Infectious Diseases Fellowship Training: Program Aims
- To produce highly skilled Infectious Diseases clinicians who are models of exceptional patient care and dedicated advocates for patients of all backgrounds
- To train future leaders in medical education innovation, research and leadership in academic Infectious Diseases
- To produce world-class Infectious Diseases physician-scientists by providing unparalleled resources, structured oversight and superb research mentorship
Structure of the BIDMC ID Fellowship Educational Program
The training program in Infectious Diseases is comprised of the following essential components:
- A minimum of 2 years of training, with the first year being entirely clinical, and the second year providing a focused research experience (laboratory based, clinical, or medical education depending upon the specific interests of each fellow)
- Additional years of training providing additional research experience can be arranged depending upon the interests of each fellow and the funding resources available
- A continuity ambulatory experience consisting of 24 months of a longitudinal infectious diseases clinic, whereby each fellow will provide outpatient consultation in infectious diseases, follow-up for previously hospitalized patients seen on the inpatient consult service, and management of patients with HIV infection under the supervision of a dedicated faculty preceptor. The continuity clinic will be held for one half day each week for the 24 month period. Additional clinic experience beyond the 24 months may be arranged depending upon the specific goals and career track of each individual fellow,
- A dedicated block experience in Ambulatory ID involving a one-week rotation seeing general urgent and specialty ambulatory ID consults under the supervision of dedicated ID faculty. Fellows work with senior ID clinicians and rotate through specialty ID clinics such as Urgent Care ID, Mycobacteria clinic, HIV/hepatitis co-infection, Transplant ID, Travel Clinic, etc. based on availability and fellow interest. Each fellow has approximately 5-6 weeks of this experience during year one and approximately 4 weeks during year two.
- A dedicated block experience in Clinical Microbiology, involving an intensive 2-week rotation with the Director of the Clinical Microbiology Laboratory and residents in the Department of Clinical Pathology. 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 the Director of the Clinical Micro Lab 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.
- A dedicated block experience in Infection Control/Antimicrobial Stewardship(IC/AST) involving an intensive 2-week rotation with BIDMC Infection Control and Antimicrobial Stewardship Teams to learn principles and hands-on practice of IC/AST, to build content knowledge and also to explore future career possibilities within these fields. During this rotation fellows will complete an online Infection Control Module where principles of hospital epidemiology and infection control are learned through didactics (recently this has been an on line course sponsored through SHEA-IDSA). Fellows will also complete the online IDSA Antimicrobial Stewardship Curriculum during this two week block. These modules are aimed at providing supplemental teaching which will add to the experiences acquired on the rotation.
- A 4-day STD course during fellowship year two, developed and delivered by the Massachusetts Department of Public Health. 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
- A curriculum in Patient Safety and QI delivered as a half-day retreat to learn these principles during fellowship year one, followed by a 2 session curriculum during year two. Each second year fellow will present one M+M Conference during which he/she performs root cause analysis (RCA). Each second year fellow will also complete a QI project, either independently or as a group, under the supervision of ID divisional QI faculty leadership.
- A dedicated block experience in Pediatric Infectious Diseases involving 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. The fellow works with a pediatric Infectious Diseases fellow and is supervised by an attending in the Infectious Diseases Division at Children's Hospital.
- A description of the core clinical training sites and opportunities for both inpatient consultation and ambulatory training opportunities for BIDMC ID fellow trainees is below:
The Inpatient Consultation Service
Consultation requests come to the Division of Infectious Diseases from all services within the BIDMC. The Division of Infectious Diseases provides same-day consultation services for new requests and continued follow-up services for patients seen previously. There are two inpatient consultative teams. One consultative team focused on immunocompromised patients averages 4-5 consults a day and one general ID consultative team averages 5-6 consults per day. Each service includes two Infectious Diseases fellows and a supervising Attending Infectious Diseases faculty member. By design, fellows work with their colleagues, learn from one another and distribute their workload. Members of the Division's faculty directly supervise fellows on each of the consultation services. HMS students and BIDMC medical residents as well as visiting trainees rotate through this service and are an integral part of the team. Each first year fellow also spends one four-week rotation on the inpatient ID consultation service at Boston Children's Hospital to gain knowledge regarding pediatric infectious diseases.
Outpatient Infectious Disease Care
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.
Infectious Diseases Ambulatory Clinic
Each fellow spends one half-day session per week working with a designated faculty preceptor. This experience ensures, in a controlled and supervised manner, that Fellows participate in the longitudinal continuity care of patients with HIV infection and provide consultative services to ambulatory patients with general Infectious Diseases problems. Each fellow also participates in the follow up of OPAT (Outpatient Parenteral Antibiotic Therapy) patients with nursing, pharmacy and administrative support for this intensive follow-up provided by the ID clinic OPAT program. In addition, all Fellows have one-week long blocks of a dedicated Ambulatory ID rotation, during which they work with senior ID clinicians and rotate through specialty ID clinics such as Urgent Care ID, Mycobacteria clinic, HIV/hepatitis co-infection, Transplant ID, Travel Clinic, etc based on availability and fellow interest.
Elective Clinic Experiences
During the second fellowship year, additional longitudinal ambulatory clinic experiences may be added if desired, including an additional longitudinal clinic for the care of patients with HIV, rotation through the Hepatitis/HIV co-infection clinic, Travel Clinic, Transplant Infectious Diseases Clinic, STD clinic, TB clinic, Refugee Health Clinic or Anal Dysplasia Clinic. Finally, additional ambulatory experiences in the care of patients with HIV, TB and/or viral hepatitis may be arranged at local community HIV clinics affiliated with BIDMC such as Fenway Health Center, Dimock Community Health Center, Harvard Vanguard/Atrius Health and Cambridge Health Alliance or in Provincetown, through the Outer Cape Health Services Clinic, under the supervision of division or affiliated faculty preceptors.
The Infectious Diseases Division offers fellows many educational conferences and formats for learning: didactic presentations, current literature reviews, case-based clinical conferences and rounds, and evaluation of specific topics of interest. Several multi-institutional conferences complement those held by the Division.
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, based on fellow interest, 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 BIDMC, other Harvard teaching hospitals and basic science departments of the Harvard Medical School.
Weekly Core ID Division Conferences
Microbiology Summer Bootcamp
- Directed by Dr. Nira Pollock (Director of Clinical Micro Lab at Boston Children's Hospital), this summer bootcamp covers high yield clinically important micro topics. Conference starts in July and continues for 5 weeks before micro plate rounds officially start. This conference brings together ID fellows from BIDMC and BCH to learn together.
Immunocompromised Host Summer Bootcamp
- Directed by Dr. Barbra Blair, this conference provides an introductory review of important ID issues relevant to the IC host with particular focus on SOT, BMT and heme malignancies. Topics include Fever and Neutropenia, Review of Antifungal Therapy, Pre-Transplant ID Evaluation, and more. After summer bootcamp is completed, the BIDMC ICH curriculum continues with monthly didactics on Thursdays.
ID Conference on Research, Education and Science (ID-CRES-previously Journal Club)
- Directed by Dr. Douglas Krakower, this weekly conference provides a forum for weekly discussion of current scientific, clinical and educational literature, presented by fellows and faculty. Fellows present one journal club annually, choosing paper/topic to review with faculty mentor discussant. Senior fellows also present their research project results during this conference.
Immunocompromised Host Case Conference
- This is a multi-institutional weekly conference for real-time discussion of cases seen on the immunocompromised host consult services at BIDMC, BCH, and Dana Farber Cancer Institute. Primary data is reviewed electronically, extensive differential diagnoses are generated, current literature pertaining to the case is discussed, and management decisions are made and critiqued.
ID-Orthopaedics Interdisciplinary Case Conference
- Directed by Dr. Wendy Stead (ID) and Dr. Ayesha Abdeen (Orthopaedics), this quarterly interdisciplinary case conference attended by ID and Orthopedic faculty/trainees, advanced practice practitioners and microbiology staff, reviews complicated orthopaedic infections and related literature informing clinical decisions about diagnosis and treatment of these infections.
ID Core Curriculum Case Conference
- Directed by Dr. Wendy Stead, this core ID Division weekly conference provides real-time discussion of cases seen on the consult services. Typically two cases are presented weekly, one general ID case and one immunocompromised ID case, and primary clinical data is reviewed by ID fellows. Senior ID fellows in attendance generate initial differential diagnoses. Current literature pertaining to the case is discussed and management decisions are suggested and critiqued. Five times per year this conference is utilized for ID Morbidity and Mortality Conferences presented by each second year fellow.
Harvard Combined Infectious Diseases Case Conference and Core Curriculum
- Directed by Dr. Molly Paras (MGH) this multi-institutional conference is a forum for weekly core didactics in Infectious Diseases over the summer, followed by clinical case discussions, and research presentations by faculty and fellows. First year clinical fellows present two cases/topics during the year to the combined Harvard ID Divisions.
HIV Clinical Case Conference
- Directed by Dr. Robin Wigmore (ID) and Dr. Rebecca Glassman (General Medicine and Primary Care), this weekly post-practice case-based and didactic conference discusses challenging management issues in HIV clinical care. Core clinical didactics in HIV are presented with structured curriculum to teach key issues in HIV clinical management. Presenters rotate between ID faculty, senior ID fellows and medical residents and address many ambulatory HIV issues, including ARV resistance, new HIV medications, drug side effects, HIV/hepatitis co-infections.Frequent case discussions as well as discussions re: real-time clinical management issues in HIV care are also presented for input from the group. This conference is attended by general internists, NPs, case managers, medicine house officers, ID fellows and ID faculty).
Department of Medicine Grand Rounds
- Directed by Dr. Eileen Reynolds (Internal Medicine) this departmental conference covers a broad array of topics in general internal medicine.
Microbiology Plate Rounds
- Co-directed by Dr. Barbra Blair (ID) and Dr. James Kirby (Microbiology), this conference is held on the second and fourth Thursdays of each month and provides a forum for acquiring clinically relevant knowledge and skills pertaining to the diagnosis of various infectious pathogens. Hands-on learning and didactics on various topics, including molecular diagnostics, traditional gram stain and culture methods and susceptibility testing among others. Consult service ID fellows are responsible for identifying teaching cases for micro plate rounds bimonthly.
Summer HIV Core Curriculum
- Directed by Dr. Rajesh Gandhi (MGH), this is a summer HIV didactic lecture series covering core HIV topics with attending presenters from BIDMC, BCH, MGH and BWH.
ID Fellow Teaching Conference
- Directed by Dr. Wendy Stead, this weekly conference is dedicated to reviewing high-yield clinical topics in focused 30 minute reviews for purposes of covering important literature that informs day-to-day clinical care of patients. Topics are presented by faculty and senior fellows and provide a chance for clinical fellows to be taught high yield topics by their senior peers and attendings in a small group setting.
Antibiotic Stewardship Conference
- This conference is held on first and third Friday of each month. Issues relevant to Antimicrobial Stewardship are reviewed with fellows by Dr. Howard Gold, director of AST program and ID Pharm D staff, Dr. Christopher McCoy, ID PharmD as well as senior AST fellows and AST pharmacy team members.
ID Fellow Career Development Conference
- Directed by Dr. Wendy Stead and Dr. Christopher Rowley, this bimonthly conference on Friday afternoons addresses issues of high relevance to developing various career paths within ID. Topics include Planning for the ID Job Search, ID Career Panel Discussion, Navigating Financial Challenges Post-Fellowship, Malpractice in ID, Optimizing the Mentor-Mentee Relationship, Writing a Research Manuscript, among others.