A. Program Design

1. Format

The program design and sequencing of educational experiences will be approved by the RRC as part of the accreditation process.

2. Goals and Objectives:

• To provide intensive training to physicians who have completed ACGME- accredited residency training in internal medicine in the evaluation and management of patients with a wide variety of infectious disease problems.


• To provide training in infectious diseases at the level of Clinician Track (Training at the level of Clinical Investigator or Basic Investigator is not currently available at the Medical College of Georgia [MCG]).


• By the end of the first year of fellowship training, to develop in the trainee essential knowledge of basic microbiology including viral classification, pathogenesis, and replication, bacterial classification, growth requirements, and pathogenesis of major families of bacteria, Gram-staining techniques, classes and mechanisms of action of antimicrobial agents, fungal classification and pathogenesis, and identification, life cycles, and diseases produced by common protozoa and helminths.


• By the end of the first year of training, to develop in the trainee essential skills in the evaluation of patients proven to have or suspected of having infectious disease problems in both the inpatient and outpatient setting.


• By the end of the second year of training, to have enhanced in the trainee essential skills in the evaluation of patients proven to have or suspected of having infectious disease problems in both the inpatient and outpatient setting.


• By the end of the second year of training to have developed advanced skills in solving complex problems in infectious diseases dealing with the detailed understanding of antimicrobial agents and mechanisms of action, mechanisms of microbial resistance, toxicity, drug-drug interactions, and susceptibility testing.


• By the end of the second year of training to have developed advanced skills in solving complex problems in infectious diseases in severely immunocompromised patients.


• By the end of the second year of training to have developed advanced skills critical analysis of the literature in general and infectious disease literature in particular.


• By the end of the second year of training to have developed preliminary skills in scientific writing and publication of abstracts, journal articles, and book chapters as well as presentation of observations at regional or national meetings.


• By the end of the second year of training to have sufficiently facilitated the study of in infectious diseases that trainees that trainees are well prepared to pass the American Board of Internal Medicine Certifying Examination in Infectious Diseases.

a) Rotations and major learning experiences:

Microbiology Laboratory—goals and objectives

purpose: learning of basic techniques of diagnostic microbiology as conducted in the MCG Microbiology Laboratory

teaching methods: observation of activities of certified microbiology technologists in daily activities (1) Gram, AFB, Giemsa, Gomori-methenamine-silver [GMS] trichrome staining(2) microscopical interpretation of stained smears or wet mounts including KOH and India ink mounts (3) agar plate reading (4) streaking for isolation (5) quantitative culture methods (6) fungal identification (7) stool for WBCs, ova and parasites (8) antibiotic susceptibility testing

mix of diseases: specimens suspected of being infected or infested are processed from virtually all disciplines in medicine

patient characteristics: patients from MCG Hospitals and Clinics and the Children’s Medical Center

educational resources: (1)physician-supervisor of Microbiology Laboratory, (2) certified microbiology technologists, (3)numerous textbooks of diagnostic virology, bacteriology, mycology, and parasitology
method of evaluating fellows’ competence: (1) informal quizzes by microbiology technologists on smear interpretation, identification of bacteria from various agar plates (2) informal assessment by ID consult attending during laboratory rounds

- Formal Didactic Infectious Disease Lectures—goals and objectives
purpose: (1)to give fellows regularly scheduled formal instruction in infectious disease topics (2) to cover a broad range of infectious diseases including rare and exotic diseases less likely to be encountered in the course of a two-year clinical fellowship

teaching methods: 30 minute didactic lectures presented by faculty and fellows; each scheduled following Medical College of Georgia City Wide Problem Conference (lectures limited to 30 minutes because current data show that attention span of audience for the average topic is 20-30 minutes in length)

mix of diseases (and subjects): viral, bacterial, fungal, parasitic diseases, antimicrobial compounds, organ system-based discussions (eg pneumonia, endocarditis, osteomyelitis, meningitis)

patient characteristics: not applicable

procedures: not applicable

pathological material: photographs and photomicrographs shown as part of lecture

educational resources: computers, LCD projectors, classroom, and personnel from Division of Classroom Services to assist as needed

methods for evaluating fellows’ competence: (1)informal evaluation by faculty at ID Section meetings (2) formal monthly evaluation by consult attending (3) monitor perfomance on Infectious Disease Board Examination (4)
formal evaluation of lectures given at conference by attendees as part of CME credit documentation

- Informal Didactic Infectious Disease Lectures—goals and objectives

purpose: (1)weekly, informal lecture given by ID Program Director to fellows over lunch (2) to give fellows additional regularly scheduled formal instruction in infectious disease topics (3) to cover a broad range of infectious diseases
including rare and exotic diseases less likely to be encountered in the course of a two-year clinical fellowship
teaching methods: (1) 30-minute didactic lectures with frequent, extemporaneous questions and answers (2) review of unknown Gram-stained smears to enhance skills in microscopy

mix of diseases (and subjects): viral, bacterial, fungal, parasitic diseases, antimicrobial compounds, organ system-based discussions (eg pneumonia, endocarditis, osteomyelitis, meningitis)

patient characteristics: not applicable

procedures: not applicable

pathological material: photographs and photomicrographs shown as part of lecture

educational resources: computers, archived slides available from microbiology laboratory methods for evaluating fellows’ competence: ongoing, informal evaluation of fellows fund of knowledge, depth of questions

- Basic Scence Lectures –goals and objectives

purpose: review of basic microbiology & immunology teaching methods: voluntary attendance at immunology & microbiology lectures as well as infectious disease lectures given as part of the MCG sophomore curriculum during the academic year, August through April mix of diseases: infectious diseases presented in organ-
based curriculum (ie Cardiopulmonary, GI, Endocrine, GU, CNS, Hematology/Oncology)

patient characteristics: not applicable

types of clinical encounters: not applicable

procedures: not applicable

services: not applicable
pathological material: not applicable

educational resources: Power Point lectures and handouts

method for evaluating fellows’ competence: provide exam questions given to sophomores dealing with infectious
diseases

- Infectious Disease Consult Service—goals and objectives

purpose: achieving competency in evaluating primarily inpatients, but also occasional outpatients with suspected or proven infectious diseases

teaching methods: (1)initial patient assessment with history and physical examination by the infectious disease fellow followed by (2) presentation of the patient’s problem at the bedside to a board-certified infectious disease faculty member and (3) review with faculty of pertinent microscopy and imaging, (4) subsequent discussion of differential diagnosis, appropriate laboratory testing, and treatment

mix of diseases: A wide variety of infectious disease problems arise daily at the teaching hospitals of the Medical College of Georgia and the adjacent VA Medical Center in Augusta and the Infectious Disease Section is asked for assistance by way of formal and informal consultation. Examples include (1) fever (2) drug reactions
(3) infections in patients with chronic diseases such as diabetics, patients with chronic cardiovascular,lung, and renal disease, (4) immunocompromised patients including AIDS patients and patients with immunosuppressive treatment and malignancies (5) patients with spinal cord injuries (6) patients with major trauma (7) orthopaedic infections (8) surgical site infections (9) infections in the critically ill (10) zoonoses (11) parasitic infestations (12) CNS infections.

patient characteristics: adult inpatients and occasional outpatients at the Medical College of Georgia Hospital and VA Hospital, Augusta, GA

types of clinical encounters: bedside and occasional clinic or emergency room evaluation

procedures: (1) lumbar punctures (2) aspiration of skin lesions (3) Gram, Wright, and AFB staining of clinical specimens (4) microscopy of stained specimens and wet mounts (5) review of pertinent sections prepared by the Department of Pathology

pathological material: (1) sputum and endotracheal suctioned specimens (2) purulent material from abscesses, drains, and skin lesions (3) joint fluid (4) cerebrospinal fluid (5) peripheral blood films (6) tissue associated with infected medical devices (7) peritoneal fluid (8) pleural fluid (9) touch imprints of infected tissue

educational resources: (1) medical literature including current infectious disease texts and periodicals available in the medical libraries of MCG and the VA Medical Centers and on-line (2) Up-to-Date available on-line at no charge at the VA Medical Center (3) handouts from recent infectious disease lectures on a variety of topics given by faculty (4) archived binder of articles from infectious disease journal club on-hand in the Infectious Disease Office
(5) infectious disease faculty assigned to the Consult Service (6) infectious disease faculty not assigned to Consult Service but with specific expertise in infectious disease problem for which consultation requested

method of evaluating fellows’ competence: Fellows receive formal evaluation from each faculty member assigned to the Consult Service on a monthly basis. They are informally evaluated by the faculty at the weekly infectious disease problem conference for their communicative and educational skills and periodically discussed at faculty meetings. Informal assessment is also communicated to the ID Program Director when excellent work is observed or when problems in performance arise.

- Infectious Disease Clinic—goals and objectives

purpose: (1) to develop in ID fellows an ability to assess and treat oupatients referred for evaluation of proven or suspected infectious disease problems (2) to facilitate in ID trainees a philosophy of continuity of care and long-term followup of patients with proven or suspected acute, sub-acute, or chronic infectious diseases as they transition from the inpatient setting to that of an outpatient or for patients who need evaluation and treatment exclusively in the outpatient setting

teaching methods: (1) evaluation of outpatients with scheduled appointments two half-days per week under the supervision of board-certified infectious disease faculty (2) presentation of patients to faculty after taking pertinent history, performing physical examination, and reviewing pertinent laboratory studies or performing microscopy on smears or wet mounts of clinical specimens (3) agreement by faculty of diagnostic or treatment plan with countersignature of signed notes and/or dictations.

mix of diseases: (1) HIV infection (early and advanced) and other chronic viral infections (2) infections in patients with chronic diseases predisposing them to infections [eg diabetes mellitus, end-stage renal disease, COPD and other chronic lung disease, cancer, primary or secondary immunodeficiency diseases] (3) osteomyelitis (4) infections associated with the implantation of medical devices (5) fever of unknown origin (6) chronic fatigue syndrome (7) recurrent urinary tract infections (8) chronic wound infections (9) infective endocarditis (10) opportunistic fungal infections (11) endemic mycoses (12) parasitic infestations (13) sexually transmitted diseases (14) chronic sinusitis (15) gastroenteritis (16) central nervous system infections (17) tuberculosis and other mycobacterial infections

patient characteristics: adult outpatients at the Medical College of Georgia Hospital and VA Hospital, Augusta, GA
types of clinical encounters: one on one patient interviews and examinations

procedures: (1) lumbar punctures (2) aspiration of skin lesions (3) Gram, Wright, and AFB staining of clinical specimens (4) microscopy of stained specimens and wet mounts when appropriate

pathological material: sputum, CSF,urine, vaginal, stool samples, peripheral blood films, aspirates from skin lesions

educational resources: (1) medical literature including current infectious disease texts and wall charts available in clinic (2) Up-to-Date available on-line at no charge at the VA Medical Center (3) infectious disease faculty assigned to the clinic (4) infectious disease faculty not assigned to Consult Service but with specific expertise in infectious disease problem for which patient is being evaluated

method of evaluating fellows’ competence: Fellows are given direct feedback on their proposed diagnostic and therapeutic plans for each clinic patient seen and informally evaluated by the faculty for their clinical skills and periodically discussed at faculty meetings. Informal assessment is also communicated to the ID Program Director when excellent work is observed or when problems in performance arise.

- Infectious Disease Research—goals and objectives

purpose: (1) to introduce infectious disease fellows to critical thinking and analysis of medical literature; (2) to introduce fellows to the process of identifying an aspect of medical microbiology of particular interest which needs further study, analyzing the available literature, and choosing a research project (ie case report or series, literature review, laboratory exercise) which would lead to submission of an abstract for a local, regional, or national medical meeting and completion of a manuscript suitable for submission to a medical periodical by the end of fellowship training. (3) to further the skills of fellows in scientific writing.(4)to teach the fellow standards of ethical conduct of research (5) to acquaint fellows with design and interpretation or research study data, responsible use of informed consent and research methods

teaching methods: (1) meeting with fellows and Program Director on a monthly basis to discuss selection of the research project, to identify a faculty member to mentor and advise, and to follow progress of project to assure completion; (2) critical review of design, organization, data analysis, conclusions, and editorial critique of each draft of the manuscript as it moves toward completion by the faculty mentor.

mix of diseases: (1) any aspect of any viral, bacterial, fungal, parasitic disease of interest to fellow is eligible for study (2) diseases which present as infectious diseases (3) common problems referred to infectious disease specialists for evaluation

patient characteristics: In the event that a clinical project is chosen, adult inpatients or outpatients undergoing evaluation at the Medical College of Georgia or Veterans Affairs Hospital, Augusta, from whom permission is granted are eligible

types of clinical encounters: (1) history and physical examinations (2) analysis of laboratory aspects of diagnosis and treatment (3) microscopy of clinical specimens (4) review of medical records
procedures: with permission as indicated by research project

pathological material: clinical specimens (tissue or fluid) or tissue samples archived in tissue blocks in Department of Pathology

educational resources: (1) current medical literature (2) medical libraries of the Medical College of Georgia and VA Hospital, Augusta (3) microbiology laboratories or other clinical laboratories of the Medical College of Georgia or VA Hospital, Augusta (4) research facilities of the Medical College of Georgia or VA Hospital, Augusta
method of evaluating fellows’ competence: (1)ongoing informal assessment of project to completion (2) formal presentation before Infectious Disease Section of research project (3) acceptance of abstract for presentation by fellow at local, regional, or national meeting (4) reviewers’ comments on manuscripts accepted or rejected for publication in medical periodical

- Citywide Infectious Disease Problem Conference—goals and objectives:

purpose: presentation of unusual, instructive, problem cases proven or suspected to be infectious diseases (1) to keep fellows and faculty current and up-to-date in the latest diagnostics and therapeutics of their discipline (2) to broaden the educational scope beyond the core curriculum by discussion of patients which might not be encountered on the ID Consult or Clinic rotations (3) to further develop case presentation skills of ID Fellows

teaching methods: (1)2-3 formal case presentations by ID Fellows of patients currently or previously evaluated on the ID Consult Service or in ID Clinic (2) discussion of differential diagnosis and treatment issues by ID faculty infectious disease consultants from the community (Dwight David Eisenhower Army Medical Center, University Hospital), community physicians, and other interested persons including house officers, medical students, nurses, pharmaceutical representatives, and microbiologists

mix of diseases: patients from acute and chronic care facilities of the Medical College of Georgia, VA Hospital, University Hospital, St. Joseph Hospital, Doctor’s Hospital and Dwight David Eisenhower Army Medical Center with a wide variety of acute and chronic infectious diseases caused by viruses, bacteria, fungi, and parasites.

patient characteristics: pediatric patients, adult patients with acute and chronic infectious diseases, infectious diseases in active duty and retired military personnel and dependents

types of clinical encounters: generally not applicable, but occasional patients brought to conference for interview and examination

procedures: review of stained clinical specimens (portable microscope)

pathological material: vide supra

educational resources: vast combined knowledge and experience of attendees of the weekly conference

method of evaluating fellows’ competence: (1)informal evaluation by all attendees over the course of ID fellowship training with discussion of fellows’ performance at ID Section meetings (2) formal monthly evaluation of ID fellow responsible for conference by consult attending (fellow’s preparation, organization, and presentation style is part of monthly evaluation and may be commented upon by evaluating attending)

- Infectious Disease Journal Club—goals and objectives

purpose: (1) to keep fellows and faculty current and up-to-date in the state-of-the-art practice of infectious diseases (2) to teach critical evaluation of medical literature

teaching methods: (1) current literature relevant to infectious disease problems and cases presented at the City-
Wide Infectious Disease Problem Conference is presented by fellows, house officers, or students rotating on the ID Consult Service (2) journal article content summarized for attendees (3) critical analysis of papers discussed is done by fellows and attendees (4) Log of diseases discussed and literature presented is maintained by first-year fellow (in addition, a copy of the first page of the article discussed is placed in a folder and copies are distributed to the members of the ID Section annually for ready reference)

mix of diseases: a wide variety of acute and chronic infectious diseases caused by viruses, bacteria, fungi, and parasites as presented at the City-Wide Infectious Disease Problem Conference

patient characteristics: pediatric patients, adult patients with acute and chronic infectious diseases, infectious diseases in active duty and retired military personnel and dependents

types of clinical encounters: not applicable

procedures: not applicable

services: not applicable

pathological material: not applicable

educational resources: Robert Greenblatt Medical Library of the Medical College of Georgia, on-line services (eg Pub Med), major infectious disease periodicals (eg J Infect Dis, Clin Infect Dis, Antimicrob Ag Chemother) and national periodicals (eg N Engl J Med, Ann Intern Med)

method of evaluating fellows’ competence: (1)informal evaluation by all attendees over the course of ID fellowship training with discussion of fellows’ performance at ID Section meetings (2) formal monthly evaluation of ID fellow responsible for conference by consult attending (fellow’s preparation, organization, and presentation style is part of monthly evaluation and may be commented upon by evaluating attending)