In their first 12 months of training, all fellows have a continuous, rigorous responsibility regarding inpatient consultative and ambulatory care as well as educational responsibilities in weekly conference presentations. In preparation for their research training, traditional track (i.e., 3 year) fellows are required to develop a research project with a faculty mentor, and write a five page research training proposal that is reviewed by a Research Training Committee.
As the fellows progress to their research training, they begin in their first Research Training year (i.e., the second overall year of training) with combined coursework and practical research training (either laboratory or clinical research) specific to their project under the supervision of their faculty mentor. Most of their educational experience in the second and third years is provided by the program of the faculty member with whom the trainees are working.
There is intense daily interaction of fellows with faculty during the first year. This provides rigorous supervision. Most of the procedures associated with the practice of Infectious Disease are carried out in the Microbiology Laboratory. The aspiration of abscesses for culture can be performed by Infectious Disease Fellows, but also by surgeons in conjunction with consultation by the Infectious Disease Fellows. The Fellows are more responsible for supervising the work-up of such materials in surgical pathology and the microbiology lab.
To be sure that each microbiological procedure is well understood, Infectious Disease Rounds begin four times a week in the Microbiology Laboratory with a 60-minute session devoted to procedures being performed upon specimens from patients who the trainees have seen in the hospital or other interesting cases.
The involvement of the faculty in conducting rounds is intense. At all institutions and on all rotations, teaching rounds are held daily in which all new consults are presented to the attending, as well as follow-up of patients previously consulted on by the service. In these teaching rounds, attendings discuss all aspects of diagnosis and management related to the consultative issues, pertinent microbiology/surgical pathology/ and radiologic data are reviewed, as well as relevant literature. All new consults for the day are examined at the bedside with the trainee that same day, as well as problematic follow up issues on other patients on the service.
Additionally, teaching rounds are held in Clinical Microbiology at YNHH (4 times per week under the direction of Drs. S. Edberg and F. Bia). In these rounds, culture material (including Gram stains and culture plates) is reviewed on several contemporary patients that the Infectious Disease trainees have consulted on.
In addition, formal didactic instruction is given twice per week and includes the following topics: microbiologic staining techniques, use of microbiologic media, blood culture technology, automated systems for the isolation and characterization of fungi and mycobacteria, mycoplasma cultures, gene probe techniques for chlamydia and gonococci, fluorescent microscopy, antimicrobial susceptibility testing, parasitologic techniques including acid-fast stains and ELISA techniques for cryptosporidia, and all special techniques for identification of viruses through cell culture, antigen detection and serology.
Work rounds are held separately from teaching rounds, occur 7 days per week, in which the trainees and attendings round independently to follow up on all patients previously consulted on by the Infectious Disease Consult Service (until the time of discharge or the date in which Infectious Disease follow up is no longer necessary). Faculty are required to examine all patients every day, insuring that faculty will provide close supervision of fellow training on all consultative issues.
Finally, faculty are involved in a weekly formal teaching conference, the Didactic Lecture Series, in which faculty give didactic instruction in a series of 8 lectures on antibiotic pharmacokinetics/clinical use/adverse effects, a series of 10 lectures on HIV related issues, as well as a series of lectures on common community and nosocomial infectious disease problems.
These topics include the following:
Basic principles of pharmacokinetics;
Pharmacology, mechanism of action, side effects and clinical use of antimicrobial agents
including antiviral, antibacterial, antifungal, and antiparasitic agents (10 conferences)
Community acquired and nosocomial meningitis
Sepsis and Septic Shock
Hepatitis B and C
Herpes Virus Infections
Urinary Tract Infections
Nosocomial Infections (including CDC isolation, and Infection Control issues)
Management of the Febrile Neutropenic Patient (including fungal disease)
Infections in the Immunocompromised Host (including fungal disease)
Soft tissue infections
Catheter related bacteremia
Diabetic Foot Infections
Sexually Transmitted Diseases (s series of 6 lectures)
HIV Disease: a series of 10 lectures on topics including antiretroviral therapy, epidemiology of HIV, psychosocial issues in HIV, HIV resistance testing, post-exposure prophylaxis, opportunistic infection prophylaxis, HIV associated malignancies, pulmonary complications of HIV, TB in AIDS, palliative care of AIDS, and use of laboratory surrogates in monitoring of HIV progression.