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UCSF Fresno

Infectious Diseases
Fellowship

Policy & Procedure
Manual

2010/2011

Revised July 20010

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INFECTIOUS DISEASE FELLOWSHIP

INTRODUCTION

Infectious Diseases remain a major cause of morbidity and mortality. New organisms have been
emerging, older pathogens re-emerging and the specter of bioterrorism requires a broad range of
knowledge. The fellowship program’s purpose is to train the Infectious Disease specialist to
treat and manage patients with Infectious diseases in a changing world.

The Infectious Disease Medicine division is proud to welcome you into our fellowship training
program. Enclosed in this notebook you will find the outline of your 2-year curriculum and
general guidelines for your entire fellowship program.

It is expected that each fellow attend all conferences that are listed on the monthly-published
calendar. Twice yearly individual evaluations of fellow performance will be conducted by the
program director. You will also be expected to evaluate the faculty and the training program.
Over the 2-year period of training, fellows will be expected to have increasing responsibility for
patient care and involvement in administrative tasks.

Infectious Disease Fellows are expected to exhibit the highest level of professionalism at all
times.

Research is a core component to the training program. Each fellow must identify a research
mentor early in the program and develop a substantive research project. A careful evaluation
process will also guide the research aspect of the program.

Please review the entire contents of this notebook and refer to it as needed throughout your
training.

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FELLOW SUPERVISION POLICY
Infectious Diseases Fellowship

The Program Director, with the assistance of attending physicians, assures that fellows are
appropriately supervised. Fellows are permitted to take on progressively greater responsibility
throughout the course of the fellowship, consistent with individual growth in clinical experience,
judgment, knowledge, and technical skill. Fellows are supervised by attending physicians so that
the fellows assume progressively increasing responsibility according to their level of education,
ability, and experience.

The Program Director, with the assistance of attending physicians, will assess fellows’
competence as the basis for determining the minimum level of supervision required for different
activities. The objective criteria used to evaluate the fellow’s progressive ability, and which will
be consistently applied, is contained in evaluation forms; program director review of fellow
competency / feedback form; procedure logs; Competency-based curriculum and objectives. This
assessment includes the evaluation of the fellow’s technical, patient management, and
communication skills and capacity to perform as required. The Program Director communicates
the assessment of the fellow’s competence to the fellow and supervising attending physician at
least annually and when significant progress or deficiencies are noted.

On-call schedules for attending physicians shall provide for supervision, that is readily available
to a fellow, on duty 24 hours per day, 7 days per week. Under circumstances in which urgent
judgments by highly experienced physicians are typically required, attending physicians must be
immediately available on site at all times. Under other circumstances, attending physicians can
provide adequate supervision off site as long as their physical presence within a reasonable time
can be assured in case of need. The Program Director assures that a schedule with the name and
contact number of the responsible attending physician is available at all times to program
fellows.

All patients seen by a fellow on an outpatient basis must be seen by, discussed with, or reviewed
by the responsible attending physician

General Attending Physician Responsibilities

An attending physician is responsible for and actively involved in the care provided to each
patient, both inpatient and outpatient.

An attending physician directs the care of each patient and provides the appropriate level of
supervision for a fellow, based on the nature of the patient's condition, the likelihood of major
changes in the management plan, the complexity of care, and level of education, ability,
experience, and judgment of the fellow being supervised.

The attending physician, in consultation with the program director, accords a fellow progressive
responsibility for the care of the patient, based on the fellow’s clinical experience, judgment,
knowledge, technical skill, and capacity to function.
The attending physician advises the program director if he/she believes a change in the level of
the fellow’s responsibility and supervision should be considered. The overriding consideration
must be the safe and effective care of the patient that is the personal responsibility of the
attending physician.
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5 . and any associated limitations. The fellow is responsible for communicating to the attending physician any significant issues regarding patient care. or management plans that he/she is unauthorized to perform or lacks the skill and training to perform. The fellow must not independently perform procedures or treatments. and technical skill. knowledge. Fellow Responsibilities and Requirements The fellow must be aware of his/her level of training. judgment.The attending physician fosters an environment that encourages questions and requests for support or supervision from the fellow. and encourages the fellow to call or inform the attending physician of significant or serious patient conditions or significant changes in patient condition. his/her specific clinical experience.

com). ¾ All moonlighting activities must be approved by the Program Director in writing. or of any fellows not reporting their hours. Any duty hours violations will be reported to the Program Director and the Program Director will work with the fellow to correct the issues involved Moonlighting Policy The Internal Medicine Department of UCSF Fresno and the UCSF Fresno Infectious Diseases Fellowship endorses the ACGME and the UCSF Fresno GMEC policy on Moonlighting. ¾ All moonlighting activities must e requested in writing using the UCSF Fresno “moonlighting request” form available in the Department Office. The Moonlighting Policy. the GMEC is responsible for monitoring resident duty hours. To ensure the fellow is in compliance with all duty hours regulations. ¾ No resident on probation or remediation may participate in moonlighting. The schedule is posted in advance on a web based program (Amion.Duty Hours Resident duty hours are governed by ACGME guidelines and are monitored by the Graduate Medical Education Committee via its Duty Hours Subcommittee and individual programs. taking into consideration all the work hour rules. Outside work (moonlighting) cannot interfere with this primary responsibility. The program will also notify the Program Director of any duty hours violations. he or she will be responsible for entering their hours daily on the duty hours module of a web based product: E Value. All schedules for the fellows are designed in a yearly format. The term “resident” denotes all levels of trainees in the UCSF Fresno Medical Education programs. is as follows: ¾ The resident’s primary responsibility is to fulfill the education expectation of the program. All efforts should be made to maximize educational opportunities while minimizing fatigue and service requirements via the individual training programs and the Duty Hours Sub-Committee.com – this program is designed to stay within all duty hour rules. which my also be found in the UCSF Fresno Resident handbook. (The department office has these forms) 11 . ¾ Failure to follow this policy can result in suspension from the training program. E-Value is set up to send email reminders to the fellows if they do not log their hours. Any necessary schedule changes are posted immediately to Amion. ¾ Approval of the Program Director does not provide malpractice coverage for this activity that is outside the scope of the educational process.

Vacation Policy Fellows are entitled to 3 weeks of vacation and 1 week of continuing medical education activity per year. VACATION/CONFERENCE REQUEST FORM NAME:___________________________________________DATE___________ DATES REQUESTED_______________________________________________ NUMBER OF WEEK DAYS__________ NAME OF CONFERENCE____________________________________________ ROTATION________________________________________________________ SIGNATURE OF COVERING FELLOW________________________________ SIGNATURE OF PROGRAM DIRCTOR_______________________ 12 . It is requested that the fellows work out their plans with each other regarding coverage and present their requests to the Program Director.

Fellows are able to access (free of charge) our Employee Assistance Program. with a successful recovery. To protect patients from risks associated with care given by an impaired resident physician. The privacy and dignity of the affected individual will be maintained to the extent possible. 3. Isolated instances of any of these signs and symptoms may not impair ability to perform adequately. and both health plans offered have covered services for mental or emotional issues. but if they are noted on a continual 13 . including substance abuse. preliminary assessment. Impairment may result from depression or other mental health/behavioral disorders. UCSF Fresno has the Impaired Residents/ Fellow Policy listed below: POLICY: Impaired Residents / Fellows PURPOSE: To provide a guide to prevent or minimize the occurrence of impairment by resident* physicians. and to prevent or eliminate. The safety of both the impaired individual and of patients is of prime importance. The Program Director and the faculty monitor fellows for unusual behavior that could signal impairment. several principles are involved: 1. impaired resident physicians. opportunity for treatment. medical illnesses. and appropriate rehabilitation. physical conditions. To prevent or minimize the occurrence of impairment. an opportunity to return to training in an appropriate capacity. among resident physicians at the UCSF Fresno Medical Education Program and its affiliated medical centers. To compassionately confront problems of impairment to effect diagnosis. 2. Impairment in resident physicians will be recognized and managed as a medical/behavioral illness. This concept of impairment allows for diagnosis. and. In addition. and substance abuse and subsequent chemical dependency. In achieving these goals. This policy is written to ensure optimal patient care. diagnostic evaluation. treatment as indicated. and work with the State Diversion Program. 2.We take the issue of fellow stress very seriously. the UCSF Fresno Wellness Committee will facilitate education. relief from patient care responsibilities if necessary. 3. Procedure: Diagnosis of Impairment The following are signs and symptoms of impairment. The goals of this policy are: 1. excellence in medical education. We discuss these issues with the fellows at orientation. *For the sake of this policy resident also refers to fellows Policy: Impairment of performance by resident physicians places patients at risk. and address it in our lecture series throughout the year. To the extent that its resources allow. to the extent possible.

This lecture series is open to all housestaff and faculty. accidents. The Program Director will notify the HR Manager who will assemble the Wellness Committee if needed. The Program Director and the HR Manager will discuss the resident’s options regarding any leave of absence and/or suspension from the Medical Education Program in accordance with the UCSF Fresno Due Process Policy. 3. Should the evaluating physician recommend a level of treatment that can be addressed locally. Warning signs and symptoms of impaired functioning may include: 1. inappropriate behavior in the professional setting. multiple physical complaints. 2. an educational component addressing Resident Physician Impairment policies and services will be presented. If a resident physician is observed to be impaired/disabled while engaged in the performance of his/her duties. any individual action may be at risk. 5. 4. any mention of the concern will be removed from his/her file and the individual will be allowed to return to the Medical Education program without prejudice. and aggressive behavior. The need for reporting to the State of California Licensing Board will be made with consultation with the Board and University Legal Counsel and the evaluating physician. increased argumentativeness. 3. 6. tardiness. the HR Manager will assist the resident in the re-entry to the Medical Education Program. unpredictable behavior. Access and Reporting Process 1. Social withdrawal and isolation from peers. If a leave of absence is indicated. 3. dilated or pinpoint pupils. and inadequate professional performance. decreasing quality and interest in work. and ultimately to the Program Director. Should a resident about whom the concern has been expressed be determined not to be impaired. Follow-up The HR Manager will serve as liaison with the Diversion Board. Each year during New House staff Orientation. 2. the resident will be informed of the decision to require a LOA as soon as possible. the course of action shall be as follows The observer shall report his/her concern immediately to a responsible supervisor. Prevention and Education Services 1. 5. The addiction specialist will report to the State Medical Board should that be necessary. At departmental request. the HR Manager will assist the resident in obtaining local mental health/treatment services. If further evaluation is thought to be warranted. a designated representative will be available to provide educational lectures addressing Impaired Physician issues. Changes in professional behavior patterns such as unexplained absences. Appropriate and complete documentation of the events shall be performed. eating disorders. Seminars addressing the Impaired Physician will be presented at least yearly in the UCSF Fresno Wednesday Special Lecture series. the resident will be sent for an evaluation by the addiction specialist for Fresno County. deterioration in personal hygiene and appearance. When it is determined by the Board that the resident is ready to re-enter the Medical Education Program. 14 . The diversion services of the Board will arrange appropriate treatment and monitor resident compliance. 4. Physical signs such as fatigue. Disturbances in personal and professional relationships. Drug use indicators such as excessive agitation or edginess. noticeable odor of alcohol or cannabis. 7.basis or if multiple signs are observed. 2.

ID present Chest C Journal club noon th 4 Friday UCSF 301 IM Fellows 7:30am – IM 12:30 .4th Research Research Meeting Thursday .daily Committee 10:00 am 4th Friday Inf. Conference UCSF 108 VA ROTATION Monday Tuesday Wednesday Thursday Friday ID Clinic 1:00 pm 1:00 pm Rounds. 7:30am.daily Microbiology 7:30-11:30 7:30-11:30 7:30-11:30 ETC 3RD Thursday. Control Lectures Please See Schedule above 15 .Daily rounds CRMC ROTATION Monday Tuesday Wednesday Thursday Friday Pgy 5 ID Clinic HIV clinic Pgy 4 ID Clinic HIV clinic Hep clinic Lecture noon noon noon noon noon Grand HIV Case Conf ID case conf ID Core Lecture UCSF 301 Rounds UMC – 12-1 Rm 333 Rm 301 Board Review Rounds CRMC .

Conference attendance is expected to be 100%. The system also has “on the fly” evaluations which allow for concern or praise cards of either fellows or faculty. The fellows must have the opportunity to assess formally the effectiveness of ambulatory teaching on an ongoing basis. The evaluations are sent out by email. These evaluations should include a review of the faculty’s clinical teaching abilities. The fellows meet as a group with the Fellowship Program Director every 4 months and as needed. both fellow to fellow and resident to fellow. The participating hospitals send out patient evaluations. Attendance record is kept in the Fellowship office. and fellows will evaluate their attending each rotation. with vacations as the only excuse to not attend. Faculty. Nursing personnel also use E-Value to evaluate fellows. Problems delineated from those discussions are then addressed by the Program Director until they are resolved satisfactorily. During those meetings all aspects of the fellowship program are open for discussion and critical review is encouraged. We utilize a web based evaluation program called E-Value. Two times per year. and this information is shared on a regular basis with the Program Director. commitment to the educational program. All evaluations are based on the core competencies. The fellows do a complete written survey of the program once a year. clinical knowledge. the Fellowship Program Director meets with each individual fellow and solicits from the fellow their observations and recommendations for improvements in the program. Fellows will be evaluated on each rotation by the faculty. the effectiveness of rotation or assignment in achieving the goals and objectives identified in the curriculum for that rotation. 16 . The evaluation must include at lest annual written confidential evaluations by fellows. Issues which require general consideration are presented at the Division’s Bi-monthly Faculty Meeting for discussion by the entire Division faculty. and scholarly activities. the program must evaluate faculty performance as it relates to the educational program. professionalism. These evaluations go directly to the Program Director. with reminders until the evaluations are complete. At least annually. We follow similar policies already in effect for the Internal Medicine Residency Program. The system is also set up to send a notice immediately both to the fellow’s mentor and Program Director if a fellow receives a less than satisfactory score in any area of his / her evaluation. Peer evaluations are also sent out to fellows.Evaluations: Fellows. Fellows should evaluate the faculty’s effectiveness as teacher.

with selective staff students/ residents review review Research directed background execution of existing analysis and presentation of reading. after confirmation teams/ referring MDs discussion with staff Antibiotic approvals after discussion with independent. with selective staff assessments/ plans confirmation confirmation Communication of after discussion with preliminary. with staff independent. with staff independent. with staff independent. Clinical proficiency levels correspond approximately with the first. final. independent. with selective staff supplementation confirmation confirmation Formulation of clinical jointly with staff independent. with staff independent. with staff independent. tutored skill projects with staff results. with staff independent. new project development oversight development. and third 4-month blocks of clinical experience. 17 . independent conduct of research with selective staff review *As assessed by supervising faculty based on observation of fellow’s performance. Level of responsibility/ independence by proficiency level* Function/ activity Beginning Developing Proficient Clinical data collection independent. with selective staff staff confirmation confirmation Case conference jointly with staff independent. with selective staff recommendations to 10 staff independent. according to a three-tiered format as shown below. GRADED RESPONSIBILITY Fellows are assigned incrementally increasing responsibility and independence during their training appropriate for their demonstrated level of competency and professional development (as assessed by the supervising physicians). second. with selective staff preparation confirmation confirmation Supervision of jointly with staff independent. but individual fellows move through the levels at different rates depending on their rate of developing the relevant competencies.

g.g. Name/Year 1 (F1) months) On-Call (including during this Q3. ID Inpatient Consult CRMC 24 wks 2/wk 50 1 0 VA ID Inpatient VA 12 wks 2/wk 50 1 0 Pediatric ID Consult CHILDREN’S 4 wks 2/wk 50 1 0 Kaiser ID Consult KAISER 4 wks 2/wk 50 1 0 Microbiology CRMC 4 wks 0 40 2 0 Second year Average Average Frequency Duration number of number of of of hours on full days in house experience Frequency duty off night Rotation Institution/Site (weeks or of Nights per week per week call (e.CONSULTS First year Average Average Frequency Duration number of number of of of hours on full days in house experience Frequency duty off night Rotation Institution/Site (weeks or of Nights per week per week call (e.ROTATION TEMPLATES .. Name/Year 2 (F2) months) On-Call (including during this Q3. CRMC ID Consult CRMC 12 wks 1/wk 50 1 0 VA ID Consult VA 4 wks 1/wk 50 1 0 UCSF Transplant UCSF 4 wks 1/wk 50 1 0 Research (required) CRMC/VA 20 wks 0 0 2 0 CONTINUITY CLINIC EXPERIENCE: 21 ..

Duration ½ day sessions Average patients Name of Experience ID (months) per week seen per session Special Services Clinic (HIV) CRMC 18 1 6 Other Ambulatory Experience: ½ day Average Duration sessions patients seen Name of Experience ID (months) per week per session ID Clinic CRMC 18 1 12 ID Clinic VA 5 1 5 ID Clinic (elective) CHILDRENS 1 1 10 ID Clinic (elective) KAISER 1 1 12 CORE CURRICULUM 22 .

and hepatobilliary infections Skin and soft tissue infections Bone and joint infections Infections of prosthetic devices Infections related to trauma Sepsis syndromes Nosocomial infections Urinary tract infections Infections in the immunosuppressed host. ear. intra-abdominal. nose and throat Infections in the elderly and geriatric population Sexually-transmitted infections Immunizations Bioterrorism Zoonotic infections 18 . REQUIRED CLINICAL COMPETENCIES IN INFECTIOUS DISEASES Infections and other complications in patients with HIV/AIDS Cardiovascular and endovascular infections Central nervous system infections Gastrointestinal. other than HIV Infections in international and returning travelers Antibiotic use and utilization management Clinical microbiology and parasitology Infections of the eyes.

discussing each topic. 1. 100% attendance is expected. Helicobacter pylori 34. GI Infections and food poisoning 11. Bone and Joint Infections (including Prosthetic device and joint infections) 12. URI 3. Antimicrobial Therapy – (7 sub topics) 27. Skin and Soft Tissue Infection 9. Anaerobic infections 32. Infections in Travelers 25. and Medicine Grand Rounds. Nosocomial Infections 18.Teaching conferences Fellows are expected to present at the weekly Case Management conference as well as the monthly Journal Club and M & M. Central Nervous System Infection 8.. Cardiovascular Infection 7. Anthrax 33. Core Curriculum: Conferences are held once each week. Fungal Infections (7 sub topics) 31. Sexually Transmitted Diseases 14. Infections in Parenteral Drug Users 26. Pleuropulmonary Infections 4. influenza 38. Bioterrorism 28. vacation being the only excuse for absence. Catheter Related Infections 29. Sepsis Syndromes 17. one time per year. Immunizations 36. Infections of the Eye 15. infection control 37. Infections Related to Trauma(including bites and burns) 10. lyme disease 19 . Infections in Marrow Transplant Patients 22. and the weekly ID Core conference. Infections in Solid Organ Transplants 23. herpes viruses 35. Chest conference. Emerging infectious diseases and pathogens 30. Infections in Neuropenic Hosts 20. The febrile patient 2. Intra-Abdominal Infection 6. Urinary Tract Infections 5. HIV Infections and its Complications 19. Infections in Patients with Leukemia and Lymphoma 21. Infections in Geriatric Patients 24. Infections of Reproductive Organs 13. Viral hepatitis 16.

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It is expected that calls are returned as soon as possible where practical. The “Antibiotic” pager receives calls for all restricted antimicrobials. Pediatrics. It houses Central California's only burn and Level 1 trauma center. staffed by the Infectious Diseases fellows on clinical rotations at CRMC. post transplant medicine. and Psychiatry and Fellowships in Cardiology. an ID pharmacist and pharmacy resident and students. the UCSF Fresno Medical Education Program (residencies in Internal medicine. and the hospital currently serves an average of 332 inpatients a day. to name a few. The fellow should only carry the pager for no longer than 24 hours during a workday week and only one weekend a month. minimize the development of resistant nosocomial pathogens and practice cost effective medicine. Surgery. trauma. Approximately 80 beds are dedicated for the ICU. The fellows will have frequent interaction with the microbiology laboratory personnel through their clinical rotations and the clinical microbiology rounds. brain abscess. Ophthalmology. meningitis. physical examination and laboratory values including microbiology. as well as patients with varying degrees of severity of illness including intensive care patients. Emphasis will be placed on generating a strong database including history. robotic surgery such as CyberKnife. empyema. antibiotic levels. bacteremia. all fellows on clinical rotations have clinical microbiology rounds 72 . CRMC has a large full-service microbiology lab. These data will be used to make initial treatment plans and subsequent day-to-day treatment decisions. vascular. osteomyelitis. This is worked out with the other fellows to coordinate with their days off of their concurrent clinical rotation. minimize toxicities. Approximately 60% of all consults are men and 40% are women. This pager is required to be on and available 24/7. Neurosurgery. F1 F2 F3 Site(s):Fresno-CRMC 6 6 Duration of rotation: [x] one month General description of the rotation including educational purpose. 1 to 3 residents and medical students.Name of rotation: General ID Consultation Service Division: Infectious Diseases Average Number of Months Fellows at Hospital Course Director: Robert Libke. orthopedic. and radiology. pneumonia. Subsequently through the rest of the year. There is no in-house call. It will allow the fellows to acquire expertise and knowledge in the appropriate utilization and management of antimicrobial agents in order to optimize patient care. etc. gynecological. M.D. All first year fellows spend several days during the 2 week orientation learning the basics of the clinical microbiology laboratory. infectious endocarditis. Ob-Gyn. OBGYN. Our fellows will see an average of 50 to 60 consultations per month covering patients across a wide range of services including Medicine. CRMC has an antimicrobial management program to ensure the appropriate utilization of antibiotic therapy. rationale or value: Fresno CRMC is an academic center which has 457 licensed beds with expansion to about 700 beds underway.. Oral Surgery. neurological. aortic and peripheral vascular stent placement and prostate brachytherapy. laser transmyocardial revascularization. which occur almost daily. Pulmonary Medicine and Gastroenterology) and specialty programs such as general. HIV. Family Practice. and urinary tract infections. including a hyperbaric chamber. Common presentations include: fever of unknown origin. ENT. urological. burn and ENT surgery. The infectious diseases consult team includes the ID attending physician. Surgery. both in the intensive care units and on the general medical/surgical wards. The general infectious diseases consultative service at the CRMC sees a mix of both primary and tertiary care patients with a variety of acute and chronic infectious disease problems. vascular and neurological surgery are offered. The pager will be supervised by the attending on the consult service. the da Vinci Surgical System. New innovations in cardiac.

The fellow will take call two of the four weekends per block making certain to maintain 1 day off in every 7 averaged over 30 days. The fellow will be responsible for management of the patients i. Educational Objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. Read and interpret gram stains. Those listed here are specific to this rotation and pertain to fellows at all levels of training. Discuss the major classes of antibiotics. and promoting cost effectiveness. 4. o. The fellow will develop the on-call schedule for him/herself and for the rotating residents j. and understand the general principles of obtaining and interpreting microbiologic cultures and sensitivity reports. Patient Care 1. The fellow will confer with the attending physician if difficulties are encountered in running the service. their appropriate use. The fellow will present cases to the faculty physician. Fellow responsibilities: a. Allow residents to go to clinic and conferences in a timely manner i. k. Help the student develop a plan for the management of the patient. Develop expertise in the management of infectious diseases. Understand and utilize the principles of anti-infective management to maximize treatment effectiveness while at the same time minimizing side effects. preventing emergence of resistant pathogens. The fellow will supervise all the residents and medical students on the service. ii. Discuss differential diagnoses for common infectious disease problems encountered in the large referral hospital setting 73 . Suggest appropriate times to sign off of patients l. Demonstrates knowledge of the application of microbiologic laboratory tests and their clinical application 3. r. 3. p. AFB smears. These rounds include acquiring knowledge of all aspects of microbiology including: basic culture techniques. Confirm the history and physical examination ii. The fellow will be responsible for organizing and presenting cases at the weekly case conferences. n. 2. iii. i. other diagnostic techniques. Assigning new consultations to students and residents rotating on the consultation service. q. Provide education and references to the students and residents iv. Providing a link between the inpatient consultation service and the outpatient clinic in order to maintain continuity and prevent medical errors. iii.almost daily in the microbiology lab. and appropriate cost-effective utilization of the microbiology lab. iv. fungal stains. Develop expertise in the epidemiology as well as in the clinical and microbiological diagnosis of infectious diseases. The fellow will take first call regarding antimicrobial approvals. 2. m. Provide constructive feedback to the students and residents. Medical Knowledge 1. Determining the appropriate strategy for diagnosis and treatment of the patient. and important side effects. The fellow on service should be available 24 hours per day by telephone except during the weekend off or when being covered by a colleague. The fellow will be responsible for interaction with the requesting services.

3. 2. 6. 4. [x ] Other: Clinical Microbiology Rounds including radiology Principal ancillary education materials used: [ ] Reading lists [x ] Pathologic material [x ] Radiologic studies [ ] Other noninvasive studies [x ] Handouts on relevant topics [x ] Articles from the literature [x ] Other: Small group discussion of [x ] Case studies prepared cases Methods used to evaluate the resident and the rotation: [x ] Evaluation of fellow performance and professionalism [x ] Evaluation of attending teaching skills and other attributes [x ] Rotation assessment by fellow [x ] Observation of fellow's clinical competency [x ] Observation of fellow's leadership and teaching skills [x ] Review of the fellow's history/physical exam. cultural differences. etc.) 74 . Practice-Based Learning 1. toxicities. spectrum of activity. Advocate for quality patient care and assist patients in dealing with system complexities. read textbooks and journal articles pertinent to the infectious diseases’ cases that are being seen on service. Interpersonal and Communication Skills – See Core Competencies 1. 3. Awareness of community and cultural attitudes toward the illness and the need for confidentiality Professionalism – See Core Competencies System-Based Practice – See Core Competencies 1. progress notes and documentation of procedures in the chart [x ] Fellow's attendance of rounds and conferences monitored [ ] Other: ________________________ Conferences or Attending/Patient Care Rounds: (Journal club. Demonstrates knowledge of the pharmacology. 5. appropriate laboratory tests. Discuss the issues surrounding indications for testing. 2. 5. Practice cost-effective health care and resource allocation that does not compromise quality of care. HIV and other sexually transmitted diseases. division rounds.4. including an understanding of the mechanisms of resistance. Appreciates the importance of support from family members and others. Apply principles of infection control and hospital epidemiology to the inpatient units Check all principle teaching methods used during this rotation: [x ] Attending teaching rounds [ ] Interdisciplinary rounds [x ] Patient management discussions [x ] Small group discussions [x] Conferences specific to rotation [x ] Bedside clinical rounds [ ] Individual instruction of procedures [x ] Review of diagnostic studies. Discuss the basic principles guiding hospital epidemiology and infection control in the referral hospital setting. Recognizes the importance of quality-of-life issues. and pre.and post- test counseling for communicable infectious diseases such as TB. Demonstrates compassion and objectivity when dealing with patients who have a chronic and potentially life-threatening illness. limitations and drug interactions of antimicrobials utilized in treating infections. Examines personal attitudes toward sexuality. Perform literature searches. intravenous drug abuse. 7. Discuss the epidemiology and pathophysiology of common infectious diseases encountered in the referral hospital setting. communicable diseases and death.

5/09 Name Location Day Time ID Clinical Conference UCSF Building Tues 1200-1300 ID Didactic Lectures UCSF Building Wed 1200-1300 HIV Case Conference Cedar Campus Tues 1200-1300 ID Board Review UCSF Building Fridays 1200-1300 Journal Club UCSF Building 4th Friday 1200-1300 Microbiology Rounds CRMC Lab Wed 1000-1100 75 .Fellows are expected to attend the following conferences while on this rotation. Rev. This is in addition to attending/patient care rounds as outline above under fellow responsibilities.

It has 53 acute care beds with 12 ICU - telemetry beds and 60 geriatrics extended care unit beds. ventilator associated pneumonia and methicillin resistant Staph aureus. The ambulatory experience will include providing medical care to veterans with a variety of acute and chronic infectious diseases.O. All objectives pertain to first and second year fellows (PGY-4. etc). e) The fellow will take call two of the four weekends per block making certain to maintain 1 day off in every 7 averaged over 30 days. Surgery (general surgery. Fellow responsibilities: a) The fellow will perform all of the Infectious Diseases consultations requested. orthopedics. osteomyelitis. On Average 30-50 inpatient infectious disease consultation are provided per month. d) The fellow will review all laboratory results and work with the attending physician to appropriately act to provide patient care. Patients are seen with a variety of presentations including bacteremia. Those listed here are specific to this rotation. Infectious diseases more commonly seen in the veteran population and especially those in the geriatric unit will be emphasized. efforts to improve outcomes in community acquired pneumonia and antibiotic use will be part of the experience. and other immune-compromising settings. The inpatient ID consultative service includes patients from a number of services including Medicine. the fellows will have an opportunity to participate in quality improvement measures related to infection control issues such as wound infection. In addition. Educational Objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. rationale or value: The fellowship rotation at the Veterans Affairs Central California Health Care System (VACCHCS) facility will include both inpatient and outpatient experiences. and urinary tract infections. empyema. urology. b) The fellow will present cases to the faculty physician on clinical rounds c) Interesting cases from the VA should be incorporated into the weekly case conference. VACCHCS serves veterans throughout Central California.5). It is expected that the achievement and mastery of these objectives will occur over multiple rotations. Shobha Sharma. including an ambulatory infectious diseases program that will provide experience for the fellows during the rotations at the medical center. While at the VACCHCS. The fellows will learn to work in the unique system of health care that has been developed for veterans and participate in health care using a mature integrated electronic records system that has been a model for other health care systems. D. Elective Duration of rotation: [x] one month General description of the rotation including educational purpose. and intensive care. pneumonia. diabetic complications. There are on-site microbiology and pathology labs which process cultures and biopsy specimens. meningitis. Patient Care 76 .Name of rotation: General ID Consultation Average Number of Months Service Fellows at Hospital Division: Infectious Diseases F1 F2 F3 Site(s): Fresno VA 3 4 Required Course Director:. The Fresno VACCHCS has an active outpatient program. brain abscess. Fellows will have the chance to interact closely with microbiology and pathology staff. infectious endocarditis.

intravenous drug abuse. 2. Demonstrates compassion and objectivity when dealing with patients who have a chronic and potentially life-threatening illness. Discuss differential diagnoses for common infectious disease problems encountered in the large referral hospital setting 4. including an understanding of the mechanisms of resistance. Examines personal attitudes toward sexuality. Appreciates the importance of support from family members and others. System-Based Practice 1. Develop expertise in the management of infectious diseases. Perform literature searches. their appropriate use. Medical Knowledge 1. 4. Practice-Based Learning 1. and understand the general principles of obtaining and interpreting microbiologic cultures and sensitivity reports. and pre. 3. preventing emergence of resistant pathogens. 5. Advocate for quality patient care and assist patients in dealing with system complexities. Apply principles of infection control and hospital epidemiology to the Fresno VA inpatient units Check all principle teaching methods used during this rotation: [x ] Attending teaching rounds [ ] Interdisciplinary rounds [x ] Patient management discussions [x ] Small group discussions [x] Conferences specific to rotation [x ] Bedside clinical rounds [ ] Individual instruction of procedures [x ] Review of diagnostic studies. cultural differences. Recognizes the importance of quality-of-life issues. 1. 2. Discuss the epidemiology and pathophysiology of common infectious diseases encountered in the referral hospital setting. limitations and drug interactions of antimicrobials utilized in treating infections. and important side effects. Read and interpret gram stains. [x] Other: Optional Clinical Microbiology rounds including radiology Check the principal ancillary education materials used: [ ] Reading lists [ ] Pathologic material [x] Radiologic studies [ ] Other noninvasive studies 77 . 5. Understand and utilize the principles of anti-infective management to maximize treatment effectiveness while at the same time minimizing side effects. fungal stains.1. Discuss the basic principles guiding hospital epidemiology and infection control in the referral hospital setting. spectrum of activity. 2. appropriate laboratory tests. 4. HIV and other sexually transmitted diseases. 3. Practice cost-effective health care and resource allocation that does not compromise quality of care. Develop expertise in the epidemiology as well as in the clinical and microbiological diagnosis of infectious diseases.and post- test counseling for communicable infectious diseases such as TB. 6. Discuss the major classes of antibiotics. Awareness of community and cultural attitudes toward the illness and the need for confidentiality Professionalism – See master list for these competencies. read textbooks and journal articles pertinent to the infectious disease cases that are being seen on service. Interpersonal and Communication Skills – See master list for these competencies. promoting cost effectiveness. Discuss the issues surrounding indications for testing. communicable diseases and death. toxicities. Demonstrates knowledge of the application of microbiologic laboratory tests and their clinical application 3. 7. AFB smears. 2. 3. Demonstrates knowledge of the pharmacology.

[x] Handouts on relevant topics [x] Articles from the literature [x] Other: Small group discussion of prepared [x] Case studies cases Methods used to evaluate the resident and the rotation: [x ] Evaluation of fellow performance and professionalism [x ] Evaluation of attending teaching skills and other attributes [x ] Rotation assessment by fellow [x ] Observation of fellow's clinical competency [x ] Observation of fellow's leadership and teaching skills [x ] Review of the fellow's history/physical exam. This is in addition to attending/patient care rounds as outline above under fellow responsibilities. division rounds. etc. Rev 5//09 Name Location Day Time ID Clinical Conference UCSF Building Tues 1200-1300 ID Didactic Lectures UCSF Building Wed 1200-1300 HIV Case Conference Cedar Campus Tues 1200-1300 ID Board Review UCSF Building Fridays 1200-1300 Journal Club UCSF Building 4th Friday 1200-1300 Microbiology Rounds CRMC Lab Wed 1000-1100 78 .) Fellows are expected to attend the following conferences while on this rotation. progress notes and documentation of procedures in the chart [x ] Fellow's attendance of rounds and conferences monitored [ ] Other: ________________________ Conferences or Attending/Patient Care Rounds: (Journal club.

M. The Pediatric Infectious Diseases rotation includes an active ambulatory pediatric infectious disease experience for the fellows during their time at that medical center. Patients are seen with an array of acute and chronic infections. Fellow responsibilities: f) The fellow will perform all of the Infectious Diseases consultations requested. surgery (general surgery. Develop knowledge in the epidemiology as well as in the clinical and microbiological diagnosis of pediatric infectious diseases. and a variety of viral illnesses. On average 25-30 inpatient infectious disease consultations are provided per month. orthopedics. The clinic experience will include providing medical care to children with HIV disease and with a mixture of acute and chronic infectious diseases such as coccidioidomycosis. Duration of rotation: [x] one month Average Number of Months Fellows at Hospital F1 F2 F3 Required 1 Elective General description of the rotation including educational purpose. CA Course Directors: David Pugash. AFB smears. i) The fellow will review all laboratory results and work with the attending physician to appropriately act to provide patient care. and understand the general principles of obtaining and interpreting microbiologic cultures and sensitivity reports. oncology and neurologic services. Educational Objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. Infectious diseases more commonly seen in the pediatric population and especially those related to immunologic and genetic disorders will be emphasized. 79 . Madera. 3. Develop knowledge in the management of pediatric infectious diseases. Those listed here are specific to this rotation.D. g) The fellow will present cases to the faculty physician on clinical rounds h) Interesting cases from the Children’s Hospital should be incorporated into the weekly case conference. It is expected that the achievement and mastery of these objectives will occur over multiple rotations. 2.5). Read and interpret gram stains. osteomyelitis. Educational experiences in dealing with viral illness and prevention of infectious illnesses by vaccination will be prominent during this rotation.D. cardiology. Name of rotation: Pediatric Infectious Diseases Consultation Service Division: Infectious Diseases Site(s): Children’s Hospital of Central California. & James McCarty. M. infections in compromised pediatric hosts. The inpatient ID consultative service includes patients from a number of services including pediatric medicine. The fellows will experience the practice of the specialty of Pediatric Infectious Diseases in a medical center that serves both as a primary care facility and as a referral center for the care of children. etc). Patient Care 1. rationale or value: The Children’s Hospital of Central California has 255 beds. All objectives pertain to first and second year fellows (PGY-4. The fellowship elective rotation at Children’s Hospital of Central California will include both inpatient and outpatient experiences. urology. intensive care. fungal stains.

Demonstrates knowledge of the application of microbiologic laboratory tests and their clinical application 3. and important side effects. [x] Other: including radiology Check the principal ancillary education materials used: [ ] Reading lists [ ] Pathologic material [x] Radiologic studies [ ] Other noninvasive studies [x] Handouts on relevant topics [x] Articles from the literature [x] Other: Small group discussion of prepared [x] Case studies cases Methods used to evaluate the resident and the rotation: [x ] Evaluation of fellow performance and professionalism 80 . Examines personal attitudes toward sexuality. spectrum of activity. read textbooks and journal articles pertinent to the pediatric infectious disease cases that are being seen on service. 3. communicable diseases and death. 6. Discuss the epidemiology and pathophysiology of common pediatric infectious diseases encountered in the referral hospital setting. promoting cost effectiveness.4. Perform literature searches. their appropriate use. 2. and pre. 4. 3. Discuss the issues surrounding indications for testing. appropriate laboratory tests. Practice cost-effective health care and resource allocation that does not compromise quality of care. Discuss the basic principles guiding hospital epidemiology and infection control in the referral hospital setting. limitations and drug interactions of antimicrobials utilized in treating infections. Practice-Based Learning 1. including an understanding of the mechanisms of resistance. intravenous drug abuse. Discuss the major classes of antibiotics. cultural differences. toxicities. 7. Awareness of community and cultural attitudes toward the illness and the need for confidentiality Professionalism – See master list for these competencies. Discuss differential diagnoses for common pediatric infectious disease problems encountered in the large referral hospital setting 4. Apply principles of infection control and hospital epidemiology to the Children’s Hospital inpatient units Check all principle teaching methods used during this rotation: [x ] Attending teaching rounds [ ] Interdisciplinary rounds [x ] Patient management discussions [x ] Small group discussions [x] Conferences specific to rotation [x ] Bedside clinical rounds [ ] Individual instruction of procedures [x ] Review of diagnostic studies.and post- test counseling for communicable infectious diseases such as TB and HIV. 5. Demonstrates compassion and objectivity when dealing with patients who have a chronic and potentially life-threatening illness. Understand and utilize the principles of anti-infective management in pediatric patients to maximize treatment effectiveness while at the same time minimizing side effects. 5. Demonstrates knowledge of the pharmacology. System-Based Practice 1. Appreciates the importance of support from family members and others. Medical Knowledge 1. preventing emergence of resistant pathogens. 1. Recognizes the importance of quality-of-life issues. Interpersonal and Communication Skills – See master list for these competencies. 2. 2. Advocate for quality patient care and assist patients in dealing with system complexities.

[x ] Evaluation of attending teaching skills and other attributes [x ] Rotation assessment by fellow [x ] Observation of fellow's clinical competency [x ] Observation of fellow's leadership and teaching skills [x ] Review of the fellow's history/physical exam. division rounds. This is in addition to attending/patient care rounds as outline above under fellow responsibilities. etc.) Fellows are expected to attend the following conferences while on this rotation. progress notes and documentation of procedures in the chart [x ] Fellow's attendance of rounds and conferences monitored [ ] Other: ________________________ Conferences or Attending/Patient Care Rounds: (Journal club. Rev: 5/09 Name Location Day Time ID Clinical Conference UCSF Building Tues 1200-1300 ID Didactic Lectures UCSF Building Wed 1200-1300 HIV Case Conference Cedar Campus tues 1200-1300 ID Board Review UCSF Building Fridays 1200-1300 Journal Club UCSF Building 4th Friday 1200-1300 Microbiology Rounds CRMC Lab Wed 1000-1100 81 .

urinary tract infections. antibiotic levels. Those listed here are specific to this rotation. with patients demonstrating varying degrees of severity of illness including intensive care patients. mycobacterial infections. blood stream and urinary tract infections. They will also participate in antibiotic use and monitoring and the surveillance of daily microbiologic reports.5). On Average 25-30 inpatient infectious disease consultations are provided per month. The Fellows will also have a rich ambulatory experience with an opportunity to see. as well as surgical site . Surgery. again on a first contact basis. m) The fellow will review all laboratory results and work with the attending physician to appropriately act to provide patient care. The Infectious Disease Fellows will provide first contact for requested consultations and will be supervised by Board Certified Infectious Disease faculty members who are experienced Kaiser medical staff physicians. Inpatient consultative service includes patients on Medicine. All objectives pertain to first and second year fellows (PGY-4. infectious endocarditis. and chronic pulmonary infections. Ph. The ID services at Fresno Kaiser Permanente Medical Center includes a wide range of services with both inpatient and outpatient coverage. Lacy. Name of rotation: General Infectious Diseases Service Division: Infectious Diseases Course Director: Dee A. pneumonia. The patients include those with fungal infections (especially coccidioidomycosis). k) The fellow will present cases to the faculty physician on clinical rounds l) Interesting cases from the Kaiser Hospital should be incorporated into the weekly case conference. bacteremia and sepsis. The Fellows will have an opportunity to participate in a mix of quality improvement activities in the Kaiser system. including infection control and epidemiology with monitoring of ventilator associated pneumonia. 82 . meningitis. Oncology. empyema. Emphasis will be placed on generating a strong database including history. It is expected that the achievement and mastery of these objectives will occur over multiple rotations. Site(s): Kaiser Permanente Fresno Medical Center Duration of rotation: [x] one month Average Number of Months Fellows at Hospital F1 F2 F3 Required 1 Elective General description of the rotation including educational purpose. Patient Care 1. MD. HIV infection. Fellow responsibilities: j) The fellow will perform all of the Infectious Diseases consultations requested. brain abscess. Neurology. a variety of infectious disease problems in a busy Infectious Diseases Clinic. OB/GYN. Neurosurgery. and ENT. osteomyelitis. Educational Objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. and radiology. Common presentations include prolonged fever.D. physical examination and laboratory values including microbiology. These data will be used to make initial treatment plans and subsequent day-to-day treatment decisions. Develop expertise in the epidemiology as well as in the clinical and microbiological diagnosis of infectious diseases. rationale or value: Kaiser Permanente Fresno Medical Center has 189 beds. and surgical site infections to name a few. osteomyelitis.

spectrum of activity. 7. Awareness of community and cultural attitudes toward the illness and the need for confidentiality Professionalism – See master list for these competencies. Demonstrates compassion and objectivity when dealing with patients who have a chronic and potentially life-threatening illness. and important side effects. cultural differences. Practice-Based Learning 1. Examines personal attitudes toward sexuality. Interpersonal and Communication Skills – See master list for these competencies. 5. 3. Discuss differential diagnoses for common infectious disease problems encountered in the large referral hospital setting 4. 4. 2. Demonstrates knowledge of the application of microbiologic laboratory tests and their clinical application 3. including an understanding of the mechanisms of resistance.and post- test counseling for communicable infectious diseases such as TB. fungal stains. AFB smears. Recognizes the importance of quality-of-life issues. 6. Discuss the basic principles guiding hospital epidemiology and infection control in the referral hospital setting. promoting cost effectiveness. 3. 3. appropriate laboratory tests. 2. their appropriate use. Medical Knowledge 1. Understand and utilize the principles of anti-infective management to maximize treatment effectiveness while at the same time minimizing side effects. intravenous drug abuse. 2. limitations and drug interactions of antimicrobials utilized in treating infections. Discuss the major classes of antibiotics. HIV and other sexually transmitted diseases. and understand the general principles of obtaining and interpreting microbiologic cultures and sensitivity reports. System-Based Practice 1. Demonstrates knowledge of the pharmacology. and pre. Develop expertise in the management of infectious diseases.2. toxicities. Appreciates the importance of support from family members and others. Practice cost-effective health care and resource allocation that does not compromise quality of care. Read and interpret gram stains. [x] Other: including radiology Check the principal ancillary education materials used: [ ] Reading lists [ ] Pathologic material [x] Radiologic studies [ ] Other noninvasive studies [x] Handouts on relevant topics [x] Articles from the literature [x] Other: Small group discussion of prepared [x] Case studies 83 . read textbooks and journal articles pertinent to the infectious disease cases that are being seen on service. 5. Discuss the epidemiology and pathophysiology of common infectious diseases encountered in the referral hospital setting. Apply principles of infection control and hospital epidemiology to the Kaiser Hospital inpatient units Check all principle teaching methods used during this rotation: [x ] Attending teaching rounds [ ] Interdisciplinary rounds [x ] Patient management discussions [x ] Small group discussions [x] Conferences specific to rotation [x ] Bedside clinical rounds [ ] Individual instruction of procedures [x ] Review of diagnostic studies. 1. Discuss the issues surrounding indications for testing. Advocate for quality patient care and assist patients in dealing with system complexities. Perform literature searches. preventing emergence of resistant pathogens. 4. communicable diseases and death.

5/09 Name Location Day Time ID Clinical Conference UCSF Building Tues 1200-1300 ID Didactic Lectures UCSF Building Wed 1200-1300 HIV Case Conference Cedar Campus Tues 1200-1300 ID Board Review UCSF Building Fridays 1200-1300 Journal Club UCSF Building 4h Friday 1200-1300 Microbiology Rounds CRMC Lab Wed 1000-1100 84 . This is in addition to attending/patient care rounds as outline above under fellow responsibilities. Rev.cases Methods used to evaluate the resident and the rotation: [x ] Evaluation of fellow performance and professionalism [x ] Evaluation of attending teaching skills and other attributes [x ] Rotation assessment by fellow [x ] Observation of fellow's clinical competency [x ] Observation of fellow's leadership and teaching skills [x ] Review of the fellow's history/physical exam. etc. progress notes and documentation of procedures in the chart [x ] Fellow's attendance of rounds and conferences monitored [ ] Other: ________________________ Conferences or Attending/Patient Care Rounds: (Journal club. division rounds.) Fellows are expected to attend the following conferences while on this rotation.

b. The fellow receives the calls for consultations and he/she will then evaluate the patient. Patient Care 1. rationale or value: The goal of this mandatory rotation is to provide the fellow with the skills necessary to understand the unique infectious complications in transplant patients and to learn the appropriate evaluations required for diagnosis and treatment of these infections. AFB smears. The patients to be managed on the transplantation service include solid organ and bone marrow transplants. 2. c. e. The fellows will join the ID consultative service at UCSF- Moffett Hospital in San Francisco and participate by both seeing the transplant patients as primary consultative contact and by supervising residents making primary contact. Read and interpret gram stains. All objectives pertain to first and second year fellows (PGY-4. MD Duration of rotation: [x] one month Average Number of Months Fellows at Hospital F1 F2 F3 1 Required Elective General description of the rotation including educational purpose. Develop expertise in the epidemiology as well as in the clinical and microbiological diagnosis of infectious diseases in immunosuppressed patients. Fellow responsibilities: a. and understand the general principles of obtaining and interpreting microbiologic cultures and sensitivity reports. The fellow will then be involved in the discussions with the primary service regarding the final plan of action.5).Name of rotation: Transplant Infectious Diseases Service Division: Infectious Diseases Site(s): University of California. The fellows will participate in ID transplant rotation conferences f. San Francisco Moffitt Hospital Course Director: Peter Chin-Hong. Educational Objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. Develop expertise in the management of transplant infectious diseases. 85 . It is expected that the achievement and mastery of these objectives will occur over multiple rotations. They will also learn how to assess the literature relative to infections in the transplant patients and be prepared to discuss key articles. but also gain knowledge on the indications and approach to infection prophylaxis. 3. They will be supervised by the Infectious Disease Specialist attending on the ID transplant service and will be monitored by the site director. The patient will be presented to the transplant attending for teaching and review of the plan of management. The fellow will take call two of the four weekends per block making certain to maintain 1 day off in every 7 averaged over 30 days. d. Interesting cases from the San Francisco Moffitt Hospital should be incorporated into the weekly case conference. During the rotation they will not only learn the diagnostic and treatment skills required for transplant patients. Those listed here are specific to this rotation. g. fungal stains.

Awareness of community and cultural attitudes toward the illness and the need for confidentiality Professionalism – See master list for these competencies. Practice-Based Learning 1. 3. Recognizes the importance of quality-of-life issues. Medical Knowledge 1. [x] Other: Optional rounds with oncology team including radiology Check the principal ancillary education materials used: [ ] Reading lists [ ] Pathologic material [x] Radiologic studies [ ] Other noninvasive studies 86 . 4. 5. System-Based Practice 1. Examines personal attitudes toward sexuality. Discuss the major classes of antibiotics. Appreciates the importance of support from family members and others. Demonstrates compassion and objectivity when dealing with patients who have a chronic and potentially life-threatening illness. 4. Understand adverse reactions and drug-to-drug interactions of commonly used post-transplant immuosuppressive agents 6. and promoting cost effectiveness. 1. Discuss the basic principles guiding hospital epidemiology and infection control in the referral hospital setting. Advocate for quality patient care and assist patients in dealing with system complexities. Examines personal attitudes toward sexuality. communicable diseases and death. Apply principles of infection control and hospital epidemiology to the Fresno VA inpatient units Check all principle teaching methods used during this rotation: [x ] Attending teaching rounds [ ] Interdisciplinary rounds [x ] Patient management discussions [x ] Small group discussions [x] Conferences specific to rotation [x ] Bedside clinical rounds [ ] Individual instruction of procedures [x ] Review of diagnostic studies. preventing emergence of resistant pathogens. Appreciates the importance of support from family members and others. 2.4. 3. 2. spectrum of activity. cultural differences. and important side effects. 5. Discuss the epidemiology and pathophysiology of common transplant-related infectious diseases encountered in the referral hospital setting. Demonstrates knowledge of the pharmacology. Discuss differential diagnoses for transplant-related infectious disease problems encountered in the large referral hospital setting 4. 3. Understand and utilize the principles of anti-infective management to maximize treatment effectiveness while at the same time minimizing side effects. 2. Awareness of community and cultural attitudes toward the illness and the need for confidentiality quality of care. 2. Perform literature searches. their appropriate use. intravenous drug abuse. toxicities and limitations of antimicrobials utilized in treating infections. 7. including an understanding of the mechanisms of resistance. Demonstrates knowledge of the application of microbiologic laboratory tests and their clinical application in transplant patients. intravenous drug abuse. cultural differences. read textbooks and journal articles pertinent to the infectious disease cases that are being seen on service. 3. 5. Demonstrates compassion and objectivity when dealing with patients who have a chronic and potentially life-threatening illness. Interpersonal and Communication Skills – See master list for these competencies. communicable diseases and death. Recognizes the importance of quality-of-life issues.

This is in addition to attending/patient care rounds as outline above under fellow responsibilities. division rounds.) Fellows are expected to attend the following conferences while on this rotation. etc. progress notes and documentation of procedures in the chart [x ] Fellow's attendance of rounds and conferences monitored [ ] Other: ________________________ Conferences or Attending/Patient Care Rounds: (Journal club. We will need to get the conf schedule @ San Francisco Moffitt Hospital 87 .[x] Handouts on relevant topics [x] Articles from the literature [x] Other: Small group discussion of prepared [x] Case studies cases Methods used to evaluate the resident and the rotation: [x ] Evaluation of fellow performance and professionalism [x ] Evaluation of attending teaching skills and other attributes [x ] Rotation assessment by fellow [x ] Observation of fellow's clinical competency [x ] Observation of fellow's leadership and teaching skills [x ] Review of the fellow's history/physical exam.

Accurately document information gathered from as well as given to each patient. Provide effective health maintenance and anticipatory guidance. Fellow responsibilities: d. Gather essential and accurate information about the patient. Demonstrate ability to diagnose. The fellow is responsible for all paperwork for their patients including Ryan White forms. including appropriate follow up of all diagnostic tests ordered. 2. Those listed here are specific to this rotation. Medical Knowledge 1. The clinic session will be 4 hours once per week. Practice-Based Learning 88 . Evaluate not fewer than 3 or greater than 6 patients per scheduled 1/2-day session when averaged over the year. evaluate and manage patients with broad ID problems. Make informed diagnostic and therapeutic decisions based on patient information. 4. current scientific evidence. g. The fellow is responsible for following up labs and phone calls for their patients. Each fellow will be assigned a panel of 50 patients for their longitudinal continuity care clinic. In addition. They will also provide prescription refills for their patients. Cedar Campus Duration of rotation: [x ] longitudinal General description of the rotation including educational purpose. The fellow will present all patients to the attending physician for teaching and development of a plan of management. and patient preference. Discuss the diagnosis and treatment of common infectious disease and internal medicine problems. With dieticians. 8. 7. Demonstrate an investigatory and analytic approach to clinical problem solving and knowledge acquisition. There will be one clinic per week for the 24 months of the fellowship program in order to provide continuity of care. f. 2. the inpatient consult service provides at least 3 HIV consults/week which allows the fellow to focus on the inpatient HIV- related complications and to gain in depth knowledge of the acute care aspect of these immunosupressed patients. During this rotation the first year fellow (PGY-4) will: Patient Care 1. Demonstrate knowledge of the basic evaluation. In addition. MD Site(s): CRMC. . including HIV and Hepatitis C. The fellow will see and evaluate patients sent to Special Services clinic. 5. e. Educational objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. This clinic will serve as the continuity clinic. 25-30 pediatric patients are cared for by the HIV clinic.Name of rotation: Special Services Clinic (HIV) Division: Infectious Diseases Course Director: Simon Paul. clinical judgment. rationale or value: The Special Care Clinic (HIV) at CRMC provides care to over 700 active patients who span the spectrum of disease from acute to far advanced infection. social workers and nurses all working in the clinics. Carry out patient management plans. 3. fellows are exposed to an inter-disciplinary approach to patient care. 6. There may also be consultations performed. treatment and management of patients with HIV and Hepatitis C. The clinic also provides primary care for 15-20 HIV-infected pregnant women every year. HIV and Hepatitis C. pharmacists. encountered in an outpatient clinic.

including HIV and Hepatitis C. Partner with members of the health-care team to manage complex patient issues. Locate. 4. Identify and work with other health care professionals and organizations that may assist in a patient’s care. Practice-Based Learning 1. evaluate and manage patients with HIV and Hepatitis C. Function as the coordinator of a health-care team to manage complex patient issues. Develop and maintain a willingness to learn from errors. Medical Knowledge 1. Demonstrate commitment to the practice of cost-effective medical care. 3. appraise and assimilate evidence from scientific studies related to their patients’ health problems.1. including appropriate follow up of all diagnostic tests ordered. 2. Provide effective health maintenance and anticipatory guidance. appraise and assimilate evidence from scientific studies related to their patients’ health problems. Interpersonal and Communication Skills 1. During this rotation the second year fellows (PGY-5) will: Patient Care 1. 4. Demonstrate ability to diagnose. Demonstrate an investigatory and analytic approach to clinical problem solving and knowledge acquisition. 2. 7. Check all principle teaching methods used during this rotation: [ ] Attending teaching rounds [x ] Interdisciplinary rounds [x ] Patient management discussions [x ] Small group discussions [x] Conferences specific to rotation [x ] Bedside clinical rounds 89 . Continue to expand expertise regarding infectious disease and internal medicine problems. 3. 5. Evaluate not fewer than 4 or greater than 8 patients per scheduled 1/2-day session when averaged over the year. 2. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf. System-Based Practice 1. treatment and management of patients with HIV and Hepatitis C. 2. Carry out patient management plans. 3. Develop and maintain a willingness to learn from errors. Make informed diagnostic and therapeutic decisions based on patient information. 2. Gather essential and accurate information about the patient. Demonstrate knowledge of the basic evaluation. 2. Assess practice style. 6. 3. 3. System-Based Practice 1. Demonstrate commitment to the practice of cost-effective medical care. Communicate effectively and respectfully with the referring physician and other members of the health care team. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf. Communicate effectively and respectfully with other members of the health care team. Interpersonal and Communication Skills 1. Locate. clinical judgment. and patient preference. encountered in an outpatient clinic. Accurately document information gathered from as well as given to each patient. 4. current scientific evidence. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families. 2. Identify and work with other health care professionals and organizations that may assist in a patient’s care. identify areas requiring improvement and implement changes accordingly. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families. 2.

[x ] Individual instruction of procedures [x ] Review of diagnostic studies,
[ ] Other: ________________________ including radiology

Check the principal ancillary education materials used:
[x ] Reading lists [ ] Pathologic material
[x ] Radiologic studies [ ] Other noninvasive studies
[x ] Handouts on relevant topics [x ] Articles from the literature
[ ] Other: ________________________ [x ] Case studies

Methods used to evaluate the fellow and the rotation:
[x ] Evaluation of fellow performance and professionalism
[x ] Evaluation of attending teaching skills and other attributes
[x ] Rotation assessment by fellow
[x ] Observation of fellow's clinical competency
[x ] Observation of fellow's leadership and teaching skills
[x ] Review of the fellow's history/physical exam, progress notes and documentation of
procedures in the chart
[x ] Fellow's attendance of rounds and conferences monitored
[x ] Other: Evaluation of interviewing skills and approach to psychosocial problems

Conferences or Attending/Patient Care Rounds: (Journal club, division rounds, etc.)
Fellows are expected to attend the following conferences while on this rotation. This is in addition to
attending/patient care rounds as outline above under fellow responsibilities.

Rev. 5/09

Name Location Day Time
ID Clinical Conference UCSF Building Tues 1200-1300
ID Didactic Lectures UCSF Building Wed 1200-1300
HIV Case Conference Cedar Campus Tues 1200-1300
Board Review UCSF Building Fridays 1200-1300
Journal Club UCSF Building 4th Friday 1200-1300

Microbiology Rounds CRMC Lab Wed 1000-1100

90

General Clinic Organization, HIV
Scheduling:
General stuff:
--Clinic starts at 8:30 (first patient is scheduled at 8:15 and should be registered, vital signs done
by 8:30).
--after having their vital signs done, patients wait in the clinic waiting room. When you are ready
to see the patient, get them from the waiting room, introduce yourself if they do not already
know who you are, and take them to the exam room you will be using.
--If the patient is not in the waiting room they may be meeting with their case manager
somewhere. Unless you are very short of time, try not to interrupt their meeting but wait until the
case manager finishes and then go get the patient from the waiting room. The case managers try
to work around the provider’s schedule, so this doesn’t happen often.
--when you are done seeing the patient, send them back to the waiting room. That’s where their
case manager will look for them and that’s where the nursing staff will look for them if they need
any vaccines/injections etc.
--It’s fine to use the computers in the exam room, but make sure to close windows etc. if patients
can view the screen so as to protect other patient’s confidentiality. If you are using the computer
in the exam room be very careful about leaving patients alone in the room when you are not there
(i.e. don’t). You can click on the encentuate icon in the lower right corner of the toolbar to close
all windows and lock the computer if you need to.
Scheduling:
--New patients and your own patients will be added to your schedule without contacting you if
there is an available appointment.
--Case managers will check with you first prior to adding on any: same-day add-on
appointments, overbooked patients, or to have you see another provider’s patient.
--If you do not have an appointment slot available, case managers will contact you to get your
OK for your patient to see another provider (vs. waiting to be seen by you if that’s a reasonable
alternative).
--Canceling clinics/vacation dates: please give six weeks notice to cancel a clinic date. If you
need to cancel a clinic with less than six weeks notice then provide an alternate clinic session for
the patients to be moved to. Email all schedule change requests to Karla
(kvilla@communitymedical.org) and me as well.
Paper flow:
--We do not use the med sheet in the medical paper chart. Instead we print out the active
medications at each appointment, the provider signs off on that list, and the front desk staff adds
that current med list to the paper chart.
--Labtracker IS NOT the official medical record, so anything that needs to be in the medical
record has to be printed out and sent off for filing….
--return the billing sheet, order sheet (either orders on the progress note or the separate sheet with
instructions), labsheet, and prescriptions to the front desk staff. They will give everything to the
patient when they give them their next appointment date.

Labtracker:
(Detailed instructions regarding how to do these things are attached below)
--Prescriptions: ALL prescriptions need to be entered in labtracker. This includes rx’s such as
narcotics that have to be written by hand
--clinic visit notes: you can type these in labtracker OR write your note by hand and enter a 2-3
sentence summary in labtracker so that covering providers/case managers know what’s going on
--health maintenance: this screen also has to be updated. Case managers also help update these
fields, but ultimately it’s the primary provider’s responsibility to document that health
maintenance has been completed. Our performance reporting to the federal gov’t is extracted
91

automatically from the health maintenance screen so it’s critical this be updated: writing that
something was done in your progress note isn’t enough.

Health Maintenance:
As we are the patient’s primary care provider, all recommended health maintenance for all
conditions/age/sex that’s indicated should of course be done. Specific to HIV, the things we care
about are:
--Baseline labs get done (including hep serologies, lipids, repeat HIV ab test if not in chart, u/a,
gc/Chlamydia, toxo IgG, cmv ab, cd4/hiv vl)
--PAP Smears: at least yearly
--PPD or quantiferon yearly
--VDRL q 6 months
--Adherence counseling
--assessment of drug use, risk assessment/prevention/safe sex

If you want to know if your patient is due for anything, click on the “decision support” box that
is on the main patient screen when you first select your patient from the active patient list. (note:
check with the patient before ordering anything. Sometimes it will say a ppd is due, but actually
they have had a +PPD in the past and they really just need questioning re if they have
symptoms/signs of active tb as their particular yearly tb screening)

The specific health maintenance outcomes that we monitor at present and our minimum
acceptable levels are:
PPD: at least 40% of active patients should be up to date (last ppd within 12 mo)
PAP: at least 40% of active patients should be up to date (last pap within 12 mo)
RPR: at least 50% of active patients should be up to date (last vdrl within 12 mo)

Conferences:
Each Tuesday at noon we have the clinic case conference. The first Tuesday of the month we go
over patients in the MediCal Waiver/CMP intensive case management program. The other
Tuesdays we go over the previous week’s patients that came to clinic. Each week we also try and
go over new patients that will be coming in the next week, and any inpatients on the HIV service.

The primary purpose of this conference is to coordinate care between the various providers, case
managers, and clinic staff.

The current format is for the casemanager to present first, then the physician or psychiatrist. It’s
helpful for people to know a few basic things about where you patient is at clinically, where they
are going and any new/unusual issues that came up. For example: “has a low cd4 count but is
planning to begin arv’s at their next visit. They were hospt for pcp but currently they feel fine…”

LabTracker Orientation:

Entering Medications:
1. Find patient in patient list, select patient
2. click on “medication” tab, med list should appear (note you can select “all meds” or “active
meds” and various other options from the combo box near the top of the med list)
3. to add a new medication click on “new med”
3a. search for the med in the search box, click on the name once it appears
92

. If no info has ever been entered for that test. If not. click on “edit soap” and write your note in labtracker (easier than it sounds once you figure out how to enter them). it just means that you are adding new test info for that patient! So click on the “new test/imm” box near the top left and select a test that is already on the list in the window that will appear. interval. OR. Click on “new visit date” and enter a date Click on “visit type” and select “routine clinic visit” Select your name under “provider” Enter a time. the front desk staff will have already entered the visit date and possibly visit type/provider info. you can either write a quick summary in the “visit comments” box (2-3 sentences) and initial that (and write a regular progress note by hand). and select “attended” If you asked the patient about adherence. 93 .e. Enter a new start date. you will get a message about “adding a new test”.. Visits: Often by the time you get around to writing your note. select a dosing interval (i. A new screen for just that medication will appear. if you click on that box. probably you are looking at their “active med” list. length of visit (ballpark).e “bid”) in the next box 3d. If you write your note in labtracker you need to print it out and sign it to go off to the paper chart. click on done Reactivating an inactive med: Sometimes when you go to add a new medication you will get a “patient already has this medication” box. click on the “y” box over on the left under adherence and fill in that pop up window. then click done… Inactivating a medication: Just enter a date in the “end date” window for that medication. If you don’t see the medication on their list. click on the box in the first column under “reason for drug” and select “treat” for antiretroviral meds and “prophylaxis” for oi prophylaxis meds. That doesn’t mean adding a new test to labtracker. click on the square box under the heading “click for more date”. and you need to change to “all meds” list. enter a dose in the first box (has to include a number) 3c. You can enter a reason if you feel like it in the next box over… Reason for Drug: For antiretroviral meds that you enter. here’s what needs to be entered: Go to the “Visits” tab (top right area when you have selected a patient). 3b. Once you have done the above. so even though it may seem obvious from the drug name that the patient is on antiretrovirals this box is still important… Health Maintenance: This section is kind of a pain. Do not click on the “new test” option at that point as that option is for adding a completely new test that labtracker has never heard of before. Once you are at the “all meds” list. a ppd was done 16 months ago). This helps us report what percent of our patients are on appropriate medications. just click on the box in the “click for more dates” column and go with whatever it asks for in the next window. but here are some tips: If a test already has info recorded (i. dose.

search for the med in the search box. Enter a new start date. click on “medication” tab. You can enter a reason if you feel like it in the next box over… Reason for Drug: For antiretroviral meds that you enter. Once you are at the “all meds” list. enter a dose in the first box (has to include a number) 3c. select patient 2. probably you are looking at their “active med” list.. med list should appear (note you can select “all meds” or “active meds” and various other options from the combo box near the top of the med list) 3. but here are some tips: If a test already has info recorded (i. click on the square box under the heading “click for more date”. A new screen for just that medication will appear. here’s what needs to be entered: Go to the “Visits” tab (top right area when you have selected a patient). it just means that you are adding new test info for that patient! So click on the “new test/imm” box near the top left and select a test that is already on the list in the window that will appear. Find patient in patient list. and you need to change to “all meds” list. dose. That doesn’t mean adding a new test to labtracker. so even though it may seem obvious from the drug name that the patient is on antiretrovirals this box is still important… Health Maintenance: This section is kind of a pain. If no info has ever been entered for that test.LabTracker Orientation: Entering Medications: 1. interval. Click on “new visit date” and enter a date 94 . if you click on that box. Visits: Often by the time you get around to writing your note. If you don’t see the medication on their list. click on the box in the first column under “reason for drug” and select “treat” for antiretroviral meds and “prophylaxis” for oi prophylaxis meds. you will get a message about “adding a new test”. Do not click on the “new test” option at that point as that option is for adding a completely new test that labtracker has never heard of before.e “bid”) in the next box 3d.e. just click on the box in the “click for more dates” column and go with whatever it asks for in the next window. This helps us report what percent of our patients are on appropriate medications. If not. then click done… Inactivating a medication: Just enter a date in the “end date” window for that medication. to add a new medication click on “new med” 3a. a ppd was done 16 months ago). the front desk staff will have already entered the visit date and possibly visit type/provider info. select a dosing interval (i. click on the name once it appears 3b.. click on done Reactivating an inactive med: Sometimes when you go to add a new medication you will get a “patient already has this medication” box.

and select “attended” If you asked the patient about adherence. click on the “y” box over on the left under adherence and fill in that pop up window. If you write your note in labtracker you need to print it out and sign it to go off to the paper chart. length of visit (ballpark). Once you have done the above. 95 . OR.Click on “visit type” and select “routine clinic visit” Select your name under “provider” Enter a time. you can either write a quick summary in the “visit comments” box (2-3 sentences) and initial that (and write a regular progress note by hand). click on “edit soap” and write your note in labtracker (easier than it sounds once you figure out how to enter them).

6. Accurately document information gathered from as well as given to each patient. including appropriate follow up of all diagnostic tests ordered. Approximately 60% of all consults are men and 40% are women. Medical Knowledge 1.Name of rotation: Infectious Diseases Outpatient Clinic Division: Infectious Diseases Course Director: Robert Libke. MD Site(s): CRMC. Make informed diagnostic and therapeutic decisions based on patient information. 5. The one exception is pain medications and other controlled substances. treatment and management of patients with coccidioidomycosis. e) The fellow will be primarily responsible for answering phone consultations by outside physicians and discuss them with the attending physician as required. Carry out patient management plans. with emphasis on long- term care for patients with coccidioidomycosis. and patient preference. Fellow responsibilities: a) The fellow will see and evaluate patients referred to the clinic for consultation. Gather essential and accurate information about the patient. Demonstrate ability to diagnose. Provide effective health maintenance and anticipatory guidance. Demonstrate knowledge of the basic evaluation. 4. b) The fellow will present the patients to the faculty physician to develop the plan for management. clinical judgment. Evaluate not fewer than 3 or greater than 6 patients per scheduled 1/2-day session when averaged over the year. We hope for the fellows to achieve an appreciation for the natural history of infectious diseases and familiarity with common problems encountered in the outpatient practice of infectious diseases. During this rotation the first year fellow (PGY-4) will: Patient Care 1. evaluate and manage patients with broad ID problems emphasis on long-term care for patients with coccidioidomycosis. current scientific evidence. Those listed here are specific to this rotation. 2. d) The fellow will be responsible for prescription refills for their own patients and if there is no assigned attending physician. 7. 2. 8. Discuss the diagnosis and treatment of common infectious disease and internal medicine problems encountered in an ID outpatient clinic. c) The fellow will review the laboratory and radiology results returned to the clinic that are not on the EMR and address those results that require immediate action while forwarding others to the appropriate provider. 3. rationale or value: The weekly Infectious Diseases Clinic provides both follow up consultations to patient seen in the inpatient setting and new patient consultations. Cedar Campus Duration of rotation: [x ] longitudinal General description of the rotation including educational purpose. Educational objectives: An expanded version of the competencies is listed under Core Competencies in Internal Medicine. because of its high endemicity in the California Central Valley. Demonstrate an investigatory and analytic approach to clinical problem solving and knowledge acquisition. Patients have a wide range of infectious diseases. 96 .

Partner with members of the health-care team to manage complex patient issues. and patient preference. Demonstrate commitment to the practice of cost-effective medical care. 2. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families. Develop and maintain a willingness to learn from errors. Identify and work with other health care professionals and organizations that may assist in a patient’s care. encountered in an outpatient clinic. System-Based Practice 1. appraise and assimilate evidence from scientific studies related to their patients’ health problems. Check all principle teaching methods used during this rotation: [ ] Attending teaching rounds [ ] Interdisciplinary rounds [x ] Patient management discussions [ ] Small group discussions 97 . 4. Practice-Based Learning 1. 4. 2. Medical Knowledge 1. Demonstrate an investigatory and analytic approach to clinical problem solving and knowledge acquisition. treatment and management of patients with coccidioidomycosis. 2. System-Based Practice 1. Locate. 2. 3. Interpersonal and Communication Skills 1. Demonstrate commitment to the practice of cost-effective medical care. 5. 2. Locate. Demonstrate ability to diagnose. Communicate effectively and respectfully with other members of the health care team. 3. 2. 3. Communicate effectively and respectfully with the referring physician and other members of the health care team. 3. 4. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families. 3.Practice-Based Learning 1. Provide effective health maintenance and anticipatory guidance. 2. Carry out patient management plans. Gather essential and accurate information about the patient. Continue to expand expertise regarding infectious disease and internal medicine problems. Make informed diagnostic and therapeutic decisions based on patient information. including appropriate follow up of all diagnostic tests ordered. 6. Assess practice style. current scientific evidence. 7. Function as the coordinator of a health-care team to manage complex patient issues. Interpersonal and Communication Skills 1. Evaluate not fewer than 4 or greater than 8 patients per scheduled 1/2-day session when averaged over the year. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf. appraise and assimilate evidence from scientific studies related to their patients’ health problems. evaluate and affectively manage patients with coccidioidomycosis. clinical judgment. identify areas requiring improvement and implement changes accordingly. Accurately document information gathered from as well as given to each patient. During this rotation the second year fellows (PGY-5) will: Patient Care 1. Demonstrate knowledge of the basic evaluation. Identify and work with other health care professionals and organizations that may assist in a patient’s care. Develop and maintain a willingness to learn from errors. 2.

[ ] Other: ________________________ including radiology Check the principal ancillary education materials used: [ ] Reading lists [ ] Pathologic material [x ] Radiologic studies [ ] Other noninvasive studies [x ] Handouts on relevant topics [x ] Articles from the literature [ ] Other: ________________________ [x ] Case studies Methods used to evaluate the fellow and the rotation: [x ] Evaluation of fellow performance and professionalism [x ] Evaluation of attending teaching skills and other attributes [x ] Rotation assessment by fellow [x ] Observation of fellow's clinical competency [x ] Observation of fellow's leadership and teaching skills [x ] Review of the fellow's history/physical exam. division rounds.[x] Conferences specific to rotation [x ] Bedside clinical rounds [x ] Individual instruction of procedures [x ] Review of diagnostic studies.) Fellows are expected to attend the following conferences while on this rotation. progress notes and documentation of procedures in the chart [x ] Fellow's attendance of rounds and conferences monitored [x ] Other: Evaluation of interviewing skills and approach to psychosocial problems Conferences or Attending/Patient Care Rounds: (Journal club. This is in addition to attending/patient care rounds as outline above under fellow responsibilities. Rev: 5/09 Name Location Day Time ID Clinical Conference UCSF Building Tues 1200-1300 ID Didactic Lectures UCSF Building Wed 1200-1300 HIV Case Conference Cedar Campus Tues 1200-1300 Board Review UCSF Building Fridays 1200-1300 Journal Club UCSF Building 4th Friday 1200-1300 Microbiology Rounds CRMC Lab Wed 1000-1100 98 . etc.

the majority of the time will be spent in Research Fellows must demonstrate evidence of recent research productivity in the scholarship of discovery. Paul has also collaborated with Dr. The bi-monthly course also provides a forum for fellows in training to present their ongoing research projects. Dr. Abstracts published 6. Our program has developed a broad range of research interests that will provide a foundation for fellows in infectious disease to gain research training. Paul has also served as the local PI for an NIH funded multi-center study validating in Spanish an adolescent risk for HIV infection survey. Fungal meningitis is also an area of active investigation. This research course assists fellows in developing their research projects by providing training in research design. abstracts. Book chapter in a medical textbook 5. In addition Dr. Dr Muhammed Sheikh. Abstracts presented at national specialty meeting. Roger Mortimer in a study of risk factors for cryptococcal meningitis in HIV infected patients. Chief of the Gastroenterology Fellowship. as evidenced by peer-reviewed funding or by publication of original research in a peer-reviewed journal. Dr. Simon Paul is the Principal Investigator of an NIHfunded study using exercise testing and isotopic tracers to study the effects of antiretroviral therapy on glucose and lactate metabolism. Tanya Warwick of neurology is studying the use of transcranial doppler for prediction of complications of fungal meningitis. we began an interactive research design workshop for fellows in specialty training. or the scholarship of dissemination. thus providing opportunities for fellows training in infectious disease to participate in multi-center clinical trials. Publication of original research 2. or application as evidenced by the publication or presentation of case reports. this course is required for infectious disease fellows. Our HIV program also served as a site for the CPCRA SMART study of structured treatment interruptions for antiretroviral therapy and has participated in several industry-funded clinical trials. Robert Libke is studying the epidemiology of coccidioidal meningitis and Dr. or clinical series at national or international specialty society meetings. Simon Paul has been very involved in teaching research methods. Dr. Dr. Review article 3. Paul has received funding to establish an internet based patient education center in the HIV clinic and is currently mentoring internal medicine residents studying the effectiveness of this approach. As research director for the internal medicine residency program. is actively involved in multiple studies of different treatment modalities in HCV. Fellows are expected to attend his 99 . In the year 2008. He plans to go forward with this methodology in the future to study more broadly the effects of infections on metabolism and mitochondrial function.Research In the Second year of the fellowship. as evidenced by review articles or chapters in textbooks. The Review Committee defines acceptable Fellow publications as: 1. Dr. Editorial in a peer-reviewed (indexed) journal or a funded peer-reviewed grant 4. data analysis and statistics and also by providing exposure to basic science methodologies.

1 month. M. 1st year 6 miles See page 70 for Specific Rotation Information 4.D.D.Clinic Campus See page 76 for Specific Rotation Information 2. Shobha Sharma.5 miles See page 61 for Specific Rotation Information 3. Participating Institutions: 1. Simon Paul. 7300 N. 445 South Cedar . . Dee Lacy.D. D.weekly HCV clinic and participate in evaluating and initiating HCV treatment as outlined in these studies. 1st year 9300 Valley Children’s Blvd.2nd Campus 1. M. M. Kaiser Permanente Fresno Medical Center Site Director. Robert Libke. 2823 Fresno Street – Main Campus See page 57 for Specific Rotation Information Cedar Campus Site Director. Fresno . Madera 10 miles See page 67 for Specific Rotation Information 5. M.O. M. 505 Parnassus SF 180 Miles See page 73 for Specific Rotation Information 100 . Peter Chinn Hong. San Francisco Moffitt Hospital 1 month 2nd year Site Director. 1 month. Children’s Hospital of Central California Site Director.D.D. Veterans Affairs Central California Health Care System (VACCHCS) Site Director. University of California. HIV. James McCarty. Clinton .Community Regional Medical Center: (CRMC) Site Director. 2615 E.

At each participating site. the key clinical faculty with the Program director. monitoring and evaluation of the fellows’ clinical and research training. or. there must be a sufficient number of faculty with documented qualifications to instruct and supervise all fellows at that location. 5. The faculty must regularly participate in organized clinical discussions. Key clinical faculty are attending physicians who dedicate. 101 .Faculty requirements: In addition to the program director. The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. devote sufficient time to the educational program to fulfill their supervisory and Teaching responsibilities and to demonstrate strong interest in the education 2. Qualifications: The key faculty must: 1. Some members of the faculty should also demonstrate scholarship by one or more of the following: 1. 3. and 2. journal clubs and conferences. administer and maintain an educational environment conductive to educating the Fellows The nonphysician faculty must have appropriate qualifications in their field and hold appropriate institutional appointments. each program must have two key clinical faculty. participate in national committees or educational organizations. have current certification in Infectious Diseases or possess qualifications judged by the Review Committee to be acceptable. 10 hours per week throughout the year to the training program. faculty should encourage and support fellows in scholarly activities. be active clinicians with broad knowledge of experience with and commitment to Internal medicine/Infectious Diseases as a discipline. rounds. regional. publication or presentation of case reports or clinical series at local. are responsible for the planning implementation. They must: 1. 4. or national professional and scientific society meetings. on average. publication of original research or review articles in peer reviewed journals or chapters in textbooks. In addition to the responsibilities of all individual faculty. peer-reviewed funding 2.

and help to define. Fellows must have clinical experiences in efficient. 102 . effective ambulatory and inpatient care settings. Electronic medical literature databases with search capabilities should be available. All deaths of patients who received care by fellows must be reviewed. and work/study space. Support Services: Administrative support must include adequate secretarial and administrative staff and technology to support the program director. including meeting rooms. A sufficient number of patients must be available to ensure adequate inpatient and ambulatory experience for each subspecialty fellow. Inpatient clinical support services must be available on a 24 hour basis to meet Reasonable and expected demands. including intravenous services. There must be patients of both sexes with a broad age range. Medical Information Access: Fellows must have ready access to specialty-specific and other appropriate reference material in print or electronic format. as defined in the specialty program requirements. examination rooms. phlebotomy Services. There must be space and equipment for the educational program. visual and other educational aids. computers. including geriatric patients. classrooms. Fellows must have lounge and food facilities during assigned duty hours. messenger/transporter services and laboratory and radiologic information Retrieval systems that allow prompt access to results.Facilities and Resources The institution and the program must jointly ensure the availability of adequate resources for fellow education. Medical Records: Clinical records that document both inpatient and ambulatory care must be readily available at all times. Patient Population: The inpatient and ambulatory care population must provide experience with patients whose illnesses are encompassed by. the fellowship.

malaria 40. Small Pox 46. SARS 44. parasites 41. parvovirus 42. Septic Shock 45.39. rabies 43. Zoonosis 20 .

Clinical skills needed to achieve competency include: ability to obtain an accurate history focusing on the issues of particular interest to infectious diseases and perform a complete and accurate physical exam. hepatitis C and other chronic infections. d. The fellow must also demonstrate the ability to accurately review medical records. c. The purpose of the fellowship program at UCSF-Fresno is to broadly train our fellows to treat and manage patients with infectious diseases in a changing world. e. In addition. the fellows follow the patients longitudinally and commonly serve as the primary care providers. Demonstration of competency will be evaluated by using the following competencies. older pathogens have been re-emerging and the specter of bioterrorism requires a broad range of knowledge for physicians practicing clinical infectious diseases. b. This will demonstrate evidence of independent scholarship. Core Competencies 1. Understanding etiologic agents and the pathogenesis of diseases is a required skill to achieve competency. The appropriate use of antimicrobial agents is an important skill that must be mastered. Access and critically evaluate the medical literature. The skills to be evaluated are: the ability to synthesize patient data and the literature to come to an accurate differential diagnosis. Medical Knowledge a. 23 . Patient management skills are necessary to achieve competency. demonstration of sound clinical judgment. The fellows serve as consultants in the hospital as well as in the outpatient setting. Apply an open minded and analytical approach to acquiring new knowledge. Patient Care a. and incorporation of the patient preferences into the final plan. appropriately use antimicrobial agents and other approaches to therapy. The fellow must demonstrate a mastery of the literature in Infectious Diseases. new organisms have been emerging. For patients with HIV. Curriculum for Fellowship Training in Clinical Infectious Diseases UCSF-Fresno MEP Educational Purpose Infectious Diseases remain a major cause of morbidity and mortality. b. 2. Upon completion of training the fellows are required to be competent specialists in our field.

c. Practice-Based Learning and Teaching a. f. Identify the infectious diseases that are reportable to state and county health departments. Actively educate colleagues. Participate in quality improvement activities to optimize patient care. c. Understand what information is required to make an accurate and complete presentation (pertinent positives and negatives). g. f. Work within regional and national medical systems to deliver optimal medical care. other healthcare workers and patients. e. Be able to work at all medical facilities understanding the systems available for patient care. Maintain credentials to be an active member of the medical staff. 6. e. d. e. compassion and integrity when working with patients and families. If performing clinical research. Present cases in a concise and focused manner. System-Based Practice a. b. c. maintain certification to achieve the expected completion of the clinical projects. The fellow must acknowledge mistakes without being defensive. d. b. The fellow should demonstrate the ability to recognize and identify deficiencies in peer performance in a constructive manner. 4. The fellow must be able to critique his/her own performance. The fellow is required to adhere to HIPAA standards for patient confidentiality. g. The fellow is expected to adhere to principles of scientific and academic integrity. b. The fellow must be receptive to constructive criticism. Appropriate use of on-line resources to access information. 5. The fellow is expected to demonstrate respect and integrity with fellow physicians and healthcare providers. CORE CURRICULUM CORE COMPETENCIES 3. d. Maintain comprehensive. d. b. Develop an approach to appropriately and accurately perform patient handoffs. Develop a good working relationship and rapport and communicate clearly to other physicians. 24 . patients and self with a variety of sources of information. The fellow is expected to demonstrate respect. Professionalism a. Interpersonal and Communication Skills a. The fellow should learn from his/her own errors and errors of colleagues. c. timely and legible medical records. Perform research or other creative activity that will enhance learning and teaching. The fellow must take responsibility for providing quality patient care.

Kaiser Hospital. journal club. The fellow evaluates the patient and the faculty member supervises and helps direct the clinical practice. A basic science series. 3. Fresno (Elective) x Inpatient Consultation Service. 4. The fellow must understand the correct use of antimicrobial drugs and the utility of antimicrobial formularies. The fellow must be able to effectively manage patients with chronic infectious diseases such as HIV infection and hepatitis C infection. The fellow must have physical access and be able to effectively use the Clinical Microbiology Laboratory. Infection Control at Community Regional Medical Centers x Research x Inpatient Transplant Infectious Diseases Services at UCSF Campus x Inpatient Consultation Service. List of Rotations x Inpatient Consultation Service at Fresno Community Regional Medical Center x Inpatient Consultation Service at the Fresno VA Hospital x Outpatient ID Clinic at Community Regional Medical Centers. Cedar campus x Infectious Diseases Outpatient Clinic at the Fresno VA Hospital x Clinical Microbiology Rotation at Community Regional Medical Centers. The fellow must be able to evaluate a patient with an infectious disease and determine the diagnosis and a plan for management. case conference. The fellow must be able to critically interpret the medical literature and research data. Self-directed learning by reading textbooks and current literature is an expectation. The fellow will interact with the pharmacy and other healthcare providers in order to optimally utilize these important drugs as part of the Antimicrobial Stewardship Program. Cedar campus x Outpatient (Continuity) Clinic at Special services Clinic (HIV) Community Regional Medical Centers. and core curriculum lectures provide didactic teaching. 5. Children’s Hospital. The fellows participate in these conferences by providing some of the teaching through their reading and evaluation of the literature. The fellow must understand the principles and practice of healthcare epidemiology and infection control. 6. Goals and Objectives 1. CORE CURRICULUM Teaching Methods The primary method of teaching is at the patient’s bedside. other pathology laboratories and radiology and understand the results provided. 2. Fresno (Elective) 25 .

e. The fellow on service should be available 24 hours per day by telephone except during the weekend off or when being covered by a colleague. ii. The fellow will be provided 2 weekends free from clinical service while on the 4-week consultation service block so that there is one day off in every seven averaged over 30 days. The fellow will also work no more than 80 hours in a week and there will be a minimum of 10 hours off between shifts The fellow must inform the program director regarding any schedule change. Assigning new consultations to students and residents rotating on the consultation service. Provide constructive feedback to the students and residents. Confirm the history and physical examination ii. h. Determining the appropriate strategy for diagnosis and treatment of the patient. The fellow will take first call regarding antimicrobial approvals. iii. Inpatient Consultation Service at Fresno Community Regional Medical Center a. CORE CURRICULUM VI. 2. The fellow will present cases to the faculty physician. c. Provide education and references to the students and residents iv. The fellow will be physically present at the appropriate site for the rotation. The fellow will supervise the residents and medical students on the service. iv. The fellow will be responsible for organizing and presenting cases at the weekly case conferences. The fellow will confer with the attending physician if difficulties are encountered in running the service. Help the student develop a plan for the management of the patient. iii. c. i. 3 Inpatient Consultation Service at the Fresno VA Hospital b. Allow residents to go to clinic and conferences in a timely manner v. The fellow will perform all of the Infectious Diseases consultations requested. The fellow will be responsible for management of the patients i. The fellow will develop the on-call schedule for self and the rotating residents b. g. The fellow will be responsible for interaction with the requesting services. Providing a link between the inpatient consultation service and the outpatient clinic in order to maintain continuity and prevent medical errors. f. The fellow will present cases to the faculty physician on clinical rounds 26 . Suggest appropriate times to sign off of patients d. i. Responsibilities of the Fellow 1.

The fellow will review the laboratory and radiology results returned to the clinic that are not on the EMR and address those results that require immediate action while forwarding others to the appropriate provider. The fellow will present the patients to the faculty physician to develop the plan for management. The fellow will be primarily responsible for answering phone consultations by outside physicians and discuss them with the attending physician as required. c. The fellow is responsible for following labs. Cedar campus There will be one clinic per week for the 24 months of the fellowship program in order to provide continuity of care. There may also be consultations performed. e. b. The fellow will see and evaluate patients referred to the clinic for consultation. Outpatient Clinic at the VA a. The fellow will present all patients to the attending physician for teaching and development of a plan of management. The fellow will see and evaluate patients sent to Special Services Clinic. This clinic will serve as the continuity clinic. c. d. d. The fellow will attend one outpatient clinic at the VA Hospital during the months that they serve on the inpatient rotation. f. Cedar campus a. a. 5. . ID Outpatient Clinic at Community Regional Medical Centers. The fellow will be responsible for prescription refills for their own patients and if there is no assigned attending physician. The fellow is responsible for all paperwork for their patients including Ryan White forms. The one exception is pain medications and other controlled substances. The fellow will take call 2 of the 4 weekends per block making certain to maintain 1 day off in every 7 averaged over 30 days. b. Interesting cases from the VA should be incorporated into the weekly case conferences. d. The patients will be seen and evaluated by the fellow who will then present the case to an Attending physician to review the plan of management. CORE CURRICULUM RESPONSIBILITIES OF FELLOW d. The fellow will review all laboratory results and work with the attending physician to appropriately act to provide patient care. c. 6. Special Services Clinic (HIV) Community Regional Medical Centers. 4. They will also provide prescription refills for their patients. e. Transplantation Service at UCSF Campus 27 . The fellow is responsible for following up labs and phone calls for their patients. radiology and paperwork related to their patients. b.

Responsibility as the teaching attending at CRMC-HIV clinic is shared by faculty assigned to Special Services Clinic. Infection Control a. Clinical Microbiology Laboratory a. They will rotate through mycology. This rotation occurs for a total of one month during the first year of the fellowship. The patients to be managed on the transplantation service include solid organ transplants (kidney. h. b. VII. virology. CORE CURRICULUM RESPONSIBILITIES OF FELLOW e. The faculty member is expected to provide an environment conducive to learning. The faculty is assigned to the Inpatient Consultation Service in 4-week blocks. f. Responsibilities of the Faculty 1. 3. The fellow on the consultation service is responsible for addressing bloodborne pathogen exposures on off-hours (5:00 PM through 7:00 AM). c. At CRMC the fellow on the consultation service is expected to help with tuberculosis management by evaluating patients regarding necessity for isolation. 28 . The faculty member is expected to respond to questions appropriately. 7. molecular diagnostics and mycobacteriology. d. all fellows are sent to the CDC/SHEA Infection Control training course. c. g. 5. Some of the faculty are also assigned to one Infectious Diseases Clinic at CRMC. In the clinic the faculty member is expected to see and evaluate all of the fellows patients and participate in the development of a plan of action (Please see the Graded Responsibility Document). They will learn to read gram stains as part of the bacteriology. The fellow receives the calls for consultations and he/she will then evaluate the patient. Due to time constraints it is often difficult for the fellow to spend much time at CRMC in Infection Control. lung and heart) and bone marrow (stem cell) transplants. 4. b. Therefore. 2. The faculty member is expected to be present for rounds on the consultation service and in the clinic to staff the patients. 6. The fellow will report to a designated educator (Director or supervising technologist) who is responsible for their experience. The patient will be presented to the transplant attending for teaching and review of the plan of management. 8. The fellow will rotate to the different benches in the microbiology lab learning the methods used and how to interpret these tests. The fellow will then be involved in the discussions with the primary service regarding the final plan of action. On the consultation service the faculty member is expected to perform teaching rounds daily. liver.

The program director is responsible for providing an environment conducive to learning. The program director is responsible for the schedules of the fellows guaranteeing adherence to all work hour rules. Assess the risks and benefits of relevant diagnostic procedures 2. Learn how to obtain relevant information for the solution of problems presented by infectious diseases b. 5. 2. Role of the Program Director 1. The program director is responsible for organizing the curriculum. CRMC and VA Inpatient Consultation Service and General Infectious Diseases Curriculum General a. Learn to do a directed history and physical examination c. Evaluate results of microbiological data including susceptibility testing e. 4. The faculty member must provide written evaluations at the end of each rotation for the consultation service and quarterly evaluations for the clinic rotations using E- value. The faculty member must provide goals and objectives at the beginning of the rotation and verbal feedback to the fellow at the end of each rotation. Contents of The Infectious Diseases Rotations (Goals and Objectives) A. IX. The program director is responsible for the final evaluation and determining whether the fellow has met the criteria for advancement and are competent to practice Infectious Diseases and qualified to sit for the board examination. case conference. 29 . 3. The faculty member is expected to participate in weekly conferences such as journal club. 8. CORE CURRICULUM 7. 9. Learn how to interpret the antibiogram in the selection of empiric and directed antimicrobial therapy. and core curriculum lectures. Learn to collect relevant laboratory data d. VIII.. Understand the rationale for selection and use of antimicrobials on the CRMC hospital formulary i. The program director is responsible for reviewing all evaluations and meeting with the fellow quarterly to review their progress. Select antibiotics and usual dosing regimens based on the hospital formulary ii.

and in lectures provided by the Infectious Diseases pharmacy specialist iv. Understand the role of the consultant. resistance and toxicity ¾ Acyclovir. Understand Mechanisms of Action and Resistance Mechanisms of Anti-Infectives 1. resistance and toxicity ¾ Oseltamivir and Zanamivir Understand the spectrum of activity and the limited time window for use Understand the mechanism of action. Principles of pharmacokinetics and pharmacodynamics c. Master the physical diagnostic skills necessary to be an effective Infectious Diseases physician B. Participate in the Antibiotic Subcommittee Meetings 3. in case conferences. The role of bactericidal vs. Valacyclovir. Monitoring of drug concentrations 2. Penciclovir. Drug-drug interactions d. mechanisms of action Understand the different dosing regimens for different viruses and the different delivery mechanisms ¾ Ribavirin 30 . ¾ Interferon Understand this class’s broad spectrum of activity. CORE CURRICULUM CONSULTATION SERVICE iii. Ganciclovir and Valganciclovir Understand the relationship among this class of antivirals in relationship to their structure and function. Participate in the discussions of antibiotic pharmacology on consultation rounds. Famciclovir. Antivirals (other than antiretrovirals) ¾ Amantadine and Rimantadine Understand the limited spectrum of activity and the limited time window for use Understand the mechanism of action. including the importance of communication and clarity of recommendations 4. and toxicities ¾ Foscarnet Understand its place in the sequence of treatment of viral disease and its structure and function in relation to its toxicity ¾ Cidofovir Define the role of cidofovir for the treatment of CMV infection as well as for adenovirus and papovavirus infections. Understand the Mechanisms of Action and Resistance of Anti-Infective Agents a. bacteriostatic agents e. Antimicrobial dosing b. resistance mechanisms.

44: 159-77. et al. spectrum of activity Understand the dosing regimens Understand potential drug interactions Competency Requirement The fellow will provide advice to consulting physicians regarding use of antiviral medications. x Steven J. 41: 435-40.. 1015-1025 (December 2006) 3. 34. S64-73. J. 2008. et al. Brickner.1981–90 31 . Antiviral agents active against influenza A viruses Nature Reviews Drug Discovery 5.Lancet. Principles and practices of Infectious Diseases. 41: 441-9 x AJIC 2006. These drugs will also be discussed in the core curriculum lecture series. 6th Ed. x CID 2005. CORE CURRICULUM ANTIRETROVIRALS Understand the mechanism of action. Chem. References Mandell. Competency Measurement The fellow will review the use of these medications with the attending on the consultation service. Principles and practices of Infectious Diseases. 2006. Med. 6th Ed. Jefferson T. The evaluation will be based on appropriate use. et al. Antibacterials Competency Requirement Fellows will participate in the approval restricted antibacterials in accordance with institutional formulary and guidelines as well as approve restricted antibacterials appropriate to specific ID indications. 51 (7). Competency Measurement Fellows will review approval of restricted antibacterials with the attending on the ID Consult Service. x PNAS 1999. x Guidelines: Antimicrobial Stewardship x CID 2007. 96: 1152-56 x CID 2005.367303-13 Erik De Clercq. References x Mandell.

ticarcillin. correct dosing. Penicillins ¾ Understand the difference between the agents in this class. amoxicillin ¾ Beta-lactam. ¾ Knowledge of pharmacodynamics and the role of continuous infusions is necessary. d. D. 30 March 2006. toxicity of medications and when they occur. Hauser Antibiotics Basics For Clinicians: Choosing the Right Antibacterial Agent 2008 AJ O'Neill. 941-948 Kluytmans J. International Journal of Antimicrobial Agents Volume 32. CORE CURRICULUM ANTIBACTERIALS b. December 2008. beta-lactamase inhibitors – amoxicillin/clavulanic acid.dicloxacillin. c. Expert Opinion on Investigational Drugs March 2008. The fellow must have knowledge of the mechanisms of action. Biochemical Pharmacology Volume 71. resistance profiles. ceftriaxone. and these drugs combined with tazobactam or clavulanate. cefuroxime o 3rd generation-cefotaxime. Understand the concept of an antibiotic formulary and appropriate use of medications within it’s context. ampicillin/sulbactam and piperacillin/tazobactam ¾ Antipseudomonal – piperacillin. Supplement 4.338:b364 a. Pages 297-302 Peterson l. Cephalosporins ¾ Understand the differences and similarities between the cephalosporins including spectrum of activity and toxicities. ceftazidime 32 . Pages S215-S222 Hawser S. Fellows must have a good understanding of all the major antibacterial agents used in clinical practice.ampicillin. major mechanisms of resistance. methicillin. cefoxitin. Issue 7. BMJ 2009. ¾ Antistaphylococcal agents . No. oxacillin/nafcillin ¾ Aminopenicillins. ¾ Basic understanding of pharmacokinetics. o 1st generation-cefazolin o 2nd generation-cefotetan. toxicities and management of these problems including desensitization of allergies. 3. Vol. KarageorgopoulosJournal of Antimicrobial Chemotherapy 2008 62(1):45-55 Alan R. 17.

¾ Understand the nature of cross-reaction regarding beta-lactam allergies. and amikacin ¾ Learn the spectrum of these antibiotics for gram-negative infections and their use for synergy in the treatment of serious gram-positive bacterial infections. and mechanisms of resistance. basic pharmacology and adverse reactions of the members of this group of drugs. ¾ Differentiate imipenem. o 4th generation-cefepime e. Lipopeptides (Daptomycin) ¾ Understand mechanism of action. and mechanisms of resistance. Carbapenems ¾ Understand the mechanism of action.vancomycin ¾ Understand mechanism of action. f. antibacterial spectrum and mechanism of resistance. Glycopeptides . antibacterial spectrum. and mechanisms of resistance. Oxazolidinones ¾ Understand the mechanism of action. antibacterial spectrum. j. tobramycin. k. i. ¾ Understand the toxicities and drug interactions of the agent. ¾ Understanding the dosing. ¾ Management of drug toxicities h. Additionally understand the pathogens that are resistant to vancomycin including VRE and VRSA. 33 . pharmacokinetics and pharmacodynamics of the drug in different disease states. meropenem. Streptogramins ¾ Understand mechanism of action. CORE CURRICULUM ANTIBACTERIALS ¾ Understand the role of this class in relation to other agents with similar spectrum of activity ¾ know the adverse effects of this class of drugs and the management of side effects. Monobactams ¾ Understand the role of aztreonam in the treatment of gram- negative bacterial infections. Aminoglycosides ¾ Gentamicin. antibacterial spectrum. ¾ Understand the possible molecular interactions with glycopeptides. streptomycin. doripenem and ertapenem and identify the role each plays in the treatment of infectious diseases. ¾ Learn the appropriate manner of dosing this medication understanding the monitoring of blood concentrations and interaction of these parameters with toxicity and efficacy. g. ¾ Understand the dosing and pharmacodynamics of the drug in different disease states. antibacterial spectrum.

drug interactions and therapeutic uses of this class of drug. therapeutic uses. o In particular. Other antimicrobials 34 . ¾ Knowledge of basic pharmacokinetics and pharmacodynamics to direct the appropriate dosing schedules ¾ Understanding the appropriate monitoring of patients receiving treatment with these medications l. ¾ Role in treatment of staphylococcal infections ¾ Role in treatment of mycobacterial infections. ¾ Understand the importance of resistance to this class of drugs and the role utilization plays in development of resistance. o Understand the role in treatment of mycobacterial infections. Fluoroquinolones ¾ Learn mechanism of action. and moxifloxacin o. antimicrobial spectrum. Tetracycline. CORE CURRICULUM ANTIBACTERIALS ¾ Understand drug toxicity in both healthy individuals and in patients with underlying disease states i. antibacterial spectrum. minocycline. azithromycin.e. Glycylcyclines and Chloramphenicol ¾ Learn mechanism of action. ¾ Erythromycin. ¾ Combination preparation – trimethoprim/sulfamethoxazole p. ¾ Understand the pharmacokinetics and pharmacodynamics of these agents. basic pharmacology. understand the role of the D-test in identifying inducible MLS resistance via the ermB gene. clarithromycin. Rifamycins ¾ Understand the mechanism of action of the rifamycins (rifampin) ¾ Understand the ease that resistance can develop when treating a bacterial infection with rifampin. diabetes. children and unusual infections. ¾ Understand the role of rifabutin and rifaximin in treatment of infectious diseases q. doxycycline. and relevant toxicity issues. toxicity and issues of resistance. o Understand the difference in spectrum with the traditional fluoroquinolones like ciprofloxacin and the respiratory fluoroquinolones like moxifloxacin. drug spectrum. Sulfonamides and Trimethoprim ¾ Understand the mechanism of action. drug interactions and therapeutic uses of this class of drug. Learn the appropriate use of these drugs in pregnancy. clindamycin n. ¾ Ciprofloxacin. toxicity. tigecycline and chloramphenicol m. ¾ Tetracycline. levofloxacin. Macrolides and Clindamycin ¾ Learn mechanism of action.

¾ Understand the “niche” for other antimicrobials used in inpatient infectious diseases setting o o Metronidazole o o Nitrofurantoin o Topical antibiotics r. dosing. and dosing Develop knowledge of the different lipid formulations in terms of dosing and toxicity and the unique advantages to the different formulations ¾ Flucytosine Understand its limited role in the treatment of fungal infections and the dosing adjustments in relation to toxicity ¾ Azoles Ketoconazole Understand the spectrum of activity.Understand the relevance of resistance in clinical practice. the limits of the clinical trials data. toxicity. Antibiotics and pregnancy ¾ Know the drugs that would be contraindicated for treatment of infections in pregnant women. Antifungals (systemic) ¾ Amphotericin B Deoxycholate and the Lipid Formulations Understand the mechanism of action. Antimicrobial Resistance . ¾ Understand the pharmacokinetics of antimicrobials in pregnant women. and the unique toxicities of this class of antifungals Triazoles (Fluconazole. Voriconazole and Posaconazole) Understand the spectrum of activity. Beta-lactamasesBypass of antibiotic inhibition ¾ Membrane permeability ¾ Promotion of antibiotic efflux CORE CURRICULUM ANTIFUNGALS ¾ Alteration of target enzymes 4. dosing in relation to toxicity.e. t. methods to prevent toxicity. Micafungin and Anidulafungin 35 . Itraconazole. spectrum of activity. .Comprehend the mechanisms of resistance ¾ Enzymatic inhibition ¾ i. and toxicities ¾ Echinocandins Caspofungin. Antimycobacterials – see tuberculosis and other mycobacterial pathogens s.Develop an understanding of methods to limit development of resistant pathogens by understanding mechanisms of resistance .

Dodds E. other pathogens. Understand the potential role of this class of antifungals in combination therapy Competency Requirement Demonstrate knowledge of antifungal agents based on the performance of consultations. References Nagappan V. c. ¾ Causative agents include bacterial. Kanafani ZA. Deresinski S. Clin Infect Dis. spirochetes. Recognize clinical presentation of acute meningitis. Diagnosis and Management of Major Clinical Syndromes 1. fungal. Clin Infect Dis. and Herpes simplex virus (Mollaret’s meningitis). b. Meningitis a.Interpretation of the CSF cell formula. organism directed treatment.infectious causes. Perfect JR. rickettsiae. postexposure prophylaxis. diagnostic tools available and treatment. Lyme disease (neuroborreliosis). Understand major causes of chronic and recurrent meningitis. and serologic evaluation. protozoa. Understand the spectrum of activity. ¾ Know the major causes including tuberculosis. Understand causative agents. cultures. Thecurrent policy requires consultation for any restricted antifungal agent.46:120-8. physical exam and the utility of laboratory/radiologic diagnostic tests. Competency Measurement Appropriate utilization of the antifungal agent will be demonstrated by recommendations and presentation to the faculty consulting physician. ¾ Diagnosis . and non. adjunctive therapy such as the use of steroids. ¾ Understand the issues regarding treatment including empiric therapy. fungi. dosing and toxicities. and the infection control aspects of this infection. Grasp the role of careful history. 2008. 2007. CID 2006. viral. 43:S28–39 CORE CURRICULUM C. 36 .45:1610-7. Recognize the differences in etiology and presentation in immunocompromised hosts.

and neuritis. Cochrane Database of Systematic Reviews 2007. No. No. myelitis.70:943-947 BMJ 2008. b. c. 2002. Understand basic epidemiology. 2. Encephalitis. Streptococcus anginosus group. antigen or PCR testing). Learn the relevant laboratory workup to define an etiologic diagnosis.336:36-40 Expert Opinion on Pharmacotherapy July 2007.: CD004405 Journal of Intensive Care Medicine. MRI vs. Pages 1493- 1504 N Engl J Med 2010. 10. and mosquito-borne pathogens including West Nile Virus. 22. Aspergillus sp. Diagnosis and management ¾ CT vs. References N Engl J Med 2006.e.362:146-154 Clinical Microbiology Reviews. July 2008. Antimicrobial Therapy ¾ Empiric vs.i.354:1429-1432 Lancet. Vol. 37 . culture driven ¾ Duration of therapy CORE CURRICULUM MAJOR CLINICAL SYNDROMES Competency Requirement Fellows will diagnose and manage patients with central nervous system infections including meningitis. a. and Zygomycetes ¾ Protozoan/helminthic-i. Know the causative agents and clinical manifestations. Understand therapeutic strategies for the management of these patients. Vol. Competency Measurement Appropriate management of the patients will include obtaining appropriate clinical samples (cultures. Understand the most common causes of these syndromes including enterovirus. and herpes viruses. and recommending the appropriate antimicrobial therapy where indicated. and mixed infections ¾ Fungal including Candida sp. 115:143-146 van de Beek D. Issue 1. Brain Abscess a. 8. 3. 194-207 (2007) NEUROLOGY 2008. Understand clinical presentation of these syndromes. Toxoplasmosis c. SPECT ¾ Appropriate surgical intervention ¾ Brain abscess and HIV infection d. Art. 4.. ¾ Bacterial. encephalitis and brain abscess.359:507-13 Am J Med 2003.e. Bacteroides sp. b. No. d. tick-borne pathogens. mumps.

coli 0157:H7. Enteric Infections a. Salmonella. 519-537. Sepsis a. c. Shigella and Campylobacter o The role of antimicrobial use with O1 57:H7 and the development of HUS. Vol. Learn the use of adjunctive therapies in the patient with sepsis. 132:1967-76 Critical Care 2008. Competency Measurement Appropriate management will include obtaining appropriate cultures and recommending appropriate antimicrobial therapy and duration. Learn a thoughtful approach to discovering cause of the sepsis syndrome. Chronic Diarrhea ¾ Develop an approach for the diagnosis and management of patients with chronic diarrhea. Competency Measurement Management of a variety of cases of diarrhea.2010:A5802 5. o Public health implications CORE CURRICULUM MAJOR CLINICAL SYNDROMES b. Understanding the role of 38 . inflammatory and invasive diarrhea. Competency Requirement Fellows will diagnose and manage patients with sepsis. d. difficile associated diarrhea o Viral causes of diarrhea ¾ Develop a systemic approach to all patients with enteric infections. ¾ Understand prevention and control of infections. 12:213 Am J Respir Crit Care Med 181. ¾ Understand common causes of enteric infections. p. 2007. 21. Competency Requirement Fellows will help manage difficult cases of diarrhea with particular focus on Clostridium difficile infection. o Antibiotic associated diarrhea including C. Understand the appropriate use of antimicrobials in the septic patient. Acute diarrhea ¾ Understand concept of noninflammatory. References Wheeler AP. Chest. 3 4. Recognize clinical and physiologic manifestations of sepsis. No. o Bacterial causes of diarrhea including E. b.

Know appropriate management issues in relation to the treatment and prevention of UTIs.50:625–663 a Know the predisposing pathophysiology. c. Urinary Tract Infections Competency Requirement Fellows will diagnose and manage difficult cases of urinary tract infections on the ID consult services. Clin Infect Dis. 104:S10–S16 Aliment Pharmacol Ther 30.29:S41–S50 Clinical Infectious Diseases 2008. Understand spectrum of illness including cellulitis. Understand spectrum of illness ¾ Pyelonephritis. 45(3):302-7. Toxic shock syndrome including streptococcal and staphylococcal toxic shock syndrome. d. 29: 745-58 CID 2007.p 1-7 6. Reference Zar FA. fasciitis. 2006. 44: 769-74 CID 2001.46:251–253 Clinics in Geriatric Medicine Volume 25. cystitis. prostatitis. Skin and Soft Tissue Infections a. c. 33: 615-21 Ann Intern Med. selection of antimicrobial and de-escalation and duration of therapy References CID 1999.144:116-126 Infect Control Hosp Epidemiol 2008. b. Necrotizing fasciitis and clostridial myonecrosis CORE CURRICULUM 39 . furunculosis. Appropriate management will include ensuring appropriate cultures obtained. erysipelas. 187–196 Current Opinion in Gastroenterology: 2009 Volume 25 . Define the likely pathogen for each of these syndromes. et al.Issue 1 . folliculitis and impetigo. Am J Gastroenterol 2009. 6. 2007. Learn to identify and manage bacteruria in all patient groups. Competency Measurement Fellows will manage a variety of cases of UTI’s during fellowship. antimicrobial therapy and the appropriate drugs of choice for the different pathogens. abscess e. relevant host factors. Identify common organisms with characteristic epidemiologic factors and microbiologic factors that may allow differentiation of these organisms. Issue 3. d. Pages 423-436 CID 2010. August 2009. and route of infection.

fungal causes of pneumonia 8 Endocarditis and intravascular infections 40 . VAP and pneumonia in compromised hosts. They will demonstrate expertise in the use of antimicrobial therapy and prevention of recurrent disease based on presentations to the faculty. Develop knowledge of diverse epidemiological exposures and associations with different pathogens. d. Art. et al. 33: 615-21 Critical Care Medicine. 29: 745-58 CID 2007. and appropriate treatment. No. References CID 1999. Pneumonia Competency Requirement Fellows will diagnose and manage difficult cases of pneumonia on the ID consult services. N Engl J Med 2007. predisposing host factors. Issue 4. classic exposures. Learn to perform a physical exam to support the diagnosis of this infection c. 44: 769-74 CID 2001. 36(1):1-7. Competency Requirement The fellows will help manage difficult cases of skin infections including recurrent infections with MRSA.357:380-90. 2005.44:777–784 CID 2008.: CD002109 a. Understand the body’s host defenses and the pathogenesis of infection b.41:1373-406. MAJOR CLINICAL SYNDROMES ¾ Know clinical manifestations. They will demonstrate expertise by the antimicrobial choices and duration of therapy recommended. Competency Measurement Fellows will see cases of pneumonia due to various pathogens during fellowship. References Stevens DL. Clin Infect Dis. January 2008 Critical Care 2008.46:S368–S377 7. Develop knowledge of different bacterial. (See Staphylococcus aureus) Competency Measurement Fellows will see a variety of cases with skin and soft tissue infections. 12:R56 Cochrane Database of Systematic Reviews 2009. The fellow must manage CAP. viral. CID 2007.

Fowler VG Jr et al. Learn the utility and limitations of various diagnostic tests including echocardiogram.116:e547.355:653- 65. Albrich WC.115:e408. 2007. Competency Measurement Competency will be defined by knowledge of appropriate microbiology testing to make the appropriate diagnosis.American Heart Association. CORE CURRICULUM MAJOR CLINICAL SYNDROMES d. 2007. Learn to perform a physical exam to identify the clinical manifestations of disease c. No. 2005. 66:82- 98 Eur J Clin Microbiol Infect Dis (2007) 26:849–856 41 . Art.4:777-84 Cochrane Database of Systematic Reviews 2008. N Engl J Med. Apply the modified Duke Criteria to help in determining the diagnosis e. Issue 4. Understand the epidemiology in relation to etiologic agents and risk factors b. Circulation. Competency Requirement The fellow will manage patients with blood stream infections including endocarditis. et al.: CD003813 Am J Health-Syst Pharm. 2005. Circulation. S. Infectious Diseases Society of America. aureus References Endocarditis and Bacteremia Study Group. Be able to diagnose culture negative endocarditis and know the pathogens responsible. 2004.111:e394-434. Lancet Infect Dis. Additionally the fellow will appropriately manage the patients including correct antimicrobials and duration. Guidelines . Circulation.. a. 2009. Erratum in: Circulation.112:2373. 2006.

279:1537- 41 Arch Intern Med. duration of illness and presence or absence of orthopedic devices ¾ Understand the limitations of chronic suppressive therapy Competency Requirement Fellows will understand the pathophysiology of infectious arthritis and osteomyelitis. based on pathogen. 24(Suppl 1): S145–S161. Infectious Arthritis ¾ Understand the different mechanisms of pathogenesis of infectious arthritis ¾ Recognize the important historical clues to etiology.299:806-13. et al. Osteomyelitis and Prosthetic Joint Infections ¾ Understand the pathogenesis of osteomyelitis CORE CURRICULUM MAJOR CLINICAL SYNDROMES ¾ Recognize the common bacterial pathogens associated with osteomyelitis ¾ Understand the utility and pitfalls of the various clinical. et al. Stengel D. physical exam and laboratory findings of infectious arthritis ¾ Recognize the various etiologies of infectious arthritis: bacterial. laboratory and imaging modalities used to diagnose and monitor disease ¾ Develop knowledge concerning duration of therapy for osteomyelitis. Diabetes Metab Res Rev 2008. 2008.28:1290–1298 10. 2001. et al. 9. International Journal of Antimicrobial Agents 29 (2007) 233–239 Infect Control Hosp Epidemiol 2007. JAMA. Bone and Joint Infections a. Know the evidenced based guidelines for prevention of nosocomial infections 42 . mycobacterial ¾ Understand the role of surgical and medical management in treatment of patients. viral. b. JAMA. They will know the appropriate approach to treatment. Competency Measurement The fellows will be responsible for management of cases of bone and joint infection.168(8):805-819. Nosocomial Infections Competency Requirement Fellows will understand the pathophysiology of different nosocomial infections.3:175-88 Zimmerli W. References Butalia S. Lancet Infect Dis. 1998. 2008.

Clin Infect Dis. 24: 362-386. References 1. 2. ICHE 2003.299(10):1149-1157 a. ¾ Understand the differences in efficacy of antiseptic scrub solutions in performance of sterile procedures ¾ Develop knowledge of methods of treatment based on the etiologic agent. ¾ Understand the criteria for diagnosis CORE CURRICULUM MAJOR CLINICAL SYNDROMES NOSOCOMIAL INFECTIONS ¾ Develop knowledge of common bacterial causes and the treatment ¾ Understand how to use the clinical pulmonary infection score (CPIS) in the management of nosocomial pneumonia f. Develop a framework for antimicrobial prophylaxis in the setting of surgical procedures ¾ Clean Surgery ¾ Clean – Contaminated Surgery ¾ Contaminated Surgery d. Understand infection control practices in the hospital (see infection control) e. diagnosis.43:322-30 Infect Control Hosp Epidemiol 2007. ¾ Develop knowledge of the common pathogens and treatment ¾ Learn the SCIP measures to monitor hospital compliance with appropriate practices of prevention of surgical site infections. 23: S3-S40. ¾ Understand when to consider preservation of the catheter and use of antibiotic lock solution g. 101e108 JAMA. Be able to define a nosocomial infection b.28:1290–1298 Journal of Hospital Infection (2007) 66. Ventilator associated pneumonia ¾ Understand the pathogenesis and methods of prevention including the IHI bundles. 3. ¾ Understand utility and importance of removal of the catheter in clinical management of documented infection and evaluation of fever. ICHE. Understand the risk factors for nosocomial infections and the different methods to prevent them. 43 . 2002. Surgical Site infections ¾ Understand the pathogenesis and methods of prevention including the timing of antimicrobial prophylaxis. 2006. duration of antimicrobial therapy and proscribed medications. Catheter related infections ¾ Understand the pathogenesis and methods of prevention including the IHI bundles.Competency Measurement Fellows will perform a system quality improvement project related to either the prevention. 2008. or management of nosocomial infections. They include timing of administration of antimicrobial therapy. focusing on medical devices. c.

. Management of Specific Microbes 1. Enterococcus species 44 . methicillin-resistant CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES ¾ (MRSA). pp. vancomycin-intermediate (VISA) and vancomycin-resistant (VRSA) Staphylococcus aureus ¾ Understand the concept of heteroresistance ¾ Understand the differences in epidemiology between hospital-associated and community-acquired MRSA Competency Requirement The fellow must be able to appropriately diagnose and manage patients with serious S.Clin Infect Dis. 2006.4:668-74. septic arthritis. especially ones listed below o Localized infection o Localized infection with diffuse skin rash o Bacteremia and endocarditis o Toxic Shock Syndrome o Osteomyelitis. and pyomyositis o Staphylococcal food poisoning ¾ Understand the treatment using the most active drug based on susceptibility of methicillin-susceptible (MSSA). Volume 6. Bacteria a. Expert Review of Anti-Infective Therapy.40:563- 573. biochemical and other tests. Public reporting of nosocomial infections Understand the background for reporting and the methodology for obtaining good surveillance data D. N Engl J Med. Clin Infect Dis 2005. June 2008 . Fowler VG et al. h. ¾ Understand the epidemiology and pathogenesis of different clinical syndromes caused by S. Number 3. aureus infections. Staphylococcus aureus ¾ Learn how the organism is identified in the Microbiology Laboratory by morphology. Competency Measurement The fellow will be evaluated on the management of patients through interaction with faculty (e-value or mini- CEX) References Deresinski S. 299- 307(9) b. 2008.355:653-65 Sievert DM. et al. aureus.

No. Pages 921-944 Current Opinion in Microbiology 2007. o Pseudomonas and HIV ¾ Understand the role of antimicrobial resistance in the management of bacterial infections o Stenotrophomonas maltophilia Acinetobacter baumannii and Burkholderia cepacia. Pseudomonas aeruginosa ¾ Understand basic microbiology.146:574-9 J Infect. Ann Intern Med. The particular focus is 45 . and treatment. hospital acquired pneumonia. o Infections of interest include endocarditis. 7. 2007. epidemiology and pathogenesis of this organism. o The role of extended-spectrum beta-lactamases (ESBL) and class I chromosomal beta-lactamases (AmpC) in the treatment of serious infections with gram-negative bacteria. Mayo Clin Proc. CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES o The role of multidrug resistance in the management of infections caused by P. c. Patel R. Vol. Competency Requirement The fellow will be responsible for the knowledge of infections due to gram- negative bacteria. 54(6): 567–571. References Zirakzadeh A. 10:436–440 JAC 2008 62(Supplement 1):i17-i28 Ann Intern Med. aeruginosa. respiratory tract infections in patients with cystic fibrosis. 2007 June. 2007. ¾ Learn to identify by morphology and biochemical tests ¾ Understand the pathogenesis of the different manifestations of infection ¾ Understand the risk factors for colonization or infection with vancomycin- resistant enterococci (VRE) ¾ Develop knowledge of different antibiotics used for treatment and understand when treatment is necessary Competency Requirement The fellow must be able to appropriately diagnose and manage patients with enterococcal infections. host factors that put patients at risk. ¾ Know classic clinical manifestations of syndromes caused by this organism. Competency Measurement The fellow will be evaluated based on management of patients through interaction with faculty. 18.146:574-579.81:529-36 Gavaldà J. Expert Opinion on Investigational Drugs July 2009. et al. 2006. ear infections.

Clin Microbiol Rev. 2006. o Thrush. 351-368(18) 2. o Know appropriate management of infections with Candida sp. Diekema DJ. 2005 Oct. 46 . Bonomo RA. Candida species ¾ Understand microbiology.20:133-63. CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES References Pfaller MA. Pappas PG. resistant organisms including Pseudomonas aeruginosa Competency Measurement Competency will be measured by observations on rounds and evaluation. Competency Requirement Fellow will be required to demonstrate the knowledge of diagnosis and management of candidal infections Competency Measurement The fellow will be evaluated while on clinical service using e-value.1093/jac/dkm357 Drugs. and pathologic findings. Volume 67.18(4):657-86. 10:436–440 JAC doi:10. pathogenesis. Infect Control Hosp Epidemiol. Patterson JE. Antifungal therapy for candidal infections is part of the antimicrobial approval process. esophagitis. Infect Dis Clin North Am. Also presentations at Case Conference and the Basic Science Conference will demonstrate competency. Number 3.27:889-92. 2006. fungemia and deep organ manifestations. line infections and peritonitis o Understand relationship between different species particularly the non-albicans candida and antifungal agents. 2007. Fungi a. cutaneous syndromes. Current Opinion in Microbiology 2007.20:485- 506. as determined by cultures of blood or sterile body fluids. pp. Clin Microbiol Rev. ¾ Learn spectrum of clinical manifestations. 2007 . References Paterson DL. x Endocarditis.

epidemiology.195:756–764 d. Infection 2007. References Barnes PD. Aspergillus species ¾ Understand the ecology and epidemiology of different species of aspergillus ¾ Understand the manifestations of the different syndromes of infection o Allergic bronchopulmonary aspergillosis o Aspergilloma o Invasive Aspergillosis ¾ Be able to identify hyphae as aspergillus-like by microscopy ¾ Determine the role of CT scan and galactomannan assay in the diagnosis of invasive aspergillosis. pp. o Amphotericin B and lipid formulations o Voriconazole/Posaconazole o Echinocandins Competency Requirement Fellow must demonstrate knowledge regarding the diagnosis and management of infections with Aspergillus species. 35: 51–58 infection Vol 10 April 2010 JID 2007. 45. o ¾ Know clinical manifestations of illness. Zygomycetes ¾ Understand the ecology and epidemiology of different species of Zygomycetes. ¾ Understand the different clinical manifestations and pathogenesis of infection o Rhinocerebral o Pulmonary 47 . ¾ Develop knowledge of the different treatments options for treatment or prevention of infections. 269- 298(30) Infection 2008. Cryptococcus neoformans (See HIV infection section) ¾ Understand basic mycology. 2006. Infect Dis Clin North Am. c. Medical Mycology June 2007. o HIV infected patients vs non-infected patients ¾ Understand diagnostic work up and treatment options. Competency Measurement The fellow will be evaluated on service by e-value and their role in antimicrobial approval process.20:545-61. 321_346 CID 2007. 2007 . Number 2. and host factors. ¾ Understand the risk factors for infection with these organisms. Volume 67. 36: 296–313 b. Marr KA.44:402–409 Drugs.

30:679–83 3. Blastomycosis dermatitidis.20:581-607. The most important is coccidioidomycosis as we are in an endemic area. Viruses a. ¾ Be able to identify organism by microscopy in tissue and in culture. Competency Measurement The fellow will be evaluated on service by e-value and their role in antimicrobial approval process. JAC (2008) 61. Paracoccidioides ¾ Develop knowledge of the geographic ecology and epidemiology of these pathogens. 48 . i35–i39 e. medical treatment in the management of infected patients. Enterovirus ¾ Understand different species of enterovirus. Lewis RE. ¾ Develop knowledge of the different treatment options and the risks and benefits. Histoplasma capsulatum. 45:807–25 Clin Infect Dis 2000. 2006. Competency Requirement Fellows will comprehend the management and diagnosis of endemic mycoses.. Infect Dis Clin North Am. o Amphotericin B and lipid formulations o Posaconazole Competency Requirement Fellows will be required to understand the diagnosis and management of patients with zygomycosis based on management of cases on the consultation service. Competency Measurement The fellows will be evaluated on the consultation service and in the ID clinic by either e-value or mini-CEX. CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES FUNGI o Cutaneous o Gastrointestinal o Central nervous system ¾ Be able to identify hyphae by microscopy. Differentiate Zygomycetes from other groups of fungi such as Aspergillus ¾ Understand the importance of surgical vs. References Clin Infect Dis 2000. References Kontoyiannis DP. ¾ Understand the antifungal agents with activity against these moulds. 1. Suppl. Endemic mycoses – Coccidioides immitis. 30:658–61 Clin Infect Dis 2007.

reactivation and past infection o Develop knowledge of the management of patients with active infection with EBV including post-transplant lymphoproliferative disorder and Burkitt’s lymphoma ¾ HHV 6 and 7 o Understand the epidemiology and clinical manifestations o Understand the diagnosis and treatment ¾ HHV-8 (KS associated Herpes Virus) o Understand the epidemiology and different clinical syndromes ƒ Kaposi’s sarcoma ƒ Primary effusion lymphoma ƒ Castleman’s disease o Understand the treatment of visceral disease in HIV Competency Requirement The fellow will diagnose and manage multiple patients with serious herpes virus infections. CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES VIRUSES o Understand the epidemiology. ¾ Cytomegalovirus o Understand the pathogenesis and clinical manifestations in various hosts including patients with HIV infection. clinical manifestations. o Understand the therapeutic and prophylactic options for management of patients ¾ Epstein Barr Virus o Understand the epidemiology. pathogenesis and clinical manifestations o Understand the interpretation of the serology panel for diagnosis of the various stages of infection: acute. Human herpes viruses ¾ Herpes Simplex 1 and 2 o Understand the pathogenesis and spectrum of disease o Understand the various methods of diagnosis and treatment and prevention ¾ Varicella Zoster Virus o Understand the pathogenesis and clinical manifestations with primary infection and reactivation disease o Identify the distinguishing characteristics from smallpox o Develop knowledge of the treatment of different clinical syndromes. coxsackievirus. pathology. o Poliovirus. b. o Understand the different techniques for diagnosis including culture based. 49 . bone marrow and solid organ transplantation. and management of patients. immunological and molecular methods. echoviruses and other enterovirus species such as 71. The primary illness that will likely be treated is viral meningitis. o Understand the infection control implications of exposure to varicella o Understand the use of the varicella virus vaccine and the shingles vaccine in adults including healthcare providers.

Clin Infect Dis. The fellow must understand the prevention and treatment approaches. Smith TF et al. CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES Competency Measurement The fellow will be evaluated in the management of these infections in multiple settings. The consult service and the transplant service will provide the source of inpatients. Understand the use of smallpox vaccine.359:507-13. Lancet. Competency Requirement The fellow will know the agents involved in bioterrorism. 2005. N Engl J Med. c. Understand the agents involved in bioterrorism. Human Immunodeficiency Virus (HIV) – see ambulatory curriculum and HIV specific curriculum (CARES) 4. The fellows will be evaluated using e-value in these settings. References Legendre C. 2007. Be aware of the chain of command if an attack were to occur including the county and state health officers. 50 .45:1056-61. Gnann JW. Agents of Bioterrorism a. Pascual M. Know the infection control issues involved in the management of patients infected with agents of bioterrorism d. Oxman MN et al. 2008. the clinical presentation and management. Clin Infect Dis.46:732-40. c.352:2271- 84. 2002. Special Services Clinic and the ID clinic will be a source of herpes virus infections in the outpatient setting and in AIDS. b. Whitley RJ. benefits and complications. the risks.

Breman JG. viral and immunologic monitoring of HIV infection iv. HIV infection (Also see HIV/AIDS Curriculum) a. development of resistance 51 . et al.287:2236- 52. the competency measure will be didactic sessions providing information on these organisms. Risk of transmission/safer sex and/or safer needle practices iii. Treatment strategies for HIV infection with antiretroviral agents c. CORE CURRICULUM MANAGEMENT OF SPECIFIC BIOTERRORISM Competency Measure As it is unlikely that management of many of these infections will be undertaken due to the rarity of the disease. Develop knowledge about antiretroviral agents – indications. Clinical. Understand the use of serology to establish the diagnosis of HIV infection b. 15: 700–705 E. References Inglesby TV. Henderson DA. drug interactions. Understand how to counsel newly infected HIV patients i. JAMA. common side effects.346:1300-8. Therefore. Meaning of HIV test results ii. 2002. N Engl J Med 2002. Clin Microbiol Infect 2009. Infectious Diseases Ambulatory Clinic Educational Objectives 1. Develop knowledge of recommended immunizations for HIV infected patients d.

Understand the pathogenesis of osteomyelitis b.et al.354(2):119-30. based on pathogen and the presence or absence of mechanical devices 3. et al. The fellow must also be competent in managing the ill returning traveler Competency Measurement The fellow will be evaluated by the attending using e-value and verbal feedback. Infective endocarditis (Competency measures noted in “Diagnosis and Management of Major Clinical Syndromes”) 52 . Clin Infect Dis 2006. Understand diagnostic imaging studies used to diagnose and monitor treatment of osteomyelitis d. Assess comorbid medical illnesses of traveler d. Traveler’s health a.cdc. References Hill DR. Understand the differential diagnosis in the febrile returning traveler. immunization status and comorbid medical illnesses e. Recognize common bacterial pathogens associated with osteomyelitis c. g. Develop plan for preventive therapy and recommended immunizations based on itinerary. Develop knowledge about role of resistance testing. Assess traveler’s itinerary for risk of acquiring infectious diseases b. http://wwwn. Develop knowledge about common vaccines and side effects g. diagnosis and treatment of opportunistic infections CORE CURRICULUM INFECTIOUS DISEASES AMBULATORY CLINIC OBJECTIVES 2.cdc. Competency Requirement The fellow is expected to be competent to perform an evaluation and treat a traveler prior to a trip.gov/travel/) f. Develop knowledge about the clinical presentation. Develop knowledge about antimicrobial agents used to treat osteomyelitis. Develop knowledge concerning duration of therapy for osteomyelitis. interpretation of genotypic and phenotypic resistance tests f. their common side effects and required therapeutic drug monitoring e. N Engl J Med.gov/travel/default. e. 43:1499–1539 Freedman DO. Develop knowledge about preventive therapy options for malaria and their indications h. Osteomyelitis (Competency measures noted in “Diagnosis and Management of Major Clinical Syndromes”) a. Develop the knowledge of tropism testing for the use of CCR5 inhibitors and the role of HLA B5701 testing for prevention of abacavir hypersensitivity reactions. Assess immunization status of traveler c.aspx 4. 2006 Jan 12. Understand role of CDC Traveler’s Health web site in patient education and counseling (http://www. Develop knowledge about non-drug methods to prevent traveler’s diarrhea and insect bites while traveling abroad i.

References 1. Understand the epidemiology and natural history of hepatitis C virus b. Develop familiarity with the IDSA and ACP clinical practice guidelines regarding diagnosis and treatment of Lyme disease e. a. fine needle aspiration of cold abscesses. Evaluations will be based on interaction with attending physician and evaluations in E*value. Develop knowledge about outpatient management of patients with infective endocarditis. Competency Measurement Fellows will evaluate and manage cases of suspected Lyme disease in the outpatient clinic. Understand the clinical presentation of hepatitis C virus disease c. Understand the epidemiology of cocci. Understand the role of Lyme disease serology. Understand the role of cardiac valve replacement in the management of infective endocarditis CORE CURRICULUM TRAVELERS’ HEALTH d. diagnosis and management of Lyme. including recognition of late cardiac and septic complications 5. Develop knowledge about the natural history. including prosthetic valve endocarditis. clinical presentation. Understand the role of bone scan. including the common microorganisms involved in this infectious disease b. Understand the clinical presentation of acute and chronic Lyme disease c. chest CT scan and lumbar puncture in the diagnosis of disseminated cocci d. Lyme disease Competency Requirement Understand epidemiology. Hepatitis C a. diagnosis and therapeutic management of localized and disseminated cocci. b. Develop proficiency in the long-term clinical management of disseminated cocci 6. with an emphasis on liver biopsy. 2006. clinical management and antimicrobial treatment of bacterial endocarditis c. Understand the role of antimicrobial therapy in the management of established Lyme disease 7. genotype and quantitative and qualitative RNA assays d. serology. Understand the diagnostic approach to the patient with suspected or proven disseminated cocci i. Understand the clinical presentation of localized and disseminated cocci c. 43: 1089-1134. CID. a. pathophysiology. Understand the epidemiology of Lyme disease b. and the significant limitations of this diagnostic tool d. Coccidioidomycosis (cocci) (Competency measures noted in “Diagnosis and Management of Major Clinical Syndromes”) a. Become proficient in the utilization of cocci complement fixation and immunodiffusion titers in the diagnosis and follow-up management of cocci ii. Understand the epidemiology of infective endocarditis. with an emphasis on the role of triazole agents e. diagnosis. Understand the principles of antifungal therapy for localized and disseminated cocci. Understand the indications for antiviral treatment for hepatitis C virus 53 . Understand the role of the laboratory in the diagnosis and clinical management of hepatitis C virus infection.

Strader. Develop familiarity with antiviral agents and their associated toxicities for treatment of hepatitis C virus CORE CURRICULUM TRAVELERS’ HEALTH Competency Requirement The fellow will be expected to be able to diagnose. First line vs. clinical stages (latent versus active disease) and clinical manifestations of tuberculosis. Clin Infect Dis. 54 . second/third line agents ii. including interpretation of PPD skin test and interferon J induction assays. Doris B. Tuberculosis a. Become familiar with the use of antimicrobial therapy in the management of latent and active tuberculosis i.46:78-84. d. susceptibility testing and follow-up of patients with tuberculosis f. stage and treat patients with hepatitis C infection with or without HIV coinfection. e. References Poordad F. The fellow will be evaluated on the management of patients through interaction Competency Measurement with faculty (e-value or mini-CEX) References MMWR 2003. Competency Measurement The fellow is expected to diagnose and manage patients with hepatitis C in the VA clinic setting as well as at Special Services Clinic and the CRMC Outpatient clinic. Hepatology 2004. et al. Common side effects of antituberculous agents iii. Understand the pathogenesis. Competency will be measured by the attending physician evaluation after reviewing the patients with the fellow. Understand the role of screening for the diagnosis of tuberculosis. 2008. 39: 1147-1171 8. Understand the epidemiology of tuberculosis b. Periodic laboratory tests and clinical exams used to monitor for toxicity of antituberculous therapy Competency Requirement The fellow should be able to diagnose and manage patients with tuberculosis. et al. Become familiar with the IDSA/ATS/CDC guidelines on the diagnosis and treatment of latent and active tuberculosis e Become familiar with the role of the microbiology laboratory in the diagnosis. 52 (RR-11) Am J Respir Crit Care Med2005.

33:871-881 CORE CURRICULUM TRAVELER’S HEALTH TUBERCULOSIS 9. including their associated side effects and required monitoring Competency Requirement The fellow must be able to diagnose and treat patients with non-tuberculous mycobacterial infections in normal and immunocompromised hosts. Antimicrobial agents commonly used for these diseases k. Eur Respir J 2009. Understand the epidemiology of the various MOTT pathogens g.52(RR-2):15-8. Mycobacteria Other Than Tuberculosis (MOTT) (Environmental mycobacteria) f. J Clin Oncol 26:606-611 j. Competency Measurement The fellow will be evaluated on the management of patients through interaction with faculty (e-value or mini-CEX) References Griffith DE. Become familiar with required clinical and laboratory monitoring required for patients receiving potentially toxic antimicrobial therapy in the outpatient setting 55 .149:177-184.175:367–416. Understand the diagnostic modalities for MOTT diseases. Ann Intern Med. MMWR 2003. Become familiar with clinical management of MOTT and the antimycobacterial agents used in the treatment of MOTT. Competency will be measured based on management in the outpatient clinic. 10. with an emphasis on microbiology laboratory tools i. Outpatient intravenous antimicrobial therapy management Competency Requirement Understand the general principles of management of patients with OPAT Competency Measurement Fellows will manage patients with OPAT. Compatible disease states for this treatment modality ii. 38: 1651-72. 2008. 172:1169–227 Mazurek GH. 2008. References CID. Understand the varied clinical presentations of MOTT in normal and immunocompromised hosts h.149:123-134. Ann Intern Med.et al. 2004. Am J Respir Crit Care Med 2007.45:837-45. Become familiar with the clinical management of percutaneously implanted central catheters (PICCs) used for this treatment modality l. Understand the indications for outpatient intravenous antimicrobial therapy i. Clin Infect Dis. 2007. in particular looking at complications that are potentially preventable.

2001. et al. Know the differential diagnosis of CFS p. including collaboration with the pharmacy. 2001. 2010. Lerner AM. Curriculum for The Treatment of Patients Infected With The Human Immunodeficiency Virus (HIV) Table of Contents Virology Epidemiology Approach to the HIV positive patient Preventive medical care Management of other sexually transmitted diseases Clinical Manifestations of HIV/AIDS Anti-retroviral Therapy Issues of adherence Prophylaxis against opportunistic infections Resistance testing Therapeutic drug monitoring Pharmacodynamics and pharmacokinetic 56 . The evaluation will be based on discussion with the attending physician. Competency Measurement The fellow will be involved in the workup and management of patients with CFS in the outpatient clinic.134:838- 43. Chronic fatigue syndrome (CFS) n. Ann Intern Med. home health agency and referring physician 11. HIV F. Clin Infect Dis. References Wessely S. Become familiar with commonly indicated referrals for specialty evaluation in patients with CFS. 5(1): e8519. Become facile with the communication skills required to manage patients receiving this treatment modality.32:1657-8. Understand the IDSA/ACP clinical practice guidelines for diagnosing and managing CFS o. m. PLoS One. Develop communication skills required in long-term management of CFS patients CORE CURRICULUM MANAGEMENT OF SPECIFIC MICROBES CHRONIC FATIGUE Competency Requirement The fellow will understand the differential diagnosis and management of patients with chronic fatigue syndrome. including Psychiatry and Rheumatology q.

hepatitis A and B vaccines. trachomatis and Neisseria gonorrhoeae. Tdap x STD Screening: RPR. HIV and Hepatitis C co-infection HIV and Hepatitis B co-infection Virology Nomenclature Direct cell killing Anti-genetic diversity Receptor signaling theory TH1 – TH2 Switch Viral load and replication kinetics Concept of long term non-progressors Concept of virologic controllers CORE CURRICULUM HIV Chemokines as receptor antagonists Mucosal Immunity Immune Activation Epidemiology Demographic trends Prevalence x USA Trends and prevalence x California Trends and prevalence x Global prevalence x Geographic distribution of hiv-1 and hiv-2 infection x Clades & Distribution Approach to the HIV positive patient History Physical exam Ordering and interpretation of required laboratories Patient education x Safer sex practices x HIV Super-infection x Risk / Harm Reduction x Family Planning x Adherence. influenza vaccines. Q12 mo Pap smears PPD tests Routine dental – Q12 mo. 57 . Resistance x Chronic Disease Self-Management Preventive medical care Vaccines x Pneumococcal vaccine. and urine tests for C.

Pelvic inflammatory disease x Screening. clinical manifestations and treatment. Granuloma inguinale x Screening. diagnosis. clinical manifestations and treatment. clinical manifestations. Chancroid x Screening. Chlamydia x Screening. diagnosis. clinical manifestations and treatment. Colorectal CA Screening. indications for cerebrospinal fluid analysis and treatment. clinical manifestations and treatment. Mammograms. Clinical Manifestations of HIV/AIDS Acute retroviral syndrome Clinical presentations and treatment of opportunistic infections: x Pneumocystis jiroveci pneumonia x Mycobacterial infections o M. clinical manifestations and treatment. diagnosis. x Ophthalmology in selected populationDiabetes mellitus CD4 counts ”FHOOVPP3 Mental Health Issues x Depression x Bi-polar Disorder x Addiction CORE CURRICULUM SEXUALLY TRANSMITTED DISEASES Management of other sexually transmitted diseases Syphilis x Screening. diagnosis. diagnosis. clinical manifestations and treatment. diagnosis. clinical manifestations and treatment. clinical manifestations and treatment. Herpes simplex virus x Screening. diagnosis. Lymphogranuloma venereum x Screening. Human papillomavirus x Screening. tuberculosis o M. diagnosis. diagnosis. avium complex o Other environmental mycobacteria x Protozoan/parasitic infections o Toxoplasmosis o Cryptosporidiosis o Microsporidiosis / Isospora o Leishmaniasis 58 . Gonorrhea x Screening.

BK shedding vs. Neuromuscular weakness syndrome. VZV EBV] x Polyoma virus [PML]. Peripheral neuropathy Pancreatitis o Indinavir 59 . and zalcitabine. didanosine. x Herpes viruses [CMV. disease x Parvovirus B19 x Fungal infections o Candidiasis o Cryptococcosis o Histoplasmosis o Coccidioidomycosis o Penicillium marneffei CORE CURRICULUM CLINICAL MANIFESTATIONS OF HIV/AIDS Kaposi’s sarcoma –human herpesvirus 8 HIV Wasting Syndrome Lymphoma Neuropathy x Distal symmetrical Polyneuropathy x Acute and chronic inflammatory Demyelinating polyneuropathy [AIDP/CIDP] x CMV polyradiculopathy Anti-retroviral Therapy x Mechanisms of action x Treatment theory x When to start x Treatment sequencing x Treatment naïve patients x Second Regimen patient x Treatment experienced patient x Salvage Therapy x Acute and long term side-effects of antiretroviral therapy o NRTI associated Lipodystrophy Lactic acidosis. role of HLA B5701 o Zidovudine associated anemia [acute and latent] o Stavudine. Nonalcoholic steatohepatitis Antiretroviral therapy -induced pancreatitis Antiretroviral therapy induced peripheral neuropathy x NNRTI-induced Hepatotoxicity Rash x Special consideration to specific medications: o Abacavir hypersensitivity syndrome. HSV.

o Utility of resistance testing in selecting a drug regimen Treatment naïve Treatment experienced Salvage therapy Therapeutic drug monitoring x Understanding its principles and utility Pharmacodynamics and pharmacokinetic x Cmin. ATV. Retinoid-like cutaneous side effects o Indinavir and atazanavir – hyperbilirubinemia.nephrotoxicity and possible bone effects x Mineral effects x Acid reducing agents: IDV. and limitations. and inhibitory quotient (IQ) and x Ritonavir’s effect on the pharmacokinetic of anti-retroviral medications HIV and Hepatitis C co-infection x Screening x Evaluation x Treatment options x Management of treatment side-effects HIV and Hepatitis B co-infection x Screening 60 . area under the curve (AUC). IC 50. strengths. Mycobacterium.central nervous system toxicity o Tenofovir . Cmax. Toxoplasmosis] CORE CURRICULUM ANTI-RETROVIAL THERAPY x When to start x Medication options and their side-effects x When to discontinue Issues of adherence x Understanding factors that influence medication compliance o Positive o Negative o Counseling patient’s on adherence Resistance testing x Understanding currently available resistance assays – o Proper use. NFV x Hyperlipidermia x Insulin Resistance Prophylaxis against opportunistic infections [Pneumocystis. nephrolithiasis o Efavirenz .

cryptococcosis and invasive infections with other moulds ¾ Other pathogens such as Pneumocystis jiroveci and Toxoplasma gondii f. parvovirus B19. Comprehend the opportunistic pathogens most likely to be involved in solid organ transplantation ¾ Virus infections including herpes simplex virus. Solid organ transplantation a. Define the sites infection including infections of the surgical site. cytomegalovirus. BK virus and human herpes virus-8 ¾ Fungal infections including candidiasis. Understand the common pathogens involved in these infections. Epstein-Barr virus (post-transplant lymphoproliferative disorder [PTLD]). aspergillosis. zygomycosis. Competency Requirement Have a detailed understanding of the different kinds of infections in the setting of solid organ transplantation. e. Understand the time of occurrence of infections after solid organ transplantation b. c. g. Curriculum for Transplantation Infectious Diseases 1. Be able to evaluate a patient prior to transplantation to determine risk of infection and strategies to prevent them. Understand medications used to treat and prevent infections in patients with solid organ transplants. h.gov/contentfiles/AdultandAdolescentGL. i. Be aware of the types of transplants and the different risks and characteristic infections.nih.pdf Antiviral Research 85 (2010) 241–244 Current Infect Dis Report Volume 11. 51(RR-8) http://aidsinfo. 39:609–29 MMWR 2002. respiratory tract. use laboratory testing and imaging to come to a diagnosis in a febrile patient with solid organ transplantation. Number 4 / July. Understand the medications used to immune suppress patients to prevent rejection and their role in infectious diseases. x Evaluation x Treatment options x Management of treatment side-effects Competency Requirement The fellow is expected to manage patients with HIV infection in the inpatient setting and provide continuity care in the outpatient setting. Be able to perform a history and physical examination. 61 . urinary tract. 2009 CORE CURRICULUM TRANSPLANTATION INFECTIOUS DISEASES G. gastrointestinal tract. d. central nervous system and bloodstream infections. Competency Measurement The fellow will be evaluated on the management of patients through interaction with faculty (e-value or mini-CEX) References Clin Infect Dis 2004.

¾ Other pathogens of interest include mycobacteria. and Toxoplasma gondii ¾ Late period pathogens (13-52 weeks) include VZV and encapsulated bacteria.Competency Measurement Fellows will manage infectious complications in patients with solid organ transplantation References Infect Dis Clin North Am. host disease b. pre-engraftment vs. Competency Measurement Fellows will manage infectious complications in patients with bone marrow transplantation References 1. EBV. early post-engraftment vs.4:657-73 2. H. bacteria (gram-positive and gram-negative). Aspergillus spp. skin rashes and diarrhea. Candida spp. and respiratory viruses ¾ Early post-engraftment period (4-12 weeks) pathogens include CMV. Have knowledge of the use of immunoglobulin replacement in bone marrow transplantation and the use of vaccines once the immune system has been partially reconstituted. MMWR. host disease. 44(R10): 1-128. Bone Marrow Transplantation Competency Requirement Have a detailed understanding of the different kinds of infections in the setting of bone marrow transplantation. Determine the different infection risks and pathogens at different times during the procedure. d. 2000.. Understand the difference in infection risk posed by autologous bone marrow transplantation and allogeneic transplantation. idiopathic pneumonia syndrome. 2001. Nocardia spp. Infectious Diseases Curriculum in Medical Microbiology 62 . BK virus. late. e. ¾ Pre-engraftment period pathogens include Herpes simplex virus. veno-occlusive disease. Legionella pneumophila and Listeria monocytogenes. mucositis. HHV-6. c.. Be aware of unique syndromes in bone marrow transplantation including graft vs. 2000. ¾ Define the risks posed by the use of immunosuppressive medications as prophylaxis for graft vs. CORE CURRICULUM BONE MARROW TRANSPLANTATION a. Understand the antimicrobial agents used to treat infections in BMT patients and duration of therapy f.15:901-52 Clin Liver Dis. Understand the role of the microbiology lab and other diagnostic tests in the management of patients with bone marrow transplantation ¾ PCR testing for CMV ¾ Galactomannan assay for aspergillosis ¾ Rapid influenza testing g. Define the antimicrobial agents used to prevent infections in the peri procedure period of bone marrow transplantation.

VRE.21:172-89 I. knowledge will be evaluated on the clinical service. Competency Measurements The fellow will be evaluated by the preceptor of the microbiology rotation. difficile and others ¾ Define the infections based on diagnostic and therapeutic procedures ¾ Recognize the use of isolation in the healthcare setting to prevent transmission of nosocomial infections ¾ Understand the role of standard precautions in prevention of transmission of nosocomial infections ¾ Define contact. ¾ Be knowledgeable about other strategies to control nosocomial infections ¾ Learn how to investigate an outbreak of nosocomial infection in the hospital ¾ The fellow will be required to participate in a workup of an outbreak h. Attend monthly Infection Control Committee meetings and when possible Attend weekly Infection Control Department meetings 63 . ¾ Understand the policies regarding bloodborne pathogens ¾ Be aware of the criteria for post-exposure prophylaxis of healthcare workers for exposure to a communicable disease ¾ Define the role of antimicrobial restrictions in the control of antimicrobial resistant bacterial infections. infections of intravascular devices.Competency Requirements The fellow will become knowledgeable regarding the appropriate use of the microbiology laboratory and the interpretation of data provided. Understand the epidemiology of nosocomial infections CORE CURRICULUM INFECTION CONTROL ¾ Define the infections based on organ systems such as ventilator associated pneumonia. o Understand the role of fit testing in airborne precautions o Know the policies regarding isolation for meningococcal disease and the criteria for removal of the patient from isolation. References Curr Clin Top Infect Dis. 2001. Infection Control Curriculum a. droplet and airborne precautions and understand the role each plays in the transmission of nosocomial infections o Know the policies regarding isolation for tuberculosis and presumed tuberculosis and what criteria are used to take the patient out of isolation or allow for hospital discharge. Additionally. C. urinary tract infections and others ¾ Define the infections based on the specific pathogens such as MRSA. ¾ Be knowledgeable about hand hygiene and its role in control of nosocomial infections.

The fellow will attend the CDC/SHEA training program. References Mayhall Textbook Hospital Epidemiology and Infection Control 64 . Management of infection control issues will be evaluated Competency Measurement while on service and with phone calls. The participation in the antimicrobial approval process is another part of infection control and is evaluated by reviewing antimicrobial approvals.Competency Requirement The fellow will become knowledgeable in infection control and healthcare epidemiology practice.

The overall performance of the trainees in ID Medicine is reported to the Program Director of the Department of Medicine on an annual basis. research programs. and eligibility for subspecialty certification. it is the fellow’s responsibility to obtain informed consent and perform the procedure. Trainees in ID Medicine participate in developing written evaluations of medical residents and students who have served with them on the ID consultation and clinic. When the number of cases increase. When an internal medicine resident is on the infectious diseases elective he/she will perform the initial consultation and write the preliminary note. the resident may do the procedure under the fellow’s supervision. The Chairman of Medicine is directly involved in faculty performance evaluations. The attending physician will supervise any procedure the fellow is not qualified to perform independently. 6 . advancement and assignment of responsibilities. When appropriate. All offers of appointment for new trainees are issued jointly by the Program Director of Medicine as well as the ID Medicine program director. INTERDEPARTMENTAL RELATIONSHIPS Relationship with Department of Medicine The ID Program Director reports directly to the Program Director of the Department of Medicine. faculty development including promotion and educational activities are reviewed on a regular basis. He/She is required to sign all forms indicating satisfactory performance. completion of training. the fellow will also perform initial consultations. The status of clinical services. Should a patient require a procedure. Policy outlining lines of responsibility between Infectious Diseases residents and Internal medicine residents Our policy follows the guidelines established in the UCSF Fresno GMEC policy regarding resident supervision. The ID fellow will advise and educate prior to presentation to the attending physician.

ƒ Sick Leave – Leave that is used in the event of personal illness or injury. injury or death of an immediate family member. The trainee will be informed of what effect the leave will have on the completion of training. If extended leave results in the requirement for additional training in order to satisfy specialty Board requirements or RRC requirements. Absences/Leaves (including Sick Leave) from the training program may jeopardize the resident’s approval of credit for training. or illness. For this reason UCSF Fresno has adopted the following guidelines regarding leave time for residents. Specialty Board requirements and RRC requirements should be reviewed prior to granting any leave by the program director and resident to assure the resident is familiar with the possibility of having to make up time away from training. As a 7 . Paid leave will be based on the normal academic year. ƒ Extended Term Military Leave VACATION LEAVE Vacation leave with compensation shall be fifteen (15) days per academic year. At the time each trainee requests a leave of absence. Any consecutive leave beyond four (4) calendar months needs to be reviewed and approved by the Associate Dean. If a resident begins training outside of the normal academic year. sick and educational leave will be prorated from the beginning of the training year to the end of the normal academic year on June 30th. or additional training may be required by the specialty Board/RRC. the terms will be put in writing and signed by the Program Director and the trainee. A summary of the leave policies referred to within this document include: PAID LEAVE ƒ Vacation/Educational Leave – Leave that is used at the resident’s discretion with program approval. all vacation time must be scheduled with the prior approval of the designated department faculty member and/or Program Director. including leaves of absence. ƒ Short Term Military Leave ƒ Jury Duty ƒ Bereavement (sick leave) UNPAID LEAVE ƒ Medical Leave – leave without pay for illness. In addition to any department regulations concerning vacations. All leave time is subject to UCSF Fresno department and/or program approval. financial support for the additional training time must be determined when arrangements are made for the leave and the makeup activity. including any pregnancy related illness (includes CFRA & FMLA) ƒ Personal Leave – Leave without pay for any reason.Leave Policy for Residents/Fellows Policy: UCSF Fresno supports a work and training environment that offers solutions to the complex issues individuals face in balancing their work and family commitments. A copy of the written consent will then be sent along with the Personnel Action Form (PAF) to the UCSF Fresno Office of Medical Education. vacation. Any leaves of absence identified as a part of the UCSF Fresno Academic Due Process policy are not covered under this policy.

vacation leave and educational leave to remain on full pay status for the initial period of the leave. who have worked 1. FAMILY & MEDICAL LEAVE ACT (FMLA) PREGNANCY-RELATED DISABILITY The California Family Rights Act allows for an additional twelve (12) workweeks of leave after the birth of a child for pregnancy-related disability. child. However. PATERNITY LEAVE Paternity leave is covered under the Family and Medical Leave Act (FMLA). EDUCATIONAL LEAVE Educational leave with compensation shall be five (5) days per academic year. The total duration of the maternity disability leave (paid and unpaid) may not exceed 24 calendar weeks. residents may request up to 3 days of bereavement in the form of sick leave to make arrangements and/or attend the funeral. Residents must discuss the amount and any additional time needed with their Chief and/or Program Director. residents enrolled in the UCSF Housestaff Benefits Plan are entitled to disability coverage following 30 consecutive days of “total disability. Residents employed by UCSF Fresno for one year. SICK LEAVE Sick leave with compensation shall be twelve (12) days per academic year for personal illness. This leave is in addition to the (12) workweeks of Family and Medical Leave in a twelve-month period. please contact UCSF Fresno Human Resources at (559) 499-6416. sister. Any incidents of sick leave over 3 consecutive calendar days may require medical certification from the resident’s health care provider. bereavement or disability. The resident may elect to use accrued sick leave. brother.general rule. grandchild. Sick leave does not carry forward from year to year and must be taken in the same academic year the sick leave is earned. or domestic partner w/affidavit on file w/UCSF Fresno Human Resources Office). In addition. each resident is entitled to use the department educational leave days consistent with the policies and procedures of the department.” For more information. DISABILITY BENEFITS Please note that residents are not eligible for. any remaining educational or vacation leave may be used to cover illness or disabilities that exceed twelve (12) days of sick leave. spouse. Programs must notify HR if a resident is on sick leave for 3 consecutive calendar days or more so that they will receive Family and Medical Leave information that describes rules and regulations under the policy. grandparent. father-in-law.250 hours in the previous 12 8 . To the extent that a resident's department does not include educational leave as a portion of the annual vacation leave. Educational time does not carry forward from year to year and must be scheduled and taken in the same academic year the educational leave is earned. mother-in-law. nor covered by the state of California for short- term disability insurance. BEREAVEMENT (SICK LEAVE) Upon the death of an immediate family member (parent. vacation time does not carry forward from year to year and must be scheduled and taken in the same academic year the vacation is earned.

If the leave extends beyond six (6) months residents have the option of maintaining insurance coverage for the remainder of the leave by reimbursing the University the total cost of their insurance 9 . All benefit coverage will continue during paid military leave. Residents who do not qualify for paternity leave may request an unpaid personal leave of absence from their program. If the event necessitating the leave is based on the expected birth. Approvals are subject to the requirements of applicable law. is unpaid and may follow the required use of any remaining unused vacation and/or educational leave. A personal leave. or planned medical treatment for a serious health condition. time consuming nature or if other leaves of absence are not available. notice must be given as soon as practicable. as determined by the court on a case-by-case basis. placement for adoption or foster care. Consecutive leaves of absences cannot be granted for more than one (1) year in duration. the program. Only the court pursuant to the procedure outlined in the Jury Summons Notice can grant deferment or excused absence from jury service. JURY DUTY A resident called to Jury Duty or to Grand Jury Duty will not suffer a loss of regular pay for those days when one would otherwise be scheduled to perform their resident duties. A resident’s request for a leave of absence must be in writing. the resident must provide at least 30 days advance notice before leave is to begin. to limit employees to a combined total of 12 weeks of family leave. If UCSF Fresno employs both parents. UCSF Fresno reserves the right. are eligible for Family Medical Leave. A resident is obligated to keep their department. MILITARY LEAVE Residents are eligible for up to thirty (30) days of military leave with pay while engaged in the performance of military duty. if granted. If 30 days notice is not practicable. BENEFIT STATUS DURING LEAVE Residents are eligible to maintain insurance coverage during any leave of absence for up to six (6) months as long as they pay their portion of their premium contribution (if applicable). the appropriate specialty Board and the RRC. Absence from the training program to meet military service obligations must be with the approval of the program director and/or department. Requests must be in writing. and have a qualifying status change. The total duration of the personal leave (including paid and unpaid time) may not exceed four (4) calendar months. and appropriate rotation service supervisor apprised of the status once a jury summons has been received. PERSONAL LEAVE A resident may request from his/her program a personal leave of absence in order to attend to personal matters of a serious. if consistent with system-wide University policy.months. Approval of a personal leave of absence is subject to the needs of the program in addition to the requirements of the appropriate specialty Board and RRC. DURATION OF LEAVE The total length of any leave (paid and unpaid together) may not exceed four (4) calendar months unless expressly extended in writing by the Program Director with acknowledgement and approval of the Associate Dean. Deferment or excused absence is generally not granted for inconvenience but may be granted for reasons of personal health or undue hardship.

as a result of a leave. Late payments will initiate termination of benefits and COBRA Continuation Coverage information will be forwarded to residents’ address of record. Group coverage may be continued under COBRA benefits for up to 18 months. additional training experiences are necessary in order for the resident to satisfy Board or RRC requirements.coverage (University’s contribution plus the resident premium contribution.. M. Co-Chair GMEC 10 .D. (Original signed Policy is available in the UCSF Fresno Office of Medical Education) Joan L. the pay status of the time spent in such make-up training will be determined by the department prior to the commencement of the make-up activity. CA 93701 Any payment covering insurance benefits must be received on the first of the month in which the coverage is applicable. the operational needs of the department (including funding constraints) and the requirements of applicable law and University policy. Voris. Fresno Street Fresno. Associate Dean. MAKE-UP FOR TIME ON LEAVE If. The provision of make-up training is subject to the availability of an appropriate residency position. Premium payments must be made payable to the “UC Regents” and delivered or mailed to: UCSF Fresno Attention: Human Resources 155 N. if applicable) on a monthly basis.

ACGME Program Requirements for Graduate Medical Education in Infectious Diseases Common Program Requirements are in BOLD Effective: July 1.d) ensure that adequate salary support is provided to the program director for the administrative activities of the internal medicine subspecialty program. I. I. and resources for education. The sponsoring institution must: I. Institutions I. I. The sponsoring institution and program must ensure that the program director has sufficient protected time and financial support for his or her educational and administrative responsibilities to the program.A.1.1.A.c) provide fellow compensation and benefits.A. I.f)). It is suggested that this support be 25-50% of the program director=s salary.1.1. (See Section III.A.2.2. as described in the Institutional Requirements. faculty.1.a) The minimum number of fellowship positions supported by the institution in each training program must not be less than the Infectious Diseases 1 . The program director must not be required to generate clinical or other income to provide this administrative support. Sponsoring Institution One sponsoring institution must assume the ultimate responsibility for the program. I.A. facilities. or resources that affect the educational program. and this responsibility extends to fellow assignments at all participating sites.1.b) establish the internal medicine subspecialty fellowship within a department of internal medicine or an administrative unit whose primary mission is the advancement of internal medicine education and patient care. clinical care. and. depending on the size of the program.A. and research required for accreditation.A.4. I. Graduate education in the subspecialties of internal medicine requires a major commitment to education by the sponsoring institution. affiliation.e) notify the Review Committee within 60 days of changes in institutional governance. Evidence of such a commitment includes each of the following: I.A.A. 2007 I.a) demonstrate a commitment to education and research sufficient to support the fellowship program.A.

B. required for all fellows.B.4. or six months or more of training in a 36 month program. The primary training site is defined as the health-care facility that provides the required training resources. Assignments at participating sites must be of sufficient length to ensure a quality educational experience and should provide sufficient opportunity for continuity of care.b) specify their responsibilities for teaching. I. supervision. of one month full time equivalent (FTE) or more through the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System (ADS). and. the location where the fellow spends the majority of their clinical training time.B.B. I.2. The program director must submit any additions or deletions of participating sites routinely providing an educational experience.2.B. Exceptions must be justified and prior-approved by the Review Committee.B.B.1.3. as specified later in this document. I. There must be a program letter of agreement (PLA) between the program and each participating site providing a required assignment.A. The PLA should: I. I.B. should be the location of the program director's major activity. I. all participating sites must demonstrate the ability to promote the program goals and educational and peer activities.c) specify the duration and content of the educational experience. and the primary location of the core program in internal medicine.a) identity the faculty who will assume both educational and supervisory responsibilities for fellows. and formal evaluation of fellows.1.1.1.1. The Review Committee must give prior approval for participation by any site providing three months or more of training in a 12 or 24 month program. Program Personnel and Resources Infectious Diseases 2 . I.B. I. II. I.b) The institution must ensure significant research in each subspecialty for which it sponsors a training program. Although the number of participating sites may vary with the various specialties= needs. Participating Sites Participating sites include both the primary training site and other training sites. I.d) state the policies and procedures that will govern fellow education during the assignment. number of accredited training years in the program. The PLA must be renewed at least every five years.

a) requisite specialty expertise and documented educational and administrative experience acceptable to the Review Committee.A. II. The program director must: II.4. II. II.2. The sponsoring institution's GMEC must approve a change in program director. including but not limited to the program information forms and annual program fellow updates to the ADS.f) prepare and submit all information requested by the ACGME. Program Director II.3.A.e) monitor fellow supervision at all participating sites. and ensure that the information submitted is accurate and complete.4.II. The program director should continue in his or her position for a length of time adequate to maintain continuity of leadership and program stability.A.3.A.3.c) approve the selection of program faculty as appropriate.A. II. II.A.4.b) current certification in the subspecialty by the American Board of Internal Medicine.A.A.A.b) approve a local director at each participating site who is accountable for fellow education. There must be a single program director with authority and accountability for the operation of the program.c) current medical licensure and appropriate medical staff appointment.A. II. Infectious Diseases 3 . or specialty qualifications acceptable to the Review Committee.A.d) at least five years of participation as an active faculty member in an ACGME-accredited internal medicine subspecialty fellowship program.d) evaluate program faculty and approve the continued participation of program faculty based on evaluation.A. the program director must submit this change to the ACGME via the ADS.4.4.A. Qualifications of the program director must include: II.1. II.3.4. II.4. After approval.A. The program director must administer and maintain an educational environment conducive to educating the fellows in each of the ACGME competency areas.3. II. and. II.A.a) oversee and ensure the quality of didactic and clinical education in all sites that participate in the program. II.

monitor the demands of at-home call and adjust schedules as necessary to mitigate excessive service demands and/or fatigue.A. II. for selection.A. II. as set forth in the Institutional Requirements and implemented by the sponsoring institution.A.4. including those specified in compliance with the Institutional Requirements.4.4.4.j). Infectious Diseases 4 .(1) distribute these policies and procedures to the fellows and faculty. including moonlighting.A.g) provide each fellow with documented semiannual evaluation of performance with feedback. must: II.4.j). according to sponsoring institutional policies. and. II. II.4.(4) if applicable.h) ensure compliance with grievance and due process procedures.n) obtain review and approval of the sponsoring institution’s GMEC/DIO before submitting to the ACGME information or requests for the following: II.(1) all applications for ACGME accreditation of new programs.A. II.4. II. and supervision of fellows.4.A. II.j) implement policies and procedures consistent with the institutional and program requirements for fellow duty hours and the working environment.4. II.II. II.A. evaluation and promotion of fellows.j). disciplinary action.k) monitor the need for and ensure the provision of back up support systems when patient care responsibilities are unusually difficult or prolonged. including those who leave the program prior to completion.i) provide verification of fellowship education for all fellows.4.A.A. and.j).4. II.n).A.A.l) comply with the sponsoring institution’s written policies and procedures.A.4.4. with a frequency sufficient to ensure compliance with ACGME requirements.A.(2) monitor fellow duty hours. to that end.(3) adjust schedules as necessary to mitigate excessive service demands and/or fatigue.m) be familiar with and comply with ACGME and Review Committee policies and procedures as outlined in the ACGME Manual of Policies and Procedures.

4.p) seek the prior approval of the Review Committee for any changes in the program that may significantly alter the educational experience of the fellows. and.n). II. including financial.4.(1) program citations.A.A.A.A.4.n).4.4. as well as any correspondence or document submitted to the ACGME that addresses: II.II.n). II.o). and drug- or alcohol-related dysfunction.o).(5) responses to all proposed adverse actions.(2) changes in fellow complement. II.4.A.q) be responsible for monitoring fellow stress.4.A. and receive institutional support for that administrative time.4.4. II.4.4.(6) requests for increases or any change to fellow duty hours.(2) request for changes in the program that would have significant impact. II.(3) major changes in program structure or length of training.n).(7) voluntary withdrawals of ACGME-accredited programs.A.A. II.n). including mental or emotional conditions inhibiting performance or learning.o) obtain DIO review and co-signature on all program information forms. II.n). and/or II. II.(10) proposals to ACGME for approval of innovative educational approaches. II. Infectious Diseases 5 .A.n).r) dedicate an average of 20 hours per week of his or her professional effort to the internal medicine subspecialty educational program.4. II.A.A. with sufficient time for administration of the program.A.A.4.(4) progress reports requested by the Review Committee.(9) appeal presentations to a Board of Appeal or the ACGME.4.(8) requests for appeal of an adverse action. on the program or institution.A. II.n). Both the program director and faculty should be sensitive to the need for timely provision of confidential counseling and psychological support services to fellows.n).A. II.4. Situations that demand excessive service or that consistently produce undesirable stress on fellows must be evaluated and modified.

At each participating site.B. II. and conferences.5.b) administer and maintain an educational environment conducive to educating fellows in each of the ACGME competency areas. The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. II.4. especially as it pertains to the teaching and evaluation of the ACGME Competencies (as outlined in Section IV of this document). II.u) be located at the principal clinical training site. II.1.1.B.a) The faculty must regularly participate in organized clinical discussions. II. and. rounds.B. The physician faculty must possess current medical licensure and appropriate medical staff appointment.II.4. and to demonstrate a strong interest in the education of fellows.B.1.s) participate in academic societies and in educational programs designed to enhance his or her educational and administrative skills.B.5.B. journal clubs.b) Some members of the faculty should also demonstrate scholarship by one or more of the following: Infectious Diseases 6 . II.3. II.A. or possess qualifications judged to be acceptable by the Review Committee.3. there must be a sufficient number of faculty with documented qualifications to instruct and supervise all fellows at that location.a) devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities. The physician faculty must have current certification in the subspecialty by the American Board of Internal Medicine. II.4.B. The faculty must: II. II.a) The physician faculty must meet professional standards of ethical behavior. II.t) implement a program of continuous quality improvement in medical education for the faculty.5.B.B. The nonphysician faculty must have appropriate qualifications in their field and hold appropriate institutional appointments.B.2.4. II.A.A.B. Faculty II.

5.C. and commitment to the internal medicine subspecialty as a discipline.5.(2) publication of original research or review articles in peer-reviewed journals or chapters in textbooks.b.B.II.b).1.a) Qualifications: The key clinical faculty must: II. II.e) The majority of key clinical faculty must demonstrate evidence of productivity in the scholarship as defined in II. II. II. or (2) above. II.b).(1) above.(1).B.b. II.(1).5.5.5.5.(2) have current certification in the subspecialty by the American Board of Internal Medicine or possess Infectious Diseases 7 .5. or. or national professional and scientific society meetings.a).B.C.: The required number of key clinical faculty may vary by subspecialty.5.5.5.B.B. (2). II.(4) participation in national committees or educational organizations.C. 10 hours per week throughout the year to the training program.B.1.(3) publication or presentation of case reports or clinical series at local.5.(1) be active clinicians with broad knowledge of. technical.a).B.C. Key Clinical Faculty In addition to the program director.B.d) The majority of faculty must be involved in scholarship as defined in II.b).f) At least one faculty member must be active in the scholarship defined in II. II.B. and II. (N.b. experience with. and clerical personnel for the effective administration the program. each program must have two key clinical faculty.B. Key clinical faculty are attending physicians who dedicate.b). Other Program Personnel The institution and the program must jointly ensure the availability of all necessary professional. regional. a ratio of key clinical faculty to fellows of at least 1:1.(1) peer-reviewed funding.B.B.5 must be maintained.) II. or (3) above. II. II.1.C.1.c) Faculty should encourage and support fellows in scholarly activities. For programs with more than five fellows enrolled during the accredited portion of the training program. on average.

3. II.(2) When fellows are assigned night duty in the hospital or called in from home.3.b) Facilities II. visual and other educational aids.1. II. including meeting rooms. II.(1) Fellows must have lounge and food facilities during assigned duty hours. II. Section II.D.a) The inpatient and ambulatory care population must provide experience with patients whose illnesses are encompassed by. II. Resources The institution and the program must jointly ensure the availability of adequate resources for fellow education. classrooms. examination rooms.D.D.b) Responsibilities for the key clinical faculty include: In addition to the responsibilities of all individual faculty. effective ambulatory and inpatient care settings.2.D.a) Space and equipment There must be space and equipment for the educational program. All clinical faculty members should participate in prescribed faculty development programs designed to enhance the effectiveness of their teaching.2. Medical Records Clinical records that document both inpatient and ambulatory care must be readily available at all times. and a restful environment with a secure space for their belongings.1. safety. computers.D. as defined in the specialty program requirements.D.d)) II. they must be provided with on-call facilities that are convenient and that afford privacy.1. Fellows must have clinical experiences in efficient. implementation. II.C.D. (See Institutional Requirements.D. Patient Population II. the key clinical faculty with the program director.C.D. II. monitoring and evaluation of the fellows’ clinical and research training.b).b).1. II.1.D. are responsible for the planning. qualifications judged by the Review Committee to be acceptable.1. Infectious Diseases 8 .3. and work/study space.

and help to define, the subspecialty.

II.D.3.b) There must be patients of both sexes, with a broad age range,
including geriatric patients.

II.D.3.c) A sufficient number of patients must be available to ensure
adequate inpatient and ambulatory experience for each
subspecialty fellow.

II.D.4. Death Reviews and Autopsies

II.D.4.a) All deaths of patients who received care by fellows must be
reviewed and autopsies performed whenever possible.

II.D.4.b) Fellows must receive autopsy reports after autopsies are
completed on their patients.

II.D.5. Support Services

II.D.5.a) Administrative support must include adequate secretarial and
administrative staff and technology to support the program
director.

II.D.5.b) Inpatient clinical support services must be available on a 24-hour
basis to meet reasonable and expected demands, including
intravenous services, phlebotomy services, messenger/transporter
services, and laboratory and radiologic information retrieval
systems that allow prompt access to results.

II.D.5.c) Consultations from other clinical services in the hospital must be
available in a timely manner. All consultations should be
performed by or under the supervision of a qualified specialist.

II.E. Medical Information Access

Fellows must have ready access to specialty-specific and other appropriate
reference material in print or electronic format. Electronic medical literature
databases with search capabilities should be available.

III. Fellow Appointment

III.A. Eligibility Criteria

The program director must comply with the criteria for fellow eligibility as
specified in the Institutional Requirements.

III.B. Number of Fellows

The program director may not appoint more fellows than approved by the
Review Committee, unless otherwise stated in the specialty-specific
requirements. The program’s educational resources must be adequate to

Infectious Diseases 9

support the number of fellows appointed to the program.

III.C. Fellow Transfer

III.C.1. Before accepting a fellow who is transferring from another program,
the program director must obtain written or electronic verification of
previous educational experiences and a summative competency-
based performance evaluation of the transferring fellow.

III.C.2. A program director must provide timely verification of fellowship
education and summative performance evaluations for fellows who
leave the program prior to completion.

III.D. Appointment of Fellows and Other Students

The presence of other learners (including, but not limited to, residents from
other specialties, subspecialty fellows, PhD students, and nurse
practitioners) in the program must not interfere with the appointed fellows'
education. The program director must report the presence of other learners
to the DIO and GMEC in accordance with sponsoring institution guidelines.

III.E. Fellows responsibilities and professional relationships

Fellows must have clearly defined written lines of responsibility for all clinical
experiences.

III.F. When averaged over any five-year period, a minimum of 75% of fellows in each
subspecialty training program must be graduates of an ACGME accredited
internal medicine training program. Non-ACGME internal medicine trained
fellows must have at least three years of internal medicine training prior to
starting fellowship. Prior to appointment, the program director must inform non-
ACGME trained applicants in writing of the ABIM policies and procedures that
may affect the fellow=s eligibility for ABIM certification. (N.B.: Fellows in the
subspecialty of geriatric medicine may be graduates of an ACGME-accredited
family medicine training program.)

IV. Educational Program

IV.A. The curriculum must contain the following educational components:

IV.A.1. Overall educational goals for the program, which the program must
distribute to fellows and faculty annually;

IV.A.2. Competency-based goals and objectives for each assignment at
each educational level, which the program must distribute to fellows
and faculty annually, in either written or electronic form. These
should be reviewed by the fellow at the start of each rotation;

IV.A.2.a) for each rotation or major learning experience, the written goals
and objectives:

Infectious Diseases 10

IV.A.2.a).(1) should include the educational purpose; teaching methods;
the mix of diseases, patient characteristics, and types of
clinical encounters, procedures, and services; reading lists,
pathological material, and other educational resources to
be used; and the method for evaluation of fellows’
competence;

IV.A.2.a).(2) must define the level of fellows’ supervision by faculty
members in all patient-care activities; and,

IV.A.2.a).(3) should be reviewed and revised at least every three years
by faculty members and fellows’ to keep the goals and
objectives current and relevant.

IV.A.3. Regularly scheduled didactic sessions; and,

IV.A.4. Delineation of fellow responsibilities for patient care, progressive
responsibility for patient management, and supervision of fellows
over the continuum of the program.

IV.A.5. ACGME Competencies

The program must integrate the following ACGME competencies
into the curriculum:

IV.A.5.a) Patient Care

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

IV.A.5.a).(1) 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.

IV.A.5.b) 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:

IV.A.5.b).(1) are expected to learn the scientific method of problem
solving, evidence-based decision making, a commitment to
lifelong learning, and an attitude of caring that is derived
from humanistic and professional values.

IV.A.5.c) Practice-based Learning and Improvement

Fellows must demonstrate the ability to investigate and

Infectious Diseases 11

(4) act in a consultative role to other physicians and health professionals.c). and assimilate evidence from scientific studies related to their patients’ health problems.5.(4) systematically analyze practice.A. appraise.(6) locate. IV. if applicable. Fellows are expected to develop skills and habits to be able to meet the following goals: IV.(3) work effectively as a member or leader of a health care team or other professional group. across a broad range of socioeconomic and cultural backgrounds. deficiencies. IV.d). Fellows are expected to: IV.A.d) Interpersonal and Communication Skills Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients. IV. their families. students. IV. to appraise and assimilate scientific evidence.A. fellows and other health professionals. Infectious Diseases 12 . IV.A.(8) participate in the education of patients. and.5. and limits in one’s knowledge and expertise.c).(3) identify and perform appropriate learning activities. evaluate their care of patients. IV. and to continuously improve patient care based on constant self-evaluation and life-long learning. IV.5. IV.A.5. as appropriate. families.5.A. and the public.(7) use information technology to optimize learning. IV.5.c).5. and health related agencies.c).(2) set learning and improvement goals.c).A.A.A.A. IV.c).5.5.c). and implement changes with the goal of practice improvement.d).5.A. and legible medical records.c).A. and health professionals.(2) communicate effectively with physicians.(1) identify strengths.5.d). IV.d).(1) communicate effectively with patients. using quality improvement methods.d). other health professionals. timely.A.5.(5) incorporate formative evaluation feedback into daily practice.5.(5) maintain comprehensive.A. families. and.5. IV.

A.5.(1) work effectively in various health care delivery settings and systems relevant to their clinical specialty.e).A.(3) respect for patient privacy and autonomy.A. Fellows are expected to: IV.5.f) Systems-based Practice Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care.5.5. IV.5.A.(5) work in interprofessional teams to enhance patient safety and improve patient care quality.5. culture.A. integrity.e).A. IV.A.A.5. including but not limited to diversity in gender. IV. disabilities. IV.(2) coordinate patient care within the health care system relevant to their clinical specialty. and respect for others.5.A.(2) responsiveness to patient needs that supersedes self- interest.IV.A.f). race. as well as the ability to call effectively on other resources in the system to provide optimal health care.f).A.5. IV. society and the profession.f).(4) advocate for quality patient care and optimal patient care systems.(5) sensitivity and responsiveness to a diverse patient population.A.5.e).A.(1) compassion.(6) participate in identifying system errors and implementing potential systems solutions. and sexual orientation.e).f).5.f).e) Professionalism Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.e).5. IV. Fellows are expected to demonstrate: IV. IV. IV.5. age. religion. and.(3) incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population- based care as appropriate.f).(4) accountability to patients. Infectious Diseases 13 . IV. IV. and.

IV.B.a).B.2.(1) The program must ensure a meaningful. IV.C.2. Fellows should participate in scholarly activity. Fellows’ Scholarly Activities IV.B.a) Participation in an active research program is an essential component for fellows enrolled in subspecialty fellowship training programs of 24 months or greater duration. design and interpretation of research studies.a).(a) publication (manuscripts or abstracts) in peer- reviewed journals. Subspecialty training in internal medicine is a voluntary component in the continuum of the educational process. The curriculum must advance fellows’ knowledge of the basic principles of research.2.B.a).a).(4).2.C.(b) abstracts presented at national specialty meetings (N. Infectious Diseases 14 .B. Definition and Scope of Specialty IV. and applied to patient care.2. IV. and interpretation of data.B.B.B. evaluated.(2) Fellows must be advised and supervised by qualified faculty members in the conduct of research. including how such research is conducted.: Training programs in one-year critical care medicine and internal medicine-geriatric medicine are exempt from this requirement relative to research productivity by fellows.1. responsible use of informed consent.B.(4) The majority of fellows must demonstrate evidence of recent research productivity through: IV. IV. such training should take place after satisfactory completion of an accredited program in internal medicine. IV.) IV.a).IV. The sponsoring institution and program should allocate adequate educational resources to facilitate fellow involvement in scholarly activities. IV.3. IV.2.B.B. or IV.(4).(3) Fellows must learn the standards of ethical conduct of research. explained to patients.2.2. research methodology.1. supervised research experience with appropriate protected time for each fellow—either in blocks or concurrent with clinical rotations—while maintaining the essential clinical experience.B.a).

C. and.1. Infectious Diseases 15 .1.D. To be eligible for accreditation.D.D. the term subspecialty is used throughout the document for both types of training programs.2.a).a). IV. IV.IV.a) Conferences must be conducted regularly as scheduled and must be attended by faculty and fellows. pathophysiology.4.a) Teaching and management rounds are usually combined in subspecialty training programs. IV.D. the appropriate use of technology.(1) at least one clinical conference weekly. IV.2.D. Inpatient and Consultation Teaching IV. when averaged over one year.C. IV. IV.D.2. differential diagnosis. the incorporation of evidence and patient values in clinical decision making. a subspecialty program must function as an integral part of an accredited residency program in internal medicine. IV.(3) one research conference monthly.b) The total teaching time spent in combined management and teaching rounds must exceed by a minimum of five hours per week the time required to supervise the care of patients. from the program director of the subspecialty program to the program director of the parent internal medicine residency program.(4). IV.D.D.(2) one literature review conference (journal club) monthly. These rounds must be patient- based sessions in which current cases are presented as a basis for discussion of such points as interpretation of clinical data. Subspecialty programs must provide advanced training to allow the fellow to acquire competency in the subspecialty with sufficient expertise to act as a consultant. specific management of the patient.D. these must include: IV.a).C.(4) at least one core curriculum conference weekly. and disease prevention.2. to ensure compliance with the ACGME accreditation standards.2.2. There must be a reporting relationship. (For editorial purposes.3. The discipline must be one for which a certificate or a certificate of added qualifications is offered by the American Board of Internal Medicine.2.(a) The core curriculum conference series must include the basic sciences relevant to the subspecialty. IV.2.5.C. Didactics IV. Conferences and Seminars IV.) IV.D.a). At a minimum.1.D.a).

and dietitians.D. medical informatics.2.c) Fellows must participate in planning and in conducting conferences. IV. language interpreters.3. Clinical IV.2.2.E.a). clinical epidemiology. medical genetics.E. to afford each fellow an opportunity to attend or review most of the core conference topics.D. and. This continuity experience should expose fellows to the breadth and depth of the subspecialty.E.1.D.D.a) Fellows must have a continuity ambulatory clinic experience a half day each week to develop a continuous healing relationship with patients for whom they provide subspecialty care. social workers. IV.(b) The core curriculum conference series must cover the major clinical topics in the subspecialty. or be made available for review on tape or electronically. patient safety.a) Fellows should become proficient in the critical assessment of medical literature. risk management. IV. quality assessment.(c) The core curriculum conference series must repeat often enough.E.: May vary by subspecialty. and physician impairment. IV. preventive medicine. (N.a) There must be on-site faculty whose primary responsibilities must include the supervision and teaching of fellows. IV.c) There should be services available from other health-care professionals such as nurses.3.2. IV.E.2.(4).b) Educational experiences should include instruction in the following: clinical ethics.1.D. Ambulatory medicine IV. IV. Experience with continuity ambulatory patients IV.b) Fellows must participate in formal review of gross and microscopic pathological material from patients who have been under their care.D.a). quality improvement.2.D.) This may be accomplished by either: Infectious Diseases 16 .b) Fellows must be able to obtain appropriate and timely consultation from other specialties for their ambulatory patients. pain management. end-of-life care. Interdisciplinary Topics IV.E.IV.E.(4).3. IV.1.1. and biostatistics.B. IV.

3.2.c) Faculty supervision of procedures performed by each fellow must occur until proficiency has been acquired and documented by the program director.2. IV.(3) document achievement of proficiency.g) It is suggested that fellows should be informed of the status of their continuity patients when they are hospitalized so the fellow can make appropriate arrangements to maintain continuity of care.b) Fellows must acquire knowledge of and skill in educating patients about the rationale. be responsible for four to eight patients during each half day session. Procedures IV.E. IV. and complications of procedures and in obtaining procedure-specific informed consent.3.E. IV.E.(1) identify key procedures.(2) define a standard for proficiency. on average. IV.3. complications.E.E.a).E. excluding a fellow's vacation.E. limitations.E.d) Each program must: IV. IV.c) Over the course of accredited training.E.(1) A single continuity clinic for the length of the accredited fellowship. and. IV.f) During the continuity experience. IV.3.E.E.b) Each fellow should.3.3.d).2.2. IV.a). IV.E.E. and interpretation of results of those diagnostic and therapeutic procedures integral to the discipline.E. techniques.2.3. IV.e) The continuing patient-care experience should not be interrupted by more than one month. arrangements should be made to minimize interruptions of the experience by fellows' duties on inpatient and consultation services.(2) Blocks of at least six months duration for the length of the accredited fellowship. each fellow=s panel of patients must include at least 25% of patients from each gender.E.E. or IV. IV.3. contraindications.2.a) Fellows must develop a comprehensive understanding of indications. technique.IV. Infectious Diseases 17 .2. IV.d) Each fellow=s clinical experiences with ambulatory patients must provide fellows the opportunity to observe and to learn the course of disease.d).2.d).

1.1.b). V. skills.1. V.a) The faculty must evaluate fellow performance in a timely manner during each rotation or similar educational assignment.d).d).1.(a) This includes formal evaluations of knowledge.1.(4).(2) use multiple evaluators (e. professionalism.1. V.A.b). and other professional staff). Evaluation V.1. and professional growth of fellows and required counseling by the program director.(3) document progressive fellow performance improvement appropriate to educational level.d) Permanent records of both the evaluation and counseling sessions (and any others that occur) for each fellow must be maintained in the fellow's file and must be accessible to the fellow and other authorized personnel..c) The evaluations of fellow performance must be accessible for review by the fellow.A. Fellow V. V. and. in accordance with institutional policy.1.(2) The record of evaluation should document that records were maintained by documentation logbook or by an equivalent method to demonstrate that fellows have achieved competence in the performance of invasive Infectious Diseases 18 . V. and systems- based practice. V. medical knowledge. V.A.(1) The faculty must discuss this evaluation with the fellow at the completion of the assignment. peers.(1) provide objective assessments of competence in patient care.1.a).A. self.1.A.A.1.A.b).A. V.V.g.(1) The record of evaluation should document the fellow’s achievement of the competencies using appropriate evaluation methods. faculty.A.b).A. practice-based learning and improvement. interpersonal and communication skills.b) The program must: V. and document this evaluation at completion of the assignment. Formative Evaluation V. patients.A.b). V.1.1.A.(4) provide each fellow with documented semiannual evaluation of performance with feedback.A.A. V.

) V.3. (N. commitment to the educational program. interpersonal and communication skills.. This evaluation must include at least annual written confidential evaluations by fellows.: This summative evaluation is in addition to the completion of the ABIM tracking form.1. Such records must be of sufficient detail to permit use in future credentialing. V. V.b). Infectious Diseases 19 . This evaluation must become part of the fellow’s permanent record maintained by the institution.B. professionalism.2.b). These records must state the indications and complications.d).A. V.A.a) document the fellow’s performance during the final period of education.B. procedures. the program must evaluate faculty performance as it relates to the educational program. and include the names of the supervising physicians. V.A.2.(2) The summative evaluation must stipulate the degree to which the fellow has achieved the level of performance expected in each Competency (i.(1) The program director must also prepare annually a written summative evaluation of the clinical competence of each fellow.1. and must be accessible for review by the fellow in accordance with institutional policy. Faculty V.B. medical knowledge.2.2. professionalism.2.e.A. patient care. V. and systems-based practice).d). V. V.(3) The record of evaluation should document that fellows were evaluated in writing and their performance reviewed with them verbally on completion of each rotation period.2.(4) The record of evaluation should document that fellows were evaluated in writing and their performance in continuity clinic reviewed with them verbally on at least a semiannual basis.A. practice-based learning and improvement.b) verify that the fellow has demonstrated sufficient competence to enter practice without direct supervision.A.B. and V.A. These evaluations should include a review of the faculty’s clinical teaching abilities.B.1. At least annually. clinical knowledge. This evaluation must: V. Summative Evaluation The program director must provide a summative evaluation for each fellow upon completion of the program. and scholarly activities.

Fellows should evaluate the faculty’s effectiveness as teachers. The action plan should be reviewed and approved by the teaching faculty and documented in meeting Infectious Diseases 20 .C.(1) At least 80% of those eligible to take an ABIM subspecialty certifying examination upon completion of their training for the most recent five year period must have taken an ABIM subspecialty certifying examination.B. The fellows must have the opportunity to assess formally the effectiveness of ambulatory teaching on an ongoing basis.b) faculty development. and V.5. The program must document formal. V.C.C.a) fellow performance.1.C.C.c).1.1.1.1.V. systematic evaluation of the curriculum at least annually.C. V.B. (Note: Five-year rolling pass rate for first time takers of the ABIM certifying examination will be examined at each program review). V.d). V.(1) Fellows and faulty must have the opportunity to evaluate the program confidentially and in writing at least annually. the program should prepare a written plan of action to document initiatives to improve performance in the areas listed in section V.C. fellows must also evaluate the effectiveness of rotation or assignment in achieving the goals and objectives identified in the curriculum for that rotation or assignment. If deficiencies are found. and for the evaluations to be reviewed annually with faculty.C.4. and.B. Program Evaluation and Improvement V. including performance of program graduates on the certification examination.d) program quality. V.1. V.C.1.C. Provision must be made for fellows to confidentially provide written evaluations of each teaching attending at the end of a rotation. The program must monitor and track each of the following areas: V.1. V.(2) The program must use the results of fellows’ assessments of the program together with other program evaluation results to improve the program.c) graduate performance.1.6. V. The results of the evaluations must be used for faculty-member counseling and for selecting faculty members for specific teaching assignments. V.C.d).7. Specifically: V.B.2.

VI.. VI. VI. i.D. administrative duties relative to patient care. Duty Hours (the terms in this section are defined in the ACGME Glossary and apply to all programs) Duty hours are defined as all clinical and academic activities related to the program. time spent in-house during call activities. Didactic and clinical education must have priority in the allotment of fellows' time and energy. Adequate time for rest and personal activities must be provided. Principles VI.1. VI. Fellows must be provided with one day in seven free from all educational and clinical responsibilities.A.B.3. Fatigue Faculty and fellows must be educated to recognize the signs of fatigue and sleep deprivation and must adopt and apply policies to prevent and counteract its potential negative effects on patient care and learning.D. Infectious Diseases 21 .C.D. patient care (both inpatient and outpatient). Supervision of Fellows The program must ensure that qualified faculty provide appropriate supervision of fellows in patient care activities.2. VI. the provision for transfer of patient care.e. averaged over a four-week period. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.A. Duty hours do not include reading and preparation time spent away from the duty site. averaged over a four-week period.2. VI. VI. Fellow Duty Hours in the Learning and Working Environment VI. The learning objectives of the program must not be compromised by excessive reliance on fellows to fulfill service obligations.A. Duty hours must be limited to 80 hours per week. inclusive of call. VI. inclusive of all in-house call activities. The program must be committed to and be responsible for promoting patient safety and fellow well-being and to providing a supportive educational environment.A.4.D. such as conferences. VI.A. minutes.1. VI.3. Duty hour assignments must recognize that faculty and fellows collectively have responsibility for the safety and welfare of patients. and scheduled activities.

VI. VI.E. VI. Moonlighting VI.E.E.4. averaged over a four-week period.4. conduct outpatient clinics. or 24+6 limitation.3. Infectious Diseases 22 . No new patients may be accepted after 24 hours of continuous duty.a) The frequency of at-home call is not subject to the every- third-night.4. Duty Hours Exceptions A Review Committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale.E.1.E. VI. Continuous on-site duty.G. In preparing a request for an exception the program director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures.E.a) Internal Medicine residency programs are not allowed to average in-house call over a four-week period. the hours fellows spend in-house are counted toward the 80-hour limit. In-house call must occur no more frequently than every third night.2. VI.2. Fellows may remain on duty for up to six additional hours to participate in didactic activities.VI. including in-house call.3.E.G.F. VI.F. and maintain continuity of medical and surgical care.b) Fellows taking at-home call must be provided with one day in day completely free from all educational and clinical responsibilities. However at home-call must not be so frequent as to preclude rest and reasonable personal time for each fellow.E. VI.4.a) A new patient is defined as any patient to whom the fellow has not previously provided care.F.1.E. transfer care of patients.1. must not exceed 24 consecutive hours. On-Call Activities VI. VI.c) When fellows are called into the hospital from home. VI. VI. At-home call (or pager call) VI. Internal moonlighting must be considered part of the 80-hour weekly limit on duty hours. Moonlighting must not interfere with the ability of the fellow to achieve the goals and objectives of the educational program. VI.E.1. averaged over a four-week period.

2.A. VI.I. common and specialty specific program requirements must be approved in advance by the Review Committee.A.H. the sponsoring institution and program are jointly responsible for the quality of education offered to fellows for the duration of such a project. VI.1. the program director must follow Procedures for Approving Proposals for Experimentation or Innovative Projects located in the ACGME Manual on Policies and Procedures. In preparing requests.a) The Review Committee for Internal Medicine will not consider requests for exceptions to the limit to 80 hours per week. The program should identify and participate in at least one ongoing performance improvement activity which relates to the competencies.I. phlebotomy. VI. VI.3. VI. The performance improvement activities must involve both fellows and faculty in planning and implementing.H.G. Once a Review Committee approves a project. averaged over a four-week period. Prior to submitting the request to the Review Committee. In the event of an adverse annual evaluation. Fellows must not be required to provide routine intravenous. or messenger/transporter services.1. VII. Fellows' service responsibilities must be limited to patients for whom the teaching service has diagnostic and therapeutic responsibility VI. Performance Improvement Process VII. VII.2. VII.1. Infectious Diseases 23 . There must be a written policy that ensures that academic due process is provided.2.2.H.A.VI. Experimentation and Innovation Requests for experimentation or innovative projects that may deviate from the institutional. Service Versus Education A sponsoring institution must not place excessive reliance on residents to meet the service needs of the participating training sites.G. a fellow must be offered an opportunity to address a judgment of academic deficiencies or misconduct before a formally constituted clinical competence committee.I. the program director must obtain approval of the institution’s GMEC and DIO. VI. The admission and continuing care of patients by fellows must be limited to those patients on the teaching service.H.2. Grievance Procedures and Due Process VI.

A minimum of 12 months must be devoted to clinical experiences. Facilities and Resources In addition to the facilities and resources outlined in the Program Requirements for Fellowship Education in the Subspecialties of Internal Medicine. IX.B. Ambulatory medicine experience Continuity ambulatory care experience of 24 months must be included in the training program.3.C.A. X.B.D. During their ambulatory experience. Resources. The training program must be 2 years in duration. such that direct and frequent interaction with microbiology laboratory personnel is readily available. X. Educational Program VIII.A. VIII. Facilities for the isolation of patients with infectious diseases must be available. Infectious Diseases 24 .D. Surgery and Pathology No additional facilities or services are required. Faculty See Program Requirements for Fellowship Education in the Subspecialties of Internal Medicine.B. or Support Services X. VIII. (N.VII. fellows must have training in both consultative services and continuing care in infectious disease.1.C. The performance improvement activities should result in measurable improvements in patient care or residency education. each of the following must be present at the primary training site: X.: This laboratory does not need to be located at the primary training site. Other Facilities.A. X. VIII. Diagnostic Laboratory Services Fellows must have convenient access to a laboratory for clinical microbiology. Imaging No additional facilities are required.) X. including human immunodeficiency virus (HIV) infection. A subspecialty educational program in infectious diseases must be organized to provide training and supervised experience at a level sufficient for the fellow to acquire the competency of a specialist in the field. VIII.D.

B.D.1.b) This experience includes. pediatrics.B.A.B.E.B. service on an infection control committee. Infectious Diseases 25 . lymphoma or other malignancies.1. Therapeutic modalities should include management of antibiotic administration in settings such as the acute care hospital.3. Patient Population See Program Requirements for Fellowship Education in the Subspecialties of Internal Medicine. Specific Program Content XI. Clinical Experience XI. but is not limited to: XI.A.B. Such opportunities must encompass longitudinal experiences in a continuum of care in order to observe the course of illness and the effects of therapy. as offered through organized coursework. Fellows must have clinical experience and demonstrate competence in the evaluation and management of infections in patients with major impairments of host defense. gynecology. Fellows must receive formal instruction and gain practical experience in hospital epidemiology and infection control.2.B.b). Technical and Other Skills XI.3. obstetrics. Experience with pediatric infectious diseases is suggested.3.b). It is suggested that the training program be conducted in a setting in which training programs in surgery. XI. XI. XI. X. Clinical experience must include opportunities to manage adult and geriatric patients with a wide variety of infectious diseases in both an inpatient and ambulatory basis. and other medical and surgical specialties and subspecialties are available.A.2. This can be accomplished by didactic or practical experience.a) The teaching services on which fellows work must provide an average of at least 50 consultations per fellow during the period in which fellows are rotating on these services for their clinical training.X. XI. XI.(1) patients who are neutropenic.B.3.(2) patients with leukemia. XI. Fellows must receive formal instruction and gain practical experience in clinical microbiology.3. and in conjunction with the non-acute care facility or home-care services.B. or by an assigned rotation on a hospital epidemiology service. XI.2. XI. the office.

XI.B.3.b).(3) patients following solid organ or bone marrow
transplantation; and

XI.B.3.b).(4) patients with HIV/AIDS or patients immunocompromised
by other diseases or medical therapies.

XI.B.3.c) Documentation of the number of consultations above may be
completed for the teaching service overall rather than per fellow, if
these numbers are available for the service; in this case, individual
fellow logs are not necessary. Otherwise, fellows should
document the number of consultations by an individual log.

XI.B.4. Fellows must have formal instruction or clinical experience and must
demonstrate competence in the evaluation and management of the
following disorders:

XI.B.4.a) infections of the reproductive organs;

XI.B.4.b) infections in solid organ transplant patients;

XI.B.4.c) infections in bone marrow transplant recipients;

XI.B.4.d) sexually transmitted diseases;

XI.B.4.e) viral hepatitis, including hepatitis B and C; and

XI.B.4.f) infections in travelers.

XI.B.5. Consultation Experience

The inpatient teaching services on which fellows work must provide an
average of at least 250 consultations per fellow during the period the
fellows are rotating on these services for their clinical training. These
consultations must be provided in a variety of clinical settings, including:

XI.B.5.a) Inpatient General Medical and Surgical Wards, and Intensive Care
Units

In these settings, fellows must have clinical experience and must
demonstrate competence in the evaluation and management of
patients with the following disorders:

XI.B.5.a).(1) pleuropulmonary infections;

XI.B.5.a).(2) infections and other complications in patients with
HIV/AIDS;

XI.B.5.a).(3) cardiovascular infections;

XI.B.5.a).(4) central nervous system infections;

Infectious Diseases 26

XI.B.5.a).(5) gastrointestinal and intra-abdominal infections;

XI.B.5.a).(6) skin and soft tissue infections;

XI.B.5.a).(7) bone and joint infections;

XI.B.5.a).(8) infections of prosthetic devices;

XI.B.5.a).(9) infections related to trauma;

XI.B.5.a).(10) sepsis syndromes;

XI.B.5.a).(11) nosocomial infections; and

XI.B.5.a).(12) urinary tract infections.

XI.B.6. Ambulatory Medicine Experience

XI.B.6.a) Ambulatory training must include longitudinal care (at least 12
months of direct supervision of each patient) of at least 20 patients
with HIV infection.

XI.B.6.b) Direct oversight of the longitudinal care of patients with HIV
infection by the fellows must be provided by an experienced HIV
physician.

XI.B.6.c) At a minimum, 25% of patients of either gender must be
represented in the fellow’s panel of patients. If this gender
distribution is not feasible due to the local epidemiology of HIV,
then alternative clinical experiences or didactic instruction must be
provided.

XI.C. Formal Instruction

XI.C.1. The training program must provide formal instruction for the fellows in the
cognitive aspects of the following:

XI.C.1.a) mechanisms of action and adverse reactions of antimicrobial
agents; antimicrobial and antiviral resistance; drug-drug
interactions between antimicrobial agents and other compounds;
the appropriate use and management of antimicrobial agents in a
variety of clinical settings, including the hospital, ambulatory
practice, non acute-care units, and the home;

XI.C.1.b) methods of determining antimicrobial activity of a drug; techniques
to determine concentration of antimicrobial agents in the blood
and other body fluids; interpretation of antibiotic levels in blood;

XI.C.1.c) appropriate procedures for specimen collection relevant to
infectious disease, including but not limited to bronchoscopy,
thoracentesis, arthrocentesis, lumbar puncture, and aspiration of

Infectious Diseases 27

abscess cavities;

XI.C.1.d) principles of prophylaxis and immunoprophylaxis to enhance
resistance to infection;

XI.C.1.e) characteristics, use, and complications of antiretroviral agents,
mechanisms and clinical significance of viral resistance to
antiretroviral agents, and recognition and management of
opportunistic infections in patients with HIV/AIDS;

XI.C.1.f) methods for accessing databases of relevance to the care and
management of individuals with infectious diseases; and,

XI.C.1.g) the epidemiology, clinical course, manifestations, diagnosis,
treatment and prevention of mycobacterial infections and major
parasitic diseases.

XI.C.2. Conferences and Seminars

As part of the required conferences and seminars outlined in the Program
Requirements for Fellowship Education in the Subspecialties in Internal
Medicine, a minimum of 25 hours each year must be devoted to
discussion of HIV-related topics.

***

ACGME Approved: September 28, 2004 Effective July 1, 2005
Revised Common Program Requirements Effective: July 1, 2007
Editorial Revision: July 1, 2009

Infectious Diseases 28

ABIM REQUIREMENTS: 103 .

104 .

105 .

106 .

ABIM reserves the right to make changes in its fees.abim. www. For information about the Maintenance of Certification program. not-for-profit corporation. and procedures at any time without advance notice. and (4) developing and conducting examinations and other assessments. All ABIM certificates issued in 1990 (1987 for critical care medicine and 1988 for geriatric medicine) and thereafter are valid for 10 years.org. Admission to ABIM’s examinations will be determined under the policies in force at the time of application. these certificates must be renewed through ABIM’s Maintenance of Certification program. Certification is not a requirement to practice internal medicine. ABIM administers the certification process by: (1) establishing requirements for training and self-evaluation. July 2008 107 . examinations. ABIM’s mission is to enhance the quality of health care by certifying internists and subspecialists who demonstrate the knowledge. Dates of validity are noted on the certificates. and ABIM does not confer privileges to practice. Board members are elected by the Board of Directors and serve two-year terms. www. (2) assessing the professional credentials of candidates. A candidate's eligibility for certification is determined by the policies and procedures described in this document and on ABIM’s website. ABIM receives no public funds and has no licensing authority or function. This edition of Policies and Procedures supersedes all previous publications.CERTIFICATION JULY 2008 1 TABLE OF CONTENTS Requirements for Certification in Internal Medicine Requirements for Certification in Subspecialties Certification Using the Research Pathway Special Training Policies Other Policies INTRODUCTION The American Board of Internal Medicine (referred to throughout this document as “ABIM”) was established in 1936 and is a private.abim. To remain valid. Certification by ABIM recognizes excellence in the discipline of internal medicine and its subspecialties. (3) obtaining substantiation by appropriate authorities of the clinical competence and professional standing of candidates. 1-800-441-2246. Certificates issued before these dates are valid indefinitely. and attitudes essential for excellent patient care.org. although ABIM strongly recommends such certificate holders recertify as well. visit ABIM’s website. policies. skills. ABIM does not intend either to interfere with or to restrict the professional activities of a licensed physician based on certification status. or contact ABIM.

Candidates who graduated from medical schools in the United States or Canada must have attended a school that was accredited at the date of graduation by the Liaison Committee on Medical Education (LCME). In addition. or office orthopedics. training as a subspecialty fellow cannot be credited toward fulfilling the internal medicine training requirements. the Royal College of Physicians and Surgeons of Canada. a physician must complete the requisite predoctoral medical education. (2) comparable credentials from the Medical Council of Canada. The 36 months of residency training must include 12 months of accredited internal medicine training at each of three levels: R-1. R-2. as proposed by the American Medical Association. Up to four months of the 30 months may include training in areas related to primary care. Graduates of international medical schools must have one of the following: (1) a standard certificate from the Educational Commission for Foreign Medical Graduates without expired examination dates. of graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME). Graduate Medical Education To be admitted to the Certification Examination in Internal Medicine. or the Professional Corporation of Physicians of Quebec by August 31 of the year of examination. meet the licensure and procedural requirements. physicians must have satisfactorily completed 36 calendar months. and R-3. 108 . including vacation time. No credit is granted for training repeated at the same level or for administrative work as a chief medical resident. (2) May include up to three months of other electives approved by the internal medicine program director.REQUIRMENTS FOR CERTIFICATION IN INTERNAL MEDICINE Predoctoral Medical Education To receive a certificate in internal medicine. or the American Osteopathic Association. Content of Training The 36 calendar months of full-time medical residency education: (1) Must include at least 30 months of training in general internal medicine. Residency or research experience occurring before completion of the requirements for the MD or DO degree cannot be credited toward the requirements for certification. office gynecology. or (3) documentation of training for those candidates who entered graduate medical education training in the United States via the Fifth Pathway. the Committee for Accreditation of Canadian Medical Schools. demonstrate clinical competence in the care of patients. such as neurology. and pass the Certification Examination in Internal Medicine. dermatology. subspecialty internal medicine and emergency medicine. meet the graduate medical education training requirements.

109 . ABIM requires program directors to complete clinical competence evaluations each spring for internal medicine residents. Through its tracking process. (2) At least six months of the direct patient responsibility on internal medicine rotations must occur during the R-1 year. Vacation or other leave cannot be forfeited to reduce training time. a period of observation period of observation period of observation will be required will be required. (5) professionalism. PROGRAM DIRECTOR RATINGS OF CLINICAL COMPETENCE COMPONENTS and R-1 and R02 R-3 Fellows (any year) RATINGS Overall Clinical Competence Satisfactory Full Credit Full Credit Full Credit Marginal Full credit for one marginal Not Applicable Not applicable year. physical examination. or supervises less experienced residents who provide. In addition.(3) Must include three months of leave for vacation time (or for parental or family leave or illness. including pregnancy-related disabilities). A candidate may be excluded from an ABIM examination if the required components of clinical competence are not satisfactorily documented by the training program. Clinical Competence Requirements ABIM requires documentation that candidates for certification in internal medicine are competent in: (1) patient care (medical interviewing. a ABIM’S discretion. the following requirements for direct patient responsibility must be met: (1) At least 24 months of the 36 months of residency education must occur in settings where the resident personally provides. Repeat one year if both Ri & R2 ar e marginal Unsatisfactory No credit. and procedural skills) (2) medical knowledge (3) practice-based learning and improvement. (4) interpersonal and communication skills. all residents must receive satisfactory ratings in overall clinical competence and moral and ethical behavior in each year of training. a ABIM’S discretion. must repeat No credit-must repeat No credit – must repeat Moral & Ethical Behavior Satisfactory Full credit Full credit Full credit Unsatisfactory Repeat year or. must Must repeat year of repeat year during final year of required training As outlined in the table above. at Repeat a year. will be required. In addition. It is the resident's responsibility to arrange for any additional training needed to achieve a satisfactory rating in each component of clinical competence. direct care to patients in inpatient or ambulatory settings. or at Repeat a year or at ABIM’s discretion. (6) systems-based practice. Evaluation of Individual Generall Competencies Satisfactory Full credit Full credit Full credit Unsatisfactory Full credit No credit. residents must receive satisfactory ratings in each of the components of clinical competence during the final year of required training.

proper techniques for handling specimens and fluids obtained. Active participation is defined as serving as the primary operator or assisting another primary operator. For certification in internal medicine. ABIM encourages program directors to provide each resident with sufficient opportunity to be observed as an active participant in the performance of required procedures. Specimen Handling Interpretation of Requirements and Perform Safely Recognition and Management Results Knowledge to Obtain of Complications. ABIM does not specify a minimum number of procedures to demonstrate 110 . pain management. At the end of training. Contraindications. contraindications. ABIM requires all candidates to demonstrate competence and safe performance by means of evaluations performed during residency training. as part of the evaluation required for admission to the Certification Examination in Internal Medicine. In addition. and test results. It is also expected that the internist be thoroughly evaluated and credentialed as competent in performing a procedure before he or she can perform it unsupervised. ABIM has identified a limited set of procedures in which it expects all candidates to be competent with regard to their knowledge and understanding. This includes: (1) demonstration of competence in medical knowledge relevant to procedures through their ability to explain indications. patient preparation methods sterile techniques.Procedures Required for Internal Medicine Safety is the highest priority when performing any procedure on a patient. (2) ability to recognize and manage complications (3) ability to clearly all facets of the procedure necessary to obtain informed consent. ABIM believes that residents should be active participants in performing procedures. Pain and Competently Informed Consent Management. Sterile Techniques Abdominal paracentesis X X X X Advanced cardiac life X N/A N/A N/A X support Arterial line placement X N/A X X Arthrocentesis X X X X Central venous line X X N/A X placement Drawing venous blood X X X N/A X Drawing arterial blood X X X X X Incision and drainage of X X X X an abscess X X X X Lumbar puncture X X X X Pap smear and X X X X endocervical culture X X X X X Placing a peripheral X N/A N/A N/A X venous line Pulmonary artery catheter N/A X X placement Thoracentesis X X X X To help acquire both knowledge and performance competence. ABIM recognizes that there is variability in the types and numbers of procedures performed by internists in practice. PROCEDURES REQUIRED FOR INTERNAL MEDICINE COMPETENCY KNOW UNDERSTAND EXPLAIN Indications. ABIM strongly recommends that procedural training be conducted initially through simulations. The set of procedures and associated competencies required for each are presented in the table on page 4. For a subset of procedures. Internists who perform any procedure must obtain the appropriate training to safely and competently perform that procedure. program directors must attest to each resident’s knowledge and competency to perform the procedures in the table above.

or Canadian accredited non-internal medicine residency program if all of the following criteria are met: (a) the internal medicine training occurred under the direction of a program director of an accredited internal medicine program.S.abim. Guidelines for proposals are available at 111 .S. (c) a maximum of three months of credit for training in a non-internal medicine specialty program. Candidates who have already completed 12 months of accredited U. (2) For trainees who have satisfactorily completed some U. after formal training. Before being proposed. No credit will be granted to substitute for 24 months of accredited R-2 and R-3 internal medicine training. (3) Up to 12 months of credit may be granted for at least three years of U. Guidelines for proposals are available at www. * Requires a fee of $300. and (4) have completed eight years. CREDIT IN LIEU OF STANDARD TRAINING FOR INTERNAL MEDICINE CANDIDATES Training Completed Prior to Entering Internal Medicine Residency ABIM may grant credit for some or all of the 12-month requirement at the R-1 level for training taken prior to entering training in internal medicine. (1) Month-for-month credit may be granted for satisfactory completion of internal medicine rotations taken during a U. each resident should be an active participant for each procedure five or more times. or.S. ABIM may grant (a) month-for-month credit for the internal medicine rotations that meet the criteria listed under (1) above.S. plus. The program director of an accredited internal medicine residency program must petition ABIM to grant credit in lieu of standard R-1 internal medicine training. or Canadian PGY-1 internal medicine training are not eligible to be petitioned for credit.aspx. (2) have completed three or more years of verified internal medicine training abroad.S. (3) hold an appointment at the level of Associate Professor or higher at the time of proposal.* * Requires a fee of $300. and (c) the rotations were identical to the rotations of the residents enrolled in the accredited internal medicine residency program. or Canadian accredited training in another clinical specialty and certification by an ABMS member Board in that specialty. Training Completed Abroad by Current Full-Time U. however. (b) the training occurred in an institution accredited for training internal medicine residents. the candidate should have been observed by the proposer for a minimum of three months. as a clinician-educator or a clinical investigator in internalmedicine with a full-time appointment on a medical school faculty.org/certification/policies/special. to assure adequate knowledge and understanding of the common procedures in internal medicine. o Canadian accredited training in another specialty.* (4) Up to 12 months of credit may be granted for at least three years of verified internal medicine training abroad. or Canadian Faculty* Full-time internal medicine faculty members in an LCMEaccredited medical school or an accredited Canadian medical school may qualify for admission to the Certification Examination in Internal Medicine if they: (1) are proposed by the chair or program director of an accredited internal medicine residency program.competency. (b) a maximum of six months of credit for the training in family medicine or a pediatrics program.

abim.org/certification/policies/imss/im. Guidelines for the combined training programs and requirements for credit toward the ABIM Certification Examination in Internal Medicine are available at www. Training in Combined Programs ABIM recognizes internal medicine training combined with training in the following programs: • Dermatology • Emergency Medicine • Emergency Medicine/Critical Care Medicine • Family Medicine • Medical Genetics • Neurology • Nuclear Medicine • Pediatrics* • Physical Medicine and Rehabilitation • Preventive Medicine • Psychiatry * Combined medicine/pediatrics training initiated July 1. demonstrate clinical competence in the care of patients. ABIM certifies physicians in the following subspecialties: • Adolescent Medicine • Cardiovascular Disease • Clinical Cardiac Electrophysiology • Critical Care Medicine • Endocrinology. and Metabolism • Geriatric Medicine • Gastroenterology • Hematology • Hospice and Palliative Medicine • Infectious Disease • Interventional Cardiology • Medical Oncology • Nephrology • Pulmonary Disease • Rheumatology • Sleep Medicine • Sports Medicine • Transplant Hepatology To become certified in a subspecialty. 112 .aspx. Diabetes.www. meet the licensure and procedural requirements.aspx. and pass the secure examination for that discipline. 2007 or after must be undertaken in a combined medicine/pediatrics program accredited by the ACGME. physicians must have been reviously certified in internal medicine by ABIM and must satisfactorily complete the requisite graduate medical education fellowship training.abim. REQUIREMENTS FOR CERTIFICATION IN SUBSPECIALTIES GENERAL REQUIREMENTS In addition to the primary certificate in internal medicine.org/certification/policies/special.

sleep medicine. including specific clinical months. Time spent in continuity outpatient clinic. Candidates for certification in the subspecialties must meet ABIM’s requirements for duration of training as well as minimum duration of full-time clinical training. Training Requirements for Subspecialties The total months of training required. candidates must have completed the required training in the subspecialty. or the Professional Corporation of Physicians of Quebec. and interpretation. Diplomates must maintain a valid underlying certificate in cardiovascular disease to obtain certification and be eligible for renewal of a certificate in clinical cardiac electrophysiology or interventional cardiology. management. and requisite procedures for each subspecialty are outlined by discipline in the table below.staining. Likewise. maintenance. hospice and palliative medicine. and sports medicine. with the exception of the formally approved pathways for dual certification. To be admitted to an examination. is in addition to the requirement for full- time clinical training. diplomates must maintain a valid underlying certificate in either internal medicine or a subspecialty. and administration of antimicrobial and biological products via all routes.S. Clinical training requirements may be met by aggregating full-time clinical training that occurs throughout the entire fellowship training period. by October 31 of the year of examination. Educational rotations completed during training may not be double-counted to satisfy both internal medicine and subspecialty training requirements. training which qualifies a diplomate for admission to one subspecialty examination cannot be double-counted toward certification in another subspecialty. including vacation time. Fellowship training must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). recommended. and removal of indwelling venous access catheters. No credit will be granted toward certification in a subspecialty for training completed outside of an accredited U. training as a chief medical resident. Diplomates must maintain a valid underlying certificate in gastroenterology to obtain certification and be eligible for renewal of a certificate in transplant hepatology. and attendance at postgraduate courses may not be credited toward the training requirements for subspecialty certification. practice experience. clinical training need not be completed in successive months.In order to be eligible for certification and renewal of a certificate in adolescent medicine. or Canadian program. Infectious Disease Microscopic evaluation of diagnostic specimens including preparation. Special Candidates for Subspecialties* ABIM diplomates in internal medicine may be proposed for special consideration for admission to a subspecialty examination by the program director of an accredited fellowship program if they: 113 . the Royal College of Physicians and Surgeons of Canada. during non-clinical training. Hospice and Palliative Medicine No required procedures. Fellowship training taken before completing the requirements for the MD or DO degree.

depending on the number of months of clinical training completed During the research period. These requests must be made in a timely manner to ensure that the new program director has the performance evaluations for review before offering a position. pulmonary disease/critical care medicine. after formal training. as a clinician educator or clinical investigator with a full-time appointment on a medical school faculty. The Research Pathway for certification in internal medicine and a subspecialty that requires 12 months of clinical training is a six-year program. A new program director may also request performance evaluations from previous programs and from ABIM concerning trainees who 114 . (2) are a full-time Associate Professor or higher in the specifies subspecialty division of the Department of Medicine in an LCME-accredited medical school or an accredited Canadian medical school. 80 percent of time is devoted to research and 10 to 20 percent of time to clinical work. and rheumatology/allergy and immunology. The trainee must attend a minimum of one half-day per week in continuity outpatient clinic.org/certification/policies/research/requirements. A minimum of 20 months must involve direct patient responsibility. Unless the trainee has already achieved an advanced graduate degree. see www. The research experience of trainees should be mentored and reviewed. For additional information. 20 percent of each year must be spent in clinical experiences including a half-day per week in a continuity clinic. training should include completion of work leading to one or its equivalent. During internal medicine research training. The last year of the Research Pathway may be taken in a full-time faculty position if the level of commitment to mentored research is maintained at 80 percent. SPECIAL TRAINING POLICIES Disclosure of Performance Information Trainees planning to change programs must make requests to their current program and to ABIM to send written evaluations of past performance to the new program. which require more than 12 months of clinical training.(1) have completed the full training required by ABIM in the subspecialty in another country and have met all current applicable ABIM procedural requirements. All trainees in the Research Pathway must satisfactorily complete 24 months of accredited categorical internal medicine residency training.abim. including 36 to 42 months of research. and for dual certification in hematology/oncology. (3) have served eight years. ABIM defines research as scholarly activities intended to develop new scientific knowledge. For subspecialties such as cardiovascular disease and gastroenterology.aspx. Program directors must document the clinical and research training experience each year through ABIM’s tracking program. at least one half-day per week must be spent in an ambulatory clinic. the Research Pathway is a full seven-year program. Guidelines for proposals are CERTIFICATION USING THE RESEARCH PATHWAY The Research Pathway is intended for trainees planning academic careers as investigators in basic or clinical science. Ratings of satisfactory clinical performance must be maintained annually for each trainee in the ABIM Research Pathway. The pathway integrates training in clinical medicine with a minimum of three years of training in research methodology. * Proposals require a fee of $300. Prospective planning of this pathway by trainees and program directors is necessary. The chart on page 10 describes the Research Pathway requirements. Time spent in continuity outpatient clinic during non-clinical training is in addition to the requirement for full-time clinical training. During subspecialty research training.

or illness. OTHER POLICIES Board's Evaluations and Judgments Candidates for certification and Maintenance of Certification agree that their professional qualifications. ABIM may make inquiry of persons named in candidates' applications and of other persons. In any 12-month period. educational. Candidates agree that the ABIM may provide information it has concerning them to others whom ABIM judges to have a legitimate need for it. Candidates agree that if ABIM determines that. including pregnancy-related disabilities). such as authorities of licensing bodies. or research activities designed to fulfill the goals of the training program.apply for a new position. Part-time training. and ABIM’s good faith judgment concerning such matters will be final. the results of their examination are unreliable. Vacation leave is essential and cannot be forfeited or postponed in any year of training Definition of Full-time Training Full-time training is defined as daily assignments for periods of no less than one month to supervised patient care. hospitals. Full-time training must include formative and summative evaluation of clinical performance. ABIM is not in a position to re-examine the facts and circumstances of an individual's performance. Training must be extended to make up any absences exceeding one month per year of training. or other institutions as the ABIM may deem appropriate with respect to such matters. As required by the ACGME in its Essentials of Accredited Residencies in Graduate Medical Education. provided that no period of full-time training is shorter than four weeks. will be evaluated by ABIM. ABIM will respond to requests from trainees and program directors by providing any performance evaluations it has in its possession and the total credits accumulated toward ABIM’s training requirements for certification. Due Process for Evaluations The responsibility for the evaluation of a trainee's clinical competence and moral and ethical behavior rests with the program. that render examination results unreliable in the judgment of ABIM. including their moral and ethical standing in the medical profession and their competence in clinical skills. is not acceptable. ABIM may require the candidates to retake an examination at its next administration or other time designated by ABIM. 115 . the educational institution must provide appropriate due process for its decisions regarding a trainee's performance. with direct observation by faculty and senior trainees Reduced-Schedule Training Interrupted full-time training is acceptable. This information will include the comments provided with the evaluation. ABIM approval must be obtained before initiating an interrupted training plan. in its judgment. not with ABIM. Patient care responsibilities should be maintained in a continuity clinic during the non-training component of the year at a minimum of one-half day per week. Situations may occur. ABIM makes academic and scientific judgments in its evaluations of the results of its examinations. at least six months should be spent in training. Leave of Absence and Vacations Trainees must take one month per year of training for vacation (or for parental or family leave. whether or not continuous. even through no fault of the candidates.

and letterheads. On a candidate's written request to ABIM. directories. If certification is revoked or suspended. This includes descriptions in curriculum vitae. ABIM may notify local credentialing bodies licensing bodies. through its website or by mail. and/or (2) the year the candidate was last admitted to examination. hardware and software problems. When such problems occur. ABIM provides a diplomate's certification status and personal identifying information." Reporting Certification Status ABIM will routinely report. advertisements. administration. Re-examination shall be the candidate's sole remedy. or recognize the term "Board Eligible. law enforcement agencies. the following information will also be provided in writing: (1) that an application is currently in process. the dates of former certification will be reported. ABIM shall not be liable for inconvenience. Errors and Disruptions in Examination Administration Occasionally problems occur in the creation. including mailing address.Board Eligibility ABIM does not use. human errors. The FSMB and ABMS use personal identifying information. as a unique internal identifier and maintain the confidentiality of this information. expense. e-mail address and social security number. and scoring of examinations. For example. or other damage caused by any problems in the creation. or weather problems may interfere with some part of the examination process. and others. 116 . In no circumstance will ABIM reduce its standards as a means of correcting a problem in examination administration. ABIM provides a diplomate’s certification status and address to the professional medical societies that provide educational resources relevant to the Maintenance of Certification program. including social security numbers. ABIM will provide the affected candidates with an opportunity for re-examination. power failures. whether candidates are certified (including dates) or not certified. ABIM will report that fact. to the Federation of State Medical Boards (FSMB) and the American Board of Medical Specialties (ABMS) which publishes The Official ABMS Directory of Board Certified Medical Specialists. define. If a diplomate was previously certified. including the date of revocation or suspension. Diplomates with expired time-limited certification or those whose certification is suspended or revoked may not claim board certification by ABIM and must revise all descriptions of their qualifications accordingly. or scoring of an examination. When a physician misrepresents certification status. Representation of Certification Status Diplomates of ABIM must accurately state their certification status at all times. including the need for retesting or delays in score reporting. administration. Confidentiality Policy ABIM considers the certification or recertification status of its candidates and diplomates to be public information. On request. publications.

Suspension and Revocation of Certificates ABIM may. Licensure Candidates for certification and Maintenance of Certification must possess a valid.ABIM provides residency and fellowship training directors with information about a trainee's prior training and pass/fail status on certifying examinations. Candidates practicing exclusively abroad and who do not hold a US or Canadian license. ABIM uses examination performance. Candidates who need accommodation for a disability during an examination must provide a written request to ABIM at the time of application for examination. engaged in misrepresentation or unprofessional behavior. unrestricted. even if the certificate was issued as a result of a 117 . contingencies. and other information for research purposes. If a trainee has given permission. the procedural skills requirement may be waived. at its discretion. or admitted to a certification examination. ABIM treats requests for accommodations as confidential.org. in any jurisdiction. its territories. or surrendered in lieu of disciplinary action. For additional information about the process and documentation requirements.org. For such individuals. please contact ABIM at accommodations@ abim. probation. or refer to the ABIM website. cannot be certified recertified. revoked. revoke or rescind certification if the diplomate was not qualified to receive the certificate at the time it was issued. www. or Canada. A candidate whose license has been restricted.abim. Substance Abuse If a candidate or a diplomate has a history of substance abuse. Disabled Candidates ABIM recognizes that some candidates have physical limitations that make it impossible for them to fulfill the requirement for proficiency in performing procedures. ABIM is committed to offering suitable examination accommodations for all candidates. documentation of at least one year of continuous sobriety from a reliable monitoring source must be submitted to ABIM for admission to an examination or to receive a certificate. training program evaluations. and stipulated agreements. self-evaluations of knowledge and practice performance. In such research. ABIM will provide the program director with the trainee's score on his/her first attempt at the certification examination for that area of training. and unchallenged medical license in the United States. ABIM treats such information as confidential. All practice performance data is HIPAA compliant. suspended. Program directors should write to ABIM for an exception before the individual enters training or when the disability becomes established. ABIM reserves the right to disclose information it possesses about any individual whom it judges has violated ABIM rules. alternative arrangements under conditions comparable to those provided for other candidates are offered to disabled individuals. Reapplication for special accommodation is not required for each examination administration unless a new accommodation is requested. or practice associations. Restrictions include but are not limited to conditions. including individuals with disabilities. or shows signs of impairment. ABIM will not identify specific individuals. including collaboration with other research investigators and scientific publications. When necessary. ABIM will then inform the candidate of the documentation that must be received by ABIM no later than the examination registration deadline. hospitals. must hold a license where they practice and provide documentation from the relevant licensing authority that their license is in good standing and without conditions or restrictions.

It may revoke or suspend the certificate if: (1) the diplomate made any material misstatement of fact or omission of fact to ABIM in connection with application or to any third party concerning the diplomate's certification status. etc. as part of its effort to assure exam integrity. It may also revoke the certificate if the diplomate fails to maintain moral. ABIM utilizes data forensic systems that 118 .mistake on the part of ABIM. failing to comply with time limits or instructions talking. A physician may petition ABIM for recertification upon restoration of unrestricted licensure. Restrictions include but are not limited to conditions. restricted. and stipulated agreements. Irregular Behavior on Examinations The ABIM’s examinations are copyrighted and administered in secure testing centers by test administrators who are responsible for maintaining the integrity and security of the certification process. such as giving or obtaining information or aid. or (2) the diplomate's license to practice medicine has been revoked. taking notes. beepers. Upon successful completion of the Maintenance of Certification program the physician will be granted a new timelimited certificate consistent with the current policies of ABIM. and upon such conditions as ABIM may require.g.. Test administrators are required to report to ABIM any irregular or improper behavior by a candidate. cell phones. suspended. the physician must complete ABIM’s Maintenance of Certification program. or other disruptive behavior. or engages in misconduct that adversely affects professional competence or integrity. In addition. looking at the test material of others. or professional behavior satisfactory to ABIM. pagers. ethical. removing examination materials from the test center. probation. If ABIM grants the petition. bringing electronic devices (e. or surrendered in lieu of disciplinary action in any jurisdiction. contingencies.) into the examination.