The Garron Family Cancer Centre's Education and Training

Program information

Successful candidates complete a three-year Royal College of Physicians and Surgeons of Canada (RCPSC) accredited Training Program, with extensive clinical exposure in:

• oncology (leukemia/lymphoma, solid tumor, neuro-oncology, cancer genetics, new agents and innovative therapies),
• haematology (haemoglobinopathies, bone marrow failure and myelodysplasia, thrombosis/haemostasis and general haematology), and
• bone marrow transplantation and cellular therapy.

Training also includes in-depth exposure to haematopathology (morphology, flow cytometry, cytogenetics, molecular genetics, blood bank and transfusion, special haematology, and coagulation), adult haematology, radiation oncology, and palliative care and symptom management.

Finally, opportunities exist to gain further experience through electives in areas such as diagnostic imaging, pathology and many others. Teaching occurs in both outpatient and inpatient settings, in addition to protected weekly Academic Half-Days, Continuity Clinics, multiple subspecialty rounds, lectures and seminars.

The focus of the first two years of this program is to gain clinical expertise in the subspecialty of Paediatric Haematology/Oncology and to begin to formulate scholarly ideas and proposals (basic science, translational, clinical, medical education and quality improvement).

The third year focuses on completing scholarly activities and pursuing further training in individual areas of interest. Successful candidates are fully funded during their 3-years of training. Clinical duties include outpatient and inpatient care, as well as on-call coverage for general haematology/oncology and bone marrow transplantation and cellular therapy.

Eligibility

• Canadian and US Graduates who have completed at least 3 of a 4-year General Paediatric Residency Training Program and meet eligibility requirements to apply through CaRMS.
• Sponsored residents from: Bahrain, Dominica, Kuwait, Oman, Qatar, Saudi Arabia, The United Arab Emirates and Libya.

After completing the program

All trainees who complete the three-year program will receive a certificate of completion from the University of Toronto. Successful trainees are eligible for Royal College certification in Paediatric Haematology/Oncology or certification via the Subspecialty Examination Affiliate Program (SEAP).

How to apply

Please apply via the CaRMS website.

Sponsored candidates can submit their application to Jessica.filion@utoronto.ca

Successful candidates complete a two-year highly clinically focused Training Program, with extensive clinical exposure in:

• oncology (leukemia/lymphoma, solid tumor, neuro-oncology, cancer genetics, new agents and innovative therapies), 
• haematology  (haemoglobinopathies,  bone  marrow  failure and myelodysplasia, thrombosis/haemostasis and general haematology), and
• bone marrow transplantation and cellular therapy.

Training also includes exposure to:

• haematopathology (morphology, flow cytometry, cytogenetics, molecular genetics, blood bank and transfusion, special haematology, and coagulation),
• adult haematology,
• radiation oncology, and
• palliative care and symptom management, the extent of which depends on each candidate’s training objectives.

Teaching occurs in both outpatient and inpatient settings, in addition to protected weekly Academic Half-Days, Continuity Clinics, multiple subspecialty rounds, lectures and seminars. Candidates are fully funded during their training. 

The second year is dependent on successful completion of the first year. Clinical duties include outpatient and  inpatient care, as  well as on-call  coverage  for  general  haematology/oncology  and  bone  marrow transplantation and cellular therapy. 

Eligibility

• International Medical Graduates
• Must have Certification in General Paediatric's
• One year experience working and/or training in Paediatric Haematology/Oncology is required

After completing the program

All trainees receive a Subspecialty certificate in General Paediatric Haematology/Oncology from the University of Toronto.

How to apply

Complete the Departmental Paediatric Haematology/Oncology Program application online. Incomplete applications will not be considered.

Timeline

• Fellowship Academic Year:  July 1, 2022 - June 30, 2023
• Application Date Opens:  January 1, 2021
• Submission Deadline:  April 30, 2021
• Selection Committee Review: May - June
• Virtual Interviews: July - August
• Program Acceptance: An email notification will be forwarded to your email address on file between August and September. Following this date, offer letters will be initiated. 

Subspecialty Training Programs are for those already trained in General Paediatric Haematology/Oncology who wish to obtain further clinical and/or research specialization.

Customized  programs  may  also  be  developed  according  to  a  trainee’s  interests.  Past customized subspecialty  programs have  included  Sarcoma, and  Adolescent and Young  Adult  Oncology Fellowships. Those interested in applying to a customized subspecialty program must highlight their rationale in the letter of intent.

Candidates  applying  to  a  Subspecialty  Program  are  ineligible  to  apply  to  the  Core  and Departmental Paediatric Haematology/Oncology Programs at the same time. Furthermore, candidates are only permitted to apply to a maximum of two Subspecialty Programs. 

How to Apply

Complete the Subspecialty Paediatric Haematology/Oncology application  online. Incomplete applications will not be considered.

Timeline

• Academic Year:  July 1, 2022 - June 30, 2023
• Application Date Opens:  January 1, 2021
• Submission Deadline:  April 30, 2021
• Selection Committee Review: May - June
• Virtual Interviews:  June - July
• Program Acceptance: An email notification will be forwarded to your email address on file between August and September. Following this date, offer letters will be initiated. 

Successful candidates complete a two-year cancer research-focused training program. A third year may be considered in exceptional circumstances. Effective September 2017, the GFCC will be awarding two GFCC Research Fellowships annually.

Eligibility

The GFCC Research Fellowship is open to physicians trainees. Eligibility is also extended to nursing and allied health professionals pursuing their Master's or PhD degree.

How to apply

1. Complete the GFCC Trainee Application online
2. Submit Current CV 
3. Submit two professional letters of reference  
4. Have supervisor complete the GFCC Fellowship Supervisor Application 
5. Submit one supervisor letter of support

Note: A supervisor and primary project must be identified at the time of application   

Timeline

• Fellowship Academic Year: July 1, 2022-June 30, 2023
• Submission Deadline: September 6, 2021
• Selection Committee Review: September - October
• Program Acceptance: An email notification will be forwarded to your email address between October and November.

Fellowship Deferral

The GFCC Research Fellowship can be deferred up to a maximum of 1 year. A written letter advising of deferral is required and include signature from fellow and supervisor.

Fellowship Requirements

Research undertaken must be cancer-related and fellows are required to participate in GFCC research seminars related to their research interests and as their schedules allow from the outset of their fellowship. As part of the fellowship, clinical fellows may be required to commit up to 10% of their time to clinical activities during research training.

Fellowship Expectations

A progress report must be provided by March 31 of the first year research is undertaken and then in the final year of the fellowship.
GFCC fellows are required to present their research by the final year of their fellowship at the GFCC Research Day held annually.

Acknowledge the Garron Family Cancer Centre in all presentations, invited/submitted poster sessions etc. and use the GFCC logo for such occasions.

Fellows must inform the GFCC in writing of any future applications for funding, publications, new findings or conclusions drawn from the project or the experience that was gained through the GFCC Fellowship opportunity.

Supervisor Contribution

Supervisors are required to provide salary support in the amount of $20,500 per annum. The GFCC will provide balance of funding to support salary up to the required PGY5 salary for clinical fellows. Please note this contribution requirement is subject to change based on PGME salary increases. If fellow receives external funding (e.g. POGO Fellowship, CIHR) the awarded funds will be deducted from the supervisor contribution.

The Division of Hematology/Oncology Clinical and GFCC Research Fellowship is a four-year combined fellowship opportunity for physicians. The GFCC Research Fellowship component begins after the completion of two years of clinical training.

Eligibility

Physician trainees awarded a two-year clinical fellowship by the Division of Haematology/Oncology.

Application Requirements

1. Division of Haematology/Oncology Fellowship Application 
2. Current CV
3. Two professional letters of reference
4. GFCC Fellowship Trainee Application 
5. GFCC Fellowship Supervisor Application
6. One supervisor letter of support

Timeline

• Fellowship Academic Year: July 1, 2022 - June 30, 2023
• Submission Deadline: September 6, 2021
• Selection Committee Review: September - October
• Program Acceptance: An email notification will be forwarded to your email address between October and November.

Applicants must apply directly through SickKids Research Training Centre's (RTC) Restracomp Program. The GFCC co-funds up to eight cancer-related research projects annually.

To learn more about the Restracomp application process and to obtain an application package visit the Research Training Centre page. Restracomp will administrate the initial evaluation of applications, and competitive applicants will be forwarded for final adjudication by the GFCC's Education Council. Interested applicants must self-identify that their project is cancer related on the application, apply through the appropriate category and approach a supervisor (Associate Scientist, Scientist, Senior Associate Scientist, Senior Scientist) to obtain a letter of endorsement that must be included in the application package.

Please email gfcc.fellowship@sickkids.ca for more information. 

Dr. Sarah Cohen-Gogo

Supervisor: Dr. Daniel Morgenstern

PARP Inhibitors and Chemotherapy for children, adolescent and young adults harbouring Tumours with homologous Recombination repair deficiency: a phase II pilot study

While the survival rate in Canada approaches 82 per cent for all child, adolescent, and young adult cancer patients, the prognosis for patients with refractory, relapsed or metastatic disease remains unacceptably poor.
A pan-Canadian collaboration called PRecision Oncology For Young peopLE (PROFYLE) was created to improve survival for the patients with ‘hard-to-treat’ cancers by providing better access to next generation sequencing and targeted therapies. The PROFYLE program expands and integrates the Toronto regional paediatric cancer precision medicine program called KiCS (Kids Cancer Sequencing).
Among the identified genetic aberrations, those leading to deficiencies in a DNA repair pathway called homologous recombination are a promising group for targeted therapy. A family of drugs called PARP inhibitors is now part of the treatment for some adult cancers (ovarian, breast) that have such abnormalities.
As it remains unclear how to best identify paediatric, adolescent and young adult patients who may benefit from these drugs, we are developing a Canadian pilot clinical trial that will provide access to these new drugs for patients with hard-to-treat cancers, and take into account the information from the PROFYLE sequencing study to look for potential biomarkers.

Dr. Grace Egan

Supervisor: Dr. Aaron Schimmer

Nuclear Hexokinase 2: Mechanism of Regulating Stemness

Acute myeloid leukemia (AML) remains one of the most difficult to treat childhood cancers given its high rates of relapse and treatment-related toxicity.  Leukemic stem cells (LSCs) are thought to be responsible for initiation, maintenance, and recurrence of AML. Understanding the biology of leukemia stem cells is crucial for developing effective, targeted, therapies for AML.

Previous work has shown that enzymes involved in metabolism can influence gene expression when they move from the mitochondria to the nucleus. Little is known about this process in AML. Hexokinase 2 (HK2) is a metabolic enzyme involved in glucose metabolism. Recent work in our lab has demonstrated that leukemia stem cells have increased levels of HK2. When nuclear HK2 is over-expressed in AML cells, it is associated with a stem-like phenotype, making cells resistance to differentiation with chemotherapy. The mechanism of how nuclear HK2 contributes to stemness is unknown. My project will decipher these mechanisms, which appear to involve epigenetic processes and DNA damage repair signaling pathways. By exploring the interacting proteins and pathways of nuclear HK2, it may be possible to discover novel therapeutic ways of selectively reducing the leukemia stem cell population in AML.

Dr. Reena Pabari

Supervisor: Cynthia Guidos

The use of high dimensional mass cytometry to detect and characterize relapse-originating cells in acute myeloid leukaemia

Patients with acute myeloid leukaemia (AML) have high rates of relapse, despite initial apparent responsiveness to chemotherapy in many cases. There is evidence that the relapsed disease derives from a population of leukemic stem cells that are present at the time of diagnosis. In patients with acute lymphoblastic leukaemia (ALL), flow cytometry is used to identify the persistence of leukemic cells (minimal residual disease) after induction chemotherapy in order to guide and intensify treatment if needed.

In contrast, AML is a heterogeneous disease that is difficult to characterize with routine flow cytometry. I will be using high dimensional mass cytometry to characterize and evaluate the relapse-originating cells in diagnosis-remission-relapse samples from patients with AML. Mass cytometry can profile up to 40 markers per cell and has a greater ability to characterize heterogeneous cell populations. Our goal is to be able to identify and monitor the relapse-seeding clones in patients with AML in order to better guide therapy and prevent further progression of disease.

Dr. Tristan Knight

Supervisor: Dr. Donna A. Wall

Re-envisioning the autologous hematopoietic stem cell transplant as immunotherapy

Autologous bone marrow transplantation plays a key role in the treatment of many aggressive childhood cancers. This procedure involves the collection and storage of a child's own blood-making stem cells, administration of high-dose chemotherapy, and then the return of the child's previously-collected cells in order to re-build the blood-making system. This allows more intensive than usual chemotherapy to be administered. However, only 1% of the collected cells (the graft) are stem cells – the rest are a mixture of immune cells, but the type, function, and abilities of those immune cells is not understood. This project will therefore aim to characterize the immune cells present in the graft, and to improve the function and anti-cancer activity of the immune cells. In this way, a child's own immune system will be harnessed to help fight their cancer following bone marrow transplantation.

Dr. Fyeza Hasan

Supervisor: Dr. Lillian Sung

Children with Cancer as Participants in End of Life Research

Survival rates for childhood cancers have increased dramatically, but 20 per cent of patients still die of their cancer or its treatment. The end-of-life (EOL) care of these children is difficult and includes addressing complex symptoms, and challenging issues around decision making, such as decisions about resuscitation, ongoing therapy and clinical trials.
Palliative care research studies can help us to identify evidence informed strategies for managing the complex EOL issues faced by children with cancer and may improve quality of life and satisfaction with care for patients and their families.

Despite the need for this type of research, palliative care studies are extremely rare in paediatric oncology. There are a number of possible barriers including the reluctance of physicians to offer research to families, and reluctance of families to take part, or remain enrolled.

My research aims to explore stakeholder perceptions about the enrolment of children with cancer in paediatric oncology palliative care research. Studying the views of potential research participants will allow researchers to understand parents’ and clinicians’ decision making processes. This will assist them in designing studies that are meaningful and acceptable to stakeholders, improving recruitment and creating knowledge that ultimately improves EOL care.