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Infectious Disease Fellowship: Program Curriculum |
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Residency & Fellowship Programs > Internal Medicine > Infectious Disease Fellowship: Program Curriculum |
During the first year, the trainee will have an in-depth education in clinical infectious diseases supplemented by infection control, hospital epidemiology, and hospital anti-infective formulary management. The third month of training will be spent in the clinical microbiology/immunology laboratory. The month of January will be a laboratory research elective. The month of April will be another elective month. The remaining nine months will be spent on the clinical infectious disease inpatient consultative service working with the six attendings on a rotating basis. The trainee will participate in the I.D. conferences, Journal club, clinical case conference, I.D. core curriculum of lectures, and research conference. The trainee will also spend a half day a week at the outpatient clinic. During the latter part of the first year the trainee will begin to develop his/her research interests and goals for the second year.
The second year will be dedicated to research. The structure of the year will be based on the goals of the fellow. Research areas may be clinical (nosocomial infections, HIV epidemiology, pharmaceutical studies, HIV/AIDS, among others); clinical laboratory microbiology / immunology, or basic science research. During this year, the trainee can elect to have additional month long rotations in hospital infection control and clinical epidemiology, study public health and epidemiology with the Vermont Department of Health, take a month or more rotation in clinical pediatric infectious diseases, or participate in the rural HIV satellite clinic project. The fellow will spend 1 full day per week in the outpatient clinic. The trainee will participate in the I.D. conferences, Journal club, clinical case conference, I.D. core curriculum of lectures, and research conference.
The ID fellow will spend one month early in their first year in the clinical microbiology and immunology laboratory. 1. Goal: To learn basic microbiology and immunology that is applicable to the practicing infectious disease specialist 2. Objective: To introduce to fellow to the techniques of microbiologic identification, sensitivity testing and work up of mycobacteria, viruses, fungi and parasites. Basics concepts of immunology will be introduced. Microbial virulence factors and host defense mechanisms will be reviewed. The laboratory evaluation of the immune compromised host and serologic diagnosis of disease will be reviewed. Specific objectives of the rotation include: Microbiology
3. Teaching environments: Working directly with the medical technologists, laboratory supervisors and medical directors, the fellow will gain hands on experience working up clinical samples for microbiologic identification and sensitivity testing. Rotations through the mycobacteriology, virology and mycology sections will introduce the fellow to culturing and identification techniques for these organisms. The fellow will also learn about parasitology identification and clinical molecular techniques. Daily rounds with the laboratory director to review specimens and work-ups in progress. 4. Mix of diseases: Bacteria, mycobacteria, viruses, parasites and fungi induced. Laboratory evaluation of the immune compromised host. 5. Reading list: Sections from the Principles and Practice of Infectious Diseases edited by Mandell concerning the clinician and the microbiology laboratory. 6. Evaluation: Written evaluation by the head of the clinical microbiology laboratory . The fellow will also provide written evaluations of the rotation to the fellowship director.
The fellow will spend about 9 months on the clinical in-patient consultative rotation 1. Goals: To introduce the fellow to the fundamentals of infectious disease diagnosis and treatment for patients hospitalized with infections including elucidation of the infectious disease problems, clinical differential diagnosis of those problems, microbiology of the infections and approach to diagnosis and therapy. Diagnosis and care will be provided to patients with a wide array of infections and in all stages of illness. 2. Objectives: Antimicrobial agents:
Specimen collection
Clinical syndromes including:
3. Teaching environment: Daily inpatient rounds with the ID attending. This includes review of the fellow's presentation, clinical bedside examination, review of all laboratory data and radiology tests. The fellow's assessment of the problems and plans are critiqued along with antibiotic management and written consult notes. Rounds generally last for 6-8 hours per day.
4. Mix of diseases: There are about 110 consults per month including those from medicine, general surgery, orthopaedics, neurosurgery, vascular surgery and ob-gyn. Patients with diseases in all categories listed above are seen. 5. Patient characteristics and types of clinical encounters, procedures and services:
6. Reading list:
7. Pathological material: Gram stains are reviewed on most patients. Pathological specimens can be reviewed with the pathology department as needed. 8. Evaluation: Immediate feedback on each patient presentation. Written evaluation by the ID attendings on service. The fellow will also provide written evaluations of the rotation to the fellowship director.
Out-Patient Rotation and Continuity of Care 1. Goals: To introduce the fellow to the management of infectious diseases in the outpatient setting. A large part of this experience will be the HIV/AIDS continuity of care clinic. The first year fellow will receive the HIV (+) patients from the fellow completing his/her training and all new HIV (+) patients during the first year. The fellow will follow these patients throughout the two years of training. All levels of care including specialty and primary care are provided. The management of patients with general ID problems will also be taught to the first and second year fellows. Issues include medical care, psychosocial assessment, drug and alcohol abuse, end of life care, medical insurance issues and patient-physician relationships. 2. Objectives: Care of the patient with HIV/AIDS
Outpatient management of:
Antimicrobial agents:
Chemoprophylaxis, immune prophylaxis, cytokines, colony stimulating factors, monoclonal antibodies 3. Teaching environment: An ID attending is present throughout clinic. Each patient is reviewed with the attending and history and physical examination confirmed at the bedside. Assessment, plans and dictated note are reviewed. The fellow will also interact with the clinic nurse practitioner, social worker and regional AIDS service organization.
4. Mix of diseases: As above 5. Patient characteristics and types of clinical encounters, procedures and services:
6. Reading list:
7. Pathological material: Gram stain and cultures 8. Evaluation: Immediate feedback on each patient presentation. Written evaluation by the ID attendings on service. The fellow will also provide written evaluations of the rotation to the fellowship director.
The fellow will have two months of elective time during their first year. The timing of these months is to allow a change in venue from the more intense in-patient consultation rotation. 1. Goals: To provide more outpatient clinical ID, HIV/AIDS care and international travelers clinic experience, allow time to develop second year research project and introduce the process of quality assessment and cost containment activities. 2. Objectives: Outpatient clinic. The fellow will work one-on-one with an ID attending during a full day of outpatient clinic. He/she will see 10-12 patients with varied infectious disease illness and HIV/AIDS. All patients will be assessed by the fellow and reviewed with the ID attending. International travelers clinic. The fellow will work with the nurse practitioner and see patients four times per month. Travel itinerary, parasitic, bacterial, mycobacterial and viral risks, malaria prophylaxis and vaccinations will be reviewed for each patient. Quality assessment (QA). QA can be performed by involvement in ongoing QA projects involving antibiotic utilization, HIV/AIDS care or hospital epidemiology. He/she will learn the fundamentals of continuous quality improvement (CQI). This program will entail developing goals and objectives for quality standards, developing data collection tools, chart review, data assessment and feedback to providers. Areas of QA that the fellow may participate in include;
Research development. The fellow will spend part of the elective month deciding on and early planning for the second year research project
3. Teaching environment:
4. Mix of diseases:
5. Patient characteristics and types of clinical encounters, procedures and services: as above 6. Reading list:
7. Pathological material: Gram stains and culture interpretation 9. Evaluation: Dr. Grace will review progress with each fellow at the end of the month. Written evaluation will be done. The fellow will also provide written evaluations of the rotation to the fellowship director. 1. Goals. Each fellow is enrolled in the Infectious Diseases of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) online infection control fellows' course. The goal of the course is to give the fellows basic training about infection control and epidemiology. 2. Objectives. The fellow will be introduced to concepts relating to identification of health care associated infections, antimicrobial resistant organisms, epidemiologically important organisms; review of epidemiology of these organisms; infection control practices and antibiotic management strategies; impact of these infections on patient safety. 3. Teaching environment: This is a self study module taken online. The course is presented as a series of lectures in audio form with accompanying power point slides. The fellow can finish the course according to his/her own pace. 4. Evaluation: Pre- and post-tests are administered at the beginning and end of the course, respectively. A certicate of completion will be issued upon completion of the course.
1. Goals: The goal of the research year is to develop, implement and complete a scientific research project so that the fellow can learn the basics of hypothesis development, design, protocol development and statistical analysis. The project can be clinically or basic science oriented. It is expected the results will be submitted to an infectious disease national meeting (IDSA or ICAAC). The current (and future) research efforts that the fellow can participate in include: Clinical:
Basic science:
2. Objectives: The fellow will be introduced to:
3. Teaching environment:
4. Mix of diseases: Not applicable 5. Patient characteristics and types of clinical encounters, procedures and services: Depending on research developed 6. Reading list:
7. Pathological material: Not applicable 8. Evaluation: Feedback on day to day progress on the project. Written evaluation by the research mentor. The fellow will also provide written evaluations of the rotation to the fellowship director
1. Core Curriculum Lecture Series This is a weekly lecture series conducted by the ID attendinga and fellows reviewing key infectious disease topics. Goal: To discuss various topics relevant to the practice of General Infectious Diseases. Topics include:
Objective: To increase the fellows' knowledge base in General Infectious Diseases. Frequency: 1 hour weekly (or two hours every other week) Format: Can either be a formal lecture, discussion on assigned readings, practice tests, or other teaching modalities deemed appropriate by the attending assigned. Supervision: An attending is assigned to conduct each session Evaluation: As part of the monthly written evaluation.
2. Case Conference This is a bimonthly conference attended by all ID attendings, microbiology staff, members from the Vermont Department of Health and members form the Microbiology and Molecular Genetics staff. Presenters include the fellows and ID attendings. There are several guest speakers each year. Goal: To review the literature regarding specific infectious diseases, therapies, immunology and microbiology. Most often these will involve the diagnosis and management of infections seen in the inpatient consultation service or clinic. Objective:
Frequency: Twice per month Format: Formal presentation of the case, literature review and typed handout Supervision: All six attendings are present and critique the fellow Evaluation: As part of the monthly written evaluation
3. HIV/HCV conference Goal: To review timely topics concerning HIV and HCV in order to remain current with these rapidly changing fields. Presenters include the fellows, ID attendings and nurse practitioner from the clinic. Objective:
Frequency: Once monthly Format: Each one-hour session will have two presentors. Presentations can be article reviews, protocols or guideline updates or psychosocial topics. Difficult patient management issues can also be presented. Supervision: All six attendings are present and critique the fellow Evaluation: As part of the monthly written evaluation
4. Research Conference Goal: To introduce the fellow to ID unit research projects, other ID related research in the College of Medicine and assess progress on fellow's research project. Objective:
Frequency: Monthly Format: Each one hour conference will have a formal presentation of a research project of the fellow or attending including design, data collection and outcomes. Guest lectures will present current research topics or summary lectures concerning research techniques. Supervision: All six attending are present and critique the fellow's presentation Evaluation: For the fellow presenting his/her research, written evaluation is performed monthly by his/her research mentor.
5. Journal club Goal: To critically review current infectious diseases articles Objective: To assess
Frequency: Once monthly Format: Articles will be reviewed by the fellows and attendings Supervision: All attendings attend the conference Evaluation: As part of their monthly written evaluation
6. Case Discussion Goal: To discuss cases seen by the fellows and attendings in their practices Objective: To outline management issues on each of the cases and solicit approaches to the issues at hand from the attendees. Frequency: Once a month Format: Fellows and attendings informally present challenging cases from either the inpatient or outpatient setting. The cases in mind will have specific issues that will be presented and the attendees will offer their approaches to the issues at hand. Supervision: All attendings attend the discussion Evaluation: As part of their monthly written evaluation
1. ID unit core lectures These are lectures given by the inpatient ID consult attendings to the Infectious Disease consult team which is usually composed of a medical resident, a medical student, a pharmacy resident, and the ID fellow. Goal: To introduce the team to general infectious disease topics such as HIV/AIDS, Endocarditis, Urinary Tract Infections, Skin and Soft tissue infections, Neutropenic fever, Antibiotics, among others. Objective: To discuss various infectious disease topics relevant to the members of the Infectious Disease consult team. Frequency: Four times per week Format: Hour long didactic lecture or discussion
2. FAHC GME Core Competencies Goal: To help the fellow become well rounded in patient care and clinical practice issues Objective: Lectures will be given concerning:
Frequency: Workshops scheduled quarterly |
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