs of hematology and medical oncology into a series of clinical rotations encompassing the first 18 or 22 months of fellow's training. Fellows whose principal interest is hematology have a primary appointment in the NHLBI and their chief clinical exposure is in clinical hematology but includes six months of clinical oncology in the Medical Oncology Branch, NCI. Fellows who have a primary interest in medical oncology have their appointment with the NCI. Their principal clinical exposure is in clinical oncology with an additional six months of hematology rotations. The first 12 months of training are exactly like that for medical oncology-alone. In the second year they undertake an additional 6 months of clinical hematology that usually includes the following: 2 months ward hematology (NHLBI), 1 month leukemia service (Johns Hopkins Transplant Unit), 2 weeks transfusion medicine, 6 weeks consult hematology and coagulation, and 1 month rotation at the Washington VA Hospital. Following completion of this 18-month clinical period, the fellow does laboratory or clinical research for up to 4 years of fellowship along with continued outpatient clinical duties. Offered throughout the Program are lectures, research seminars, conferences, journal club, teaching rounds and conferences relevant to clinical oncology and cancer research. Most of these are organized specifically for medical staff fellows. These include a core curriculum lecture series in clinical oncology, which meets once a week throughout the year, and offers lectures by members of the senior staff across the spectrum of issues in neoplastic disease. At both the NIH-CC and the NNMC, the formal didactic lectures and teaching rounds total approximately 10 hours per week. Fellows are responsible for preparing case presentations and lecture material for about 33% of the lecture time. Pathology teaching sessions are held in both the NIH-CC and NNMC in addition to multidisciplinary clinical conferences, walk rounds, and a variety of disease specific multidisciplinary meetings. In addition, there are 10 to 15 research seminars and lectures given per day throughout the NIH; these are advertised in a weekly announcement and are regularly open to the entire NIH community.
