Patient Care

Fellows must be able to provide patient care this is compassionate, appropriate, and effective for the treatment of health problems and promotion of health.

• Integrative Care: Able to integrate clinical/diagnostic information with up-to-date scientific knowledge and clinical judgment in order to develop and carry-out a diagnostic and/or management plan.
• Fellows are expected to learn the practice of health promotion, disease prevention, diagnosis, care, and treatment of men and women from adolescence to old age, during health and all stages of illness.

Ambulatory Care

• Fellows will demonstrate the ability to elicit an orderly, thorough history and physical examination pertinent to the HIV infected individual and together with laboratory and radiographic data be able to provide a list of the major HIV-associated complications of a given organ system including but not limited to: central nervous system, integument, respiratory tract, gastrointestinal tract, cardiovascular, renal, and endocrine systems.
• Identify risk factors and perform appropriate laboratory studies in individuals with possible HIV Infection.
• Provide regular longitudinal follow-up of HIV infected patients with attention to adherence, drug toxicities and status of immune competence.
• Anticipate opportunistic events such as infections and neoplasms in HIV infected patients with deteriorating immune status.
• Provide appropriate routine vaccines and immunizations, routine mammograms, and pelvic exams o f HIV infected patients.
• Handle psychosocial, family and economic issues of ambulatory care patients and to interact with social workers and psychologists to solve problems related to non-medical areas including pain management, mental health and addiction services, nutritional support, rehabilitative services, hospice, home care, social work, case management, community based services, epidemiology and public health, and pastoral services.
• Learn about anti-retroviral drug resistance, newer anti-retroviral drugs and appropriate use of such drugs alone or in combination.
• The fellow will discuss and justify the role of clinical trials in the development of the care and management of HIV infected persons.
• The fellow will be able to verbalize increased awareness of the lifestyles, cultural and psychosocial-emotional issues involved in the care of HIV infected person.
• The fellow will be willing to discuss and manage the dying process with imminently terminal patients when appropriate.
• Become competent in the care of patients who are referred to our clinics with infection-related (other than HIV) issues.  Examples of such infections include osteomyelitis, endocarditis, fungal and mycobacterial infections, sexually transmitted diseases, infections related to trauma, infections in travelers and infections in compromised hosts.
• Continue to gain experience in the care of HIV infected patients with minimal faculty supervision.
• Make complex decisions regarding anti-retroviral therapy based upon drug resistant patterns, adverse effects and patient adherence to therapy.
• Teach medical students, medical residents, nurse practitioners and nurses regarding HIV infection and its management including prevention practices.
• Communicate effectively with HIV Infected Patients and their caregivers regarding adherence, safe sex practices etc.
• Function independently as a capable and competent primary care provider for HIV infected patients.
• The fellow will accept responsibility for the care of HIV infected people in their future practice.
• Function independently as a capable and competent ID consultant for patients with non-HIV related infectious diseases.

BMT/Cancer Rotation

• Appreciate the technical aspects of transplant procedure.
• Appreciate the variation in depth of immunosuppression among transplant recipients, and cancer patients.
• Gain knowledge or drugs used for prevention of graft rejection and graft versus host disease in stem cell recipients.
• Acquire knowledge of risk factors, differential diagnoses, and complex management aspects of common and opportunistic infections in patients undergoing stem cell transplantation or in patient with hematological or oncological diseases.
• Render comprehensive infectious diseases consultations (written and verbal) on infection related issues among stem cell transplant recipients and patients with underlying hematological or oncological disorders.
• Establish a good rapport between the ID consult team and the consulting transplantation and cancer team.

Henry Ford Hospital Solid Organ Transplant

• Appreciate the technical aspects of transplant procedures.
• Gain knowledge of drugs used for immunosuppression in transplant recipients.
• Appreciate variation in the depth of underlying immunosuppression among transplant recipients and consequent risk for infection.
• Acquire knowledge of risk factors, differential diagnoses, and complex management aspects of common and opportunistic infections.
• Render comprehensive infectious diseases consultations (written and verbal).
• Establish a good rapport between ID consult team and the consulting transplant team.

In-patient ward

• Expand the fund of knowledge in infectious disease including epidemiology and microbiology, clinical presentation, diagnosis, laboratory studies and treatment of common and uncommon infections.
• Gain the ability to provide a thorough and comprehensive written consultation with precise recommendations to the consulting service.
• Develop skills to convey the rationale surrounding the recommendations to the consulting members of the house staff and their attending physicians.  (A consultation is never complete until the recommendations are verbally conveyed to the consulting team on the same day as the consultation).
• Develop skills to effectively communicate the recommended plans for management to the patient and family members.
• Understand the appropriate and cost effective use of antimicrobial therapy.
• Supervise the ID team (consisting of the medical residents, medical students, and Pharm D's) to ensure each member fully understands and carries out his or her responsibilities.
• Understand the appropriate and cost effective utilization of the clinical microbiology laboratory.
• Learn/teach how to perform and interpret Gram stains and AFB stains on clinical specimens.
• Prepare, present and discuss challenging cases in Infectious Diseases at the weekly Grand Rounds; able to assist medical residents prepare and present challenging cases in Infectious Diseases' Grand Rounds.
• Gain ability to teach medical students, medical residents and others.
• Gain a sense of responsibility, and be able to run a very busy ID consultation service in an efficient manner.
• Expand the fund of knowledge in infectious disease including epidemiology and microbiology, clinical presentation, diagnosis, laboratory studies and treatment of common and uncommon infections.
• Gain the ability to provide a thorough and comprehensive written consultation with precise recommendations to the consulting service.
• Develop skills to convey the rationale surrounding the recommendations to the consulting members of the house staff and their attending physicians.  (A consultation is never complete until the recommendations are verbally conveyed to the consulting team on the same day as the consultation).
• Develop skills to effectively communicate the recommended plans for management to the patient and family members.
• Understand the appropriate and cost effective use of antimicrobial therapy.
• Supervise the ID team (consisting of the medical residents, medical students, and Pharm D's) to ensure each member fully understands and carries out his or her responsibilities.
• Understand the appropriate and cost effective utilization of the clinical microbiology laboratory.
• Learn/teach how to perform and interpret Gram stains and AFB stains on clinical specimens.
• Prepare, present and discuss challenging cases in Infectious Diseases at the weekly Grand Rounds; able to assist medical residents prepare and present challenging cases in Infectious Diseases' Grand Rounds.
• Gain ability to teach medical students, medical residents and others.
• Gain a sense of responsibility, and be able to run a very busy ID consultation service in an efficient manner.

Pediatric Infectious Diseases

• Appreciate the differences between adults and children regarding infection-related issues.
• Familiarize with common and uncommon infections seen at a larger tertiary care, university based Children's Hospital.
• Render effective management plan for pediatric ID consultations.
• Work as an effective team member in the Children's Hospital ID consultation team.

Sexually Transmitted Diseases

• Appreciate the spectrum of sexually transmitted diseases encountered in an inner city STD clinic, and become competent in the successful management of such infections.
• Learn the varied clinical manifestations and differential diagnoses of sexually transmitted diseases, recent diagnostic/screening methods and effective treatment strategies in the outpatient setting.
• Learn the significance of treatment of patient's partner(s) and preventive aspects of sexually transmitted diseases.

Medical Knowledge

Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Fellows should be competent to:

• Apply an open-minded analytical knowledge approach to acquiring knowledge.
• Access to critically evaluation current medical information and scientific evidence.
• Apply knowledge to clinical problem solving, clinical decision making and critical thinking.
• Fellows will acquire the skills needed to identify appropriate diagnostic studies in an orderly and clinically effective manner for patients with serious infectious diseases.
• Fellows will acquire the advanced skills needed to interpret relevant microbiologic and laboratory data.
• Fellows will learn to describe infectious diseases syndromes, the infections that various etiologic agents can cause, the attendant differential diagnoses by the end of the rotation.
• Fellows will learn how to enumerate the antimicrobials that would be appropriate for empiric and specific therapy, mechanisms of action, indications, contra-indications, dosing schedule, efficacy, cost side effects and pharmacokinetics by the end of the rotation.

Clinical Microbiology

• Obtain familiarity with the methods by which all clinical specimens are handled and processed in the microbiology laboratory.
• Observe and understand laboratory procedures pertaining to clinical specimens in areas of bacteriology, virology, mycobacteriology, mycology and serology.
• Understand the principles and methods involved in culture as well as non-culture, molecular diagnostic techniques.

Research

Bench Research:

• Choose a mentor with special expertise in a specific field in Infectious Diseases; formulate questions of clinical relevance in that field, then construct experiment to answer such questions.  (The fellows will have one major project and one or more minor projects).
• Ability to understand and perform laboratory experiments using up-to-date techniques.
• Ability to analyze and interpret scientific data and apply statistical knowledge to evaluate significance of data obtained.
• Ability to construct abstracts to be submitted for regional/national conferences.
• Ability to present data at meetings and to write manuscripts for publication and peer-reviewed journals.
• Ability to collaborate with other members of the laboratory team.

Clinical Research:

• Choose a mentor with special expertise in a specific field in Infectious Diseases; formulate questions of clinical relevance in that field, and design approaches to answer the questions.  (The fellows will have one major project and one or more minor projects).
• Ability to develop appropriate methods/experiments to gather data and then document/gather data in a systematic manner.
• Ability to analyze and interpret the data and apply statistical knowledge to evaluate significance of data applied.
• Ability to construct abstract to be submitted for regional/national conferences.
• Ability to present data at meetings and to prepare manuscripts for publication and peer-review journals.

Practice- Based Learning and Improvement

Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.  Fellows are expected to develop skills and habits to be able to meet the following.

• Identify strengths, deficiencies, and limits in one's knowledge and expertise.
• Set learning and improvement goals.
• Identify and perform appropriate learning activities.
• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement.
• Incorporate formative evaluation feedback into daily practice.
• Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
• Use information technology to optimize learning and participate in the education of patients, families, students, fellows and other health professionals.

Interpersonal and Communication Skills

Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.  Fellows are expected to:

• Communicate effectively with patients, families, and the public, as appropriate, across the board range of socioeconomic and cultural backgrounds.
• Communicate effectively with physicians, other health care professionals, and health related agencies.
• Work effectively as a member or leader of a health care team or other professional group.
• Act in a consultative role to other physicians and health professionals and maintain comprehensive, timely, and legible medical records if applicable.

Professionalism

Fellows must demonstrate a commitment to carrying out professional responsibilities and adherence to ethical principles. Fellows are expected to have:

• Compassion, integrity, and respect for others.
• Responsiveness to patient needs that supersedes self-interest.
• Respect for patient privacy and autonomy.
• Accountability to patients, society and the profession.
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Systems Based Practice

Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Fellows must:

• Work effectively in various health care delivery settings and system relevant to their clinical specialty.
• Coordinate patient care within the health care system, relevant to their clinical specialty.
• Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate.
• Advocate for quality patient care and optimal patient care systems.
• Work in inter-professional teams to enhance patient safety and improve patient care quality.
• Participate in identifying system errors and implementing potential systems solutions.

Teaching Methods

Fellows gain practice instructive experience in the following areas:

• Bi-monthly seminars reviewing illustrative cases, held in conjunction with Henry Ford transplant ID physicians.
• Daily rounds for both IPD and OPD.
• Evaluating new consults.
• Performing daily assessment of the patients.
• Reviewing patient charts, laboratory and imaging results daily.
• Documenting findings and recommendations.
• Assignment of weekly readings by the ID faculty.
• Joint examination of patients by ID faculty and fellows
• Regular review and critique of fellow's patients notes.
• Observation by faculty of the fellow's interaction with patient, their family members with oral and written feedback.
• 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 agents in the blood and other body fluids; the appropriate use of management of antimicrobial agents in a variety of clinical settings, including the hospital, ambulatory practice, and the home.
• The utility of procedures of specimen collection relevant to infectious diseases, including but not limited to 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, interferon, interleukins, and colon-stimulating factors, and their application and treatment of infectious diseases.