CLINICAL TRAINING

Inpatient
During the first  year of training in our fellowship program, fellows spend approximately 8 months of the year in the inpatient setting performing consultations regarding the evaluation and management of patients with infectious diseases (ID) conditions.  Approximately 6 months of inpatient service is provided at Boston Children’s Hospital, where the inpatient consult service is divided into the General ID consult service and the Immunocompromised Hosts (ICH) ID consult service.   In addition, first-year fellows spend 1 month with the Adult General ID inpatient consult service at Beth Israel Deaconess Medical Center and a half-month with the Pediatric ID service at Boston Medical Center.  Through these clinical experiences, fellows develop skills in the diagnosis and management of a wide range of ID problems, including  surgical infections; infections in the setting of cancer, bone marrow transplant or solid organ transplant; infections in neonates; fever of unknown origin; infections in cystic fibrosis; infections caused by drug-resistant organisms; central nervous system infections; skin and soft tissue infections; musculoskeletal infections; cardiovascular infections; device-associated infections; and sexually transmitted infections. Clinical training is supervised by BCH ID faculty or by faculty at the institutions at which outside rotations take place.  First-year fellows take night call from home and weekend call approximately every third or fourth week.During the secondand third years of training, fellows continue to refine their clinical consultation skills through experiences with the inpatient consult services, but this experience is significantly limited to allow at least 80% protected time for research activities.  Home and weekend call during the second and third years of training is also restricted to 3-4 weeks per year.

Outpatient
During the first year, fellows also receive experience in caring for patients in the  outpatient clinical setting by following patients who require outpatient ID follow-up, including for Outpatient Parenteral Antimicrobial Therapy (OPAT), after being cared for by the inpatient ID service. Fellows gain skills in effective transitions of care from the inpatient to outpatient settings, as well as toxicity monitoring and assessment of therapeutic response during treatment with antimicrobial agents.  Fellows in ID Clinic are supervised by BCH ID faculty who are experienced in the routine care of outpatients within our hospital system.During the second and third years, fellows continue to see patients in ID Clinic if there are any inpatient follow-up needs from their inpatient consult service experiences.  In addition, fellows also have the opportunity to see new patients in the following clinics:

• General ID Clinic – cases are primarily comprised of referrals from hospital and community providers for common ID conditions, such as community-acquired MRSA infections, Lyme disease and other tick-borne infections, persistent or recurrent fever, recurrent HSV episodes, recurrent pharyngitis, frequent infections, and others.
• ICH ID Clinic – cases include pre-transplant ID evaluations, post-transplant ID follow-up and management of infections, management of infections in patients with any immunocompromising condition, and immunocompromised OPAT patients.
• Perinatal Diagnostics Clinic – cases include infants with congenital infections and those born to HIV-infected mothers.
• Travel Clinic
• HIV Care Clinic

Other Experiences for First-Year Fellows

Direct patient care experiences during the first year are complemented by other clinical experiences: 

• Fellows receive 1 month of formal training in clinical microbiology and virology in our hospital’s diagnostic microbiology laboratory under the supervision of our microbiology lab directors.   
• Fellows also receive a half-month of formal training in infection control and prevention, as well as antimicrobial stewardship. 

In addition, several research planning blocks during the first year provide time for fellows to meet with prospective mentors and develop a research project for their subsequent years of fellowship.

CONFERENCES AND OTHER CURRICULAR EXPERIENCES

Conferences

Fellows participate in several division conferences and interactive lecture series, as well as joint conferences that include faculty and fellows from other Harvard-affiliated ID training programs.

Division Conferences:

• PID Case Conference
• Journal Club
• PID Research Conference
• Microbiology Plate Rounds
• PID Fellows Core Lecture Series (aimed toward first-year fellows)
• PID Fellows Longitudinal Curriculum Series (aimed toward second- and third-year fellows)

Harvard-Wide Conferences

• Harvard-Wide Joint ID Case Conference
• Immunocompromised ID Case Conference
• ID Fellows Core Lecture Series
• HIV Core Lecture Series

Other Curricular Experiences and Conferences

Fellows are required and supported by the division to attend other conferences and curricular experiences as a part of their training in our program:

• Curriculum for Academic and Professional Success – local; provides education in ABP core curriculum topics including teaching and leadership, career development, academic productivity, quality improvement, research ethics, professionalism and humanism
• Introduction to Clinical Research Course – local
• Sylvie Ratelle STD/HIV Prevention Training Center of New England Advanced STD Intensive Course – regional/national
• Pediatric ID Society (PIDS)/St. Jude Children’s Research Center Fellows Research Conference – national
• PIDS Pediatric Transplant ID Training Course – national
• Intensive Pediatric HIV Course – national

TEACHING

Medical students and residents rotate frequently on our inpatient ID consult services, creating ample opportunity for teaching by our fellows.  In addition, fellows lead teaching sessions several times per year for their co-fellows, division faculty, and Harvard-wide faculty and fellows.  Fellows also have the opportunity to lead conferences and teaching sessions for pediatrics residents and medical students at BCH.