Infectious Disease (Hybrid)

This rotation is a one to four week structured clinical experience under direct supervision designed to provide the resident experience diagnosing, treating and caring for patients with infectious diseases. During this rotation, residents will rotate through a variety of infectious diseases clinics and related services during the outpatient segment. Residents will also spend time on one of the inpatient consult services. There are multiple educational opportunities throughout this block, listed in the schedule below.

Subspecialty Consults/Clinics expectations

Mandatory Wednesday Conference

Mandatory Wednesday Conference

The Division of Infectious Diseases has resumed weekly resident educational conferences on Wednesdays from 8 am - 9 am:

Conferences are currently being hosted on Microsoft Teams. You will receive an invitation at the beginning of your week on ID hybrid with the link to the virtual meeting room.
Please contact your fellow or Dr. Govind ( ) if you have not yet received the link for the weekly conference.
This lecture is mandatory while on your infectious disease hybrid.
You are excused from morning report on days these conferences are being hosted.
Please contact the chief residents if you are having difficulty making this conference.

Parkland ID Consults (General)

Parkland ID Consults

Location: 9-677(far side)
Hours: 8 AM to 5 PM. Monday through Friday. No overnight call/ weekends
1-2 residents will be assigned to this week at any given time
Team Composition: Attending staff, infectious disease fellow, 1-2 residents, PharmD, 1-3 students.
Expectations

Parkland HIV Consults

Location: New Parkland Hospital (NPH), 5-677 (5th floor, 600 far side). Please page the on-call fellow through PHHS web-on-call the day before to confirm the timing of rounds and in case you get lost finding the room.
Hours: 8 AM to 5 PM. Monday through Friday. No overnight call/ weekends
1-2 residents will be assigned to this week at any given time
Team Composition: Attending staff, infectious disease fellow, 1-2 residents, APP (NP or PA)
Expectations

CUH ID Consults (General)

CUH General ID Consults

Location: CUH 7th floor (orange tower), room 7.1517. Please page the on-call fellow through UT web-on-call the day before to confirm timing of rounds.
Hours: 8 AM to 5 PM. Monday through Friday. No overnight call/ weekends
1 to 2 residents will be assigned to this week at any given time
Team Composition: Attending staff, infectious disease fellow, 1-2 residents, PA, PharmD, 1-3 students.
Expectations

VA ID Consults

Location: ID suite in good old VA hospital (brick building 3rd floor near library (3C-423).
Contact: Dr. Ruben Arasaratnam
Please page the on-call fellow or attending when you arrive.
Please make sure that your VA computer privileges haven’t expired – check 1-2 weeks PRIOR to rotation
Hours: Consults are combined with various VA ID Clinics:
- Consults:
  - Monday & Tuesday: 8 AM to 5 PM.
  - Wednesday: 8 AM to 12 PM
  - Thursday: 1 PM to 5 PM
  - Friday: 8 AM to 12 PM
- VA ID Clinic (while on Consult Ribbon):
  - Wednesday: 1 PM to 5 PM
  - Thursday: 8 AM to 12 PM
  - Friday: 1 PM to 5 PM
1 resident will be assigned to this week at any given time (though others may also be on a clinic ribbon without consults)
Team Composition: 1 Attending, 1General infectious disease fellow, 1 Covid and Stewardship fellow, 1 resident, 1 PharmD, 1-3 students (PA or MS)

Inpatient Consults Goals and Objectives

Develop an understanding of the infectious diseases seen in hospitalized patients: PGY-1: Understand the basic principles of assessing and managing common presentations of infectious diseases in hospitalized patients; PGY-2: Understand the principles of assessing and managing both common and complex presentations of infectious diseases in hospitalized patients.; PGY-3: Develop advanced processes to recognize and treat complications of infectious diseases in hospitalized patients and in patients with multiple medical problems; Competency: Patient care, Medical knowledge
Developing diagnosis skills: PGY-1: Learn how to effectively use bedside clinical examination in patients with common infectious diseases; PGY-2: Effectively use the bedside clinical examination and demonstrate subtle clinical findings in patients with infectious diseases; PGY-3: Learn how to correlate bedside clinical findings with imaging and other data in patients with infectious diseases; Competency: Patient care, Medical knowledge
Understand the differential diagnosis of common infectious diseases: PGY-1: Develop a basic differential diagnosis for common clinical scenarios in patients with suspected infectious diseases.; PGY-2: Develop a differential diagnosis for common clinical scenarios in patients with infectious diseases; PGY-3: Recognize unusual presentations of common clinical situations in patients with infectious diseases; Competency: Medical knowledge
Learn pharmacological management of common infectious diseases: PGY-1: Learn the common medications utilized for the management of infectious diseases.; PGY-2: Learn the medications used in management of infectious diseases, understand how to manage complicated clinical problems, and develop specific therapeutic strategies in patients with infectious diseases; PGY-3: Learn how to develop personalized care plans for patients with infectious diseases and intersecting clinical problems; Competency: Medical knowledge
Effectively consult on inpatients, develop, and execute assessment and management plans.: PGY-1: Learn to manage ID patients on a daily basis including a daily assessment and determining progress in clinical problems.; PGY-2: Understand how to adjust patient treatment plans based on patient progress and determine the need for additional assistance such as subspecialty consultation; PGY-3: Recognize how to manage complex infectious diseases and manage both expected and unexpected complications.; Competency: Patient care
Interdisciplinary care and discharge planning: PGY-1: Learn how to communicate effectively with the interdisciplinary care team and anticipate patient needs for discharge and effective follow-up; PGY-2: Recognize the unique needs of infectious disease patients and help integrate patient needs with available resources; PGY-3: Learn how to manage advanced situations such as end-of-life decisions, complex transitions of care and advocate for patients when resources are limited; Competency: Patient care, System-based practice
Rational ordering of lab tests and imaging studies: PGY-1: Learn the indications for basic laboratory investigations and imaging in patients with infectious diseases; PGY-2: Learn how to interpret laboratory findings and imaging seen in patients with infectious diseases; PGY-3: Gain advanced knowledge of high value principles in the ordering of laboratory studies and imaging for evaluation of infectious diseases; Competency: Practice-based learning and improvement, Medical knowledge
Familiarity with the electronic health record and optimization of its use: PGY-1: Develop a basic understanding of The EHR and its core components and how it can be used to care for patients with renal disease; PGY-2: Understand how to effectively use the electronic health record in the care of patients with infectious diseases; PGY-3: Develop an understanding of advanced medical informatics in the care of patients with infectious diseases by utilizing additional resources in the EHR; Competency: Systems-based practice
Communication and teamwork: PGY-1: Recognize the core members of the patient care team involved in care of patients with infectious diseases, to include nurses, patient technicians, pharmacists, case managers, social workers, and hospital administration personnel; PGY-2: Develop effective and timely communication strategies with the interdisciplinary care team for patients with infectious diseases; PGY-3: Use advanced communication methods to engage and coordinate care with the interdisciplinary care team for patients with infectious diseases; Competency: Professionalism, Interpersonal and communication skills

Learning Objectives

Increase working knowledge of common infectious diseases and understand specific treatment strategies, with a focus on clinical manifestations of various organisms, microbiological/immunological testing, antibiotic regimens, and evidence-based practice, in accordance with current guidelines. Conditions that may be seen include (but are not limited to) HIV/AIDS associated conditions, tuberculosis, nosocomial infections, fungal infections, parasitic diseases, viral diseases, multi-drug resistant organisms.
Become familiar with the diagnosis and management of patients with HIV or AIDS. Understand the management of HIV/AIDS associated conditions, including cryptococcal meningitis, progressive multifocal leukoencephalopathy, Kaposi’s sarcoma, CMV colitis, and immune reconstitution syndrome. Understand the principles and side effects of HAART therapy.
Develop skills in interpretation of culture results while understanding the concept of MIC, breakpoint, resistance mechanisms.
Understand principles of management of various nosocomial infections in ICU patients as well as those status post orthopedic, urologic, or surgical procedures.
Become familiar with the work-up of fever of unknown origin.
Become familiar with the diagnosis and treatment of chronic infections, such as osteomyelitis and endocarditis
Become familiar with the principles of antimicrobial stewardship and how to implement them in daily practice.
Increase working knowledge of infectious complications and management of patients who are immunosuppressed secondary to history of solid and/or liquid organ transplantation.

General Expectations for ID Consult Rotations (All Sites)

VA General Infectious Diseases Rotation Expectations

Infectious Disease Resources

Outpatient Clinic Goals and Objectives

Assess acute and chronic infectious diseases in the outpatient setting: PGY-1: Learn the initial assessment of acute and chronic infectious diseases in the outpatient setting; PGY-2: Learn to assess acute and chronic infectious diseases and develop an advanced understanding of these disorders in the outpatient setting; PGY-3: Understand the intersections between acute and chronic infectious diseases and subtle variations in presentation; Competency: Patient care
Understand the principles of chronic infectious disease management: PGY-1: Learn the principles of chronic infectious disease management including the development of problem lists and preventive care principles; PGY-2: Understand the factors that create competing priorities with chronic infectious diseases. Understand the pharmacological management of chronic infectious diseases; PGY-3: Develop and utilize advanced care processes including consultation and interdisciplinary management of chronic infectious diseases; Competency: Patient care
Learn pharmacological management of common infectious diseases: PGY-1: Learn the common medications utilized for the management of infectious diseases; PGY-2: Understand the medications used for infectious diseases and how to manage complicated health problems and develop specific therapeutic strategies; PGY-3: Learn how to develop personalized care plans for infectious disease patients with intersecting clinical problems; Competency: Medical knowledge
Understand the differential diagnosis of common clinical infectious disease scenarios: PGY-1: Develop a basic differential diagnosis for common ID clinical scenarios; PGY-2: Develop an expanded differential diagnosis for common infectious disease clinical scenarios; PGY-3: Recognize unusual presentations of common infectious disease clinical situations; Competency: Medical knowledge
Develop and utilize patient dashboards to engage in population management: PGY-1: Learn how to interpret infectious disease patient dashboards in the EHR; PGY-2: Identify noncompliance or patients who are outliers in the patient dashboards; PGY-3: Develop advanced care plans with the interdisciplinary care team to manage infectious disease patients not meeting parameters in the patient dashboards; Competency: Systems-based practice, Practice based learning and improvement
Understand the unique outpatient needs of patients with infectious diseases: PGY-1: Recognize the unique outpatient needs of infectious disease patients; PGY-2: Recognize and understand the outpatient needs and community resources available to infectious disease patients; PGY-3: Learn how to work with an interdisciplinary care team to optimize the availability and utilization of community resources available to infectious disease patients; Competency: Patient care and systems-based practice