Specific Goals & Expectations 

    Infectious Diseases Clinical Service Curriculum

 

1.  Adult Infectious Disease Rotation:  During this service rotation, Fellows focus on the Adult Infectious Diseases consultation and ward experience.

 

     A.  Adult ID Inpatient Service

    Goals:  To provide a Fellow experience in evaluating and managing inpatient infectious diseases in adult patients, including diagnosis, treatment, and post-treatment stages of management.  Fellow responsibilities  include consultation for inpatient primary care services in the overall management of patients with various infections at all stages of disease.  Another objective of this clinical experience is to develop expertise in recognizing and managing latent or chronic complications of infection (e.g., such as transmission, reactivation of latent infection, etc.)  Along with these objectives, the Resident will become skilled in coordinating patient care with multiple subspecialty and ancillary inpatient services, including surgical services, orthopedics, oncology and medicine services, while working with Nurse practitioners, social workers, psychologists, registered dieticians, and financial case managers.  An integral role of the Fellow will be to supervise and instruct Residents and Medical Students in the management of the mix and diversity of infections encountered within the adult patient population in the Los Angeles County healthcare system.  These goals are designed to address the six competencies outlined by the RRC / ACGME.

 

     Format:  Adult ID Fellows will round with an Attending Physician and other members of the ID inpatient consult team daily or as guided by the Attending Physician.  The Resident may be asked to provide didactic sessions pertaining to the diagnosis or treatment of infection for purposes of Resident and Medical Student education as identified by the Program Directors and Attending Physicians.  

 

B.  Adult ID In-Patient Service Expectations 

     Each Fellow is expected to meet several performance milestones in the Adult ID in-patient consult service.  These include:

1. Participate fully in all scheduled adult ID service periods and clinics
2. Demonstrate expertise in evaluation, diagnosis, follow-up, and overall management of infected patients at all stages of disease
3. Demonstrate proficiency in the understanding and use of contemporary antimicrobial therapies, including resistance issues and use of anti-infectives in immune compromised patients
4. Demonstrate proficiency in use of antimicrobial therapies to prevent infections in at-risk patients
5. Record appropriate notes to facilitate continuity of care
6. Regularly attend ID clinical, didactic, research conferences
7. Work closely with the attending Faculty to optimize patient care
8. Perform at a high level of professionalism, collegiality, and responsibility

 

C.  Acquisition of Skills  

The Program instructs cognitive skills relevant to ID / HIV Medicine:

 

A.  Mechanisms of action and adverse reactions of antimicrobial agents; the indications for pharmacologic studies to assess absorption and excretion of antimicrobial agents; methods to assess antimicrobial activity of antimicrobial agents; techniques to determine concentrations of antimicrobial agents in the blood and body fluids; the appropriate use and management of antimicrobial agents in specific clinical settings, including the hospital, ambulatory practice, and the home;

B. The use of procedures for specimen collection relevant to infectious disease diagnosis, including but not limited to bronchoscopy, thoracentesis, arthrocentesis, lumbar puncture, and aspiration of abscess cavities, including soft-tissue infections. Additionally training on admistration of pencillin skin testing will be provided;

C.  Microbial culture techniques and methods for identification in tissues and fluids for bacteria, mycobacteria, fungi, viruse, rickettsiae, chlamydiae, and parasites;

D.  Sensitivity, specificity, efficacy, benefits, & relevant risks of emerging technologies such as those for rapid microbiological diagnosis and the use and limitations of imaging techniques in the diagnosis and follow-up of infectious processes;

E.  Principles and practice of hospital epidemiology;

F.  Principles of chemoprophylaxis & immunoprophylaxis for strategic uses to enhance resistance to infection;

G. Essential mechanisms of action of biologic agents, including treatment regimens such as monoclonal antibiotics, interferons, interleukins, and colony-stimulating factors, and their applications in the treatments and response.

 

2.  Clinical Spectrum of Diseases:   The Infectious Diseases Fellow will gain experience in evaluating and managing patients with the following disorders:

 

• Febrile patient presenting in context of rash or FUO
• Upper respiratory tract infections
• Pleuropulmonary and bronchial infections
• Urinary tract infections
• Peritonitis and other intra-abdominal infections
• Cardiovascular infections
• Central nervous system infections
• Skin and soft tissue infections
• Infectious related to trauma, burns and animal and human bites
• Gastrointestinal infections and food poisoning
• Bone and joint infections
• Infections of the reproductive organs
• Sexually transmitted diseases
• Infections of the eye
• Viral hepatitides
• Sepsis syndromes
• Nosocomial infections
• HIV infection and acquired immunodeficiency syndrome
• Infections in the immunocompromised or neutropenic host
• Infections in patients with acute leukemia and lymphomas
• Infections in marrow transplant recipients
• Infections in solid organ transplant recipients
• Infections in geriatric patients
• Infections in travelers
• Infections in parenteral drug abusers

3.  Types of Clinical Encounters: Clincal experiences include opportunities to observe and manage adult patients with a wide variety of infectious diseases on both inpatient and ambulatory basis.  Such opportunities must encompass temporally longitudinal experiences in a continuum of care to observe a course of illness and any acute or chronic effects of therapy.  Therapeutic modalities should include management of antibiotic administration in such settings as the hospital, the office, or in conjunction with home-care services.  Experience with pediatric infectious diseases is encouraged.  The ambulatory care experience affords consultative services and continuing care for HIV-infected individuals as well as in the broader field of general infectious diseases.  Fellows will receive formal instruction, clinical experience, or opportunities to gain expertise in the prevention, evaluation, and management of both nosocomial and community-acquired infections (see Clinical Spectrum of Diseases, above).

  

4.  Evaluating Fellow Performance:  Following each service period, Fellows are afforded the opportunity for bidirectional evaluation.  Each Fellow is to be encouraged to evaluate the Attending Faculty during the specific rotation. Likewise,  appropriate Faculty who supervise the Fellow will offer constructive critiques of Fellow performance.  The means of evaluation will be through written evaluation, with specific commentaries on strengths and opportunities for improvement, along with an opportunity to discuss their experience during the Fellow / Faculty meetings. Fellows may also provide feedback to Faculty directly. This process on continuous communication offers timely feedback to the Fellow such that: 1) any opportunity for improvement can be identified prior to the next research service period; 2) those activities that are performed at a high-quality level can be recognized; and 3) overall Fellow performance is optimized in real-time.