Infectious Diseases

I. Goals and Objectives:

A. Overview:

The elective in infectious diseases is designed to provide house officers with the knowledge and skills needed to diagnose and treat a wide variety of bacterial diseases, as well as fungal and viral illnesses. Patients are very diverse ethnically and socioeconomically, and are representative of the neighboring Montefiore communities.

Residents work in teams under the supervision of the infectious diseases fellow and attending. The attending physician is responsible for supervision of all patient care.

a) General Infectious Diseases (I.D.) elective: one block of 2-4 weeks (4 weeks preferred), with a 24/7 coverage by the consultation service. The elective is available to all Internal Medicine PGY-2’s and PGY-3’s. If a PGY-1 resident wishes to rotate, it is preferred that she or he be in the second half of the intern year

b) ICT (Immunocompromised Host and Transplant) I.D. elective: One block of 2-4 weeks, available for PGY-2 residents in the second half of their year and PGY-3 residents. It is recommended for residents who have already spent at least two weeks on the General I.D. service, or those with a particular interest in solid organ transplantation or hematological malignancies.

B. Level based Rotation Goals and Objectives:

PGY1:

- Patient Care: recognize the daily patient workload and prioritize; recognize the significance of a patient’s infectious conditions; differentiate the acuity level of illness, establish patient-focused care.

- Medical Knowledge: Use discussions during daily rounds; use literature and reference sources to increase knowledge base, to learn guidelines apply for patient management; acquire basic knowledge in the areas of underlying pathophysiology and the clinical aspects of infections.

- Professionalism: establish trust with critically ill patients with infections and their families; to participate in teamwork. Exhibit honesty, reliability, and responsibility in patient care; demonstrate respect for patients and staff; attend conferences.

- Interpersonal Skills: Learn to write understandable notes; listen to patients and staff and communicate; work effectively as a member of the health care team.

- Practice Based Learning and Improvement: Recognize limitations of knowledge; to use literature to improve practice patterns; accept feedback and change behavior; ask for help when needed; incorporate outcomes of patients with infections to improve outcomes in the future.

- System Based Practice: be an advocate for patients with infections; accept and try to apply necessary devised guidelines; develop understanding about the health care systems/structure and how it relates to patients with infections.

PGY2:

- Patient Care: Prioritize the daily “work”; recognize the relative significance

patient’s other medical conditions and their impact on the immune system; begin to recognize the acuity levels of illness; list the indications, contraindications and risks of drainage of abscesses and other invasive procedures required to make microbiologic diagnoses; work with all providers to provide patient focused care.

- Medical Knowledge: Use literature and reference sources to increase knowledge base in infectious diseases; demonstrate basic knowledge in the areas of underlying pathophysiology and the clinical aspects of infectious diseases states; apply knowledge in the treatment of patients.

- Professionalism: Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff; work to fulfill the needs of patients; accept assignments graciously; attend conferences.

- Interpersonal Skills: Write understandable notes and consultation reports; improve ability to listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.

- System Based Practice: be an advocate for patients with infections; accept and try to apply necessary devised guidelines; to develop understanding about the health care systems and structure and how they relates to patients with infections.

PGY3:

- Patient Care: Prioritize the daily work load of patients with infections and supervise the junior house staff appropriately; recognize the relative significance of a patients’ medical conditions and their impact on the immune system; recognize the acuity levels of illness; fully understand the indications, contraindications and risks of common and uncommon procedures; discuss risks/benefits native of patient’s with specialists.

- Medical Knowledge: Use literature and reference sources to increase knowledge base and share knowledge with junior house staff; demonstrate sophisticated knowledge in the areas of underlying pathophysiology an the clinical aspects of simple and complicated disease states; apply knowledge in the treatment of patients.

- Professionalism: Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff and junior house staff who you are supervising; work with team to fulfill the needs of patients; lead health care team in patient care; understand limitations and ask supervisors for help when indicated; accept assignments graciously; attend conferences.

- Practice Based Learning and Improvement: Recognize limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of patients with infections and alter practice patterns to improve outcomes in the future; aid junior house staff in evaluating their practice patterns.

- System Based Practice: Advocate for patients; develop a sophisticated understanding about the health care system/structure and develop mechanisms to utilize ancillary services to benefit patients.

II. Areas Covered During The Infectious Diseases Elective

1) Principles, physiology and basic sciences.

2) Practical skills unique to infectious diseases, including but not limited to: fever workup, examination of wounds and intravascular catheters, interpretation of Gram stains, interpretations of antibiograms, interpretation of drug levels.

3) Approach to presenting complaints and problems.

4) Specific diagnosis in infectious diseases: including recommendation of proper culture techniques to allow the microbiology laboratories to isolate the infecting micro-organisms, and recommendation of correct specific diagnostic tests

5) Treatment modalities: rational use of antimicrobial agents and non-pharmacologic means of treatment such as wound care.

6) Technical skills, such as handwashing, sterile techniques, and changing dressings.

7) Emergencies, such as recognition of acute bacterial meningitis.

8) Ability to access, interpret, and apply guidelines for the diagnosis and treatment of frequently-encountered infections

9) ICT ID elective: Understanding how the nature and degree of immunosuppression changes the infectious differential diagnosis; learning the interactions of antibiotics with immunosuppressive drugs

III. Schedule of Activities

1) Attending Rounds Monday to Friday, every afternoon

2) I.D. Grand Rounds Wednesday 8:30 to 10:00 A.M.

3) I.D. Core Curriculum Lectures Wednesday 7:30 to 8:30 A.M.

4) Research/Basic Science Seminar Wednesdays 8:30 to 10:00 AM

5) Journal Club occasional Wednesdays 9:00 to 10:00 A.M.

6) M&M case presentations occasional Wednesdays 9:00 to 10:00 A.M.

7) Medical Grand Rounds Thursday (8-9 AM Weiler, 12:00-1:15 PM Moses)

IV. References

Before beginning the rotation, residents should be aware that the majority of diagnosis and management questions can be answered by referring to the Practice Guidelines from the Infectious Diseases Society of America. These guidelines are available at

http://www.idsociety.org/IDSA_Practice_Guidelines/

V. Methods of Teaching Competency Assessment

The house officers are evaluated continuously during their two -four weeks of service in the infectious diseases elective with continuous feedback to the house officers. The final evaluation is completed through www.new-innov.com and the results are discussed in a meeting with the house officers, who are evaluated in their overall clinical competence with the following categories: clinical judgment, medical knowledge, clinical skills, humanistic qualities, professionalism, patient care and ability to incorporate feedback and improve.