Core Clinical Curriculum
This year is spent in clinical training through rotations on the outpatient service, pediatrics at Children's Hospital, and on the inpatient consultation services at both sites of the medical center. There is a general consultation service located on the West Campus, providing consultation for a wide variety of infectious diseases, including those seen in medical and surgical ICU patients and persons with recent travel to foreign countries. The second consultation service is focused primarily on immunocompromised hosts including bone marrow and solid organ transplant recipients, HIV-infected patients and general oncology patients, as well as providing consultative care for OB/GYN inpatients.
The Clinical Consultation Service
Consultation requests come to the Division of Infectious Diseases from all services within the hospital. The Division of Infectious Diseases provides same-day consultation services for new requests and continued daily follow-up services for patients seen previously. An average of three consultation requests are received daily on each service. There are two fellows on each service at any given time. Members of the Division's staff directly supervises fellows on each of the consultation services. Students and medical residents from Harvard Medical School as well as visiting trainees rotate through this service and are an integral part of the team.
Ambulatory training in outpatient infectious disease consultation and longitudinal care of HIV infected patients is an essential part of Infectious Diseases Fellowship training. This is considered part of the Core Clinical Curriculum, and takes place during the first and second years of training, with additional ambulatory experience beyond the first two years continuing depending upon the needs and goals of the trainee. Each Fellow spends a one half-day session weekly in the Infectious Diseases Ambulatory Clinic working with a designated faculty preceptor. This experience provides, in a controlled and supervised manner, an opportunity for fellows to participate in the longitudinal care of patients with HIV infection, as well as to become involved in the rapidly evolving clinical care and research efforts focused on HIV infected patients. In this setting, fellows also provide consultative services to ambulatory patients with general Infectious Diseases problems, and follow-up care for patients previously seen on the inpatient consultation service. The Division maintains a busy Travel Clinic in which fellows see patients as well, providing both pre- and post-travel evaluation, immunization and clinical care. In addition, all fellows have one-week long blocks of a dedicated Ambulatory Clinic rotation, during which they provide Urgent Care for patients followed in the clinic, and emergency outpatient consultation as needed (three blocks for first year fellows and six blocks for second year fellows).
During the second year, additional ambulatory clinic experiences may be added if desired, including an additional longitudinal clinic for the care of patients with HIV, or periodic rotation through the Hepatitis C/HIV co-infection clinic, Travel Clinic, Transplant Infectious Diseases Clinic or Anal Dysplasia Clinic. Finally, additional ambulatory experiences in the care of patients with HIV may be arranged at a The Fenway Community Health Center, The Dimock Center with Dr. Wong, or Outer Cape Health Center with Dr. Rowley. First and Second year fellows also participate in Teaching Rounds, Conferences, and Other Teaching Exercises
Formal daily rounds are held by the consultation service. Each new patient seen in consultation is presented and discussed. In addition, those patients seen previously who have continued active infectious disease problems are reviewed.
The Infectious Diseases Division offers the fellow many educational conferences and formats for learning: didactic presentations, current literature reviews, clinical conferences and rounds, and evaluation of specific topics of interest. There is a weekly infectious disease Clinical Case Conference wherein cases of particular interest from a diagnostic or treatment perspective are discussed. Cases for this conference are drawn from the consult services and are presented by the fellows following the patients. A weekly Journal Club and Research Seminar is offered as a forum for fellows and faculty to critically review the recent literature in basic science and clinical infectious diseases. Twice per month the Journal Club format changes to allow for research presentations and critical feedback by attendings and fellows fellows. An HIV conference, where current issues in HIV care and research are discussed, meets weekly, followed by a 30 minute HIV didactic session.
Several multi-institutional conferences complement those held by the Division. The infectious disease training programs of all of the Harvard hospitals meet weekly from September through June for alternating clinical and research conferences. In the former, a fellow presents an interesting case as an unknown, after which a faculty member discusses the case. This is followed by a brief review of pertinent literature by the presenting fellow. In the research conferences, faculty or fellows discuss their own research efforts. During the months of July and August these conferences are suspended and faculty present a series of 22 lectures reviewing core clinical topics in infectious diseases. A second inter-hospital conference, Immunocompromised Host Conference, is co-sponsored with the Infectious Disease Divisions of the Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Children's Hospital. This weekly conference focuses on the care of HIV-positive patients during the months of July and August, and on infections in other types of immunocompromised hosts during the remainder of the year. The format is didactic lectures and case-based discussions.
Trainees are active participants in the teaching activities of the Division. These include the supervision of fourth year medical students and housestaff who spend elective time within the Division. Occasionally fellows teach in the physical diagnosis course and other courses for students at Harvard Medical School and participate in teaching at various BIDMC Housestaff conferences, including Firm Conferences and Morbidity and Mortality Conference.
In addition, a variety of lectures, seminars, and special rounds are available at the Beth Israel Deaconess Medical Center and the adjacent hospitals and basic science departments of the Harvard Medical School.
BIDMC ID Weekly Conference Schedule
Journal Club/Research-in-Progress Monday 12:30-1:30 p.m.
Provides a forum for discussion of current scientific research and review of most recent peer-reviewed reference of reviewers' choice, conducted by both fellow and faculty. Teaching skills are practiced and evaluated by peers. Materials are on-line for internal reference and resource.
Immunocompromised Host Conference Tue 8:00-9:00 a.m.
Core division conference that is co-sponsored by the ID Divisions of BIDMC, BWH, DFCI and TCH with emphasis on immunocompromised hosts. The first 8 weeks are devoted to HIV. The remainder of the year is devoted to immunology, pharmacology, and opportunistic pathogens associated with highly immunosuppressed patient populations. Discussions are case-based with a didactic session, and all data are reviewed electronically and presented with the most up-to-date peer-reviewed literature. This is evidence-based and practice based learning with acquisition of knowledge base. Materials are on line for internal reference.
Core Curriculum Case Conference Tuesday 12:30-1:30 p.m.
Core Division conference for real-time discussion of cases seen on the consult services. All primary data are reviewed electronically. Discussions emphasize Division participation to generate differential diagnoses, diagnostic and therapeutic interventions, and case based review of the literature when appropriate. This provides evidence-based and practice-based learning, with acquisition of knowledge base. Materials are on-line for internal reference and resource.
Harvard Combined ID Conference Wed 8:00-9:15 a.m.
Forum for core didactics in ID, clinical case discussions and research presentations by faculty and fellows at BIDMC, BWH, DFCI, TCH and MGH. Teaching skills are learned and evaluated by peers. Materials are on-line for internal reference and resource.
HCA HIV Case Conference Wed 12:30-12:45 p.m.
Clinical case conference to discuss challenging issues in HIV care.
ID HIV Didactic Module Wed 12:45-1:30 p.m.
Core didactic module in HIV with structured curriculum to teach the key issues in HIV management and interpretation of resistance patterns.
Department of Medicine Grand Rounds Thurs 8:00-9:00 a.m.
Departmental conference that covers a broad array of topics within general internal medicine, risk management and healthcare policy
Microbiology Plate Rounds Thurs 1:00-2:00 p.m.
Forum for acquiring knowledge and skills regarding the isolation, identification, and susceptibility testing of infectious pathogens. Hands-on learning and didactic, real-time point-of-care activities. Molecular and non-molecular diagnostics, and traditional microbiologic/tissue culture techniques reviewed.
Bone Marrow Transplant Clinical Rounds Fri 12:30-1:30 p.m.
Multidisciplinary rounds for real-time discussion of cases seen on BMTU. Management decisions are made and discussed extensively with all team members, stressing communication, professionalism, and systems-based practices, together with acquisition of knowledge for the improvement of patient care.
Special Clinical Experiences
Fellows participate in two types of experiences geared to enhance their knowledge of clinical microbiology as it relates to providing infectious diseases consultation.
The hospital has an extensive diagnostic laboratory under the direction of Dr. James Kirby. Fellows meet with Dr. Kirby and the Clinical Pathology Resident on a weekly basis for Microbiology Plate Rounds. During this informal conference, interesting organisms isolated from inpatient consult service patients are discussed in the Microbiology Laboratory. Laboratory technicians participate in these lively and informative rounds. The techniques for isolating the given organism are discussed along with the pathophysiology of disease caused by the organism and the clinical syndromes that result from infection with the organism.
The second experience is a 2-week dedicated mini-course in Clinical Microbiology held during the first year of fellowship training. During this block the trainee spends the mornings working one-on-one with a laboratory technician, rotating through the different parts of the Microbiology Laboratory over the two-week period. The trainee is instructed in microbiologic procedures performed in the hospital laboratory, including the isolation, identification, and susceptibility testing (where appropriate) of bacteria, mycobacteria, chlamydia, mycoplasma, fungi, and viruses. A Parasitology Laboratory and a Serology Laboratory performing clinically relevant diagnostic tests is also included in this rotation. During the afternoons, fellows round with Dr. Kirby and the Clinical Pathology Resident discussing clinical microbiological issues that are active in the hospital at that time. In addition, focused didactic presentations are integrated into the block together with individual study of microbiological slide sets and monographs.
During the second year of fellowship, trainees participate in an online Infection Control Teaching Module consisting of 11 hours of lectures addressing the topics of nosocomial infections and infection control. The course was created by the IDSA/SHEA and was designed to standardize training in this field for all Infectious Diseases Trainees. In addition, all trainees participate in a two-week Infection Control Rotation under the direction of Dr. Sharon B. Wright, the Hospital Epidemiologist.
Sexually Transmitted Diseases Training:
During the second year of fellowship training, fellows participate in a multidisciplinary, hands-on learning experience in Sexually Transmitted Diseases diagnosis and management. Together with trainees from other Boston Infectious Diseases Fellowship Training Programs, and under the direction of the STD/HIV Prevention Training Center of New England and the Massachusetts Department of Public Health, fellows participate in a four-day course of didactics and laboratory sessions designed specifically to teach infectious diseases physicians how to recognize, treat, and report sexually transmitted infections. Didactic sessions are provided by faculty from many of the Boston ID Training Programs and by staff from the MA DPH. The laboratory sessions in particular provide an excellent, structured education in this area of infectious diseases. Upon completion of the program, fellows are well-trained to provide care for patients with various STDs
Pediatric Infectious Diseases:
Trainees in their first year also have the unique opportunity to learn about infections in the pediatric population at the Children's Hospital of Boston. This is a month long rotation where the fellow functions as an integral part of the Pediatric Infectious Disease Consultation Team at Children's Hospital. The fellow works with a pediatric Infectious Diseases fellow and is supervised by an attending in the Infectious Diseases Division at Children's Hospital.