Goals and Objectives
During all ID rotations, the fellow is responsible for consultative care of a variety of patients with numerous infectious problems in all stages of disease. Rotations will integrate infectious problems, health promotion, and cultural, socioeconomic, ethical, occupational, environmental, and behavioral issues whenever possible. On each rotation, the fellow is supervised by a staff attending. This attending will complete a written evaluation of the fellow's performance to include an assessment of the clinical competence of the fellow in each of the 6 clinical competencies (Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and System Based Practice) and how the goals and objective of the rotation were met.
Fellows are responsible for the consultative care of adult patients including teenagers and geriatrics of both sexes on medical wards, surgical wards, intensive care units.
- Formal instruction and practical experience in hospital epidemiology and infection control.
- Formal instruction and gain practical experience in clinical microbiology.
- Clinical experience in the evaluation and management of HIV infected patients with major impairment of host defenses.
- Formal instruction or clinical experience in the evaluation and management of the following disorders:
- Infections of reproductive organs
- Infections in solid organ transplant patients
- Infection in bone marrow transplant recipients
- Sexually transmitted diseases
- Viral hepatitis, including hepatitis B and C
- Infections in travelers
- Clinical experience in the evaluation and management of patients with the following disorders:
- Pleuropulmonary infections
- Cardiovascular infections
- Central nervous system infections
- Gastrointestinal and intra-abdominal infections
- Skin and soft tissue infection
- Bone and joint infections
- Infections of prosthetic deices
- Infections related to trauma
- Sepsis syndrome
- Nosocomial infection
- Urinary tract infection
Principle Teaching Methods
- Clinical and didactic teaching by the attending through daily rounds totaling 5 or more hours per week.
- Preparing case based discussion material for weekly management conference.
Ancillary Educational Materials
- Principles and Practice of Infectious Disease 6th ed.
- Current disease specific articles assessed through computer based search engines such as pubmed and ovid or provided by the attending physician.
Method of Evaluation
- Fellows will be given verbal feedback midrotation and verbal/written feedback at the end of the rotation.
- Fellows will evaluate the rotation at the end of the rotation through the computer based system new innovations.
- Fellows will be evaluated by the six core competencies- patient care, medical knowledge, practice-based learning improvement, interpersonal and communication skills, professionalism, and system-based learning.
Lines of Responsibility
Attendings are the primary supervisor for fellows while rotating on the consultative service. There is a rapid, reliable, and continuous communication structure in place for contacting supervisors through the paging system.
Progression During Fellowship
Expectations for fellow performance is as follows:
- Patient care
- Fellows are expected to arrive with the basic skills of an internist. During the first year of the fellowship, medical interviews, physical examinations, review of pertinent data and procedural skills should be thorough and complete. This should transition so that during the second year of fellowship these areas should include the finer details pertinent to infectious disease without errors. Decision making should incorporate evidence based medicine backed by sound judgment relying during the first year of fellowship on significant staff input.
- During the second year staff should have less direct input while enhancing the more subtle teaching points of the case. Decisions should be made in cooperation with other consultants and the primary care physicians managing the patients including the wishes of the patient. During this first year of fellowship it is expected that direct involvement of the attending is necessary during this communication, however during the second year the fellow should be the primary point of communication.
- Medical knowledge
- Fellows are expected to arrive with the basic medical knowledge of an internist. During the first year of training, fellows are expected to develop the basic and clinical science of infectious diseases. First year fellows should be able to cite the textbook medical literature with a solid understanding of the fundamentals of infectious diseases.
- During the second year of training, fellows should develop an in-depth knowledge of infectious diseases, and an ability to quote primary literature pertaining to this knowledge. Second year fellows should be able to clearly apply that information to management of their patients. During the second year the knowledge base should be more comprehensive with a greater depth especially with regard to the relationship and mechanisms of disease.
- Practice-based learning improvement
- During the first year of fellowship, trainees are expected to seek outside feedback with appropriate responses to improve overall health care delivery. First year fellows are expected to use the information technology available at the institutions to improve the care of their patients and for self-improvement.
- During the second year, fellows should constantly evaluate their own performance incorporating internal and external feedback. During the second year, fellows are expected to use information technology for improvement of themselves and their patients as well as the health care system.
- Interpersonal and communication skills
- During the first year of fellowship, trainees are expected to work closely with the attending to provide the highest health care possible to patients and families. This includes listening, narrative and nonverbal skills. The fellow should incorporate these skills to provide education and counseling to patients, families and colleagues while staying connected with all aspects of health care delivery.
- Second year fellows are expected to be the primary link to the primary care team, other consultants, the patient and the patient's family without relying on the attending to perform these facets of medical care.
- First and second year fellows are expected to perform to the highest level of professionalism at all times. This should include respect, compassion, integrity, and honesty. They should be committed to self-assessment along with a commitment to their patients, families and colleagues. They should willingly admit errors. During the first year of fellowship, trainees, with the guidance of their attending, perform the role of teacher and role model as the infectious disease consultant.
- During the second year the fellow should be the primary teacher and role model for the infectious disease consultative service.
- System-based learning
- During the first year of fellowship, trainees should rely primarily on textbooks and review articles to obtain the breadth of knowledge necessary for performing as an infectious disease physician. First year fellows should become involved in the systems used within the hospitals for improving health care.
- Second year fellows should rely on primary literature for depth of knowledge. During the second year, fellows should be able to apply these systems to their own practice of medicine as well as improving the entire health care system.