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Dana-Farber/Boston Children’s Redefines What It Means to be a Successful Specialist

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Over the next two posts, we’re going to present an in-depth interview that I recently conducted for Healthcare Executive Exchange Magazine with Mark Kieran, MD, PhD, clinical director, Brain Tumor Center, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center in Boston, Mass.

Although the content of the interview does not relate specifically to the physician job search, Dr. Kieran presents an advanced program that will intrigue specialists of all stripes. In many ways, the program he details is a model that organizations around the country should emulate.

During a job interview, most organizations will be interested in hearing your vision for healthcare and the ideas you can bring to the table. Dr. Kieran is among the best in his field, and maybe his thoughts and vision will inspire your vision. Above all, we hope it will help inform the answers you give to a potential employer.

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Within pediatrics, brain tumors continue to be the most malignant and complex tumors to treat, and even though they are not the most common tumors, they are the number-one cause of death among children.

Mark Kieran, MD, PhD, serves as clinical director of the Brain Tumor Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center in Boston, Mass. The Center’s Pediatric Brain Tumor Program was established in the early 1990s, Kieran said, and from the beginning, it has had a multidisciplinary approach with neurosurgeons, radiation oncologists, neurologists, and myriad other specialists working next to each other.

When Kieran took over the brain tumor program in 1998, he wanted to expand the Center’s multidisciplinary model.

“The problem with radiation therapy is that although it’s curative in many circumstances, it cognitively devastates many of the kids,” he said. “We began to recognize early on that with brain tumors, cure doesn’t tell the whole story. Even if a child is alive, they may be unable to go to school, to get a job, to have a relationship, to get married, to have kids. Basically, they become an adult who is stuck in a rocking chair back and forth all day because they are so severely neurologically handicapped by their treatment.

“To call that case a success solely because the child didn’t die underestimates what I think most people see as what they really want as the optimal outcome for their kids.”

Kieran’s first step in revising the program’s definition of success was to introduce a variety of strategies for reducing the need, amount, and volume of toxic chemotherapies and radiation.

Second, he and his researchers, in conjunction with the Adult Brain Tumor Program at Dana-Farber, intensified their efforts to integrate the latest biological research and treatments into the program.

“Brain tumors are a little complicated in the sense that the brain is a location,” Kieran said. “It’s not a single thing. When someone says you have breast cancer, you have cancer of the breast, but you’ve got multiple different parts of the brain, and therefore, there are some 300 different types and grades of pediatric brain tumors.”

Along the way, Kieran and his team became intrigued with the idea of personalized or individualized medicine.

What appealed to them the most about personalized medicine, Kieran said, is “you don’t consider all kids with a brain tumor to be the same. Each tumor and its mutations are considered individually, and the most optimal therapy for that particular child and that particular mutation are kind of developed together to optimize the cure, which means both survivability and functionability after treatment, while minimizing the damage done to get you there.”

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In our next post, Dr. Kieran will describe the final two steps he and his team took in raising the bar on how Dana-Farber/Boston Children’s defined success, including placing an emphasis on having an integrated model for treating not just adults, but also children.

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