Traveling Fellowship Experience
NATF Traveling Fellowship Experiences
2008
The NATF Travel Fellowship was very beneficial to my overall education and career development. I participated in this program during my final year of fellowship in pediatric hematology-oncology. To accomplish my goal of gaining expertise in appropriate use of anticoagulation in children I designed a unique training track in thrombosis pharmacology. This pathway included participation in the Baylor College of Medicine Clinical Pharmacology Fellowship as well as special clinical and laboratory electives on coagulation and thrombosis. The NATF travel fellowship funded one of these electives, a ten-day visit to Stollery Children’s Hospital in Edmonton, Alberta. Under the direction of Dr Patti Massicotte, Stollery is home to one of the only comprehensive pediatric thrombosis teams in the world. Texas Children’s Hospital has collaborated with this institution for the past three years, an alliance that has greatly improved the level of care at our facility. Although my time there was relatively short, having the opportunity to round with Dr Massicotte and her team and observe how a well-organized thrombosis center is run was an invaluable experience.
My time with the Thrombosis Treatment Team at Stollery exposed me to many new treatment strategies. In particular, this team has great expertise in the management of warfarin in children. Their practice includes the routine use of point of care monitoring that the patients perform at their home. Currently they are piloting a new program of patient self-management in which the patients not only test themselves, but also make dose changes independently. These unique strategies have been very effective at their center and I picked up many good ideas to incorporate into my practice.
Another unique and valuable experience I had during my visit was participating in one of the warfarin management clinics. All patients are assembled in a conference room for teaching en masse prior to individual clinic visits. This strategy allowed the team to provide education to 10 patients (and their families) at once as well as to describe ongoing research studies and enroll interested patients. This efficient use of time and resources is one of the keys to their success both in clinical and research endeavors.
Finally, this time in Edmonton allowed me to recruit patients for my own research project entitled “Use of Pharmacogenetic and Clinical Factors to Predict Warfarin Dose in Children”. This is a translational research project that explores the role of genetic polymorphisms in modifying the response to warfarin administration. The role of these polymorphisms has been studied in adults, but to date no comprehensive investigation has been performed in the pediatric population. Understanding how genetic polymorphisms affect the response to this drug will allow for more logical dosing regimens and prevent potential toxicities due to overdosing. Recruiting from the large patient population at Stollery Children’s Hospital will help us achieve our target sample size more quickly and therefore have results available to impact clinical care sooner.
In summary, I am very grateful to have received the NATF Travel Fellowship Award. The knowledge I obtained and the personal connections I made will be very valuable to my developing career.
Thrombosis researchers have equipped us with therapeutic strategies to prevent and treat life altering thrombotic complications safely and effectively. Anticoagulant medications are highly effective and continue to be the cornerstone of therapy for patients who are at risk or have suffered a thrombotic event. Unfortunately, these agents are associated with an increased risk of bleeding events and can lead to poor patient outcomes.
Dr. Joel Gore and I are the lead anticoagulation specialists at UMass Memorial Medical Center (UMMMC). We are charged with the important task of developing policies and procedures to help ensure safe storage, dispensing, prescribing, and monitoring of anticoagulation therapy. It is required by the Joint Commission (JC) that these safety practices be evaluated and actions be taken to optimize outcomes. Ongoing education of healthcare providers, patients, and family members on the appropriate use of anticoagulation therapy is one of the nine specific expectations of the JC National Patient Safety Goals (NPSG) for Anticoagulation Therapy. United States health care organizations are expected to meet these expectations in order to reduce the likelihood of patient harm associated with the use of anticoagulation therapy. The goal of my fellowship was to implement an anticoagulation education program within my organization, exchange strategies with other sites that have well-established thrombosis services, and measure the impact of these interventions on patient outcomes.
I chose to visit Dr. Frederick Spencer, a great mentor, and colleague in Hamilton, Ontario. Dr. Spencer graciously organized a multi-centered visit of five hospitals: McMaster University Medical Centre, Hamilton General Hospital, Henderson General Hospital, Chedoke Hospital, and St. Joseph’s Hospital. I was connected with key physicians, nurses, and pharmacists at each site who managed patients with various risk factors for thrombotic complications such as cardiovascular disease, thrombophilia disorders, orthopedic surgery, and cancer. The settings included academic medical centers, ambulatory clinics, and a rehabilitation center. I observed interdisciplinary patient care rounds led by thrombosis experts including Dr. Spencer and Dr. Pai. I also observed evaluations of ambulatory patients in each of the thrombosis clinics with Dr. O’Donnell at the Jaruvinski Cancer Center and Dr. Schulman at Hamilton General Hospital. Referring physicians relied heavily on the thrombosis services at each of these sites for comprehensive management of thrombotic complications. I observed education provided to other health care providers, patients, and family members. The thrombosis specialists ensured both the patient and family member were involved in the development of the care plan. This is an essential step in achieving successful patient outcomes.
There was a strong commitment to thrombosis research at all the medical centers. Patient enrollment into studies was active and there was a clear and common goal among practitioners to find new and improved ways to treat thrombotic diseases. I was able to attend a regional interdisciplinary conference led by Dr. Jack Hirsh, an internationally recognized physician and researcher in anticoagulation therapy and thrombosis. There was much discussion regarding what clinically relevant outcome measures should be used in research to establish efficacy and safety for anticoagulants in the prevention of venous thromboembolic disease.
While visiting these hospitals, I shared educational materials (e.g. educational slides, clinical practice guidelines, order forms, competencies, and patient education materials) that I developed with my colleagues at UMMMC. In return, each site shared similar educational materials they had developed for their organization. I participated in many discussions related to the challenges of educating a large number of healthcare providers in diverse healthcare systems. As a result of these discussions, UMMMC and St. Joseph’s Hospital are planning on a joint program to evaluate the impact of educational tools on prescribing patterns and bleeding events. Dr. Higgins, the Chief of Staff, and Dr. Gosse, the Pharmacy Director, are very enthusiastic and supportive about this collaboration. This work will allow us to measure the effectiveness of our interventions to bridge gaps in knowledge and standardize the quality of care in our medical centers.
I would like to thank the North American Thrombosis Forum (NATF) Board of Directors, the Scientific Advisory Committee, and everyone involved in the traveling fellowship program. This is a truly remarkable opportunity to network with other clinicians, researchers, and educators who are leaders in thrombosis care. I would also like to express my sincere gratitude to Dr. Spencer and his wonderful family for making me feel completely at home in Hamilton, Ontario. It was such a privilege to meet so many pioneers in thrombosis research and education.
2007
In September 2007, I went to the first annual North American Thrombosis Summit. With many world leaders in various aspects of thrombosis attending, this conference was an inclusive global review of the field. I had the great opportunity of sitting closely with renowned experts in the field who represented the five major areas of the North American Thrombosis Forum (NATF) focus, including translational research, clinical research, prevention, public policy, and patient advocacy. The Summit was used as the backdrop for the official announcement of my fellowship; I was offered the chance to visit any research laboratory in North America. I chose to work with my hero, Dr. Samuel Goldhaber, who leads the VTE Research Group in Boston, MA.
In March 2008, I began my Traveling Fellowship by attending NATF’s Proactive Thrombosis Prevention Forum. I spent the rest of that two-week period at the Venous Thromboembolism Research Group at the Brigham and Women’s Hospital in Boston, MA, where I worked side by side with Dr. Samuel Z. Goldhaber, and met with his Research Fellows involved in several research projects. I also visited the anticoagulation clinic and witnessed firsthand how this very busy service runs efficiently in a high-quality environment.
Among the fine physicians in Dr. Goldhaber’s group, I found skilled mentors who indicated they are interested in developing my career in thrombosis. Dr. Arthur Sasahara was very generous in sharing both his wisdom and his time. Dr Sam Goldhaber provided constructive feedback and showed real interest in my career development. John Fanikos made my stay quite enjoyable through his wonderful, positive attitude, not to mention the entertainment schedule that he had devised.
Although the 2 weeks went by too quickly, I made the most of every minute of my stay. In that short time, I was able to forge enduring relationships with members of NATF and the BWH anticoagulation group. I also gained the necessary knowledge and experience to suggest improvements for the anticoagulation clinics at my own institution.
I will be forever grateful that I made the decision to join NATF and was awarded the Traveling Fellowship. I expect that my relationships with the NATF members and those in its affiliate organizations will grow and prosper in the coming years. The world has an immediate and urgent need for leaders in the field of thrombosis to take on the major task of improving prevention and therapeutic practices.
But… none of this can work can be accomplished alone. NATF has given us the opportunity to collaborate on translational research, prevention, and patient advocacy. Together, we can accept this challenging task.
Since becoming an NATF Traveling Fellow, I am now even more determined to continue my career in thrombosis and to accept the important role as an advocate for patient awareness and education.
I thank NATF for this great experience and once in a lifetime opportunity, and I wish the best for the new Fellows in the years to come.