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During their clinical rotations, infectious disease fellows become experienced in the management of a wide variety of infectious diseases in both the inpatient and outpatient setting. There are four inpatient rotations – the two services at Barnes-Jewish Hospital, the Transplant Infectious Disease service, and one at the Veteran’s Administration Hospital. The ambulatory rotations consist of the HIV continuity clinic and the general infectious disease clinic at Barnes-Jewish Hospital, and the HIV/ID Clinic at Veteran’s Administration Hospital. Fellows can also do electives in Pediatric ID, Infection Control, as well as Microbiology, Virology, or Research.
I. INPATIENT ROTATIONS
a. Goals and Objectives
The goal of these rotations is for ID fellows to gain experience in the diagnosis and management of infectious diseases that occur in normal and immunocompromised hosts who are admitted to the hospital. Fellows learn the appropriate and cost-effective use of antimicrobials and biologics, principles of infection control, strategies for management and prevention of nosocomial infection and diagnosis and management of a wide spectrum of infectious diseases in hospitalized patients. They become familiar with inpatient management of HIV-infected patients, and learn the presentation and management of infection in hosts with impaired immunity. On the Transplant service, fellows learn how to manage complex infections in severely immunocompromised patients. At the Veteran’s Administration Hospital, they learn how to diagnosis and manage infections in patients with acute and chronic illnesses, including HIV infection. Both teams include medicine residents, fourth year medical students, clinical pharmacists, ID fellows and attendings.
b. Teaching Methods
(i) |
Infectious Disease Consult Rounds – fellows learn to function as consultants under the supervision of an ID Attending who provides didactic and bedside teaching. |
(ii) |
ID Grand Rounds – fellows prepare and present interesting and unusual cases in this weekly conference. They present a literature review of the topic under discussion. |
(iii) |
ID Core Curriculum – this is a didactic curriculum taught by ID faculty once a week. It includes formal instruction in infection control, anti-infective therapy, and pathogenic mechanisms of a wide variety of bacteria, mycobacteria, fungi, parasites and viruses. |
(iv) |
Journal Club – fellows critique a current journal article, and research the literature on the topic under discussion in this monthly conference. |
(v) |
Research Seminars – fellows and faculty present updates on their research projects twice a month. |
(vi) |
Clinical Microbiology Rounds – fellows meet with the Director of the Clinical Microbiology Laboratory to go over interesting specimens and cultures. Once a month, they meet with the Director of the Molecular Virology Laboratory. |
(vii) |
HIV Conference – interesting opportunistic infections and management challenges, including multi-drug resistant HIV, are discussed at this weekly meeting. |
c. Evaluation and feedback
Fellows are evaluated on every rotation by the ID Attending who supervises them. These evaluations are read and signed by the fellow and kept on file. Fellows also receive verbal feedback about their performance during the rotation from the Attending physician.
Fellows meet with the Program Director and Division Co-chair every other month to provide feedback on their experience during the various rotations. If any problems are indentified, these may be addressed and input sought from the fellows regarding solutions. Fellows are actively involved and provide input into every aspect of their fellowship.
II. AMBULATORY ROTATIONS
a. Goals and Objectives
(i) |
HIV Continuity Clinic
The goal of this rotation is for fellows to learn how to care for HIV-infected outpatients by actively managing the care of 20-25 patients in continuity over the duration of their fellowship. They are expected to work within a multidisciplinary team to develop management plans, follow-up on data, respond to patients questions and provide continuity of care when their patients are admitted to the hospital. This clinic is staffed by faculty, fellows, nurse practitioners, nurses, and case managers who specialize in ID and HIV. There is an electronic medical record. |
(ii) |
General Infectious Diseases Clinic
The goal of this rotation is to provide experience with patients with complex infectious diseases in an outpatient setting. Fellows are expected to provide follow-up care of hospitalized patients with infectious diseases, and see office consultations and referrals. There is an electronic medical record and support from nurse specialists and nurse practitioners. |
(iii) |
Veteran’s Administration Clinic
The goal of this rotation is for fellows to gain experience in managing immunocompetent and HIV-infected patients in a chronic care facility. They are expected to develop diagnostic and management plans for these patients during their rotation at the VA Hospital. |
b. Teaching Methods
Teaching is provided by the ID Attending who supervises the fellow during their clinic rotation. Fellows present complicated patients to ID Attendings during the weekly HIV Clinical Conference. Fellows will also present interesting clinic cases at ID Grand Rounds and HIV Conference, and are expected to briefly review the relevant literature.
c. Evaluation and Feedback
Fellows meet with the Director of the Clinic and receive feedback from supervising Attendings.
III. ELECTIVES
The goal of the elective rotations is to obtain experience with infections in hosts not commonly seen on other rotations (e.g. Pediatric ID). Electives also allow fellows to explore areas of interest in clinical or basic research, such as infection control and epidemiology, Molecular Virology, the AIDS Clinical Trials Unit, and laboratories conducting bench research in parasitology, virology and molecular microbiology. Teaching and feedback is provided by the ID Attending who supervises that rotation. |
