CLINICAL TRAINING for fellows (as discussed separately below) occurs via:
- Inpatient ID consult services (6 services, at 4 hospitals)
- Outpatient clinics
- Clinical conferences
- Fellows' symposia (core conferences)
- HIV Fellows' Forum
- Clinical microbiology laboratories
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Clinical Training
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Inpatient Care of hospitalized patients occurs on the ID consult services at four excellent teaching hospitals and occupies much of the first year of fellowship, with some extension into year two. The four hospitals include:
- a large university medical center
- a busy metropolitan county hospital
- a modern Veterans Affairs medical center
- a large private tertiary referral hospital
-The University hospital serves many immunocompromised patients (including solid organ and bone marrow transplant recipients). It has separate consult services for general ID, transplant ID, and pediatric ID.
-The county hospital, a major trauma and burn center, serves acutely ill inner-city residents and a large immigrant population from Africa, Asia, and Latin America.
-The VA serves patients with acute and chronic infectious complications of aging, surgery, diabetes, and cancer.
-The private hospital serves a diverse community-based population with both common and esoteric infectious diseases problems.
This broad spectrum of patients and their varied array of infectious diseases provide our fellows with an extensive exposure to diverse viral, bacterial, mycobacterial, fungal, and parasitic infections and their management.
Outpatient Care of patients with chronic infections is an important component of the fellowship. Three types of ambulatory care experiences are provided.
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(1)
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Beginning in the first month of fellowship, fellows develop their own supervised weekly continuity clinic for the primary care of a group of HIV-infected patients. The long-term care of these patients, and the accompanying personal relationships, interactions with support systems and allied health care providers, and first-hand observation of the natural history of HIV disease, allow fellows to develop a mature approach to patient care, particularly for this challenging group of patients.
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(2)
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Each hospital inpatient rotation includes a weekly ID clinic, in which patients with osteomyelitis or endocarditis on home intravenous therapy, chronic fungal infections, mycobacterial disease, Lyme disease, positive tuberculin tests, and travel medicine-related issues are seen.
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(3)
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The first-year fellows also have a month-long ambulatory rotation to round out their ambulatory care training. This rotation includes experiences in an International Clinic, several public and private HIV clinics, a county TB clinic, a private hepatitis C clinic, a pediatric ID clinic, and a sexually-transmitted disease clinic.
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Fellows' symposia (core lectures)(alternating Wednesday mornings) provide an in-depth interactive exchange with a designated faculty member regarding a specific core clinical topic. An extension of this lecture series is the HIV Fellows' Forum, a monthly dinner symposium during which fellows discuss topics in basic and advanced HIV/AIDS care with expert AIDS clinical faculty members.
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Clinical Conferences
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ID Clinical Conferences are held Tuesday mornings at the VA Medical Center. Attendees include ID faculty, fellows, residents, and students on the ID consult services from all 4 teaching hospitals, plus clinical microbiologists, infection control practitioners, private ID physicians from the community, and representatives from the Minnesota Department of Health.
Presentation are given in rotation by the 4 teaching hospitals, senior ID fellows, residents on the ID services, and the Department of Health's Emerging Infections program.
The county hospital also has its own ID Conference and international medicine conference, and each teaching hospital has a regular medicine grand rounds and clinical-pathological or morbidity and mortality conference, at which infectious diseases topics feature prominently.
Clinical Microbiology training, including hands-on experience in hospital clinical microbiology laboratories, is provided during a one-month rotation early in the first year of fellowship. In addition, during inpatient consult months, ID fellows participate regularly in “plate rounds” in each hospital’s clinical microbiology laboratory. These rounds include demonstrations, didactic sessions, and review of clinical test results. Instructional CDs and training sets of Gram-stained smears are available for self-study.
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