The Team 1 rotation is the principal inpatient general ID consultative service at University of Iowa Health Care. Two and half to three months will be spent on this service in Year 1 and 1.5 months in Year 2. It is the service that challenges our fellows to mature as consultants and teachers, and rewards them with a remarkable learning experience. The fellow manages this team, constituted by the attending, rotating residents, medical students and College of Pharmacy trainees. The service typically sees 120-130 new consults per month. It cares for patients on medicine wards, Medical, Cardiovascular and Surgical Intensive Care Units, Obstetrics-Gynecology and multiple surgical services. All patients are staffed with the attending.

Through rotation on the service, the fellow gains foundational experience in the evaluation and management of patients from highly diverse backgrounds with a broad array of diagnoses. A sampling of our list at any time would reveal patients whose differential diagnoses include endemic fungal, zoonotic or mycobacterial infections. We regularly encounter foreign-borne patients so infections of the tropics are often considered. Patients with iatrogenic immunocompromise or with advanced HIV are cared for by this team.

Fellows also have an opportunity to teach students and residents. Other goals of the rotation include gaining expertise in communicating as a consultant, managing transitions of care, applying principles of antimicrobial stewardship and infection prevention and applying treatment guidelines and current medical literature to individual patients.

The Team 2 rotation is the principal outpatient general ID consult service at University of Iowa Health Care. Fellows work 1:1 with the attending to evaluate and manage patients who are new referrals or are seen in follow-up after their hospital discharge. Three to four half-days are spent in clinic per week. Approximately 2.5 months in fellowship Year 1 and 1 to 1.5 months in Year 2 are dedicated to the service. Fellows assigned to this rotation typically also rotate on the inpatient ID service at the VA, which is a low-volume service.

As Iowa’s only comprehensive medical center, we encounter a great breadth of ID diagnoses in the clinic, both common and uncommon. Fellows gain skills in the management of patients receiving complex outpatient antibiotics and how to assess patients during prolonged treatment for illnesses such as tuberculosis, disseminated fungal infection, prosthetic joint infection or infective endocarditis.

As with Team 1, but with a focus on outpatients, fellows gain expertise in communicating as a consultant and apply principles of antimicrobial stewardship, treatment guidelines and current medical literature to individual patients.

Team 4 is the ID inpatient rotation that serves the hospitalist teams at University of Iowa Health Care and thus commits its time to consulting on general medicine or occasionally Family Medicine patients. Fellows work 1:1 with the attending in an apprenticeship model which provides time for more discussion about the management of individual patients and feedback to the fellow. About sixty new patients are seen per month on this service. The range of diagnoses and diversity of patients are in keeping with the distinction of being the state’s only comprehensive medical center.

Over 700 people living with HIV are cared for at University of Iowa Health Care’s Virology Clinic, which is funded by Ryan White grants.  It is a model multidisciplinary clinic that manages the complex medical and psychosocial needs of patients. Fellows gain knowledge of HIV Medicine by managing their own panel of patients (usually 30-40 patients for F2s) whom they follow throughout their fellowship. All patients are staffed 1:1 with an attending. Other members of the care team include case managers/medical social workers, pharmacists, and staff from the Department of Psychiatry. Fellows further strengthen their expertise in HIV Medicine by completing portions of the University of Washington HIV medicine curriculum. A portion of our didactic curriculum is dedicated to HIV Medicine topics to further provide a strong foundation for fellows in this important aspect of ID training.

The Transplant ID Team sees patients who are admitted to the Solid Organ or Hematopoietic Transplant Services. They also consult on patients with acute leukemia or who are CAR-T cell recipients. Lastly, related to their work with the cardiac transplant service, the ID Transplant Team manages patients with LVAD infections. Our medical center has a 24-bed ward that houses HCT or acute leukemia patients. The Solid Organ Transplant program is busy, with 160-180 transplants performed per year, including renal, lung, cardiac and liver transplants. There is an average of 25-30 inpatient consults per month.

Fellows who rotate on the Transplant ID Service staff patients 1:1 with the TP attending. This rotation provides critical experiences so that the fellow is adept in the evaluation and management of highly immunocompromised patients. Fellows come to appreciate the pre-transplant workup and how the post-transplant timeline and features of the immunosuppressive regimen impact the range of infections seen, which in turn informs the differential diagnosis and evaluation. Transplant faculty facilitate a curriculum for the fellows and invite them to participate in multidisciplinary conferences with the surgeons and other medical specialists.

Our ID fellowship benefits enormously from having an outstanding Clinical Microbiology laboratory on-site. Two to four weeks during Year 1 will be spent in the lab with intensive instruction and hands-on experience with a board-certified clinical microbiologist. Skills gained during the rotation include microscopic examination of specimens, understanding straining and culturing techniques and principles of molecular diagnostics and identification of pathogens. Fellows also learn to interpret susceptibility data and the mechanisms of antimicrobial resistance. In addition to this rotation, Clinical Micro staff also provide tutorials for ID Team 1 and other ID fellows/faculty once or twice per week.

The goals of the Year 1 rotation in Hospital Epidemiology are to give the fellows practical and scholarly training in Hospital Epidemiology/Infection Control. During the rotation, fellows will participate in multiple activities of the Program of Hospital Epidemiology at University of Iowa Health Care. 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. Additional weeks during Year 2 are available upon request.

Fellows complete/attend 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.

Fellows embed in the Antimicrobial Stewardship Teams (AMS) at University of Iowa Health Care and the Iowa City VA for one week during Year 1. Additional time is available upon request. Fellows learn the principles of AMS and how programs at the two facilities promote prudent use of antimicrobials among their providers to optimize patients outcomes and reduce the emergence of resistance. Faculty will facilitate completion of the IDSA AMS Curriculum during the rotation. Faculty provide rotating fellows with several lectures to further strengthen working knowledge of this area.

The Travel Clinic at University of Iowa Health Care prepares patients for travel to developing areas during its two half-day clinics per week. Second year fellows spend approximately 4 half days in the Travel Clinic alongside the Travel Clinic staff with the goal that they will adeptly provide patient-specific counseling and recommendation for vaccines or medications before overseas travel to maximize the health and safety of our travelers.

Patients co-infected with HIV and Hepatitis C have their Hep C treated by Virology Clinic providers. But patients with Hepatitis B or Hepatitis C who are not co-infected with HIV are managed by Hepatology staff.  In order for our 2nd year fellows to learn the approach of hepatologists to the management of patients with viral hepatitis, they rotate during several half-day clinics with a Hepatology attending.