Clinical Rotations and Facilities
The first year of fellowship training is primarily focused on providing consultations for the inpatient services the Boston Medical Center – which consists of the Menino and East Newton Pavilions – and the Veterans Administration Boston Healthcare System (VABHS). After completion of the four-week training in the Clinical Microbiology Laboratory, the fellow will rotate at each of those three sites over the course of their clinical training.
Boston Medical Center (BMC) was formed in 1996 when Boston City Hospital and Boston University Medical Center Hospital merged. Boston Medical Center is a private, not-for-profit, 508-licensed bed, academic medical center located in Boston’s historic South End. The hospital is the primary teaching affiliate for Boston University School of Medicine. Boston Medical Center emphasizes community-based care, with its mission to provide consistently accessible health services to all. The largest safety net hospital in New England, Boston Medical Center provides a full spectrum of pediatric and adult care services, from primary to family medicine to advanced specialty care.
With more than 29,070 admissions and 853,343 patient visits in the last year, Boston Medical Center provides a comprehensive range of inpatient, clinical and diagnostic services in more than 70 areas of medical specialties and subspecialties, including cardiac care and surgery, hypertension, neurological care, orthopaedics, geriatrics and women’s health.
As the principal teaching affiliate of Boston University School of Medicine, Boston Medical Center is devoted to training future generations of health care professionals. Every member of the hospital’s medical and dental staff holds an academic appointment at the Boston University School of Medicine or at the Boston University Goldman School of Dental Medicine. Boston Medical Center operates 85 residency training programs with 832 resident and fellowship positions.
Boston Medical Center is a recognized leader in groundbreaking medical research. Boston Medical Center
received more than $137 million in sponsored research funding in 2011, and oversees 574 research and service projects separate from research activities at Boston University School of Medicine. The world-renowned researchers at Boston Medical Center conduct both basic, laboratory-based biomedical research, and clinical research programs, including infectious disease, cardiology, vascular biology, Parkinson’s Disease, hematology/oncology, geriatrics, endocrinology and the Sickle Cell Center.
The VA Boston Healthcare System (VABHS) serves as a major teaching affiliate and offers an unequaled training environment to supplement the overall program. The VA Boston system is comprised of several distinct campuses and numerous community-based outpatient clinics, and it serves as a major referral center for the entire New England region. Residents participate in ambulatory experiences at the Jamaica Plain campus and inpatient rotations at the West Roxbury campus.
As the largest provider of graduate medical education in the United States, the VA takes its educational mission very seriously, and the VA Boston has a particularly rich academic history. All teaching faculty at the VA Boston have dual academic appointments at Boston University School of Medicine and Harvard Medical School, and house staff teams are composed of a mix of interns and residents from training programs at Boston Medical Center, Brigham and Women’s Hospital, and Beth-Israel Deaconess Medical Center.
Trainees at the VA Boston are exposed to a challenging but rewarding patient population characterized by a heavy burden of chronic illness, particularly cardiovascular and pulmonary diseases, and medical problems resulting from specific circumstances such as traumatic brain injury or spinal cord injury. The VA system also affords residents the unique opportunity to experience a national-scope, single-payer, integrated health system that has been at the vanguard of medical information technology, patient safety, and quality improvement developments.
The Consultation Service
Although each site cares for a wide diversity of patient populations with a broad variety of infectious diseases, the experiences are unique. The Menino Pavilion is the location of one of the busiest Emergency Departments and the largest 24-hour Level I trauma center in New England. Our Emergency Department had 128,231 visits last year. Consultations include those from the different general medical, surgical/ trauma as well as obstetrics and gynecology services. Patient populations include the underserved, refugees and persons returning from international travel, substance users, and patients seropositive for human immunodeficiency virus. The Newton Pavilion provides the majority of elective surgical services, and has a renal, hematology-oncology and geriatric service, and a cardiac intensive care unit. Both sites have medical and surgical intensive care units. The VABHS is the regional referral center for cardiac surgery and spinal cord injury, and serves a population with serious underlying disease who are at risk for a variety of infections, including healthcare-associated and antimicrobial-resistant infections.
Each consultation team has one fellow and one Infectious Disease faculty physician, who provides direct supervision. Students and medical residents from Boston University School of Medicine, as well as visiting trainees rotate through this service and are an integral part of the team. Pharmacy residents, including an Infectious Disease pharmacy resident, are frequent members of the team and are at all times a resource for the fellow. An average of two to five consultation requests are received daily on each service. Formal daily teaching rounds are conducted. Each new patient is presented, examined and discussed as are those patients seen previously who have continued active infectious disease problems.
During the second year, there are 2-3 additional months on the consultation service, with the goal of each fellow spending four months at each hospital site over the course of the fellowship training. The fellow may have clinical responsibilities in the third year of training if there is a programmatic need or by request of the fellow. However, those clinical activities will be minimized so that the concentration can be solely on research.
In addition, three inpatient clinical electives are available:
- Transplant Infectious Diseases at the Massachusetts General Hospital – Interested fellows will be able to complete a four-week rotation at the MGH Transplant Center, providing consultations for infectious disease management in transplant recipients and donors. The fellow will also learn how to provide appropriate pre- and post-transplant vaccination and evaluation.
- Pediatric Infectious Disease at Boston Medical Center – The interested fellow can join the pediatric infectious disease consultation team and work with a pediatric ID faculty member and fellow. The fellow will evaluate children at different developmental stages with infectious disease problems, with an emphasis on premature and newborn infants. They will learn about antibiotic usage and dosing in children of different ages, and learn about common infectious disease problems unique to pediatrics, including international health problems and travel issues in young children. While on this rotation, the fellow will continue to provide night call coverage for the adult infectious disease service while the pediatric ID fellows will continue to provide night call coverage for pediatrics.
- Cape Cod Hospital: Located in Hyannis, MA, Cape Cod Hospital is a 238-bed acute care hospital. The Emergency Department is one of the busiest in Massachusetts. Major services include: Cardiovascular services, including four interventional cardiology suites; the O’Keefe Surgical Pavilion, featuring inpatient and outpatient surgery in 14 operating rooms; the Davenport-Mugar Cancer Center, offering medical oncology and radiation therapy, and an active program for the care of HIV- and HCV-seropositive patients. Fellows will have the opportunity to work in a busy, community hospital. Although they will focus on the inpatient service, they will also see patients in the Emergency Department and in the ambulatory setting.
Additional training in infection control and hospital epidemiology and antimicrobial stewardship is also available.
Please click here for a description of the Ambulatory Training Experience.