Description of Clinical Duties
The fellow will spend 14 four-week blocks 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 is responsible for all of his/her cases as well as those followed by other trainees. Notes need to be finalized after rounding with faculty attending. The fellow will oversee the trainees, and both see and discuss their patients prior to rounds. The fellow needs to review the cases and examine the patients prior to rounds. Rounds will start at a pre-determined time by the faculty attending. All new consults will be presented and discussed among the team. If necessary to go to microbiology, pathology, or radiology the fellow must coordinate in advance. Follow ups will be discussed after presenting the new consults. Up-to -date literature review is encouraged to be performed prior to rounds. 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 diseases.
This rotation will consist of one block of clinical experience on the bone marrow and/or solid organ 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 or USF 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 MD Anderson and USF.
The bone marrow transplant program at Orlando Health continues to grow. During the rotation in the Lewis Pavilion the fellows will be responsible to follow bone marrow transplant and other patients in the Orlando Health Cancer Institute.
The fellow will rotate for one block of the 2nd year with pediatric ID staff at Orlando Health 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.
Fellows in our program have the opportunity rotate through the wound care center at Orlando Health ORMC. This is a highlight of our program that is not common among Infectious Diseases fellowships. We have a 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 on the Downtown campus. 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 an in-depth exposure to STDs and TB in our city. Orlando has one of the highest TB rates in the US. 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 four-week 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 and spend two weeks in the TB clinic and two weeks in the STD clinic. The public health faculty will coordinate and supervise the fellow's experience.
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. The clinic will be on Mondays AM in the Downtown clinic.
Each fellow will have a general infectious disease clinic every other week. The fellows will evaluate and follow outpatient ID consults. Patients will include hospital "follow-ups" as well as newly referred outpatients. Each fellow is assigned to a faculty attending and they will work together during the two years of fellowship.
Description of Nonclinical Duties
The microbiology block will be done at the beginning of the fellowship and will provide an in-depth study of the modern clinical microbiology laboratory. Topics covered will provide Gram stain preparation, rapid tests, mycobacteriology, mycology, parasitology and molecular testing. The rotation will be under the guidance of microbiology laboratory director. Fellows also can expand the experience in the microbiology lab during an elective rotation that is offered both years.
During the first block the fellows will also have daily lectures by our Infectious Diseases pharmacists. The curriculum includes basic topics related to antimicrobials, mechanism of resistance, antimicrobial stewardship, drug toxicity.
All fellows will have at least 4 blocks 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.
There is research conference every 4 weeks to present the progress of the research projects.
Fellows will have a four-week rotation through infection control and prevention during the second year of training. This rotation will be led by the manager of infection prevention at Orlando Health. The fellow will work along the infection preventionists in the different campuses. This is a great opportunity to learn firsthand the process of prevention of hospital-acquired infections, investigation of hospital outbreaks, planning, prevention, and management of communicable diseases.