INFECTIOUS DISEASES ROTATION CURRICULUM
Educational Purpose:
The purpose of this rotation is to provide the internal medicine resident with education
and experience in the care of patients with known or suspected infectious diseases.
Residents will see patients in consultation at SLU Hospital or the JCVAH. At the
conclusion of this rotation residents will have gained insight into the natural history of
infectious diseases, the diagnosis and management of patients with infectious diseases,
the role as subspecialty consultant, and strategies for cost-effective and evidence-based
evaluation and treatment.
The Internal Medicine categorical resident at Saint Louis University is required to
complete 1 month of infectious diseases consultation rotation at SLUH or the JCVAH
during residency. This rotation occurs usually during the PGY-II or PGY-III year.
Rotation Logistics:
Rotation Director: Donald Kennedy, MD (kenneddj@slu.edu).
Team Supervisor: The attending physician on record for the month can be found by
contacting the Division of Infectious diseases at (314) 977-9041
Team Members:
 1-2 subspecialty infectious diseases resident
 1-2 internal medicine residents: names can be found on the Monthly Schedule
available on https://www.new-innov.com/Login/Login.aspx
Where to go on day 1:
Report to the Division of Infectious Diseases at the Doisy Research Building, 8th floor at
8:00 a.m. on the first day of the rotation. Prior direct communication with the
subspecialty resident or attending is encouraged.
Location of Patient Activities: SLU-Hospital and the West Pavilion (in-patient
psychiatry) for those placed on the SLU-based rotation, the JCVAH for those placed on
the VA-based rotation.
Frequency of on-call & Days off:
 There are no on-call activities during this rotation
 All team members are guaranteed 1 day off in 7 averaged over 4 weeks
Concerns and Complaints:
Concerns and complains regarding any aspect of the rotation (including peers, attending,
and nursing staff) can be immediately conveyed to the Chief resident 24/7. This can
occur by e-mail: sluchief@slu.edu or by phone 314-577-8478 (SLU), 314-652-4100 ext
54412 (VA) during the day, or by paging the SLU chief on call through the hospital
operator. Non urgent concerns and complaints can also be discussed with Dr. Paniagua
(mpanig1@slu.edu or 314-577-8762 to schedule a meeting).
Goals, Objectives & Milestones
The curriculum is designed to address learning objectives of the following Accreditation
Council on Graduate Medical Education core competencies.
Reference: http://www.acgme.org/Outcome
Goals and objectives are not specific to level of training since this rotation occurs only
once during residency.
Patient Care
Goals
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health.
During this rotation, residents are expected to:
1) Demonstrate the ability to manage patients with infectious diseases:
a. Using clinical skills of interviewing and physical examination
b. Using the laboratory and imaging techniques appropriately
c. As a consultant to other physicians, and as a teacher to the patient and
other physicians
d. In a variety of health care settings to include the inpatient ward and the
critical care units
e. Within the framework of a multi-disciplinary team of care providers and
consultants
2) Treat their patient’s conditions with practices that are safe, scientifically based,
effective, efficient, timely, and cost effective
3) Be part of the overall program emphasis on patient centered care and resident
education
Objectives
During this rotation, the resident is expected to:
1. Acquire accurate and relevant history from the patient in an efficiently
customized, prioritized, and hypothesis driven fashion, and seek and obtain
appropriate, verified, and prioritized data from secondary sources (e.g. family,
records, pharmacy)
2. Perform an accurate physical examination that is appropriately targeted to the
patient's complaints and medical conditions, and identify pertinent abnormalities
using common maneuvers
3. Synthesize all available data, including interview, physical examination, imaging
studies, lab work and review of medical records to identify the likely presence or
absence of an infectious disease syndrome or condition
4. Formulate a differential diagnosis including likely infectious pathogens based
upon available epidemiologic and clinical information
5. Recommend additional diagnostic studies to clarify diagnostic considerations in a
cost-effective manner, when appropriate
6. Devise an initial therapeutic regimen based upon likely pathogens, knowledge of
sensitivity patterns, drug interactions, and severity of illness, and modify therapy
as appropriate when more data is available
7. Learn the role of the clinician in the prevention of transmission of infection in the
healthcare setting, including assigning appropriate isolation protocols
Medical Knowledge
Goals
During this rotation, residents are expected to demonstrate sufficient knowledge to:
1. Evaluate patients with an undiagnosed and undifferentiated infectious diseases
2. Interpret basic and advanced diagnostic tests used to diagnose infections
3. Treat common conditions managed by infectious diseases’ specialists
4. Learn cost effective use of anti-infective medication in a manner least likely to
foster the development of resistance
5. Provide basic preventive care
Objectives
During this rotation, the resident is expected to:
 Develop adequate medical knowledge regarding: pathophysiology, typical
presentation, diagnostic approach, and management plan of a variety of infectious
problems common to an internal medicine practice including:
o Fever of unknown origin
o Fever associated with skin rash
o Upper respiratory tract infections
o Lower respiratory tract infections
o Urinary tract infections
o Intra-abdominal infections
o Infective endocarditis and intravascular infections
o Central nervous system infections
o Bone and joint infections
o Sexually transmitted diseases
o Viral hepatitis
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Learn the manifestations, complications, and treatment of patients with HIV
infection and AIDS
Learn the etiology, incidence, and predisposing factors of nosocomial infections
Acquire a basic understanding of infections in special hosts (transplant recipients,
neutropenia associated with malignancy, and the elderly)
Learn 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
Learn the appropriate use of antimicrobial agents for specific pathogens as well as
disease processes, including indications, side effects and toxicities
Learn the principles of preventive medicine as it applies to infectious disease
including immunization, prophylaxis, susceptibility and exposure
Describe the indications and specific applications of infection isolation protocols
including universal precautions
Master the practice evidence-based medicine and be able to quote pertinent
landmark studies in the field
Practice- Based Learning and Improvement
Goals
Residents must demonstrate the ability to investigate and evaluate their care of patients,
to appraise and assimilate scientific evidence, and to continuously improve patient care
based on constant self-evaluation and life long learning.
During this rotation, residents are expected to develop skills and habits to be able to:
 Identify strengths, deficiencies and limits in one’s knowledge and expertise and
set learning and improvement goals pertinent
 Identify and perform appropriate learning activities in the context of this rotation
 Incorporate formative evaluation feedback into daily practice
 Locate, appraise and assimilate evidence from scientific studies related to
patients’ health problems
 Use information technology to optimize learning
 Participate in the education of patients, families, students, residents and other
health professionals
Objectives
During this rotation, the resident is expected to:
 Appreciate the responsibility to assess and improve care collectively for a panel of
patients with infectious diseases
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Identify learning needs (clinical questions) as they emerge in patient care
activities and areas in resident’s own practice that can be changed to improve
affect of the processes and outcomes of care
Actively participate in teaching conferences offered by the Division of Infectious
Diseases
Access medical information resources and evidence-based summary medical
information resources to answer clinical questions and library resources to support
decision making
Respond welcomingly and productively to feedback and reflect on feedback in
developing plans for improvement
Integrate clinical evidence, clinical context, and patient preferences into decisionmaking
Professionalism
Goals
Residents must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles.
During this rotation, residents are expected to demonstrate:
 Compassion, integrity, and respect for others
 Responsiveness to patient needs that supersedes self-interest
 Respect for patient privacy and autonomy
 Accountability to patients, society, and the profession
 Sensitivity and responsiveness to a diverse patient population, including but not
limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation
Objectives
During this rotation, the resident is expected to:
 Follow formal policies of the rotation
 Dress and behave appropriately
 Respond promptly and appropriately to clinical responsibilities including but not
limited to calls and pages
 Ensure prompt completion of clinical, administrative, and curricular tasks
 Document and report clinical information truthfully
 Demonstrate empathy and compassion to all patients and treat patients with
dignity, civility and respect, regardless of race, culture, gender, ethnicity, age or
socioeconomic status
 Maintain patient confidentiality
 Maintain appropriate professional relationships with patients, families and staff
 Recognize the need to assist colleagues in the provision of duties
 Accept personal errors and honestly acknowledge them
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Recognize and address personal, psychological, and physical limitations that may
affect professional performance
Maintain ethical relationships with industry
Interpersonal and Communication Skills
Goals
Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and teaming with patients, their families, and
professional associates.
On this rotation, residents are expected to:
 Communicate effectively with patients and families across a broad range of
socioeconomic and cultural backgrounds
 Communicate effectively with physicians, other health professionals, and health
related agencies
 Work effectively as a member/leader of a health care team
 Act in a consultative role to other physicians and health professionals
 Maintain comprehensive, timely, and legible medical records
Objectives
During this rotation, the resident is expected to:
 Effectively use verbal and non-verbal skills to create rapport with
patients/families and use communication skills to build a therapeutic relationship
 Engage patients/advocates in shared decision making for complex diagnostic and
therapeutic scenarios
 Demonstrate sensitivity to differences in patients including but not limited to race,
culture, gender, sexual orientation, socioeconomic status, literacy, and religious
belief
 Deliver appropriate, succinct, hypothesis-driven oral presentations
 Provide legible, accurate, complete, and timely written communication that is
congruent with medical standards
 Effectively communicate consultative recommendations to the referring team
 Effectively communicate with other caregivers in order to maintain appropriate
continuity during transitions of care
Systems Based Practice
Goals
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the
system to provide optimal health care.
Residents are expected to:
 Work effectively and coordinate patient care
 Advocate for quality patient care
 Work in interprofessional teams to enhance patient safety and improve patient
care quality
 Work in teams and effectively transmit necessary clinical information to ensure
safe and proper care of patients including the transition of care between settings
Objectives
During this rotation, the resident is expected to:
 Understand how utilization of isolation protocols reduces infection risks
 Work with patient and their families, case managers and insurance companies,
and assist in developing continuing therapy plans practical for outpatient
administration
 Utilize local antibiogram data and cost information, to devise an optimal
antibiotic formulary
Teaching Methods (Competency-Based):
“Every competency can be taught with every patient.”
B. Joyce, 2006
Patient Care:
 Performance of the initial history and physical examination, formulation of
diagnostic and therapeutic plans under the direct and indirect supervision of
attending physicians
 Daily attending rounds through direct discussions and role modeling
 Interaction with consultation-seeking teams and other health care providers
Medical Knowledge:
 Daily attending rounds through bed side and didactic teaching
 Discussion and learning from other health care team members
 Required lecture series provided by the Division of Infectious Diseases
Practice Based Learning and Improvement:
 Daily attending rounds through constructive criticism and role modeling
 Daily patient care activities and supervision and feedback by the resident and
attending
 Practicing evidence-based approach to patient care require daily use of medical
informatics and developing proficiency in it
Interpersonal and Communication Skills:
 Daily communication with other team members, health care professionals,
patients and families required for conducting patient care.
 Attending and peer feedback regarding written documentations
Professionalism:
 Attending rounds through role modeling
 Experiencing positive peer pressure and role modeling
System Based Learning:
 Attending rounds through role modeling and direct discussions
 Being a member of and interacting with a large multidisciplinary health care team
Teaching Methods (Topic-Based):
Key to Table:
1. Clinical teaching based on practical, supervised experience with patients and role
modeling
2. Case based presentation and teaching
3. Teaching rounds
4. Interactive seminars
5. Didactic lectures
6. Journal club, Evidence Based exercises, Quality improvement projects
7. Informal discussion
8. Chart audit
TOPICS TAUGHT
TEACHING METHODS
History, physical exam
1, 2, 3
Clinical microbiology
2, 6, 8
Clinical ID problems
1, 2, 3, 4, 5, 6, 7
Use of antimicrobials
1, 2, 3, 4, 5, 6, 7
Required Conferences:
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The conferences offered by the Division of Infectious Diseases
Grand rounds Friday at 7:30 am, LRC Auditorium A, breakfast provided
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CPC conference, third Wednesday of the month at noon (instead of noon conference),
LRC Auditorium C, lunch provided
QI meeting (M & M), last Tuesday of the month at 7:30 am (no morning report) The
Fitch classroom-8th floor, breakfast provided
Morning report and noon conferences as possible
Resident Assessment Methods (Evaluation):
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End of rotation 360 Global Rating:
 Attending evaluation addressing all 6 competencies verbally with the resident and
in writing through an online program (New-Innovation®). Verbal feedback at the
mid-point of the rotation is strongly encouraged
 Peer Evaluation addressing the 6 competencies from a peer perspective
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Mini-CEX (clinical evaluation exercise) evaluations spot lighting performance of
selected tasks of patient management such as the interview and physical examination,
formulation of differential diagnosis or problem lists, development of plans for shortterm and long-term medical management, communication of treatment plans,
invasive procedures, and discharge planning. At least one Mini-CEX per resident is
encouraged during this rotation
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Record Review
The attending reviews and evaluates written notes
Program Assessment Methods (Evaluation)
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Evaluation of the Attending:
The resident anonymously evaluates the attitude and effectiveness of the attending
physician in contributing to and facilitating the learning experience. This evaluation
occurs at the end of the month through the online program “New-Innovation®”
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Evaluation of the Rotation:
The resident anonymously evaluates the overall experience both in terms of structure
and content. The resident also judges the extent to which the rotation fulfilled its
stated goals and objectives. This evaluation also occurs at the end of the month
through the online program “new-Innovation®”
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Evaluation of the Curriculum:
Data pertinent to this specialty/skill set from both the annual in-training examination
and the ABIM certification examination are reviewed to provide objective evaluation
of the effectiveness of the curriculum of the rotation
Level of Supervision:
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Internal medicine residents are supervised by the subspecialty resident and the
attending physician who oversees the overall functioning of the team
The attending physicians personally evaluates all new patients within 24 hrs of
consultation, and as needed after that
Attending physician conducts teaching and consultation rounds daily
The attending physician will observe and evaluate the resident performance of
selected tasks of patient management such as the interview and physical examination,
formulation of differential diagnosis or problem lists, development of plans for shortterm and long-term medical management, communication of treatment plans both
verbal and written, professionalism, and discharge planning
The attending will review daily documentations by the residents and provide feed
back
Duty Hours and Tem Caps
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Average day starts at 8 am and ends at 5-6 pm
There is no overnight or home call
All team members are guaranteed 1 day off in 7 averaged over 4 weeks
The residents are required to keep track of duty hours on New Innovations®
o Duty hour guidelines are strictly enforced
o Duty Hours are defined as all clinical and academic activities related to the
program; i.e., patient care (both inpatient and outpatient), administrative
duties relative to patient care, the provision for transfer of patient care, time
spent in-house during call activities, and scheduled activities such as
conferences.
o Duty hours do not include reading and preparation time spent away from the
duty site.
o Duty hours must be limited to 80 hours per week, averaged over a four-week
period, inclusive of all in-house call activities.
o Adequate time for rest and personal activities must be provided. This should
consist of a 10-hour time period provided between all daily duty periods and
after in-house call.
Educational Resources:
Computer terminals to access the state-of-the-art SLU Online Library
(http://www.slu.edu/librarieshsc//) are available in all hospital floors, doctors’ office
building, and the Division of Infectious Diseases offices. The SLU Online Library can
also be accessed from home using the Novell user name and password.
Recommended on-line databases available through the http://www.slu.edu/librarieshsc//)
web site include:
 Up-To-Date (www.uptodate.com)
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ACP Medicine Online (http://www.acpmedicine.com)
MD-Consult (http://www.mdconsult.com/php/113741525-2/homepage)
Recommended Key textbooks for the Internal Medicine resident available through the
http://www.slu.edu/librarieshsc//) web site include:
 Harrison’s
(http://www.accessmedicine.com.ezp.slu.edu/resourceTOC.aspx?resourceID=4)
 Cecil’s (http://www.mdconsult.com.ezp.slu.edu/das/book/body/1137417532/0/1492/0.html)
 Current Medical Diagnosis and Treatment
(http://www.accessmedicine.com.ezp.slu.edu/resourceTOC.aspx?resourceID=1
Recommended print resources for the Internal Medicine resident include:
 Internal Medicine- Just the Facts (new, not available online yet) are recommended
textbook for in-depth reading on a particular disease process
 MKSAP series is recommended for brief review-style reading of a particular
subspecialty/subject and is provided for free to all residents
Residents are encouraged to go to the original literature for more in-depth learning.
Electronic version of all medical journals are available through the SLU Online Library
at the E-journals portal (http://hy2ju6vj2n.search.serialssolutions.com/
Rotation-Specific Recommended Resources
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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