Clinical Rotations and Facilities
The first year of fellowship training is primarily focused on providing consultations for the inpatient services at 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 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.
With 26,064 admissions and 874,770 patient visits last year, BMC 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, orthopedics, geriatrics, and women’s health.
As the principal teaching affiliate of Boston University School of Medicine, BMC 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.
The VA Boston Healthcare System (VABHS) serves as a major teaching affiliate and offers an unequaled training environment to supplement the overall program. The VABHS 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. Trainees participate in inpatient rotations at the
As the largest provider of graduate medical education in the
Trainees at the VABHS 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 VABHSalso 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
Each site cares for a diverse patient population with a broad variety of infectious diseases. The breadth of the fellow’s clinical experience is extensive. Consistent with our unique mission, our patient populations include the underserved, refugees and persons returning from international travel, substance users, and patients seropositive for human immunodeficiency virus and hepatitis C virus. BMC has one of the busiest Emergency Departments and the largest 24-hour Level I trauma center in New England. Our Emergency Department had 128,840 visits last year. Consultations include those from the general medical, surgical/ trauma and obstetrics and gynecology services. In 2013, one of the general medical teams became an inpatient service for the care of patients with HIV and other infectious diseases. 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.
There are two fellows assigned to BMC each month to provide inpatient clinical care. One fellow will be on the primary consultation team, which consists of the fellow, an Infectious Disease faculty physician who provides direct supervision, students and medical residents from Boston University, as well as visiting trainees. Pharmacy residents and Infectious Disease pharmacy faculty are frequent members of the team and are at all times a resource for the fellow. An average of three to six consultation requests are received daily.
The other fellow at BMC is on the secondary consultation team, with a faculty member assigned to that service. This service is meant to offload the primary consultation service and is paired with either research time or time on the inpatient HIV/ID service. Because the inpatient HIV/ID service has a dedicated housestaff team, the fellow’s role is to educate, supervise, and facilitate the care of the complicated patients on the service.
There is a third fellow assigned to the VABHS consultation service, and the team members are similar to the BMC primary consultation service.
Formal daily teaching rounds are conducted on each service on weekdays. 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 additional months on the consultation service. Each fellow is strongly encouraged and expected to complete the transplant infectious disease rotation at the Massachusetts General Hospital during the second year. In this four-week rotation, the fellow will learn infectious disease management in transplant recipients and donors. The fellow will also learn how to provide appropriate pre- and post-transplant vaccination and evaluation.
The fellow on the third year of the Hospital Epidemiology and Antimicrobial Stewardship Track will have some clinical responsibilities, however, those clinical activities will be minimized so that the research focus is not interrupted.
Inpatient Clinical Electives
There are three 2-4 week clinical electives available that are hospital-based:
- Global Health clinical elective: Fellows may choose to participate in this rotation in their second year of training. We have two sites with active program agreements:
- Mulago Hospital, Makere University – Kampala, Uganda.
- Hospital Universitario Cassiano Antonio Moraes, Universidade Federal Do Espirito Santo – Maruipe Vitoria, Brazil (proficiency in Portuguese or Spanish is required)
Both those rotations provide extensive exposure to a broad range of infectious diseases, most of which are uncommon in the United States. There is close oversight by local faculty. Fellows diagnose and manage tropical diseases and learn the principles of infectious-disease practice in resource-poor areas.
The interested fellow may also explore other sites in Africa, South America and India, where our faculty have active collaborations and colleagues who can function as preceptors.
Fellows may apply for combined training in Infectious Disease and Addiction Medicine. Those fellows will have the opportunity to participate in clinical training in addiction medicine in their second year of fellowship and participate in a scholarly project that combines both disciplines. For more information about the Addiction Medicine program, please see the program’s website. We will arrange for interested applicants to interview with Addiction Medicine faculty at the time of your visit to our program.
Please click here for a description of the Ambulatory Training Experience.