The inpatient clinical training experience includes opportunities to observe and manage adult and adolescent patients with a wide variety of infectious diseases on the University of Virginia Infectious Diseases Inpatient Consultation Service. Prior to participating in the care of hospitalized patients, trainees complete a one-month intensive course within The Clinical Microbiology Laboratory. The laboratory provides comprehensive microbiological diagnostic services for the inpatient and outpatient activities of the University of Virginia Health Sciences Center.
The Clinical Microbiology Laboratory
The staff includes approximately 20 full time technical staff and four faculty members with specific expertise, including laboratory director, Dr. Kevin Hazen (left). Professional technicians within each of the laboratory areas (Virology, Molecular Diagnostics, Mycology, Mycobacteriology, Bacteriology) provide detailed education for trainees in a review of colony/gram stain morphologies, molecular testing, and drug susceptibility testing for infectious pathogens. Time is allotted for more detailed study of areas of interest to trainees. Current areas of research and development with the laboratory include an assessment of molecular techniques for the diagnosis of fungal infections. While on the inpatient service, fellows are encouraged to attend Clinical Microbiology Rounds every weekday at 1pm. These rounds focus on the laboratory work-up of difficult pathogens and review of both microbiologic and clinical data to facilitate patient care.
Infectious Disease Inpatient Consultation Service
Fellows participate in the Infectious Disease Inpatient Consultation Service for a total of 6 months split between the second and third years of training. During this time, the fellow supervises the service, including up to three internal medicine residents and 2-4 fourth-year medical students. The fellow initially completes all inpatient consultations, and formal presentations are completed with the attending physicians, usually the following morning. This routine affords the trainee substantial initial input into the care of the patients and promotes independent thought. Inpatient attending rounds last on average 2 hours/day and include direct interaction of the fellow and attending with the patient, as well as demonstration and evaluation of the fellow's interview, physical exam, assessment and plan as well as ethical and professional behavior. Bedside teaching by the attending is included in these rounds daily. The fellow is expected to collect clinical information carefully and completely and present cases in a logical manner with an emphasis on recent, relevant literature to support decision-making. The fellow makes rounds with the attending physician 6 days per week, with at least one day off during every 7-day period (covered by the outpatient fellow), and fellows work no more than 80 hours per week allowing in compliance with recently adopted RRC requirements. All clinical duties are supervised by board-certified faculty, and faculty backup is present for periods of clinical overload.
Core Area Themes
Throughout their training, fellows will be expected to develop expertise in the prevention, evaluation, and management of infections encompassing “core” areas as defined by national standards for the training of specialists in infectious disease. These themes will be emphasized during their inpatient rotations:
- The febrile patient; specifically presenting in association with rash or as fever of unknown origin
- Upper respiratory tract infections
- Pleuropulmonary and bronchial infections
- Urinary tract infections
- Peritonitis and other intra-abdominal infections
- Cardiovascular infections
- Central nervous system infections
- Skin and soft tissue infections
- Infections related to trauma, including burns and animal and human bites
- Gastrointestinal infections and food poisoning
- Bone and joint infections
- Infections of the reproductive organs
- Sexually transmitted diseases
- Infections of the eye
- Viral hepatitides
- Sepsis syndromes
- HIV infection and acquired immunodeficiency syndrome
- in the immunocompromised or neutropenic host
- in patients with acute leukemia and lymphomas
- in transplant recipients
- in solid organ transplant recipients
- in geriatric patients
- in travelers
- in parenteral drug abusers
Fellows will also gain practical and instructional experience with the following:
- Mechanisms of action and adverse reactions of antimicrobial agents; the conduct of pharmacologic studies to determine absorption and excretion of antimicrobial agents; methods of determining antimicrobial activity of a drug; techniques to determine concentration of antimicrobial agents in the blood and other body fluids; the appropriate use the hospital, ambulatory practice, and the home
- The utility of procedures for specimen collection relevant to infectious disease, including bronchoscopy, thoracentesis, arthrocentesis, lumbar puncture, and aspiration of abscess cavities, including soft-tissue infections
- Principles and practice of hospital infection control
- Principles of chemoprophylaxis and immunoprophylaxis to enhance resistance
- Mechanisms of actions of biological products, including monoclonal antibodies, cytokines, interferons, interleukins, and colony-stimulating factors, and their applications in the treatments of infectious diseases
- Quality assurance and cost
containment in the clinical practice of infectious diseases.
Fellows have direct access to the clinical microbiology laboratories, including diagnostic bacteriology, immunology, mycology and virology. Facilities for the isolation of patients with infectious diseases are available in collaboration with the inpatient epidemiology staff.
Patients seen on this service are followed during the acute and recovery phases of their illnesses. When necessary, outpatient follow-up is provided in one of the outpatient infectious diseases clinics.