F. Clinical

1. Ambulatory medicine

a) MCG and VA Hospital ID faculty supervise and teach fellows twice weekly in respective Infectious Disease Clinic

b) All medical and surgical academic departments at MCG and VA Hospitals are available for appropriate and timely consultation for ambulatory patients under the supervised care of ID fellows

c) A variety of other health-care professionals including nurses (present in clinic), psychologists (present in clinic), social workers ( on-call), occupational therapists (on-call), and dieticians (on-call) are available to assist with the care of ambulatory patients

2. Experience with continuity ambulatory patients

a) ID fellows have a continuity ambulatory clinic experience two half-days per week (one at MCG Hospital; one at VA Hospital) to develop a continuous healing relationship with patients for whom they provide care. A variety of suspected and proven infectious disease problems are evaluated in ID Clinic in addition to a predominant HIV infection experience.

b) Each ID fellow is responsible for four to eight patients during each half-day clinic.

c) Each ID fellow’s panel of patients includes at least 25% of patients from each gender.

d) Each fellow’s clinical experiences with ambulatory patients provides the opportunity to observe and to learn the course of disease.

e) The continuing patient-care experience is year-round excluding vacation.

f) During ID Clinic, an attempt is made to minimize interruptions for both fellows including the fellow on-call for the inpatient Consult Service

g) All ID Section members including fellows are notified several times per week when continuity patients are hosptalized so that arrangements can be made to maintain continuity of care.

3. Procedures

a) Fellows develop a comprehensive understanding of indications, contraindications, limitations, complications, techniques, and
interpretation of results of diagnostic and therapeutic procedures integral to the discipline of infectious diseases.

b) Fellows acquire knowledge of and skill in educating patients about the rationale, technique, and complications of procedures and in obtaining procedure-specific informed consent.

c) Faculty supervision of procedures such as microscopical interpretation is done on a routine basis. Other procedures done have been supervised appropriately and fellows’ competence documented in their respective, accredited internal medicine training programs prior to being accepted for ID training. No invasive procedures are unique to the discipline of infectious diseases which have not been previously learned in an accredited residency program

d) Competence in microscopical interpretation is assured as follows:

(1) Entering fellows have a one-month rotation through the Microbiology Laboratory of the Medical College of Georgia Hospital

(2) Proficiency is assessed by Microbiology Laboratory supervising personnel in interpretation of Gram-stained smears, potassium hydroxide and saline wet mounts, Gomorri-methenamine silver-stained smears, acid-fast bacillus-stained smears, trichrome stains and other preparations of clinical specimens for identification of ova and parasites.

(3) Proficiency in microscopy is assessed on a continuing basis by attending ID faculty during the process of inpatient evaluations of patients whose physicians have consulted infectious diseases and outpatient evaluations of patient referred to or continually cared for by infectious disease faculty and fellows

(4) Regular sessions with identification of microscopical unknowns are conducted by the Program Director and fellows are given direct feedback on both correct and incorrect microscopical interpretations.

(5) Fellows document the microscopical training sessions as part of their evaluation of the fellowship content on a continuing basis following each such session.