Infectious Disease Curriculum – Students will have to learn and be tested on the following information laid out in the curriculum. All information can be accessed in the resources and lecture videos listed below the curriculum. 

Description

Educational Purpose

The infectious disease rotation is a required rotation primarily available for all residents. Although a primarily consultative rotation, infectious disease specialists now provide continuing care for many patients with HIV disease. Because the practice of internal medicine requires a broad knowledge base of infectious disease, acquiring fundamental skills in evaluating and managing patients in the causes of fever are critical. Developing expertise in evaluating patients with primary infections, such as pneumonia and urinary tract infections; secondary infectious processes, such as catheter related infections and ventilator associated pneumonia, etc; and immunocompromised patients is stressed. The prevention of infectious diseases by the use of appropriate vaccinations is emphasized to the residents. Clinical ethics become more complicated for the infectious disease practitioner as HIV has become more common. Many infectious diseases can be transmitted through occupational exposures and prevented by appropriate environmental precautions.

Teaching Methods

One-on-one didactic sessions with the attending, bedside rounds on all new consults and hospital follow-ups, assigned readings and reviewing articles on the reading list will provide substantial learning opportunities for each resident. During these discussions, physiology, pathogenesis, clinical presentations and natural history of infectious disorders is regularly reviewed. The importance of a careful history and physical exam is crucial for appropriate diagnosis of infectious disorders as well by the use of medical information as illustrated by those with sexually transmitted diseases and HIV.

Disease Mix

The resident will evaluate primary infectious disease processes such as pneumonia, urinary tract infections, endocarditis, and HIV. The resident will also evaluate secondary infectious disease processes such as catheter-related infections and ventilator associated pneumonia and immunocompromised patients with neutropenia, transplantation, connective tissues diseases and immunomodulating medications. Residents will also evaluate diseases that mimic infections, such as connective tissues diseases, allergic reactions. Residents will be confronted with patients with primary as well as secondary infectious processes. The major topics emphasized during this rotation include but are not limited to the following:

  1. Interpretation of culture and sensitivity data on: sputum, urine, blood, wound and quantitative burn cultures.
  2. Interpretation of serology studies: viral diseases (HIV, hepatitis, EBV, CMV, others), syphilis, Lyme disease, etc.
  3. Preparation and interpretation of gram stains and AFB smears.
  4. The spectrum, pharmacokinetics, side effects and toxicities along with the dosing of the major classes of antibiotics and antiviral.

Key clinical syndromes:

  1. Pneumonias: community acquired and nosocomial.
  2. Urinary tract infections.
  3. Complicated and uncomplicated intra-abdominal infections.
  4. Skin/soft tissue infections: diagnosis, treatment and complications.
  5. Sinusitis/otitis: diagnosis, treatment and complications.
  6. Tuberculosis: epidemiology, presentation, diagnosis, and treatment.
  7. Meningitis, encephalitis and other central nervous system infections.
  8. Endocarditis: diagnosis, treatment and prophylaxis.
  9. Bacteremia: staph species, enterococcus species, others.
  10. HIV infection: asymptomatic patient work up, antiretroviral therapy.
  11. Opportunistic infections: treatment and prophylaxis

Primary Diseases Encountered

Similar to topics covered plus:

  1. Sepsis/sepsis syndrome.
  2. Surgical wound.
  3. Fungemia.
  4. Catheter related infections.
  5. Osteomyelitis.
  6. Infections in trauma patients.
  7. Infections in transplant patients.
  8. Fever.

Patient Characteristics

Patients ranging in age from adolescents to the elderly are routinely encountered. Disease processes from the subtle to the catastrophic and the initial to terminal stages are evaluated.

Types of Clinical Encounters

Most clinical encounters seen at the consultative infectious disease practice are primarily inpatient. However, outpatient management of HIV and tuberculosis under the supervision of the attending infectious disease specialist are provided. Residents participate in the TB clinic at the Hamilton County Health Department and are introduced to the principles of community wide surveillance, the role of non-physician personnel in the appropriate management of TB and other communicable diseases.

Procedures and Services

During the infectious disease rotation, needle aspiration as well as incision and drainage of superficial abscesses may be performed. Other procedures may include lumbar puncture, arthrocentesis, preparation of gram stains for review, and review of acid fast stains.

Method of Resident Evaluation

The resident will be expected to:

  1. Attend all assigned clinic sessions, inpatient and outpatient
  2. Complete all assigned required reading.
  3. Perform a complete history and physical examination for the patient presenting with a febrile illness.
  4. Read the infectious disease section of the MKSAP to include answering the questions and reviewing the reference materials provided for further information.
  5. Demonstrate understanding of current recommendations for adult immunizations
  6. Understand the appropriate antibiotic selection for the following situations:
    1. Community acquired pneumonia in a healthy adult
    2. Community acquired pneumonia in an immunocompromised patient
    3. Nosocomial pneumonia
    4. Bacterial Endocarditis
    5. Sepsis
    6. Diabetic soft tissue infections
    7. Simple and complicated urinary tract infections
  7. Demonstrate satisfactory skills in obtaining patient history and perform a complete physical examination for the patient presenting with a febrile illness.

Goals and Objectives

  1. Patient care
    1. Ability to take a complete medical history and perform a careful and accurate physical examination.
    2. Ability to write concise, accurate and informative histories, physical examinations and progress notes.
    3. Define and prioritize patients’ medical problems and generate appropriate differential diagnoses.
    4. Develop rational, evidence-based management strategies.
  2. Medical Knowledge
    1. Expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of medical patients.
    2. Access and critically evaluate current medical information and scientific evidence relevant to patient care.
    3. Develop and demonstrate proficiency in understanding basic pathophysiology, clinical manifestations, diagnosis and management of medical illnesses seen in both outpatient and inpatient setting at rural community.
    4. Develop and demonstrate proficiency in recognizing the indications for and basic interpretation of chest and abdominal x-rays, electrocardiograms, and pulmonary function tests.
    5. Develop and demonstrate proficiency in learning indications for and basic interpretation of standard laboratory tests, including blood counts, coagulation studies, blood chemistry tests, urinalysis, body fluid analyses, and microbiologic tests.
  3. Interpersonal Skills and Communication
    1. Communicate effectively with patients and families. Communicate effectively with physician colleagues at all levels.
    2. Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of patients in both outpatient and inpatient setting at rural community.
    3. Present information concisely and clearly both verbally and in writing on patients.
    4. Communicate effectively with colleagues when signing out patients or turning over care to another service.
    5. Increase self-awareness to identify methods to manage personal and professional sources of stress and burnout.
  4. Professionalism
    1. Interact professionally toward patients, families, colleagues, and all members of the health care team.
    2. Acceptance of professional responsibility as the primary care physician for patients under his/her care.
    3. Appreciation of the social context of illness.
    4. Knowing when and how to request ethics consultation, and how best to utilize the advice provided.
    5. Understand ethical concepts of confidentiality, consent autonomy and justice.
    6. Understand professionalism concepts of integrity, altruism and conflict of interest.
    7. Increase self-awareness to identify methods to manage personal and professional sources of stress and burnout.
    8. Increase knowledge and awareness of personal risks concerning drug/alcohol abuse for self and colleagues, including referral, treatment and follow-up.
  5. Practice-Based Learning and Improvement
    1. Identify and acknowledge gaps in personal knowledge and skills in the care of clinic and hospitalized patients.
    2. Develop and implement strategies for filling gaps in knowledge and skills.
    3. Commitment to professional scholarship, including systematic and critical perusal of relevant print and electronic literature, with emphasis on integration of basic science with clinical medicine, and evaluation of information in light of the principles of evidence-based medicine.
  6. Systems-Based Practice
    1. Understand and utilize the multidisciplinary resources necessary to care optimally for hospitalized patients.
    2. Use evidence-based, cost-conscious strategies in the care of hospitalized patients.
    3. Understanding when to ask for help and advice from senior residents and attending physicians.
    4. Learning by participation in ward rounds, teaching conferences, and other educational activities.
    5. Effective collaboration with other members of the health care team, including residents at all levels, attendings, nurses, clinical pharmacists, occupational therapists, physical therapists, nutrition specialists, patient educators, speech pathologists, respiratory therapists, enterostomy nurses, social workers, case managers, discharge planners, and providers of home health services. Knowing when and how to request medical sub-specialists consultation and how best to utilize the advice provided.
    6. Consideration of the cost-effectiveness of diagnostic and treatment strategies.

Reading List:

  • Mayo Clinic: Internal Medicine Board Review
  • Harrisons Principles of Internal Medicine- online version available through Savitt medical library
  • Up to Date: available through the VA and Renown computer

*Infectious Disease Curriculum – This curriculum is a curriculum formed by the University of Nevada School of Medicine.