Resident participation in clinically oriented pathology research projects (including clinicopathologic correlations and translational research) are actively encouraged and widely conducted in our Department. These studies typically utilize case material and involve technologies ranging from established methods like immunohistochemistry to state-of-the-art approaches such as mass spectrometry and highly multiplexed tissue imaging techniques, next-generation sequencing, transcriptional profiling, and other molecular biological approaches. Even if a trainee is intending to eventually practice pathology in a non-academic setting, we believe that the process of developing a research hypothesis, generating data, writing up their findings and presenting their work in a peer-reviewed manuscript is a valuable component of their education and career development. In addition, many studies involve collaborations with physicians in other departments, fostering interdepartmental relationships.
Immunohistochemical studies, long a mainstay of clinical pathology research, are funded by the Department and continue to form the backbone of pioneering diagnostic advances from this Department that have broadly impacted routine pathology practice. The department is also fully committed to allowing trainees access to the tools of "translational molecular pathology" - innovative technologies, particularly in the realms of molecular diagnostics and cytogenetics, that permit fundamental investigation of disease mechanisms and pathogenesis and that also increasingly inform precision diagnosis, sensitive disease detection, and targeted treatment of human disease.
To support this goal, the OncoPanel and Rapid Heme Panel molecular diagnostics platforms, among others, can be used to conduct research investigations using department archival samples. Access to annotated databases such as OncDRS and the DFCI cBioPortal, which provide a compendium of treatment outcome results and other clinical data, complement such studies. Each year the Department also provides funding to trainees to perform in-depth molecular analysis of unusual or particularly informative archived samples. Testing modalities that are available in the CAMD Core lab to support such “discovery-based” work includes next-generation sequencing on existing platforms, FISH testing, microarrays, RNA-based assays on the Nanostring NCounter platform, droplet digital PCR system (KIT, EGFR), as well as others. Another resource is the Center for Cancer Genome Discovery (CCGD) which collaborates on next sequencing projects in oncology.
The future of Pathology research and practice will increasingly involve precision medicine, “big data” and digital pathology. To ensure that our trainees are prepared for this future, we have created a division of Computational Pathology with the necessary faculty and infrastructure to carry out research involving computational biology, systems biology, computer science and bioinformatics. At present, our trainees are actively involved in projects using machine learning, artificial intelligence and mathematical modeling to analyze complex datasets. Finally, in recent months, the Mass General Brigham Center for COVID Innovation was rapidly co-developed by Dr. David Walt, Professor of Pathology in our department; this venture represents an exceptional opportunity for our trainees to engage in real-time pathology-based innovations that aim to combat current and future pandemics.
Reflecting our commitment to participation of trainees in research, our residents, fellows and faculty present numerous poster and platform presentations at national and international scientific and clinical meetings, including the yearly United States and Canadian Academy of Pathology (USCAP) and the American Society of Clinical Pathologists (ASCP) meetings. Indeed, BWH Pathology consistently ranks among the top three departments in the country for first-author platform presentations (typically given by trainees and junior faculty) at the annual USCAP meeting. The Department provides up to $2000 in travel funds each year per trainee in order to present a first-author poster or platform talk at a national meeting.
The BWH Pathology Department has a longstanding tradition of fostering the career development of physician-scientists for leadership positions at the interface of science and medicine. To facilitate a smooth and productive transition from clinical service work to the early stages of a research career, BWH Pathology makes a longitudinal commitment to future physician-scientists that begins during recruitment and extends throughout clinical training into post-doctoral research and eventually junior faculty positions. Salary support during post-doctoral research is at a level commensurate with PGY year, and post-doctoral fellows are also able to maintain a partial (≤ 15% effort) clinical activity in order to sustain the clinical component of their practice.
As part of this commitment, starting during their first year of clinical training, residents are paired with research mentors who help to guide their thinking about potential areas of research and laboratories within which to pursue it. During clinical training, the Department also strives to allow sufficient time and space for trainees to be able to take advantage of the rich research ecosystem that exists at BWH, DFCI, and other nearby institutions. Residents doing their clinical work during the AP or CP Core are encouraged to attend the numerous research seminars and symposia that occur within the department and the local environs.
Clinical trainees are also encouraged to keep up-to-date on the broader research and educational opportunities within and proximate to BWH via the Brigham Research Institute (BRI), the BWH Office of Research Careers, Harvard Medical School, MIT, the combined Harvard-MIT Division of Health Sciences and Technology (HST), the Leder Harvard Biology and Translational Medicine (HBTM) program, the Consortia for Improving Medicine w/ Innovation & Technology (CIMIT), and the Boston Biomedical Innovation Center (B-BIC). Another key resource within our community is Harvard Catalyst (HC), an NIH-CTSA-funded consortium of Harvard University, MIT, Harvard Medical School, and affiliated academic medical centers that supports cross-disciplinary collaboration and provides education and mentoring for clinical and translational researchers.
Through individualized interactions with mentors and exposure to innovative, cutting-edge research, trainees who are motivated to pursue investigation typically have little difficulty in identifying laboratories in which to perform their postdoctoral studies. In addition to laboratories within our own Department, pathology residents are welcome to pursue research within the larger biomedical research community in Boston, including at the Broad Institute, the Harvard Stem Cell Institute, and the Harvard Wyss Institute for Biologically-Inspired Engineering.
One attractive source of initial funding support is the NIH-funded Oncopathology (OTP) T32 Training Grant (see below). The Director (Jon Aster, Interim Chair of Pathology at BWH) and Co-Director (Kathleen Burns, Chair of Pathology at Dana-Farber Cancer Institute) meets regularly with residents and post-doctoral research fellows to assess progress and help direct next steps in career development. Another key source of support for trainees is Lissa Olbeter, Executive Administrator for OTP. Once a research trainee embarks on a journey towards independent funding, Lissa not only keeps trainees apprised of various career development awards, but she also works closely with trainees and their mentors to ensure that submitted applications have the best possible chance of success. Historically, this system has proven to be very successful, as a large majority of our physician-scientist trainees obtain career development awards that serve as steppingstones to independence.
A major means of support for physician-scientist trainees in the department over the past 50+ years has been a T32 Training Grant from the National Heart, Lung, and Blood Institute (NHLBI) for postdoctoral-level research training. Although enormously successful in meeting its mission, research in the department has become increasingly cancer-focused over time, a change that was recognized by NHLBI. In response to this shift, the NHLBI T32 training grant is in the process of phasing out and is being replaced by a new National Cancer Institute-funded T32 entitled the Oncopathology Training Program (OTP), which began supporting its first five physician-scientist trainees as of August 1, 2020.
The mission of OTP is to train physician scientists in the field of oncopathology, defined broadly as research that seeks to improve our understanding of cancer pathogenesis and pathobiology, and in doing so lead to improvements in cancer diagnosis, prognostication, and treatment. It is specifically designed to benefit the research career development of MD and MD/PhD trainees subsequent to their training in clinical and/or anatomic pathology. Each trainee will have Postdoctoral Advisory Committee comprised of at least one of the program directors (Dr. Aster and Dr. Burns), their primary research mentor, and one or more senior cancer researchers with relevant expertise that will review their progress, provide advice and constructive criticism, and serve as a review committee for external fellowship and career development applications.
The core faculty includes highly accomplished investigators in the Department of Pathology at BWH as well as at Dana-Farber Cancer Institute and Harvard Medical School who constitute a highly collaborative mentoring community. The expertise of the faculty spans a wide-range of multidisciplinary, oncopathology-relevant areas, including animal modeling of cancer, cancer immunology, cancer genomics, computational pathology and tissue imaging, cancer diagnostics, and translational cancer informatics. Importantly, however, trainees are also allowed to choose mentors who are not members of the core faculty, as long as the focus of the laboratory and PI is on some aspect of cancer research.
For those trainees with research interests outside the scope of the OTP training grant, the Department makes a one-year commitment of salary support, while providing mentoring assistance to transition funding to other mechanisms such as foundations and the NIH F32.
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