Infectious Disease

Infectious Disease Competency-Based Curriculum

Educational Rationale

Because the practice of internal medicine requires a broad knowledge base of infectious disease (ID), acquiring fundamental skills in evaluating and managing patients in the causes of fever are critical. Developing expertise in evaluating patients with primary infections, such as pneumonia and urinary tract infections; secondary infectious processes, such as catheter related infections and ventilator associated pneumonia, etc; and immunocompromised patients is also important . Finally, it is important for the internist to know his/her role in the prevention of infectious diseases by the use of appropriate vaccinations and prophylactic medications.

Goals

A. Knowledge:

Upon completion of training, we expect our residents to understand the approach to and establish competence in the management of the following clinical presentations:

  • Cellulitis
  • Diarrhea
  • Dysuria
  • Facial or ear pain
  • Fever including fever in immunosuppressed patient
  • Hepatitis
  • Joint effusion
  • Lymphadenopathy, local and generalized
  • Meningitis
  • Prevention, public health concerns (immunizations, susceptibility and exposure, prophylactics)
  • Productive cough, pulmonary infiltrate
  • Rash (cellulitis, erythema, petechiae, purpura, tinea)
  • Red eye
  • Skin abscess and iulcers
  • Sore throat, painful swallowing
  • Vomiting
  • Bacteremia, SIRS, Sepsis and septic shock

B. Skills

  1. The resident should develop understanding of the following procedures: collection of culture specimens from throat, cervix, vagina, rectum, urethra and blood
  2. The resident should know the indications for ordering the following tests and understand the implications of the results:
    • Antibiotic sensitivity testing and serum levels
    • Cultures of tissues
    • Serology for infections (e.g. lyme disease, syphilis, etc.)
    • Plolymerase chain reaction, ELISA and Western blot for detection of infectious disease

C. Attitudes:

Upon completion of training, we expect our residents to appreciate those attitudes valued and nurtured by infectious disease physicians, including:

  1. Viewing medicine as humane science.
  2. Balancing art with science.
  3. Recognizing the limitations of technology and the value of clinical insight.
  4. Making difficult judgments when certainty is elusive.
  5. Understanding that testing, no matter how advanced or sophisticated, rarely substitutes for thorough, thoughtful evaluation by an informed clinician.
  6. Balancing intervention with patience.
  7. Recognizing limitations of our interventions.
  8. Appreciating the unique circumstances of caring for patients with infectious diseases.
  9. Learning the importance of functional considerations.

Through participating in the ID rotation, the resident will be able to appreciate prevention, diagnosis, investigation, and treatment of infectious disorders.

Educational Experiences

A. General

Residents will be responsible for seeing infectious diseases in-patient consultations and will also participate in the outpatient activities and practices of division staff/faculty.

B. Clinical Activities

1. Inpatient Experience (IP)

  1. Inpatient consultations are called to residents by faculty or their offices.
  2. The resident sees all consultations him/herself and verifies that the evaluation of the patient is complete by internal medicine standards.
  3. Consultations are presented on rounds to the consulting ID physician, at times to be mutually arranged. Usual practice is for the resident to join consulting physician for hospital rounds each morning and evening, as applicable.
  4. In each instance, the consultation is discussed with referring residents or attending physician, as applicable.
  5. It is expected that at the time of presentation to the consulting physician, the residents are totally familiar with the patient's problem(s), have read and reviewed pertinent literature, and are prepared to knowledgeably discuss the problem at hand.

2. Ambulatory Experience (AM)

  1. Outpatient activities for residents are conducted as arranged by their supervising attending
  2. Residents are expected to attend all sessions, outpatient activities, and practices.
  3. Patients are assigned in clinics and offices by the attending physicians. Every effort is made to select patients of "interest".
  4. Depending on numbers of individuals on the rotations and clinic/office loads attempts are made to permit residents to spend the first few experiences seeing patients together with attending physicians, so as to better introduce them to the patient evaluation.

3. Didactic Conferences (DC)

Numerous monthly conferences are held for the residents throughout the month. They cover a variety of topics in all the major medical subspecialties. Residents will be required to attend each of the conferences that do not conflict with their clinical duties

Evaluations

Assessment Methods (of Resident)

The evaluation methods that apply to these rotations include some or all of the following:

  • Evaluation of resident competence by faculty attendings (AE)- Formal formative evaluations should occur at the completion of the specific rotation. It is to be based on direct observation on rounds, at conferences, and at the bedside. All faculty members are encouraged to complete the form prior to the completion of the rotation and
    review their impressions directly with the resident. All completed evaluation forms are returned to the Program Director for review and placed in the resident's permanent file.
  • Mini CEXs may be used when warranted, particularly in the beginning of the academic year.
  • Self-evaluation by In-service training examination scores
  • MKSAP study plan (MKSAP)
  • Participation and presentations at didactic conferences (DC)
  • Multi Source evaluations by patients and staff (MS)

Assessment Method (of Program)

Residents have the ability to evaluate teaching faculty and experience at the end of each rotation. They are encouraged to use this opportunity to give constructive feedback.

Residents are encouraged to maintain a high level of communication with the Program Director and faculty. These informal meetings can be used to disseminate information, receive timely feedback, and for other purposes.

Annually, all residents are required to complete and return an evaluation form of the faculty and the program. Evaluations are collected in a fashion to assure the anonymity of the resident. The feedback received during informal meetings, formal meetings, and the semi-annual evaluation form will be used to make programmatic change.

Competency Based Goals & Objectives:

1) Medical Knowledge

Goals and Objectives-PGY1 Learning Activities* Assessment
Describe the epidemiology, genetics, natural history, clinical expression of related disorders encountered in the inpatient and outpatient setting. IP, AM, DC AE, DC, MKSAP
Describe function of the affected systems IP, AM, DC AE, DC, MKSAP
Describe the epidemiology, genetics, natural history, clinical expression of related disorders encountered in the inpatient and outpatient setting. IP, AM, DC AE, DC, MKSAP
Goals AND Objectives-PGY2/3 (In addition to above) Learning Activities* Assessment
Summarize an approach to the evaluation of common presentations in this specialty IP, AM, DC AE, DC, MKSAP
Interpret diagnostic tests used in the evaluation of in and outpatients with suspected related disease IP, AM, DC AE, DC, MKSAP
Demonstrate ability to critically appraise and cite literature pertinent to the evaluation of inpatients with related disorders. IP, AM, DC AE, DC, MKSAP

2) Patient Care

Goals and Objectives-PGY1 Learning Activities* Assessment
Effectively perform a comprehensive history and complete physical examination in patients with symptoms affecting this system IP, AM, DC AE, DC, MKSAP
Appropriately select and interpret laboratory, imaging, and pathologic studies used in the evaluation of disorders affecting this system IP, AM, DC AE, DC, MKSAP
Goals AND Objectives-PGY2/3 (In addition to above) Learning Activities* Assessment
Construct a comprehensive treatment plan and assess response to therapy. IP, AM, DC AE, DC, MKSAP
Counsel patients concerning their diagnosis, planned diagnostic testing and recommended therapies. IP, AM, DC AE, DC, MKSAP
Utilize validated instruments in the assessment of function and quality of life to monitor and adjust therapy. IP, AM, DC AE, DC, MKSAP

3) Practice-Based Learning and Improvement

Goals and Objectives-PGY1 Learning Activities* Assessment
Identify and acknowledge gaps in personal knowledge and skills in the care of hospitalized and ambulatory patients with related diseases IP, AM, DC AE, DC, MKSAP
Develop and implement strategies for filling gaps in knowledge and skills of patients related diseases IP, AM, DC AE, DC, MKSAP
Integrate and apply knowledge obtained from multiple sources to the care of inpatients and outpatients IP, AM, DC AE, DC, MKSAP
Demonstrate ability to critically assess the scientific literature IP, AM, DC AE, DC, MKSAP
Goals AND Objectives-PGY2/3 (In addition to above) Learning Activities* Assessment
Effectively use technology to manage information, support patient care decisions, and enhance both patient and physician education. IP, AM, DC AE, DC, MKSAP
Demonstrate ability to critically assess the scientific literature IP, AM, DC AE, DC, MKSAP
Set and assess individualized learning goals IP, AM, DC AE, DC, MKSAP
Analyze clinical experience and employ a systematic methodology for improvement IP, AM, DC AE, DC, MKSAP
Develop and maintain a willingness to learn from errors, and use errors to improve the system or processes of care IP, AM, DC AE, DC, MKSAP

4) Interpersonal Skills and Communication

Goals and Objectives-PGY1 Learning Activities* Assessment
Apply empathy in all patient encounters IP, AM, DC AE, DC, MKSAP
Demonstrate effective skills of listening and speaking with patients, families and other members of the health care team IP, AM, DC AE, DC, MKSAP
Present patient information concisely and clearly, verbally and in writing IP, AM, DC AE, DC, MKSAP
Goals AND Objectives-PGY2/3 (In addition to above) Learning Activities* Assessment
Reliably and accurately communicate the patient's and his/her family's views and concerns to the attending IP, AM, DC AE, DC, MKSAP
Compose clear and timely admission and progress notes and consultations IP, AM, DC AE, DC, MKSAP
Counsel patients, families and colleagues regarding side effects and appropriate use of specific medications, providing written documentation when appropriate IP, AM, DC AE, DC, MKSAP
Teach colleagues effectively IP, AM, DC AE, DC, MKSAP

5) Professionalism

Goals and Objectives-PGY1 Learning Activities* Assessment
Be prompt and prepared for all clinical duties IP, AM, DC AE, DC, MKSAP
Recognize the importance of patient primacy, patient privacy, patient autonomy, informed consent, and equitable respect and care to all IP, AM, DC AE, DC, MKSAP
Respect patients and their families, staff and colleagues IP, AM, DC AE, DC, MKSAP
Goals AND Objectives-PGY2/3 (In addition to above) Learning Activities* Assessment
Model ethical behavior by reporting back to the attending and referring providers any key clinical findings IP, AM, DC AE, DC, MKSAP
Demonstrate integrity IP, AM, DC AE, DC, MKSAP
Respond to phone calls and pages promptly IP, AM, DC AE, DC, MKSAP

6) Systems-Based Practice

Goals and Objectives-PGY1 Learning Activities* Assessment
Demonstrate effective collaboration with other health care providers, including nursing staff, ancillary staff, therapists, primary care physicians, and consultants in the care of patients with related diseases IP, AM, DC AE, DC, MKSAP
Develop an understanding of the hospital resources available to the evaluation and management of patients with problems encountered by the subspecialty. IP, AM, DC AE, DC, MKSAP
Demonstrate a knowledge of and commitment to the rules governing confidentiality of patient information. IP, AM, DC AE, DC, MKSAP
Goals AND Objectives-PGY2/3 (In addition to above) Learning Activities* Assessment
Discuss how the health care system affects the management of inpatients with related diseases. IP, AM, DC AE, DC, MKSAP
Determine cost-effectiveness of alternative proposed interventions. IP, AM, DC AE, DC, MKSAP
Design cost-effective plans based on knowledge of best practices IP, AM, DC AE, DC, MKSAP
Demonstrate awareness of the impact of diagnostic and therapeutic recommendations on the health care system, cost of the procedure, insurance coverage, and resources utilized IP, AM, DC AE, DC, MKSAP

Level of Supervision

Interns are supervised in their care of patients by more senior medical house staff (PGY- 2/3 and Chief Residents) and faculty.

PGY2/3 residents have direct and indirect supervision by Chief Resident and Faculty

Educational Resources

  1. Supervising clinicians-didactic and bedside rounds and concurrent patient care
  2. Medical literature including assessment of knowledge using the MKSAP
  3. Bedside rounds with team and faculty.
  4. Medical Grand Rounds weekly.
  5. Scheduled didactic conferences including: medicine morning report, journal club, ambulatory care conference, EBM conference
  6. Saint Barnabas Medical Center library, librarians, and online references/resources.

References

The Sanford guide to antimicrobial therapy, Sperryville, VA : Antimicrobial Therapy, ©2010.

Mandell, Douglas and Bennett's Principles and Practice of Infectious Disease (two
volumes) G. L. Mandell, J. E. Bennett & R. Dolin, Eds. Churchill Livingstone.

Morbidity and Mortality Weekly Report (MMWR)

www.CDC.gov

http://www.idsociety.org/IDSA_Practice_Guidelines/

Faculty

Weiner, Peter, MD, Education Coordinator
Diamond, Gigi, MD
Golubchik, Anneta, M.D.
Lin, Janet, M.D.
Miller, Lincoln, MD
Mouravskaia, Tatiana, MD
Smith, Stephen, MD
Stepanyuk, Olena, MD
Youssef-Bessler, Manal, MD