Infectious Diseases Fellowship Curriculum

We have six dedicated inpatient services, five at OSUWMC and one at East Hospital. At OSUWMC there are three general infectious diseases services (Teams 1, 2, and Overflow), the Solid Organ Transplant Service (SOT) and the James Cancer Oncology ID Service (James).

Your first year of fellowship will consist of 34 weeks of inpatient service: 22 weeks will be on the general service (Team 1 or 2), 6 weeks on SOT, and 6 weeks on the James. You will complete five months of inpatient service your second year, which will be tailored to your chosen subspecialty track.

Your second year of fellowship will consist of 22 weeks of inpatient service, and the service rotations will be tailored to your clinical interest/subspecialty track.

Each inpatient service has a dedicated ID Pharmacist, as well as medical residents, pharmacy residents, and medical/pharmacy students, providing fellows with ample opportunity for teaching.

Outpatient clinic consists of a half-day of clinic a week dedicated to the continuity care of General ID and HIV patients at our McCampbell Hall Infectious Diseases Clinic, conveniently located on the OSUWMC campus. Fellows who choose a subspecialty track are expected to participate in additional clinics related to their track, working closely with ID faculty specialists.

Other outpatient opportunities include a dedicated HIV/Dermatology Clinic and the STI and TB Clinics at the Columbus Public Health Department. Depending on your interests, there are opportunities to go to Nationwide Children’s Hospital for FACES (Family AIDS Clinic and Educational Services Program, Central Ohio’s primary pediatric and family HIV clinic), and the SOT/James clinics.

Hospital Epidemiology

A month long rotation in your second year of fellowship is designed to introduce the fellow to infection prevention and hospital epidemiology. Clinical Epidemiology conducts and reports surveillance on healthcare acquired infections (HAIs) including Central Line Associated Bloodstream Infections (CLA-BSIs), Ventilator Associated Pneumonias (VAPs), Surgical Site Infections (SSIs), Catheter Associated Urinary Tract Infections (CAUTIs), MRSA, VRE, C. difficile, influenza and other organisms of epidemiologic importance. During this rotation, you will work closely with the Clinical Epidemiology team which is comprised of four infectious diseases physicians, multiple infection preventionists, and an administrative director. You will have the opportunity to choose a QI project and upon completion present to the ID division.

Antimicrobial Stewardship

This month long rotation will take place in the second year of your fellowship, and is designed to introduce fellows to the operations of antimicrobial stewardship. The ASP team is comprised of specialty practice pharmacists, epidemiologists, and attending infectious diseases physicians. In addition to the day to day responsibilities of being a key member of the ASP team, you will have the opportunity to conduct a QI project and upon completion, present it to the ID division.

Microbiology

During the month of July in your first year of fellowship, you will spend one month learning at the microbiology/immunology lab at OSUWMC East Hospital. During this time you will familiarize yourself with the microbiology lab and work within various stations of the microbiology lab. This rotation is designed to provide you with essential knowledge of microbiologic and immunologic diagnostics necessary for success as an infectious diseases consultant. Fellows will work closely with our two microbiology laboratory directors, as well as with OSWUMC pathology residents. Fellows will continue to rotate once-weekly in the microbiology laboratory when they are not on inpatient service, in order to maintain and enhance their knowledge, as well as have the opportunity to discuss challenging cases with the microbiology/pathology faculty.

Second year fellows interested in immunocompromised patients, will have the opportunity to spend more time in the James Cancer Center, a NCI Designated Comprehensive Cancer Center, which performs over 300 stem cell transplants per year, as well as care for patients at the Comprehensive Transplant Center, the seventh busiest solid organ transplant center in the United States by volume. Our fellows will have a diverse exposure to patients with acute leukemia, lymphoma, multiple myeloma, solid tumors, and patients undergoing stem cell transplantation. They will also become experts in diagnosing and managing infections in patients undergoing mechanical circulatory support therapies, kidney, liver, pancreas, heart, and lung transplantation. During their clinical rotations, they will learn about prevention and management of infections in immunocompromised hosts and explore the effects of novel immunotherapy and chemotherapeutics agents. Fellows are encouraged to participate in multidisciplinary clinical research projects involving immunocompromised patients. In addition, our fellows will have the opportunity to be engaged in hospital epidemiology and antibiotic stewardship activities in this setting.

Second year fellows interested in the HIV subspecialty track will receive additional training and acquire expertise in all aspects of HIV care. A specific curriculum will be developed by the HIV track director based on the fellow’s specific interests. Fellows will be expected to complete an HIV research project by the end of the fellowship under the mentorship of our HIV faculty. During off-service blocks, fellows will add a second half-day HIV clinic to their regular continuity clinic precepted by one our of HIV expert faculty. To be exposed to the broadest spectrum of populations affected by HIV, HIV subspecialty track fellows will rotate through various HIV clinics including the Nationwide Children’s Family AIDS Clinic and Education Services (FACES) clinic and the Equitas Health clinic in addition to the OSU ID clinic. Fellows will also be expected to present at journal club on HIV-related articles. Fellows will also participate as sub-investigators in HIV clinical trials at our AIDS Clinical Trials Unit and will attend regular ACTU staff meetings. As part of their training to provide HIV education, HIV subspecialty track fellows will be expected to attend Community Advisory Board meetings and present on various topics of interest to the HIV community 3 times during the year. They will also be expected to present an update to the division and to the community on research presented at recent major HIV scientific conferences.

The goal of this track is to expose and teach the fellow the knowledge necessary to be a successful leader and expert in infection prevention and hospital epidemiology. This not only entails learning about tracking and preventing specific hospital acquired infections, as defined by the CDC, but also how to develop interpersonal and leadership skills in order to positively interact with administrators, physicians, facilities personnel, clinical staff and public health officials. The fellow will learn how to construct health system wide protocols, respond to potentially infectious exposures, conduct outbreak investigations, investigate new products, learn about facility systems (ie. water and airflow management) and implement quality improvement projects. The fellow will learn the essential elements needed to create a safe environment for patients, visitors and staff with particular attention to special clinical populations that need additional resources (e.g. Bone Marrow and Solid Tumor Transplant patients, surgical patients, dialysis patients, etc). Specific projects include novel pathogen preparedness, prevention of hospital acquired infections (C diff, CLABSI, CAUTI), COVID-19 response, new construction issues, hand hygiene, and surveillance of multi-drug resistant organisms. . A more detailed description of the subspecialty track can be found in this article (DOI: https://doi.org/10.1017/ash.2022.38).

The Antimicrobial Stewardship (ASP) track is designed for 2nd year fellows interested in more in depth training in antimicrobial stewardship for those planning for active involvement in antimicrobial stewardship as part of their future career path. Fellows on this track will be expected to continue to participate actively with ASP, including additional months as an ASP fellow, attendance at weekly ASP operations meetings and monthly Antibiotic Subcommittee meetings, development of their fellow research project within ASP initiatives, and actively assisting on targeted ASP interventions. The focus of ASP currently includes developing strategies to improve provider antibiotic selection and prescribing, education of health care teams and patients, development and updating of clinical treatment guidance, transitions of care and outpatient parenteral therapy (OPAT), and surveillance of antimicrobial utilization and antimicrobial resistance (AMR) patterns. The fellow will interact closely with ASP physicians and pharmacists with experience with administration and operations of ASP. The fellow can expect to learn in depth about the epidemiology of AMR pathogens and strategies to manage difficult AMR cases. They will also engage in advanced education on antimicrobial agents, dosing, PK-PD principles and prevention of adverse drug events.

The mission of the clinician educator track is to expand the pipeline of expert infectious diseases educators and thereby instill interest in and appreciation of the value of the field of infectious diseases. Within the infectious diseases fellowship, this is accomplished by provision of dedicated opportunities in a variety of educational settings to develop and enhance skills in medical education and through ongoing mentorship and feedback. Recognizing that medical education spans from pre-clinical medical students all the way to continuing medical education for practicing clinicians with years of experience, this track offers a range of education opportunities that may be tailored to a fellow’s specific educational interests. Resources to enhance and expand educator skills will be utilized (e.g., OSUMC Faculty Development for Medical Educators modules, external symposia/courses). Formative feedback will be provided throughout the process and the track will culminate with creation of a teaching portfolio chronicling the fellow’s growth and expertise as an educator. Additionally, for interested fellows, there are opportunities to pursue a structure scholarly intervention/research project with educational focus.