Ambulatory Training Experience
The ambulatory fellowship training experience in Infectious Diseases is centered on a longitudinal half-day clinic in the Center for Infectious Diseases (CID) at Boston Medical Center. Fellows have the option to work alternate weeks at the CID and the HIV Clinic at the VA Medical Center. The longitudinal ambulatory experience starts in the first month of training and continues for a minimum of 24 months. In addition, elective rotations are available in other clinics – the HIV-OB (Positive HOPE) Clinic, the Tuberculosis (TB) Clinic, the International Health Clinic, HIV/Hepatitis Clinic Co-infection Clinic and the Sexually Transmitted Diseases Clinic.
The Infectious Diseases practice at Boston Medical Center offers comprehensive diagnostic and therapeutic services in all areas of infectious diseases, with particular expertise in HIV/AIDS, sexually transmitted diseases (STDs) and diseases incurred through international travel. The magnitude and variety of our patient population offers our physicians extensive opportunity for clinical research and offers our patients the opportunity to benefit by participating in that research. The Infectious Diseases practice offers a continuum of services for patients who are HIV-positive or have AIDS. We have the largest HIV/AIDS program in the New England area and one of the largest STD practices in Massachusetts. The International Travel Program is designed to keep departing travelers from contracting any diseases or illnesses overseas, as well as to offer immediate, aggressive treatment for returning travelers who may have acquired a disease.
The Carl J. and Ruth Shapiro Ambulatory Care Center
The Carl J. and Ruth Shapiro Ambulatory Care Center, a 245,000-square feet, nine-story building on the corner of East Concord and Albany Streets, provides state-of-the-art outpatient care. Outpatient clinical services that are located across BMC’s urban campus are consolidated in this patient-centered environment designed to maximize comfort and privacy. Key clinical support services, such as phlebotomy and radiology, also are housed in the building.
The goal of this clinic is to provide fellows with the opportunity to evaluate and manage patients with infectious diseases in an outpatient setting. There are two major components to this training experience.
HIV Primary Care: Under the supervision of an infectious diseases staff physician, fellows will provide continuing care to a panel of individuals with different stages of HIV infection. The fellow will function as the primary care provider for those patients. Fellows be an integral member of the multidisciplinary team which includes staff physicians, fellows, nurses, and social service personnel. In addition, fellows will participate in weekly clinic conferences including:
- Monthly HIV conference with invited speakers presenting state of the art clinical and basic research related to the management and pathogenesis of HIV infection.
- Case-focused monthly conferences providing a forum for discussion of cases of medical or psychosocial interest will be presented by fellows, attending and clinic staff.
- Monthly HIV Journal Club reviewing recent literature relevant to HIV management
- HIV Practice Forums with the development of clinic-specific practice protocols based on accepted guidelines.
Infectious Diseases Consultation: Under the supervision of their continuity clinic preceptor, the fellow will evaluate patients referred for follow up from the ID inpatient consultation service to develop an ongoing treatment plan. These are primarily patients seen by the fellow during the hospitalization who have long-term need for infectious diseases follow-up, often because of prolonged antimicrobial therapy.
Interested fellows can increase their longitudinal experience in their second year of training to 2 or more half-day clinics per week, if their ambulatory experience does not interfere with their research training or their remaining clinical responsibilities on the inpatient service.
In addition to the continuity clinic, the fellow may elect to rotate on other clinics within CID and the Boston Medical Center.
HIV-OB (Positive HOPE) Clinic
Training Goals: To provide fellows the opportunity to participate in the management of HIV-infected pregnant female patients and to acquaint fellows with the basic knowledge of management of HIV-infected pregnant patients and the prevention of perinatal transmission of HIV infection. Fellows may elect to participate at any time during the course of their ID fellowship. Participating fellows will attend one half-day clinic per week. This may be ongoing or on an ad hoc basis with approval of the ID attending in the Positive HOPE clinic. The fellow is part of a multidisciplinary team (comprising an ID attending, a maternal-fetal medicine specialist from the Department of OB/Gyn, a clinic nurse, a research nurse, a mental health specialist, and a social worker from Center for HIV/AIDS Care and Research) that evaluates and manages all HIV-infected pregnant patients cared for at BMC. Under the supervision of the infectious disease staff attending, the fellow may provide an initial evaluation and assessment of an HIV-infected patient and formulate a plan of care. The fellow is expected to attend and participate in weekly pre-clinic conferences, reviewing patients scheduled to be seen later that day.
Tuberculosis (TB) Clinic
Training Goals: To provide an introduction to the activities and function of a large urban tuberculosis (TB) clinic. Fellows will gain familiarity with TB screening, diagnosis, and management. The elective is based at the Boston Public Health Commission (BPHC) Tuberculosis Clinic (TB Clinic) located at Boston Medical Center (BMC). Onsite supervision is provided by physicians boarded in either infectious diseases or pulmonary medicine. Both adult and pediatric patients are seen. Patients come from a wide variety of ethnic, cultural, and linguistic backgrounds. While in the TB Clinic, fellows will be expected to take patient histories, perform focused physical examinations, read chest X-rays, assess patient risk for latent or active tuberculosis infection, order and interpret appropriate diagnostic studies, prescribe appropriate therapy for infected patients, and evaluate the public health risks associated with any active cases. All fellow activities will take place in a patient care team that also includes TB Clinic attendings, BPHC nurses and outreach workers, and translators. Fellows are strongly encouraged to attend the every-other-week TB Case/Cohort Conference. Fellows may have an opportunity to accompany BPHC nurses or outreach workers as they perform contact tracing, administer directly observed therapy (DOT), or provide TB education in the community.
International Health and Travel Clinic
Training Goals: To provide fellows the opportunity to learn the principles of travel medicine and to diagnose and treat geographical diseases. Infectious diseases fellows spend at least four sessions in clinic during their 2nd year of training. Fellows work with a multidisciplinary team of adult and pediatric attendings and nurses, who have extensive experience in refugee, travel, and tropical medicine. Fellows receive a curriculum revelent to this rotation.
Sexually-transmitted Diseases (STD) Clinic
Training Goals: To understand the pathophysiology of sexually-transmitted infectious agents and their associated immunologic responses and to acquire familiarity with the broad range of clinical presentations of the various sexually transmitted diseases (STD) including complicated presentations of GC/chlamydia and syphilis. Fellows will learn to utilize the current microbiologic and serologic methods to confirm diagnoses and to understand the limitations (such as sensitivity, specificity, and positive predictive value) of the current diagnostic methodologies. They will become familiar with the current Centers for Disease Control and Prevention (CDC) treatment guidelines for individual STDs their complications in special circumstances e.g., pregnancy or HIV co-infection. Fellows may elect to participate in STD clinic activities during their first or second year of fellowship during available elective time. While intermittent attendance is acceptable it is encouraged to participate in consecutive daily or weekly sessions whenever possible. Under the overall supervision of an infectious disease staff physician, fellows will work closely with CID STD-specialty trained nurses in evaluating patients presenting for STD evaluation and management.
Although formal rotation through the CID STD clinic is elective, all second year fellows participate in the Sylvie Ratelle STD/HIV Prevention Training Center of New England course, a project of the Division of STD Prevention, Massachusetts Department of Public Health funded by the CDC as part of their core ambulatory curriculum. The intensive STD course is a 5 day clinical training which encompasses up-to-the-minute information about priority and prevalent STDs. The course includes: diagnosis, treatment, and management of STDs clinic protocols and medical record format performance standards for clinician-patient interactions; sexual history-taking and physical examinations; universal precautions STAT testing procedures for point-of-service laboratories; clinical quality assurance; and an overview of disease intervention techniques
The HIV/Hepatitis Co-infection Clinic
Training Goals: To provide fellows with an intensive experience in the immunopathogenesis, evaluation and treatment of viral hepatitis, including patients co-infected with HIV. Fellows may elect to participate at any time after completing the first year of fellowship training. Participating fellows will attend one half-day clinic per week, for a minimum of three months. Under the supervision of the Infectious Diseases and Hepatology attendings, the fellow provides an assessment of newly-referred Hepatitis C and B infected patient. All new patients and those on treatment regimens for their hepatitis are discussed in weekly post-clinic conferences, in which the fellow is expected to participate.