Rotation/Educational Experience: Year One

Clinical Training is concentrated in the first year of the program. During the first year the fellow will receive in-depth education in clinical infectious diseases. Clinical Rotations occur at University of Iowa Hospitals & Clinics and at the VA Medical Center (VAMC), which is located across the street from UI Hospitals & Clinics.  Rotations in Transplant ID and Antimicrobial Stewardship/Hospital Epidemiology will occur. The fellow will have weekly COC clinics (alternating tween HIV and general ID COC clinics) and may attend several Travel clinics when not on service.  The fellow will participate in ID conferences, journal club, ID Grand Rounds, core curriculum, research conference and fellows’ interdisciplinary conference.

Team 1 - 1st year

Team 2 - 1st year

Antimicrobial Stewardship and Hospital Epidemiology

Clinical Microbiology

Continuity of Care Clinic

Transplant Infectious Disease

Travel Clinic (Limited number of assigned clinics)

Virology Clinic

 

Team 1 - 1st year

  • Inpatient UIHC Consults. On average, this service handles 120-140 new consults per month. All consults are staffed with a faculty member
  • Approximately 5 months of the first year will be spent on Team 1 inpatient consult service
  • Medical Microbiology Rounds twice a week

Goals and Objectives

During this rotation, the first year fellow is expected to:

  • Develop medical knowledge base of infections commonly encountered in a variety of hosts and in variety of organ systems
  • Develop a logical approach to differential diagnosis of various syndromes, recognize common clinical manifestations of particular organisms and develop a diagnostic and treatment plan that is appropriate and feasible
  • Become proficient in obtaining a complete history and physical examination for a variety of infectious diseases
  • Provide appropriate inpatient follow up, and arrange for adequate outpatient follow up
  • Develop skills to effectively and appropriately supervise and teach rotating internal medicine residents and students
  • Provide appropriate inpatient follow up, and arrange for adequate outpatient follow up
  • Develop communication skills that will lead to effective relations with referring services
  • Perform a literature search for medical topics, and interpret such literature in the context of a clinical case
  • Develop facility in providing parenteral or oral antimicrobials during hospitalization and after patient’s discharge, and understand the financial and medical issues involved with extended antimicrobial administration
  • Acquire leadership skills in directing the consult team which includes residents, students and pharmacy personnel
  • Develop skills of antimicrobial stewardship
  • Develop knowledge of methods to reduce the risk of healthcare associated infections
  • Increase medical microbiology knowledge

Team 2 - 1st year

  • Outpatient consults at University of Iowa Hospitals & Clinics, plus UI Hospitals & Clinics inpatient consults with 1:1 fellow:staff model or VAMC inpatient consults
  • Approximately 3 months of the first year will be Team 2 outpatient consult service

Goals and Objectives

During this rotation, the first year fellow is expected to:

  • Develop medical knowledge base of wide variety infections encountered in the clinic, as well as in hospitalized patients
  • Develop a logical approach to differential diagnosis of various syndromes, develop a diagnostic and treatment plan that is appropriate and feasible
  • Provide effective patient follow up
  • Develop skills to communicate with the referring services or outside referral entities, both verbally and in writing
  • Perform a literature searches to address questions, and apply such literature into a clinical case
  • Prescribe parenteral and oral antimicrobials in outpatient and inpatient settings, and understand the medical and issues involved with extended antimicrobial administration
  • Apply principles of antimicrobial stewardship
  • Successfully oversee transitions of care and manage OPAT patients

Antimicrobial Stewardship and Hospital Epidemiology

The goals of the year 1 and year 2 rotations are to give the fellows practical and scholarly training in Antimicrobial Stewardship and Hospital Epidemiology/Infection Control.

  • Trainees will participate in Antimicrobial Stewardship (AMS) at University of Iowa Hospitals & Clinics and the VA Hospital, joining the physician-pharmacy teams in their patient reviews and communication with teams. Didactic instruction strengthens AMS expertise gained.

Fellows will participate in the IDSA basic and advanced AMS curricula.

  • During the Hospital Epidemiology rotation, fellows will participate in multiple activities of the Program of Infection Prevention at UIHC.  The goal is to understand the principles of surveillance and experience a programmatic approach to infection prevention, quality improvement and outbreak investigation. We anticipate this experience will ignite ideas for scholarly work/Quality Improvement.

Fellows complete one of the following: a) SHEA online infection control course (Primer on Healthcare Epidemiology, Infection Control & Antimicrobial Stewardship); or b) SHEA spring or fall meeting in infection prevention

Clinical Microbiology

Two to four weeks will be spent in the clinical microbiology laboratory with intensive instruction and hands-on experience with a clinical microbiologist.  In addition, twice-weekly medical micro tutorials occur for Team 1 members; all fellows are invited.

Goals and Objectives

By the end of this rotation, the fellow is expected to:

  • Understand and recommend various methods of appropriately collecting and transporting various specimen
  • Be competent in microscopic examination of specimen
  • Understand various staining and culturing techniques for a variety of bacterial, mycobacterial, fungal, and viral pathogens, and the principles and appropriateness of molecular diagnostic techniques
  • Be able to interpret susceptibility data, and limitations of testing
  • Understand mechanisms of antimicrobial resistance

Teaching Methods

Daily plate rounds with the Clinical Microbiology Lab: Complete bench rotations on checklist. Work with pathology resident on service to organize Micro tutorials with the ID consult Team 1.

Microbiology lecture block, monthly Pathology Department micro conference.

Continuity of Care Clinic

Fellows see patients in follow-up who were previously seen by the inpatient consult service, as well as evaluate new outpatient ID consults in this every other week clinic.

Goals and Objectives:

  • Be familiar with management of outpatient IV antibiotics
  • Be familiar with the natural course of infections that require treatment for multiple weeks or resolve over lengthy periods of time
  • Recognize when the course of illness indicates possible complication of therapy or a suboptimal response that warrants further evaluation or change in therapy
  • Gain experience in outpatient evaluation and management of Infectious Diseases

Transplant ID

One rotation will be spent on the ID Transplant service during year 1.  Additional elective rotations are available.

Goals and Objectives

By the end of this rotation, the fellow is expected to:

  • Develop a differential diagnosis and management plan for patients in this immunocompromised population
  • Understand the net state of immunosuppression and its impact on patient predisposition to infectious complications over time
  • Understand the principles of and indications for immuno-prophylaxis and chemo-prophylaxis in this population
  • Understand the drug interactions, toxicities, and mechanisms of action of immunosuppressive agents
  • Perform an appropriate pre-transplant infectious diseases assessment
  • Demonstrate appropriate inpatient follow up care for this patient population
  • Communicate effectively with the transplant service, both verbally and in the medical record
  • Recognize common infection entities of the vulnerable patient and how they vary with time after treatment

Mix of Clinical Topics

There are on average about 25-30 inpatient and 6 outpatient consults per month.

Travel Clinic

  • Held twice weekly at University of Iowa Hospitals & Clinics, fellows rotate as per schedule
  • Each fellow will participate in 4 ½ day Travel clinics

Goals and Objectives

  • During this rotation, the fellow is expected to:
  • Become proficient in obtaining pertinent health history and vaccination history
  • Become proficient in predicting possible exposures based on patient’s itinerary, travel plans and underlying health status.
  • Become proficient in recommending immunoprophylaxis and chemoprophylaxis, in a manner individualized to the traveler’s medical and social needs and planned itinerary
  • Provide advice as to general principles of avoiding a variety of environmental exposures
  • Help arrange follow up if problems arise for returning travelers.
  • Develop understanding of, and comply with, various governmental requirements for travel

Teaching Methods

  • An ID attending or experienced advance practice provider is present for each patient encounter, reviews the relevant history and travel plans, and helps decide on the recommendations and counseling given to patients. Assessment, plans and encounter notes are reviewed.
  • Simulated patient tutorial available, overseen by Travel Clinic Director

Mix of Clinical Topics

There are usually 40-60 new travel clinic visits per month at UI Hospitals & Clinics. Patients traveling to countries all over the world are seen for pre-travel recommendations.

Patient Characteristics and types of clinical encounters, procedures and services:

  • Patients from a variety of socioeconomic levels and ancestral background are evaluated

Reading/Learning Lists

  • CDC Yellow Book
  • Travax Web site
  • Principles and Practice of Infectious Disease, Mandell, et. al., 7th edition
  • Core curriculum conferences on parasitology and tropical/travel medicine

Evaluation

Immediate feedback is given on each patient presentation. Written evaluations by the Travel clinic attendings are given biannually.

Virology Clinic

Over 600 patients are provided HIV care in the Virology Clinic, part of the Ryan White Program.  An integrated multidisciplinary model is used to manage the complex needs that may be encountered.  Fellows gain experience by managing a panel of patients whom they follow during their fellowship. 

Goals and Objectives:

  • Develop competence in the evaluation and management of patients with HIV infection, working within a multidisciplinary team
  • Gain competence in the prescribing of ARV for the treatment of HIV infection as well as treatment of HIV/Hepatitis C or HIV/Hepatitis B co-infections
  • Be familiar with risk factors for and manifestations, diagnosis, treatment and prevention of opportunistic infections
  • Provide preventive care for non-infectious co-morbidities associated with HIV infection