Infectious Diseases Fellowship
The Division of Infectious Diseases of the Sidney Kimmel Medical College offers an Infectious Diseases Fellowship based at Thomas Jefferson University Hospital. The 800-bed university teaching hospital is based in Center City Philadelphia with a broad referral base from the Pennsylvania-New Jersey-Delaware tri-state area. Clinical activities at Jefferson University Hospital include:
- Active oncology, hematology and transplantation programs
- A full array of medical and surgical subspecialties
- A regional spinal cord trauma and rehabilitation unit
- Active obstetrical, gynecological and pediatric services
Clinical consults are also performed at Jefferson Hospital for Neuroscience and Wills Eye Hospital, both of which are nationally recognized in their respective fields and are located on the Thomas Jefferson University campus.
In July of 1997, an important expansion of the Clinical Fellowship occurred when the infectious diseases section of Lankenau Hospital merged with the infectious diseases section at Jefferson. Lankenau Hospital is a 500-bed community teaching hospital with a strong academic tradition. Lankenau Hospital's I.D. Section is a busy inpatient and outpatient consultative service, seeing patients with community acquired infections, surgically related infections, infections in high-risk obstetrical patients and patients with HIV.
The infectious diseases consultation service sees 55 to 70 inpatients a month on all hospital services. Residents rotating on the consultation service are involved in managing of a wide variety of clinical infectious disease problems. Emphasis is placed on a logical approach to evaluating possible infections, decision making in diagnosis and therapy of infected patients and familiarity with the use of antibiotics. Divisional faculty and fellows lead an infectious disease outpatient clinic that meets weekly. Educational activities include weekly divisional and inter-city infectious disease conferences, a monthly case conference for medical house staff, monthly divisional research conferences and journal club conferences.
A diverse patient population, collaboration with the clinical microbiology laboratory, the Department of Microbiology and numerous divisional studies allow for many opportunities to pursue basic and clinical research activities including:
- Gene therapy for HIV-1 infection
- Molecular control mechanisms of HIV-1 replication
- Pathogenesis of HIV-1 infections of the brain
- Molecular mechanisms of HIV-1 maternal-fetal transmission
- Cellular immune response to adenovirus and hepatitis C virus
- Immune modulation to HIV-1 infection
- Role of cytokine elaboration in progression of HIV-1 infection
The Infectious Diseases Fellowship at Thomas Jefferson University consists of two years of combined clinical and research training which fulfill the requirements of the American Board of Internal Medicine for certification in Infectious Diseases. The program consists of approximately 17 months of clinical training, five months of research time and one month of microbiology training. An outpatient continuity care experience occurs one half-day per week for the two years of the fellowship. It is expected that all fellows will pursue either basic or clinical research interests during their training under the supervision and guidance of the division faculty. Fellows will be encouraged to continue an additional year of research training upon the completion of the first two years of fellowship, and every effort will be made to facilitate this in order to optimally train physicians for a career in academic infectious diseases. Numerous didactic sessions are held on a regular basis throughout the fellowship. Typically, there are two first-year and two second-year fellows in the program.
Goals of the Fellowship Program
Fellows are expected to develop the following skills during their training in infectious diseases:
- Clinical competence in the practice of both inpatient and outpatient infectious diseases consultations
- Familiarity with and proficiency in interpreting the current medical literature in infectious diseases
- Familiarity with academic research in both basic and clinical areas and the ability to initiate independent investigations in either of those areas
- Competence in teaching house staff and medical students
- Competence in the practice of hospital infection control
Components of the Fellowship
The clinical portion of the Fellowship program consists of approximately 16 months on the infectious diseases inpatient consultative service. There are infectious diseases inpatient consultative services at both Thomas Jefferson and Lankenau Hospitals. The fellow spends approximately seven months on Jefferson inpatient services and seven months at Lankenau Hospital on the inpatient service. Both consultation services see an average of 55-70 consults a month from all services of the hospital, except pediatrics. The consult team at both hospitals consists of the attending, one fellow, 1-3 internal medicine residents, and 1-2 medical students. It is the responsibility of the fellow to organize and run the clinical service, to ensure that new consultations are seen and appropriate follow-up is provided and to supervise the teaching of the medical residents and students.
Teaching rounds on the consultative services are held five days per week, generally in the afternoon. At this time, new consults are presented to the attending, and rounds are conducted on the consult service patients. Radiology and special studies are reviewed, as are relevant microbiologic and pathologic specimens. The on-call fellow performs weekend rounds with the attending. Weekend call is rotated among all the clinical fellows. The fellow on-call is responsible for providing night and weekend coverage for Infection Control in the hospital.
Each week the Fellow spends one half-day session with infectious diseases attendings in the HIV outpatient clinic. The fellow is present at this clinic each week for the two years of the fellowship. All patients are HIV infected, and the fellow follows the same core group of these patients continually for the two years of the fellowship. A minimum of 1-3 new patients and 4-6 follow-up patients are seen and managed by the fellow each week.
Clinical Microbiology Training
Each fellow spends approximately one month of training in the Jefferson clinical microbiology laboratory (two weeks each year of the fellowship). During this rotation, the fellow spends time under the supervision of Dr. Jungkind and the clinical microbiology staff. The fellows rotate through the bacteriology, mycology, mycobacteriology, parasitology, virology and serology areas of the laboratory. Additional didactic material is provided to ensure that the fellows receive comprehensive training in clinical microbiology. In addition, weekly rounds in the clinical microbiology laboratory are attended by all fellows and clinical faculty throughout the year and are designed to provide clinical-pathologic correlation for some of the cases on the service.
Each second-year fellow spends one month performing inpatient and outpatient infectious diseases consultations with the attending pediatric infectious diseases specialist at the AI DuPont Children's Hospital in Wilmington, DE. The second-year fellow has an opportunity to evaluate pediatric patients with hospital-acquired infections, Lyme Disease, pediatric AIDS and a broad-spectrum of other infections.
Each second-year fellow spends two weeks at the Philadelphia Department of Health STD Clinic. The fellow becomes familiar with the diagnosis, treatment and public health follow-up of patients with all commonly encountered STDs. The fellows are directly supervised by city STD clinicians who hold joint appointments with the Drexel University College of Medicine.
Each second-year fellow spends two weeks in the Travel Clinic at Thomas Jefferson University. This clinic, under the direction of the Emergency Department, is an appointment-only clinic specializing in pre-travel vaccinations and advice, as well as travel-related infectious diseases.
Each second-year fellow spends two months rounding on the Solid Organ Transplant Service, and one month on the Bone Marrow Transplant Service. Fellows are exposed to patients with bone and stem-cell transplants, as well as those with heart, liver, kidney and pancreas transplants. Typically, fellows will round with Drs. Flomenberg or Measley, both of whom have a strong interest in transplant infections.
Approximately five months of the fellowship will be devoted to research activities. It is anticipated that during the first year of fellowship, all fellows will decide on an area of research and select a member of the division faculty as the research advisor. It is expected that the fellows will pursue a project of academic interest. Options include pursuing a basic laboratory research project in the laboratory of one of the faculty or initiating a clinical or epidemiologic study under the direction of any of the faculty
Arrangements for research at Jefferson or Sidney Kimmel Medical College outside of the Division of Infectious Diseases will be considered on an individual basis. All fellows are expected to participate in some form of academic research during the research portion of training. Every effort will be made to permit those who wish to spend an additional year of fellowship to continue their research activities. During the research time, fellows will continue to participate in outpatient clinical activities, conferences and other activities of the division.
All fellows are expected to contribute to the teaching activities of the division. This includes teaching the residents and medical students who are assigned to the clinical rotation, educating the house staff and students as part of the process of performing clinical consultations and participating in other divisional teaching activities.
Support will be provided to enable each fellow to attend one academic meeting per year. Should it be necessary for a fellow to attend additional meetings in order to present their research, additional arrangements will be made on an individual basis.