The fellow will spend 12 months over 2 years on this pivotal rotation. When there are other trainees on the service (residents, medical students) the fellow will function as team leader and assign cases for them to evaluate. The fellow will dictate all of his/her cases as well as the other trainees after discussion with staff. The fellow will oversee the "junior" trainees and both see and discuss their patients prior to rounds. A weekly case management conference will be organized by the fellow who will present and lead a literature based discussion of at least one case. The fellow will help the junior trainee present at least one case during their rotation. Attendings will expect (and grant) fellows additional latitude to lead the team and take the primary consultative role as they gain experience and knowledge in infectious disease.
This rotation will consist of one month of clinical experience on the bone marrow transplant infectious disease service. During that time, the fellow will perform ID consults and follow-up visits under the direct supervision of the MD Anderson infectious disease staff. The fellow will also present and discuss cases, interact with microbiology and radiology services, and attend didactic sessions. The activities at this site will be coordinated by the liaison director in Houston (the infectious disease fellowship director of the parent program).
Fellows will have close interactions with residents from internal medicine as well as residents and fellows for other services. The fellows will provide support and teaching to the internal medicine residents assigned to the ID consult team, as well as "situational" teaching for the consulting trainees. Fellows will guide residents, medical students and fellows of other training programs to appropriate educational resources as indicated. The fellows will be supervised by the attendings at MD Anderson under the policies of the parent program.
MD Anderson is a world leader in bone marrow transplants. Though our principal hospital does not perform transplants, we aim to give our fellows a world class experience. Our new hematology-oncology fellowship program also utilizes MD Anderson for transplant experience, and we have an MD Anderson affiliated cancer center as part of our principal teaching hospital.
The fellow will rotate for one month of the 1st year with pediatric ID staff at Arnold Palmer. The rotation will consist of a mix of both the inpatient and outpatient consults as well as follow-up visits. Exposure to HIV and other immunosuppressive disorders will be a critical part of the rotation, as will be exposure to infectious diseases more commonly seen in children. The liaison program director will direct the day-to-day activities of the ID fellows on this rotation. The fellow will be supervised closely by the pediatric ID attending, who will see all new consults and follow-up visits as indicated.
Wound care and the use of HBO are almost completely neglected by ID fellowships. Most graduating fellows who enter private practice are shocked to learn that about one- fourth of their work (and income) relates to chronic wound management. We have a one month rotation early in the fellow's training so that this clinical expertise can be applied throughout their fellowship and beyond.
The wound/HBO clinic is located at Lucerne. The wound and HBO clinics serve primarily outpatients, though inpatients may be transported to the wound/HBO area for evaluation and treatment. The fellow will participate in the evaluation and management of patients referred to the clinic for wound and/or HBO therapy. The fellow will review all new and follow-up patients with the faculty member.
This rotation will provide and in-depth exposure to STDs, TB, and HIV impacting the urban poor. Orlando has one of the highest TB rates in the US, and areas of the city have higher rates of TB than many " third world" countries. This rotation will make a virtue out of this harsh reality, and provide our fellows with extensive training into these critical diseases.
This will be a one month rotation at the County Public Health Clinic, which serves the indigent population of Orange County, Florida. During the rotation, the fellow will work with the physician staff of the public health clinic in the TB, STD, HIV and refugee clinics. The public health faculty will coordinate and supervise the fellow's experience.
This one month rotation will take place in the offices of a nearby 4 physician private ID group. During this rotation, fellows will see outpatient consults, and travel clinic patients, learn about the infusion center and home antibiotic issues, and have a chance to understand the financial aspects of private ID practice. All clinical work will be staffed with the onsite clinical ID faculty.
The adult HIV clinic provides comprehensive, longitudinal care for HIV infected. Each fellow will have clinic every other week, and will follow a diversified cadre of more than 20 HIV patients throughout his/her fellowship. Onsite faculty HIV experts will see and discuss all new patients, and provide help as needed on follow-up cases as well as ad hoc lectures on key HIV topics.
Each fellow will have a general infectious disease clinic every other week. The fellows will evaluate and follow out patient ID consults. Patients will include hospital "follow-ups" as well as newly referred outpatients, including hepatitis B and C patients. Key clinical faculty will be present at all clinics and will staff all new consults in "real time" while the patient is still in clinic; follow-up patients will be discussed with faculty as questions arise.
The microbiology month will be done in the first 1-2 months of the fellowship, and will provide an in-depth study of the modern clinical microbiology laboratory. Topics covered will provide stain preparation, rapid tests, mycobacteriology, mycology and parasitology. The rotation will be under the guidance of Dr. Kendall Bryant and his team of microbiologists
All fellows will have at least 5 months available to plan, conduct and write up a research project. Broad latitude will be given regarding the type of project, which could range from a "bench" microbiology project to a clinical trial or retrospective review of cases and literature survey. It is anticipated that all fellows will submit at least abstract to a national or international meeting, and that all fellows will submit their work for publication. It is acknowledged that the work might not be published prior to the end of the fellowship, as there is often quite a delay between submission and publication.
All fellows will complete the NIH online research course, and will present at least once during their fellowship at the monthly research conference.