Clinical Rotations and Facilities

The Facilities
               The Consultation Service               Inpatient Clinical Electives

The first year of fellowship training is primarily focused on providing consultations for the inpatient services at the Boston Medical Center (BMC) and the Veterans Administration Boston Healthcare System (VABHS).

The Facilities

BMC picture 2
Boston Medical Center

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, 514-licensed bed, academic medical center located in Boston’s historic South End. Boston Medical Center emphasizes community-based care, with its mission to provide consistently accessible health services to all. BMC is the largest safety net hospital in New England.

With 26, 339 admissions and 1,001,304 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. Boston Medical Center operates 66 residency training programs with 817 resident and fellowship positions.

Boston Medical Center is a recognized leader in groundbreaking medical research. This includes a world renowned Amyloidosis Center, groundbreaking investigations at the Chronic Traumatic Encephalopathy (CTE). Center, the primary academic home for the landmark Framingham Heart Study, the home of the newly formed Grayken Center for Addiction Medicine and the location of one of only two National Emerging Infectious Diseases Laboratories. The world-renowned researchers at BMC conduct both basic, laboratory-based biomedical research, and clinical research programs, including the Center for Infectious Disease, the Sickle Cell Center, cardiology, vascular biology, Parkinson’s disease, geriatrics, endocrinology and hematology/oncology.

Boston Medical Center hosts the Grayken Center for Addiction Medicine, which addresses addiction through research, patient care, and training.

VA Boston Healthcare System (VABHS)

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 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 housestaff 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 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 137, 864 visits last year.  Consultations include those from the general medical, surgical/ trauma and obstetrics and gynecology services. 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, each assigned to a busy consultation service. Both services, the Keefer and Finland services, are staffed by the teams that consist of one fellow, an Infectious Disease faculty physician who provides direct supervision, students and medical residents from Boston University, as well as visiting trainees. The Finland service will be staffed by faculty actively involved in HIV care.  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 for each 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  to complete the transplant infectious disease elective rotation at the Massachusetts General Hospital (see below). Fellows on the Infectious Diseases/Addiction Medicine track will complete clinical rotations in addiction medicine during the second year of training.

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 training and research focus is not interrupted.

Inpatient Clinical Electives                                                                        

  • 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.
    • Global Health Clinical Elective
      • Fellows can arrange a Global Health rotation during their second year of training that provides 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. Prior fellows have worked at Mulago Hospital, Makere University, Kampala, Uganda and Hospital Universitario Cassiano Antonio Moraes, Universidade Federal Do Espirito Santo – Maruipe Vitoria, Brazil (proficiency in Portuguese or Spanish is required). Fellows can also explore other sites in Africa, South America and India, where our faculty have active collaborations and colleagues who can function as preceptors.
    • Infectious Disease and Addiction Medicine 
      • Fellows may apply for combined training in Infectious Disease and Addiction Medicine. This innovative program is the first of its kind in the U.S. Fellows in this track have the same first year experience as other trainees but are co-mentored in the ambulatory setting by an Addiction Medicine faculty member. In year two, fellows complete the clinical requirements for Infectious Diseases as well as clinical rotations required for Addiction Medicine certification, and work on a scholarly project that combined both disciplines. Year three is focused on their research project with more limited clinical responsibilities. This program is approved by the American Board of Internal Medicine and the American Board of Preventative Medicine for dual board eligibility.

    Please click here for a description of the Ambulatory Training Experience.