Pediatric Fellowship Program

We believe that mentoring is one of the keys to success of any training program. In addition, we believe that mentorship can generally be conceptualized as involving both career counseling and intensive support around research. This type of dual mentorship is important, since many of the issues that trainees deal with are not only related to research projects, but also career issues. Our goal is to ensure that fellows have both a research and career mentor who meet with them on a regular basis.

Fellows can obtain either a Master of Public Health (MPH) degree, or a relatively new degree, the MSc, which requires less coursework. Since most of the current core research faculty in Pediatrics have joint appointments with BUSPH, faculty members can sponsor these credits. Both Masters programs require a thesis, which is commonly a specifically formatted version of fellows' independent research. Current areas of concentrations at BUSPH include: environmental health, epidemiology, biostatistics, health law, health services, international health, maternal and child health, and social and behavioral sciences.

Of the 48 credits of coursework for the MPH, 16 credits are from core courses, between 16 and 20 credits are in concentration courses, and the remaining is elective. Of the 32 credits for the MSc degree, students complete 8 courses, five of which are required biostatistics courses, two are additional biostatistics courses, and the remaining course is elective.

Over the first summer, each fellow takes two courses – one in introductory biostatistics and the other introductory epidemiology. They are taught in parallel with one another. We believe they represent an important aspect of the training program, providing the fellows with an excellent starting point in biostatistics and epidemiology as they consider their research projects.

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The fellows participate in three different seminar series - each of which serves a distinct purpose.

Division Work in Progress Sessions

Work in Progress sessions (WIPs) take place weekly within the Division of General Pediatrics. The purpose of the WIP session is for the presenter to receive constructive feedback on his/her work from the group of researchers. Often, individuals will present preliminary data analyses, methodologic quandaries or alternative methods to study a particular phenomenon. Typically, we have a statistician and an epidemiologist present, and someone designated to take notes for the presenter.

Fellows Report

Fellows Report is a combined seminar with the fellows in General Internal Medicine. This seminar gives fellows the opportunity to present their work on a regular basis to a multidisciplinary audience drawn from Pediatrics, General Internal Medicine, Family Practice, and Social and Behavioral Sciences. Fellows Report is a monthly conference (each session lasting 1½ hours). It is similar in format to the WIP session, but only fellows are allowed to present; and the emphasis is making one's research appealing to a wide array of generalist and health services researchers.

Division Fellows Seminars

This weekly conference is designed to complement the WIP session. Combined with the General Internal Medicine fellows, this seminar series emphasizes important aspects of academic medicine that are not taught in formal coursework. Sessions include: Getting the Most from Your Research Mentor; Negotiating an Academic Job; Presenting at Meetings; How to Explain Your Academic Interests on an Elevator Ride (i.e. with limited time); Abstract and Paper Writing.

Fellows Journal Club

A one-hour journal club is held approximately 14 times a year with the General Internal Medicine fellows. Sessions focus on critically evaluating a range of articles covering a range of study designs such as superiority RCT, pilot, qualitative, and cohort designs. Journal clubs are led by the fellows with support from faculty.

Fellows Coffee with the Fellowship Director and Division Chief

The fellows have coffee with the fellowship director and division chief monthly to discuss specific pediatric fellowship issues and provide on-going feedback in an informal setting.

Faculty presence is required at each of these seminars; and in this way, fellows have regular contact with the entire division of general pediatrics.

The Boston University Clinical Research Training (CREST) program was established in 1999, as part of the NIH K30 initiative, under the direction of David Felson, MD. The purpose of this program is to enhance training in patient-oriented research through formal course work and mentoring of fellows on the Boston University Chobanian & Avedisian School of Medicine campus.

Since its establishment, the fellows in the NRSA training program have become part of the CREST program. Under Dr. Felson's direction, the summer course in biostatistics and epidemiology was extensively revised and improved. Second, a biweekly CREST seminar was begun.

Fellows present at least once year, with senior leadership of the CREST program in attendance. In addition, other critically important issues, such as IRB approval, mentoring, the relationship of the genome project to clinical research, writing a grant and data management are also presented. This seminar augments the Fellows Seminars as discussed above.

Although we are just beginning to obtain information from our trainees, we believe that participation in the CREST seminar has further enhanced our training program. The fellows are exposed to research projects from other disciplines, and senior faculty presents the didactic topics from the Boston University Chobanian & Avedisian School of Medicine campus. Learn more about CREST.

One of the primary objectives of the training program is the completion of an independent research project. This objective is embedded in and emphasized in all aspects of the program, including: the interview and selection process; mentoring; course work at BUSPH; and the various research seminars. During the interview and selection process, emphasis is placed on the program as preparing trainees for an independent research career. Virtually all of the fellows have chosen research areas that they are interested in. We believe that by encouraging fellows to pursue research of their interest, that they remain more committed to the project.

While virtually all generalist fellowship programs require fellows to conduct research, our program emphasizes independence. While fellows are always given the option of joining ongoing faculty research projects, the optimal choice - we feel - for fellows is to develop and execute their own projects. Examples of ongoing and recently completed projects include:

1. Disparities in Access to Emergency Contraception - Tracey Wilkinson, MD
2. The Impact of the Medical Home on Healthy Children at Social Risk - Webb Long, MD
3. A Systemic Review of the Impact of Parenting Interventions on Children at Social Risk - Jenny Radesky, MD
4. Analysis of the Structure and Functioning of Child Protection Teams - Caroline Kistin, MD
5. Quality Indicators for Children with Sickle Cell Disease - Trish Kavanaugh, MD
6. Taxonomy of Errors in Medication Ordering via Electronic Order Entry - Katie Walsh, MD

Over the past four years we have begun to emphasize the preparation and submission of a grant during the later part of the fellowship. We have done this for a number of reasons. First, feedback from previous trainees have indicated that the amount and length of so-called "protected-time" early in their research careers is diminishing and that extramural funding is critical in ensuring their success. Second, the senior leadership of the program recognizes that primary care medical researchers need to follow the same career path as other physician-scientists, that is, in order to ensure their success as investigators, they must secure extramural funding.

The fellows are exposed to information about grants in a number of forums. Both in the Fellows and CREST Seminars they receive instruction in how to write a grant. In addition, in the CREST Seminar there is also a presentation about potential grant sources, including, career development awards sponsored by professional societies, industry, and the NIH (K awards). The NIH review process for other types of awards is also discussed. In the SERG Seminar actual grant submissions are discussed, including potential funders and collaborators.

Within the Department of Pediatrics we are also fortunate to have the Alpert Endowment. This endowment awards five to six small grants ($5,000-$10,000) each year. Approximately half of our fellows have successfully competed for these awards.

The majority of academic faculty, including primary care medical researchers, teach and communicate with other professionals. For the past eight years, during their first year, the fellows have participated in the Learning to Teach and Communicate seminar. The seminar focuses on the pedagogy of teaching and the development of communication and teaching skills. The seminar was significantly modified three years ago. The seminar was shortened from 12 months to nine months.

The first six months are devoted to specific skills development. The remaining three months are devoted to the planning and implementation a faculty development workshop. The seminar meets 3-4 times per month for two hours. It culminates in a faculty development workshop for community physicians, junior faculty, and other fellows, with the trainees acting as faculty. The seminar attendees practice their teaching skills as they implement the workshop.

The fellows participate in at least three regional and/or national research meetings, including, the regional Academic Pediatric Association (APA) meeting and the national Pediatric Academic Societies meeting. Prior to participating in these meetings, the faculty fellowship leadership discuss at the Fellows Seminar how to make effective use of such meetings.

Clinical commitment averages 20% to 30% per year over the two to three year training program. Clinical work is critical for two reasons: (1) the fellows are expected to pursue primary care research and clinical work helps to inform this process; (2) all of the fellows have felt it important to remain clinically competent, particularly since in virtually all academic positions they will have clinical responsibilities. During the third year we try to focus the fellows' clinical activities in areas in which they are conducting research. For example, a former trainee who was interested in nutrition worked in our Growth and Nutrition Clinic at BMC.