The Yale Infectious Disease Program utilizes three sites to provide fellows with inpatient consultation experience. Across the three sites, five services are staffed by one first-year fellow and one attending physician. Second year fellows only perform inpatient ID consultation when covering first-year fellow vacations, clinic block, in-service exams or maternity/paternity/sick leave.

Each site provides a very different patient population, broadening the experience of our Infectious Disease fellows. Yale New Haven Hospital is a two campus, 1,541-bed tertiary care facility that also functions as a community hospital for greater New Haven and southern Connecticut. The York Street Campus provides both an urban community and tertiary medical care experience with a strong emphasis on immunosuppressed populations (including granulocytopenic cancer patients, organ and bone marrow transplant patients, HIV/AIDS patients), critical care unit infections, and training in Clinical Microbiology. YNHH's York Street Campus has three ID consult services: General ID, Transplant ID, and Smilow (oncology) ID.

The Saint Raphael Campus provides a strong experience in community acquired and nosocomial infectious diseases, HIV and critical care unit infections, ambulatory infectious disease problems, as well as Clinical Microbiology.

The VA Connecticut Healthcare System is a 120-bed primary and tertiary care facility and provides a strong general infectious disease experience including patients with HIV, critical care unit infections, and ambulatory infectious disease problems (including ambulatory clinics in general infectious diseases issues, HIV and hepatitis C). The VA CT program has reference laboratories for Tuberculosis and Virology and an outstanding Microbiology laboratory.

Trainees are responsible for following an average number of 10-20 patients at any one time while on the Infectious Disease Consultation Service at each of the three hospitals. These are not patients for whom the trainee has direct care responsibility; in all cases, the trainee serves as a consultant and is supervised by an attending physician.

The responsibilities of the Infectious Diseases fellow are to respond to requests for consultation from any service within the hospital, including Internal Medicine; to correlate the microbiological and clinical data; to present this material to the ID attending; and to communicate recommendations to the house staff and attending caring for these patients. Following the initial consultation, these patients are generally followed daily until they are discharged from the hospital. Trainees are directly involved in the education of Internal Medicine house officers in the Yale program at YNHH and the VA CT, as well as house officers at YNHH's Saint Raphael Campus program. This includes direct consultative advice on diagnostic and management issues for patients with infectious disease problems, choice and dosing of antimicrobial agents and infection control issues.

Trainees receive practical experience in the processes of quality assessment/improvement through their experience in the Microbiology Laboratory in which diagnostic testing modalities for pathogen identification/antimicrobial susceptibilities are evaluated and discussed four days per week. Microbiology rounds continue through Zoom during the COVID-19 pandemic. ID fellows attend rounds in the microbiology laboratory, but additional trainees including students and residents attend via Zoom. Additionally, trainees participate in the Didactic Lecture Series and Antimicrobial Stewardship one afternoon every five weeks in the second year regarding aspects of antimicrobial use/resistance patterns, hospital and outbreak surveillance, quality assessment and risk management issues. At all stages of their training in inpatient consultative care, trainees acquire experience in cultural, behavioral and economic issues related to the feasibility and duration of outpatient IV antibiotic therapy. These are complex but daily issues that trainees acquire experience in through the multidisciplinary care required for patients with HIV and non-HIV related infectious disease.

Service Duties

Trainees are on call approximately every fifth night and two weekends per month in the first year. The Smilow ID fellow has every Thursday off but works every weekend for duration of the assigned month. Trainees take calls at home and only return to the hospital to evaluate new consult requests as needed. Trainees in the first year on average have one day off in seven from hospital duties. Second year fellows only take call when covering for first years. Third year investigator track fellows have no required clinical activities.

Infectious Disease fellows at Yale receive training in outpatient ID care through two ambulatory settings.

The Yale Center for Infectious Diseases was opened in October 2023 to provide comprehensive multi-specialty services including general consultative care to patients with known or suspected infectious diseases. Services include:

• Nosocomial infection control and management
• Central nervous system infections
• Fungal infections
• Hospital epidemiology
• HIV/AIDS care and prevention
• Pre-exposure prophylaxis (PrEP)
• Comprehensive general infectious disease consultation
• Transplant infectious disease consultation
• Long COVID Program
• Sexually Transmitted Infections Clinic
• Travel clinic (for pre-travel planning and infections in returning travelers)- opening March 2025!

The VA Western CT provides comprehensive outpatient infectious diseases consultative services, HIV care and prevention, and management of a wide range of infections.

Second (and some third and fourth-year) fellows take care of a panel of patients with these conditions one ½ day per week. They are supervised by a single attending throughout the year.

A weekly pre-clinic conference is held onsite at Yale Center for Infectious Diseases (and by Zoom for fellows based at the VA clinic) for didactics on HIV prevention and care, and other outpatient teaching.