Revised 3/05/08
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR INFECTIOUS DISEASE
UNIVERSITY MEDICAL CENTER
Rotation Coordinators:
Alan Greenberg, MD.
Gary Skankey, M.D.
Eugene Speck, M.D.
3006 S. Maryland Parkway, Suite 780
Las Vegas, Nevada 89109
University of Nevada School of Medicine
OVERVIEW
Infectious disease consultation involves the assessment and management of patients with
known or suspected infections. The general internist should have a broad understanding
of the concept of assessment for infections, early and therapy management including the
prescription of antibiotics as well as de-escalations or cessation (treatment duration).
Educational Purpose
The core goals of the rotation is to provide residents supervised experience in the
evaluation and care of patients with known or suspected infectious diseases, in the cost
effective use of anti-infective medication in a manner least likely to foster the
development of resistance, and in the role of the clinician in the prevention of
transmission of infection in the healthcare setting. Ancillary goals are to provide
experience in the role and ethical behavior of the subspecialty consultant, the use of the
analytic and critical tools of evidenced-based medicine to evaluate medical literature and
clinical guidelines, and the interdisciplinary dependent approach to the development of an
anti-infective formulary, and in the control and prevention of nosocomial infections.
Teaching Methods
The rotation will be under the supervision of the attending infectious disease specialist.
The resident will see consultations and patients as assigned by the attending infectious
disease specialist. The resident will obtain the initial data, write a consultation note, and
present the patient to the attending physician. The attending will confirm the findings,
teach about the case, and with the resident, craft the final recommendations. The
resident will see the patient daily, write the follow up consult notes, and review them
with the attending infectious disease specialist.
Daily rounds will occur with the attending physician at which time instruction in the
unique aspects of the consultative process will be provided. Residents will be required to
continue their regular morning report and noon conference core curriculum. The resident
and attending will review and discuss any required reading.
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Mix of Diseases
While not all entities will be seen during this rotation, the resident should become
familiar with the following disorders:
sepsis, septic shock, fever of unknown origin, HIV/AIDS, tuberculosis, Lyme
disease, malaria, endocarditis, infections in the immunocompromised patient,
fungal infections, viral infections (HSV, influenza, EBV, VSV, CMV), infections
of the central nervous system (encephalitis, meningitis), gastrointestinal infections
(cholangitis, gastroenteritis, infectious diarrhea, viral hepatitis, peritonitis),
genitourinary infections (cervicitis, vaginitis, STD’s, PID, prostatitis,
epididymitis, urethritis, urinary tract infections, pyelonephritis, Fournier’s
gangrene), respiratory infections (sinusitis, epiglottis, pharyngitis, upper
respiratory infections, bronchitis, pneumonia, empyema), skin infections
(cellulitis, ulcers, fasciitis), musculoskeletal infections (osteomyelitis, septic
arthritis).
The resident will learn to identify and manage the following infectious diseases common
to an internal medicine practice: fever, cellulitis, upper respiratory tract infections, lower
respiratory tract infections, infectious diarrhea, arthritis, urinary tract infections,
meningitis, sexually transmitted diseases including penile discharge, cervicitis, viral
hepatitis, conjunctivitis.
The resident will learn the principles of preventive medicine as it applies to infectious
disease including immunization, prophylaxis, susceptibility and exposure.
The resident will learn the diagnostic and management approaches to patients with HIV
infection / AIDS including immunization and prophylaxis.
The resident will become knowledgeable in the appropriate use of antimicrobial agents
for specific pathogens as well as disease processes, including indications, side effects and
toxicities.
The resident will learn to evaluate and manage common infectious diseases but recognize
one’s limitations and learn to refer appropriately.
Patient Characteristics
There is a diverse patient population, male and female, of all ages from adolescent to
geriatric, representing most ethnic and racial backgrounds, from all social and economic
strata. The hospital serves primarily the indigent population of Clark County but while
rotating on the infectious disease consult service, residents will see patients from the
private services as well as the resident services.
The patients seen will represent a very wide spectrum of medical problems encountered
in an inpatient setting. Most of the patients are admitted through the Emergency
Department and display either an initial presentation of an acute problem or an
exacerbation of a chronic condition. There are very few elective admissions or tertiary
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referrals. On occasion, a patient will be accepted in transfer from the Air Force Hospital
at Nellis AFB or the VA ambulatory clinic.
Types of Clinical Encounters
This rotation is predominantly an inpatient consult experience. Residents, under the
supervision of clinical faculty board-certified in infectious disease, provide inpatient
consultations for patients on the resident services as well as patients admitted to private
services. In conjunction with the attending physician, the resident will evaluate the
patient record, interview the patient and perform a physical examination. The resident
will review all available laboratory and imaging data and then formulate a differential
diagnosis and recommendations for continued evaluation and treatment. The resident will
then author an initial consultation including history and physical examination, and any
follow-up progress notes. The resident will discuss the case with the attending consultant.
Residents are encouraged to do literature searches, provide articles and should then relay
the final recommendations to the consulting physician and/or team primarily responsible
for the patient. The attending physician will see all new consultations. Subsequent visits
will occur at a rate appropriate to ensure excellence in patient care and education.
Close interaction with various other healthcare team members including care managers,
discharge planners, home health agencies, inpatient nurses, respiratory therapists,
physical therapists, and patient care technicians occurs daily.
Resident Supervision
Residents have hospital-based on-site supervision as well as daily personal supervision in
their patient care.
Procedures and Services
Procedures are not routinely performed on the infectious diseases consultation service.
Didactic Teaching
Morning Report
Residents rotating on the infectious disease service are required to maintain
greater than 60 % attendance at morning report. Morning Report begins at 8 a.m.
on Monday through Thursday and at 8:30 a.m. on Friday.
Noon Conference
Residents rotating on the infectious disease consult service are required to
maintain greater than 60 % attendance at noon conference. Noon conference
occurs daily, Monday through Friday. These sessions cover the basic core
curriculum, and other curriculum topics such as ethical issues, geriatrics,
computer systems and informatics, health care systems, occupational and
environmental health issues, and other topics of concern. An infectious disease
topic is presented at least once during each month.
Attending Rounds
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Didactic discussions will be held regarding all inpatient consultations occurring
during the month. Each resident and medical student will be required prepare and
discuss during teaching rounds one article or infectious disease topic each week.
Teaching rounds by the attending physician will occur every day for 45 - 60
minutes after regular management rounds. Each resident is required to review
common infectious disease topics.
Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper DL, ed. McGraw
Hill
Infectious Diseases, pp. 749 - 1206.
The Sanford Guide to Antimicrobial Therapy, Gilbert DN, Moellering RC,
Sande MA (editors), 37th edition, 2007.
Principles and Practice of Infectious Diseases, 6th ed. Mandell GL, ed. Elsevier
The Washington Manual of Medical Therapeutics, 32nd ed.
The Washington Manual Infectious Diseases Subspecialty Consult, Starlin R, ed.
Lippincott Williams & Wilkins
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Conferences and Research
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Residents during the rotation will present at the noon conference or morning report a
critical review of a primary journal article, or an interesting/instructive case.
Residents will have the opportunity to participate in research ongoing in the Division, or
devise a project of their own.
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have consulted and to follow the hospital care of those patients. If a patient with whom
the resident has consulted should die and have an autopsy, the resident is encouraged to
attend the post-mortem session.
Training Sites
University Medical Center
All of the inpatient infectious disease consultation experience occurs at University
Medical Center (UMC) under the supervision of one of the full-time infectious
disease attendings.
Competency-based Goals and Objectives
Infectious Disease Elective Rotation
(Only a single level of competency is described, as this is a resident-level
elective undertaken once during residency)
Learning Venues
Evaluation Methods
1. Direct Patient Care/Consultation
2. Attending Rounds
3. Residency Core Lecture Series
4. Self Study
A. Attending Evaluation
B. Nurse Evaluation
C. Written Examination
D. Self-evaluation
Competency: Patient Care
Gather essential information
from history, examination,
imaging studies, lab work and
review of medical records to
identify the likely presence or
Learning Venues
Evaluation Methods
1,2
A,B
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absence of an infectious disease
syndrome or condition.
Elaborate a differential
diagnosis including likely
microbial pathogens based upon
available epidemiologic and
clinical information.
When appropriate, order
additional diagnostic studies to
clarify diagnostic considerations
in a cost-effective manner.
Devise an initial therapeutic
regimen based upon likely
pathogens, knowledge of
sensitivity patterns, drug
interactions, and severity of
illness.
Modify therapy if appropriate
when more data is available to
construct a therapeutic regimen
that is targeted, safe, cost
effective and least likely to
drive resistance.
Use evidenced-based guidelines
when available.
Assign appropriate isolation
protocols.
Competency: Medical
Knowledge
Review clinical microbiology in
the context of the appropriate
indication, timing, and
technique of collection of
specimens, and in the
interpretation of stains,
histology, and culture reports.
Delineate the parameters used
to differentiate culture results
that likely reflect colonization
from those that represent
infection.
Describe conditions that result
in immune deficits in
1,2,3
A,C
1,2,3,4
A,C,D
1,2,3,4
A,C,D
1,2
A,C, D
1,2,3,4
A,C,D
1,2,3,4
A,B,D
Learning Venues
Evaluation Methods
1,3,4
A,C,D
1,3,4
A,C,D
1,3,4
A,C,D
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mucocutaneous barriers, and in
humoral and cell mediated
immunity.
Delineate the spectrum of
organisms that exploit specific
immune deficits.
Describe the clinical
manifestations, and when
appropriate the imaging and
laboratory findings of the major
infectious disease syndromes,
e.g. sepsis, FUO, community
acquired pneumonia, ventilator
associated pneumonia,
meningitis, encephalitis, septic
arthritis, infective endocarditis,
etc.
Relate specific infectious
disease syndromes to the most
likely causative organisms
within the context of presence
or absence of underlying
immune deficiency states, and
the geographic area of likely
acquisition of the infection.
Describe the indications and
specific applications of
infection isolation protocols
including universal precautions
Competency: Interpersonal
and Communication Skills
Maintain accurate, timely, and
legible medical records.
Communicate with consultants
and demonstrate an
understanding of the basis for
the consult, and the adequacy of
the response from the
requesting clinician’s
perspective.
Supervise and teach more junior
colleagues in a manner that
optimizes their growth and
development.
Communicate with patients in a
1,3,4
A,C,D
1,3,4
A,C,D
1,3,4
A,C,D
1,3,4
A,C,D
Learning Venues
Evaluation Methods
1
A,B,D
1,2
A,B,D
1,2
A,B,D
1,2
A,B,D
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manner that is empathetic, clear
and as accurate as possible, and
coordinated with the patients’
principal care physician.
Communicate efficiently and
effectively with referring
physician, regarding diagnoses,
treatment and follow-up
Competency: Professionalism
Demonstrate respect,
compassion, integrity, and
altruism in relationships with
patients, families and colleagues
Demonstrate sensitivity to
gender age, culture/ethnicity,
religion, sexual preference,
socioeconomic status, and
disabilities of patients and
colleagues
Respect patient’s autonomy and
privacy, and within this context
always act in the patient’s best
interest.
Competency: Practice-Based
Learning
Demonstrate an increasing
sophistication and independence
in diagnostic and analytic skills
during the rotation based upon
constructive critical review of
earlier work.
Formally evaluate published
literature and guidelines using
the tools of evidenced-based
medicine to improve the quality
of patient care.
Participate in the investigation
and control of nosocomial
infections.
1,2
A,D
Learning Venues
Evaluation Methods
1,2
A,B,D
1,2
A,B,D
1,2
A,B,D
1,2,4
A,B,D
1,2,4
A,B,D
1,2,4
A,B,D
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Competency: Systems-Based
Practice
Understand how utilization of
isolation protocols reduces
infection risks.
Using pharmacy and
microbiology data, practice
antibiotic stewardship principles
to reduce selective pressure for
the development of multiple
resistant organisms.
Working with patient and their
families, case managers and
insurance companies, assist in
developing continuing therapy
plans practical for outpatient
administration.
Learn to develop effective
immunization programs.
Utilize local antibiogram data
and cost information, to devise
an optimal antibiotic formulary.
V.
Learning Venues
Evaluation Methods
1,2,3,4
A,C, D
1,2
A,B
1,2,4
A,B
1,2,4
A,B
1,2
A,B
EVALUATION
A. Of Residents
All clinical faculty are required to complete the standard ABIM resident
evaluation form. All clinical faculty are encouraged to provide face-to-face
feedback with the residents.
B. Of Rotation and Preceptor
All residents have the opportunity to evaluate the rotation, and the clinical faculty
member, at the completion of the rotation. The form is included at the end of this
document. These evaluations are then converted to type and shared anonymously
with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
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Infectious Disease Rotation Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principles of infectious diseases.
6. Receive verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising Attending Signature___________________
Date___________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the rotation’s end.
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