Specific Goals & Expectations 

HIV Clinic and Immunocompromised Host Consult Service Curriculum

 

HIV Continuity Clinic: Throughout fellowship, Fellows will attend HIV Clinic at least weekly and maintain a panel of HIV-infected patients as well as see selected patient on an as needed basis, including post-discharge follow up.

Immunocompromised Host Rotation: During this inpatient service rotation, Fellows focus on the inpatient consultation of all HIV+ patients in our medical center, and selected immuncompromised populations, specifically those patietns with organ transplantations and neutropenic fever with suspected or documented infection.

 

     A.  Immunocompromised Host In-Patient Consultation Service

 

Goals:  To provide the Fellow experience in evaluating and managing inpatient HIV seropositive (HIV+) patients at all stages of their disease, transplant patients with suspected or documented infections, and cancer chemotherapy patients with neutropenic fever.  Fellow responsibilities will include consultation for inpatient primary care services in the overall management of HIV-infected patients admitted for a wide variety of medical or surgical reasons. Responsibilities also include infection related services for transplant patients with suspected or documented infections, and cancer chemotherapy patients with neutropenic fever. 

A primary objective of this clinical experience is to develop expertise in recognizing and managing opportunistic infections and malignancies complicating advanced HIV infection, (e.g., Pneumocystis pneumonia, cryptococcal meningitis, non-Hodgkin’s lymphoma) and relevant diseases encountered at all stages of HIV infection (e.g., bacterial pneumonia, tuberculosis, hepatitis C) and complications of HIV therapy.  The ID fellow provides consultation on all patients with HIV infection admitted to the hospital, irrespective of the reason for admission, to ensure continuity of HIV therapy, etc.  Along with these objectives, the Fellow will become skilled in coordinating multiple subspecialty services and/or resources, including Nurse practitioners, social workers, psychologists, registered dieticians, and financial case managers.  An integral role of the HIV/ID Fellow will be to supervise and instruct Residents in the management of HIV+ patients.  These goals are designed to address the six competencies outlined by the RRC / ACGME.

The other objective of this clinical experience is to develop expertise in recognizing and managing opportunistic infections among specific immuncompromised hosts, specifically transplant patients (primarily renal transplant patients) and cancer chemotherapy patients with neutropenic fever. Learning objectives include recognition and management of relevant diseases encountered at all post-transplant stages  (e.g., early post-transplant, late post-transplant) and management of neutropenic patients with suspected infections (e.g., bacterial, fungal).

 

Format:  The Fellow will round with the Attending Physician and other members of the Immunocompromised Host consult team on a daily basis.  The Fellow may be asked to provide didactic sessions pertaining to the diagnosis or treatment of HIV infection for purposes of Resident education as determined by the Attending Physician. Requests for switching coverage periods with another ID Fellow will require written 45-day advanced notice, to be approved by the Immunocompromised Host Service Director (also see below).  Both Fellows involved in the coverage switch will be required to submit a written record of the agreement to the HIV service Director and the Infectious Disease service Director.  In cases of emergency (eg., urgent medical situations), the Fellow must contact the HIV clinic Director at his/her earliest possible opportunity.

 

     B.  HIV Continuity Clinic Service

 

Goals:  To offer Fellows relevant experience in evaluating and managing ambulatory HIV seropositive (HIV+) patients at all stages of infectious disease.  Resident responsibilities will include the management of patients discharged from the hospital following an acute opportunistic infection, malignancy, or other HIV-associated complication, patients with recently diagnosed HIV infection initiating therapy, and patients well-controlled HIV infection.  An important goal of this experience will be for the Resident to establish a continuity of care for a cohort of HIV+ patients through a regular and focused interaction with these individuals.  The Resident will also acquire experience in considering ethical issues related to HIV infection and AIDS (e.g., confidentiality / HIV disclosure/ partner notification issues, hospice options, conservatorships, and specific non- resuscitation orders).  These goals are designed to be consistent with the six competencies outlined by the RRC / ACGME.

 

Format:  The fellow will see patients under the supervision of an attending Faculty member in the clinic setting.  Additionally, the Fellow will learn to integrate care with an array of multidisciplinary supportive resources in the HIV clinic, including Nurse practitioners, social workers, psychologists, a registered dietician, and financial case managers.  These resources will be present in the clinic to provide specific areas of expertise related to the overall management of HIV+ patients.  The Fellow is assigned to one half-day (4 hours) clinic per week throughout the two year fellowship, with an additional half-day clinic session assigned each during the Immunocompromised Host inpatient rotation for hospital discharge visits.  The Fellow has a reduced clinic patient load when they are serving on the in-patient ID consult service.  The clinic schedule is designed for each ID Fellow to evaluate and manage as many as 2-3 new consultations, and 3-6 follow-up consultations, during each clinic session.  The Fellow is assigned by the HIV Clinic Director to a specific clinic session each week throughout their two years of fellowship.

 

C.  Immunocompromised Host Service/HIV Clinic Expectations           

 

The Fellow is expected to meet several performance milestones during the Immunocompromised Host Consult Service and HIV clinic experience:

 

1. Participate fully in all scheduled HIV clinics
2. Demonstrate expertise in evaluation, diagnosis, follow-up, and overall management of HIV+ patients at all stages of disease
3. Demonstrate expertise in evaluation, diagnosis, follow-up, and overall management of patients with organ transplantion and neutropenic fever with suspected or documented infection
   
4. Demonstrate proficiency in the understanding and use of contemporary anti-retroviral therapies, including HAART strategies and agents
5. Demonstrate proficiency in use of antimicrobial therapies to prevent or treat opportunistic infections in HIV+ patients with advanced immunosuppression
6. Record appropriate notes to facilitate continuity of care
7. Regularly attend Tuesday HIV conferences
8. Work closely with the attending Faculty to optimize patient care
9. Perform at a high level of professionalism, collegiality, and responsibility