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Rotation/Educational Experience: Year Two

Year 2 of fellowship provides considerable flexibility to engage in specialty training pertinent to the track chosen by the fellow (see discussion of tracks and schedule above for pertinent training opportunities).  This includes time to perform a scholarly project, overseen by a faculty mentor and assisted by other faculty.  Scholarly projects may be completed in areas of hospital epidemiology/infection prevention, process improvement, clinical investigation, clinical microbiology, vaccine evaluation, clinical reviews or case series or in the basic sciences.  There are 3-4 months spent on Teams 1, 2 or D or specialty rotations.  Additional elective rotations are available.  The fellow will continue to participate in curriculum conferences, Journal Club, ID Grand Rounds, Clinical Microbiology rounds, ID Faculty and Fellows’ conference and fellows’ interdisciplinary conference.

 

Team 1 - 2nd Year

  • Inpatient University of Iowa Hospitals & Clinics Consults. On average, this service handles approximately 140 new consults per month
  • 1 to 2 months of the second year will be spent on Team 1 inpatient consult service

Goals and Objectives

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

  • Develop more advanced knowledge of infections commonly encountered in diverse human hosts and in variety of organ systems
  • Achieve greater autonomy in developing the differential diagnosis of various ID syndromes, recognize common clinical manifestations due to particular organisms or syndromes and develop a diagnostic and treatment plan that is effective and cost conscious
  • Obtain a proficient, thorough history and perform a directed physical examination; write concise, meaningful consult notes
  • Provide appropriate inpatient follow up, and arrange for safe transitions of care
  • Effectively and appropriately supervise and teach rotating internal medicine residents and students
  • Develop effective communication skills with referring services and patients/caregivers
  • Perform a literature search for medical topics, and meaningfully  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 advanced leadership skills in directing the consult team (which includes residents, students and pharmacy personnel)
  • Develop skills of an antimicrobial steward
  • Develop knowledge of methods to reduce the risk of healthcare associated infections and how/when to use vaccines or other prophylactic measures
  • Increase medical microbiology knowledge

Team 2 - 2nd Year

  • Outpatient consults at University of Iowa Hospitals & Clinics, limited UI Hospitals & Clinics inpatient consults and VAMC inpatient consults.
  • 1 or 2 months of the second year will be spent on Team 2 outpatient consult service.

Goals and Objectives

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

  • Increase independence
  • 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 in to 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

Team D - 2nd Year

  • Inpatient UIHC Consults from non-teaching hospitalist services. On average, this service handles approximately 60 new consults per month. All consults are staffed 1:1 with a faculty member
  • Approximately 4 weeks of the second year will be spend on a dedicated Team D inpatient consult service rotation, and an additional 2-4 weeks on a combined Team 2/Team D rotation.
  • The fellow can join Team 1 Medical Microbiology rounds twice a week

Goals and Objectives

  • Work in an apprenticeship model with the attending to deliver consultative ID care
  • Develop more advanced medical knowledge base of infections commonly encountered in diverse human hosts and in variety of organ systems
  • Achieve greater autonomy in developing the differential diagnosis of various ID syndromes, recognize common clinical manifestations due to particular organisms or syndromes and develop a diagnostic and treatment plan that is effective and cost-conscious
  • Obtain a proficient, thorough history and perform a directed physical examination; write concise, meaningful consult notes.
  • Provide appropriate inpatient follow up and arrange for safe transitions of care
  • Develop effective communication skills with referring services and patients/caregivers
  • 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
  • Develop skills of an antimicrobial steward
  • Develop knowledge of methods to reduce the risk of healthcare associated infections and how/when to use vaccines or other prophylactic measures
  • Increase medical microbiology knowledge
  • g hospitalist services. On average, this service handles approximately 60 new consults per month. All consults are staffed 1:1 with a faculty member
  • Approximately 4 weeks of the second year will be spend on a dedicated Team D inpatient consult service rotation, and an additional 2-4 weeks on a combined Team 2/Team D rotation.
  • The fellow can join Team 1 Medical Microbiology rounds twice a week

Goals and Objectives

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

  • Work in an apprenticeship model with the attending to deliver consultative ID care
  • Develop more advanced medical knowledge base of infections commonly encountered in diverse human hosts and in variety of organ systems
  • Achieve greater autonomy in developing the differential diagnosis of various ID syndromes, recognize common clinical manifestations due to particular organisms or syndromes and develop a diagnostic and treatment plan that is effective and cost-conscious
  • Obtain a proficient, thorough history and perform a directed physical examination; write concise, meaningful consult notes.
  • Provide appropriate inpatient follow up and arrange for safe transitions of care
  • Develop effective communication skills with referring services and patients/caregivers
  • 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
  • Develop skills of an antimicrobial steward
  • Develop knowledge of methods to reduce the risk of healthcare associated infections and how/when to use vaccines or other prophylactic measures
  • Increase medical microbiology knowledge

Transplant ID - UIHC/VAMC Solid Organ Transplantation and Hematopoetic Cell Transplant Serivce

One rotation will be spent on the ID Transplant service during year 2.  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.

Antimicrobial Stewardship

The goals of the year 1 rotation and year 2 elective are to give the fellows practical and scholarly training in Antimicrobial Stewardship

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.

 

General ID 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

Hepatology Clinic (limited number of assigned clinics)

Each fellow will have 5 to 6 half-day clinics during the second year of training.

Goals and Objectives

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

Establish an appropriate and logical work up of viral hepatitis
Understand risks and benefits of obtaining a liver biopsy
Understand the principles of and indications for anti-viral therapy in this patient population
Understand the drug interactions, toxicities, and mechanisms of action of anti-viral agents used for treatment of viral hepatitis
Demonstrate appropriate inpatient and outpatient follow up care for this patient population
Communicate effectively with the referring services, both verbally and in the medical record

Teaching Methods

A hepatology attending is present for each patient encounter, reviews the relevant history and treatment plans. Assessment, plans and encounter notes are reviewed.

Orthopedic Infectious Disease

Elective rotations will be available on the ID ortho service. 

Goals and Objectives

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

  • Establish an appropriate and logical work up of suspected infections in this population
  • Understand the unique biological environment created within the musculoskeletal system by implantation of foreign device, and its impact on emergence and persistence of infection in this patient population
  • Understand the medical and surgical indications for management of orthopedic infections
  • Understand the role of infection control measures in this patient population (screening for carriage of organisms commonly associated with wound infection (staph aureus) organisms, pre-surgical antibiotic prophylaxis, etc)
  • Demonstrate appropriate inpatient and outpatient follow up care for this patient population
  • Communicate effectively with the orthopedic surgery service, both verbally and in the medical record

Mix of Clinical Topics

There are on average about 5-10 inpatient and 4-8 scheduled outpatient consults per week from the orthopedic service.  The fellow is expected to attend at least 1 outpatient ortho-ID clinic per week while undertaking this rotation.

Travel Clinicl (limited number of assigned clinics)

Each fellow will have 4 to 6 half-day Travel clinics during the second year of training.

Goals and Objectives

To gain facility in counseling and providing vaccines and medications for patients traveling to international destinations.

Virology Clinic COC

Over 600 patients are provided HIV care in the University of Iowa Hospitals & Clinics Virology Clinic.  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:

  • Be comfortable with the evaluation of patients newly diagnosed with HIV/AIDS
  • Be comfortable initiating an ARV regimen, taking into account unique patient circumstances, and be familiar with adverse side-effects of the medications
  • Be familiar with risk factors, manifestations, diagnosis, treatment and prevention of opportunistic infections in HIV infected patients
  • Manage patients with HIV infection over years and provide preventive care for non-infectious complications of their infection.

Hospital Epidemiology

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

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

During the second year, the Clinical Microbiology one-month rotation is not required, unless the fellow did not participate during the first year.

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 rounds with the ID consult Team I.

Microbiology lecture block, monthly micro conference

Additional Opportunities

Allergy/Immunology Rotation (elective)

Pediatric Infectious Disease Rotation (elective) 

ID Week

Second meeting of fellow’s choice (During Year 2 depending on track)