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The first year of training is largely clinical. The fellow has primary responsibility for the infectious diseases consult service and sees inpatient consultations in conjunction with the service attending. The fellow also supervises a second-year medical resident and fourth-year medical student who are taking an infectious diseases rotation. There is a daily attending conference which serves as the primary formal teaching forum for day-to-day diagnosis and management to inpatients, a weekly case conference attended by infectious diseases specialists from throughout southern Maine, a weekly fellows didactic conference, and a monthly journal club. Basic science and research lectures are a regular part of the curriculum.
A major portion of training in infectious diseases occurs in the outpatient setting. First-year fellows participate in weekly infectious diseases and HIV consultation clinics and less frequently in tuberculosis, and transplant clinics. In the infectious disease outpatient clinic, the fellows see referrals from physicians throughout Maine and New Hampshire. In the past year, this included the outpatient management of common problems such as osteomyelitis as well as unusual diseases such as leishmaniasis, leprosy, and schistosomiasis.
The inpatient program includes primary infectious diseases consultative responsibility for a 42-bed critical care unit, a dedicated hematology/oncology unit, and a nephrology/renal transplantation unit.
The curriculum for the first year program also includes dedicated time spent in learning basic microbiology with a bench level experience in microbiologic techniques of bacteriology and virology. Fellows participate in the Antibiotic Stewardship Program which oversees antibiotic use for inpatients, and in the Hospital Epidemiology and Patient Safety Program. Fellows will also have a pediatric infectious diseases rotation.
- Inpatient Adult Consult
- Microbiology / Hospital Epidemiology / Antimicrobial
- Stewardship Program
- Pediatric Infectious Disease
- Outpatient Infectious Disease
- HIV /AIDS Consultation Clinic
The second year of the training program is dedicated primarily to the development and completion of a research project, which is designed to meet the particular interests of the fellow. However, the fellow continues to spend a total of 4 months on the inpatient consultative service and to attend the infectious disease clinics, including HIV and hepatitis clinics. Fellows are encouraged to fulfill the role of a junior attending both in supervising the clinical service and in supporting the teaching program.
The second year curriculum, in addition to the research project, is tailored to meet the special needs and interests of each fellow. Rotations at other medical centers may be arranged when appropriate. Opportunities exist for involvement in epidemiology and public health, molecular biology and immunology, and specialized areas of clinical infectious diseases.
- Hospital Epidemiology / SHEA
- Inpatient Adult Consult
- Outpatient Infectious Disease
- HIV / AIDS Consultation Clinic
- International Health Clinic
- Tuberculosis Clinic
- Hepatitis Treatment Clinic
- Transplant Infectious Disease
Inpatient Adult ConsultDuring the two years of fellowship, the fellow will spend a minimum of 12 months on this rotation. All inpatient consultations will be done at the MMC. Consultations will be seen and evaluated first by the fellow, with subsequent review by the attending physician on the same day. Each week the fellow will be responsible for selecting cases of teaching value for the in-depth discussion during the weekly case conference. It is expected that a literature review will be integral to those presentations, and appropriate radiologic and pathologic data will be presented. All clinical faculty will attend these conferences, along with members of the microbiology or pathology department when possible. In addition to clinical case conferences, a series of didactic discussions led by the faculty will cover major areas of this curriculum. Census on the teaching service is limited to 20 patients at maximum. Additional cases are assigned to a second attending service.
Infectious Disease ClinicFellows will attend this clinic continuously throughout the two years. This rotation is provided as a weekly half-day training session located at InterMed, where the clinical faculty see outpatients. There are reference textbooks available, a large and updated infectious disease literature file, and an on-site clinical laboratory. Fellows see two or three new patients per week, with on-site review by the attending. In addition, fellows see follow up patients from hospital consultation, such as those receiving outpatient antibiotics. At least two infectious disease faculty members are always on site to review cases with the fellows.
HIV Aids Consultation ClinicProvides training for the first and second year fellow in the management of HIV disease including infectious disease and other complications. The fellow will become familiar with the evaluation of HIV disease, and its management as part of a multidisciplinary team that assesses medical, psychological, and nutritional issues. Upon completion of this rotation, the fellow will be experienced in both primary care and consultative management of the wide spectrum of the HIV related medical problems. It is expected that the second year fellow will show facility with the full range of HIV medications, their drug-drug interactions and side effects, and their application, based on resistance assays, in complex patients with co-existing morbidities and/or multi-resistant HIV virus.
Tuberculosis ClinicThe second year fellow will gain experience with medical management of tuberculosis, and with its public health aspects. The fellow attends a minimum of two tuberculosis clinics under the supervision of the Division of Pulmonary Medicine. The clinics are held in the Outpatient Department at MMC.
ResearchFellows spend a minimum of eight months in supervised research. Projects will be of the fellow’s own choosing, provided that appropriate resources are available. Fellows may choose to work at the MMCRI research laboratories in the areas of immunology, molecular biology, or vector-borne disease. Alternatively, the fellow may choose a hospital or outpatient based clinical study, or an epidemiologic or decision analysis project. The fellow will work under supervision of a clinical faculty member of the Infectious Disease division, in addition to research faculty members. Funds for fellows’ projects are available through the MMC Research Foundation on a competitive basis, and through additional divisional funds. It is expected that the fellow will produce data of publishable merit. The fellow will also participate in the Department of Medicine’s Biomedical Research Conference where research design and evaluation will be discussed and critiqued.
Pediatric Infectious DiseaseThe first or second year fellow will understand the differences between infectious disease consultation in the adult vs. pediatric environment, and the use of the resources available for assistance in evaluating pediatric infectious disease problems in the hospital setting.
The Chief of Pediatric Infectious Diseases supervises the fellows in the evaluation of pediatric infectious disease problems as encountered at Maine Medical Center on the Pediatric floor, pediatric intensive care unit, and in the neonatal intensive care unit. Patients are also seen regularly in the pediatric infectious disease outpatient clinic. Didactic lectures and case presentations devoted to pediatric infectious diseases are included as a standard part of the weekly infectious disease conferences and in additional pediatric service conferences. The fellow will devote four weeks to pediatric infectious disease during the two years of fellowship.
Hospital Epidemiology / Patient SafetySecond year fellows are expected to learn the extent, cost, and impact of nosocomial infections. By completion of the fellowship, they should be able to serve as an infection control supervisor at a tertiary or community hospital. They will be familiar with the basic principles of acute disease epidemiology as it relates to the hospital, outpatient setting, and community. They will be familiar with the rationale for and implementation of OSHA guidelines in health care settings. They will understand the scope and role of hospital systems approaches to patient safety.
Public HealthFellows have a quarterly meeting with state and city health officials to review areas of infectious disease concern. In addition, as participants in quarterly HIV clinics, they are involved in work on disease prevention that is part of an ongoing CDC project. Lectures on acute disease epidemiology are a part of our curriculum.
MicrobiologyThe First year fellow will understand the role of clinical microbiology laboratory in infectious disease management, be familiar with the range of microbiologic laboratory procedures in current use, and be able to interpret results critically. The fellow also will develop “hands on” experience in the identification of pathogens such as gram stains, AFB smears, etc. during an onsite rotation in the first year of the fellowship.
Antimicrobial Stewardship ProgramThe first year fellow is introduced to areas of infectious diseases therapeutics, pharmacology and philosophy of appropriate antimicrobial use through a rotation in the established ASP at Maine Medical Center. Specific integration of microbiology and antimicrobial pharmacology is taught to better understand the architecture of an optimal therapeutic regimen. Discussion of the justification of antimicrobial stewardship is integrated into the program in order to prepare the fellow to better equip them for future practice opportunities. In addition to the clinical and educational aspects of this rotation, research and publication opportunities are available to provide a rounded experience. The fellows will work closely with our two infectious disease pharmacists throughout their training and during a one month rotation.
Hepatitis Treatment ServiceTraining is provided for the second year fellow in the management of viral hepatitis. Chronic hepatitis B & C patients, including co-infected patients with HIV, are evaluated as part of a multi-disciplinary team that addresses medical, nursing, and psychosocial issues. Upon completion of this rotation, the fellow will be experienced in consultation and treatment of hepatitis B & C, and HIV co-infected patients.
A weekly half day teaching clinic is held in the outpatient department at Maine Medical Center. The fellow typically sees 1 to 2 new patients and 1 to 3 follow-up visits and reviews these with the faculty attending, a gastroenterologist/hepatologist and director of the hepatitis treatment service.