A Neurology-Oncology Fellowship That Provides a More “Boutique” Feel

For Priya U. Kumthekar, MD, her role as a fellowship program director is part of a journey that has come full circle. She was the very first fellow within the Neuro-Oncology Fellowship at Northwestern Medicine Feinberg School of Medicine in Chicago, Illinois.

“I got to see the program that I grew up in and add to it, so it feels like a service that I can give back to the program that has given me so much,” said Kumthekar, who also serves as associate professor of neurology and internal medicine in the Ken and Ruth Davee Department of Neurology. “I’ve gotten to see a lot of positive evolution over the past decade.”

She also was able to see the fruits of her labor. As a fellow, she started research for a phase 2 trial (NCT01898130), which is evaluating bevacizumab (Avastin) in patients with recurrent solid tumor brain metastases who have progressed on whole-brain radiation treatment.

“Some of the research that I started as a fellow, I got to see through completion my first handful of years as an attending—which is such a gift, because I see a lot of fellows who do a great job doing research and fellowship, and then must abandon or hand off some of their work to others as they move on to a different institution,” she added.

The experience is all part of the boutique-type of experience within the Northwestern’s NeuroOncology Fellowship Program, which typically takes just 1 new fellow annually.

In an interview with Oncology Fellows™, Kumthekar details the specialized program for fellows while reflecting on her own experiences, highlights her research in brain metastases, and offers advice to both fellowship directors and current fellows in oncology.

Oncology Fellows: What does the fellowship program at Northwestern encompass? How would you describe the components of it?

Kumthekar: Our fellowship is the neuro-oncology fellowship, which is [certified by] the United Council of Neurologic Subspecialities [UCNS]. We are a relatively new fellowship, since the 2000s, in terms of officially being a fellowship. Our fellows do 1- or 2-year fellowships, and they are focused on primary brain tumors, metastatic brain tumors, and neurologic complications of systemic cancers and anticancer therapies.

You have been with this program from the very beginning—as a fellow! What has that experience been like? Is it a challenge for enrollment when there are other more established programs?

I was the first fellow to complete the program here, and now I’m the program director. When I was selecting my fellowship in 2010, I was looking for programs around the country and at the time, there was only a handful of UCNS accredited neuro-oncology programs—we were among the first.

I decided to stay at [Northwestern], but I was only selecting between about a half dozen [fellowship programs] nationally; fortunately, that happened to be a place that was one of those.

There are a few pieces of that. Building the program and having the program itself be strong in this landscape of new programs requires a lot of crosstalk with other program directors across the country. We meet at least once or twice a year. There have been some great national leaders in the fellowship who have really pioneered things, such as journal clubs. Because we’re such a [small] program, we need to come together in numbers, especially in an era like today where we can do everything remotely over Zoom—why not have those fellows feel like their co-fellows are folks across the country as opposed to just being alone at an institution or having very few fellows? That’s one way of growth.

Then there’s growth that you may have been alluding to, which is: How do we attract more applicants to the field? That takes time. There are more now than there were 10 years ago, which is great; we’re moving in the right direction.

By nature, neuro-oncology is a smaller field than, say, epilepsy or stroke or other more prevalent neurologic diseases that we see trainees go into. However, we can take fellows from internal medicine, who then have done an oncology fellowship, and we can take neurosurgical residents. It’s a unique fellowship in that we can take a multitude of different resident specialties, as opposed to other fellowships, which typically only [accept applicants] from 1 residency type.

This sounds like it provides a more personalized and/or intimate setting for a fellowship.

We usually have, on average, 1 new fellow per year. We are a big neurology center; we have just chosen to keep it as a more boutique program. There are other programs across the country that have a half dozen or more neuro-oncologists, and other programs with zero, that have great neuro-oncology specialty representation, so it varies. We [participate in the electronic San Francisco Match program].

We pride ourselves on having a more personalized experience by adding only 1 fellow annually. If there is a review, book chapter, or research project to be done, then that 1 fellow will get [the task]. That competition doesn’t exist.

By the time they’re halfway through their first year, or perhaps after their first year, they are basically acting autonomously—almost as one of our colleagues more than a fellow because the way that we have structured our program allows for that. I’m proud of our program in terms of being able to produce physicians who are very capable, ready to run their own practice, able to run busy clinics, and, at the same time, juggle and inpatient service and research—which are real-life scenarios.

Speaking to the uniqueness of this fellowship program, what else is important to highlight?

Our brain tumor program is a unique one, and we’re tied to a strong medical school. We have a brain tumor–specific SPORE [Specialized Program of Research Excellence] grant at Northwestern, which allows us to expose our fellows to more research, and potentially more research opportunities. It allows for them to see how it works, the interplay between basic science, translational medicine, and building clinical trials off that. It gives this unique viewpoint to our fellows on science and beyond.

How would you define the role of a fellowship director?

Everybody has a different way of fellowship directing. I see myself as a facilitator; I don’t necessarily have to be the best at all roles myself. This means I don’t need to be their research mentor, their personal mentor, their educational mentor, or the best educational lecturer. What I need to do is facilitate their experience. I need to facilitate them having the right research opportunities, the right education, and the right clinical exposures. Those needs are different [depending] on the fellow that comes in.

It’s not practical as a fellowship director to see yourself being all roles to your fellows. One should know the strengths and downfalls of their program so that one can facilitate the strongest experience possible for each fellow.

You have been working on clinical research that you started as a fellow, and staying at Northwestern allowed you to see it through its completion. Can you expand on this?

I wrote my first proposal with my mentor, when I was a fellow for an investigator-initiated study; it was a clinical trial for treatment [of patients with] brain metastases. A lot of fellows get this experience, where they’re learning how to write clinical trials as a fellow. Then, they typically hand that [research] off, as they leave their fellowship.

For me, when it was time to open the study, I was a new attending. I was able to open that study that I worked on as the principal investigator, see it through to completion and, a decade later, I’m writing that manuscript now. It takes time, but it’s nice to be at the same spot to be able to complete it.

What advice do you have for fellows looking to specialize in brain cancer? What do you wish that you knew then that you know now?

As a fellow, I wish I knew that you can tailor what your career looks like and what your job looks like as you’re feeling your way through it. It’s very different once you’re on your own as an attending, and it looks very different than as a trainee. You don’t have to put together that perfect job in 1 or 2 years as an attending, but over the years, you can gradually mold your career like a sculpture. It’s not just going to appear overnight, but you can gradually feel your way into what works for you.

Think about the] foci that you want to have centrally in your career and in your job, then build it to match over the years. Then 10 years later, you can hopefully say, “I liked this job that I built up, and this is suiting me.” Sometimes we have this vision of steps to get through. Often, our thought process is first: medical school, then residency, fellowship, and then a job. However, that’s not the reality of this. One should shape it and mold it as they go along.