Rotations
Our two-year clinical track is principally organized around inpatient consultation rotations coupled with a weekly outpatient clinic. There are four separate ID consult services spread across our two clinical campuses: General ID (one at the University campus, the other at the Memorial campus), Transplant ID, and a service devoted to patients with HIV and solid-organ tumors. Clinical rotations occur at two locations: The University campus and Memorial campus, each reflecting different services provided within those facilities.
Service time is tailored to individual needs, but in general, first-year fellows have approximately 32 weeks of service time, while second-year fellows have approximately 25 weeks of service time.
University General ID Service
The University General ID service covers all patients referred to the University campus hospital, which is a high-acuity, Level 1 trauma facility that serves as the academic referral hospital for healthcare facilities in central Massachusetts, northern Connecticut and Rhode Island, and southern New Hampshire and Vermont. Cases are often multidisciplinary and complex. In addition to general medical and surgical consults, the Gen ID service commonly provides consultation to patients with complex orthopedic issues, as well as those on the neurologic or psychiatric inpatient services. The University campus has six intensive care units, and the Gen ID service staffs those from the general, neurosurgical, and cardiothoracic surgical ICUs, in addition to the coronary care unit. This is often our busiest service, with a census between 15 and 25 and approximately 5 new consults per day on average.
Transplant Infectious Diseases, University Campus
Our Transplant ID service provides thorough training in all aspects of transplant ID medicine in a multidisciplinary environment. UMass has one of the two largest liver transplant programs in New England; fellows also routinely consult on patients with kidney and bone marrow transplants, as well as patients with “liquid” tumors (ie lymphoma and leukemia). The census is often in excess of 20 patients, with an average of 3-4 consults per day.
Memorial General ID Service
The Memorial campus is a medium-to-high acuity hospital with two Intensive Care units, and houses the Department of OB/GYN. There is one ID consult service for Memorial. The census typically ranges between 15-20 and sees approximately 4 new consults per day.
ICU/HIV Service, University Campus
The ICU/HIV service, which is an elective rotation for fellows, covers patients from the two Medical ICUs at the University, all inpatients with HIV requiring ID consultation, and patients with solid-organ malignancies. The census averages 10-15 patients and sees approximately 3 high-complexity consults per day.
Outpatient Clinic
The Outpatient ID clinic is on the Memorial campus, and fellows attend the clinic one morning each week with a continuity preceptor who serves as their clinical mentor throughout their fellowship. Our clinic serves more than 600 patients with HIV infection and cares for a substantial number of patients requiring outpatient antimicrobial therapy. In addition to these two patient populations, fellows see a large number of outpatient referrals for issues including recurrent infections, fever of unknown origin, non-tuberculous mycobacterial infection, and Lyme disease. Further, we have specialized clinics available staffed by our clinical ID faculty that are available for fellow electives; such clinics include our TB clinic (which sees approximately 800 cases per year, of which approximately 50 have active TB), travel clinic, and patients with viral hepatitis.
Non-Clinical Rotations
In addition to direct clinical care, our fellows receive training in infection control (two weeks per year), antibiotic stewardship (two weeks per year), and laboratory microbiology (three weeks during the first year).
Electives and Research
Fellows may take advantage of multiple clinical electives as part of tailoring their infectious disease training. In the recent past, we have had fellows rotate on the Pediatric ID service, work with the Massachusetts Department of Public Health, and pursue clinical time in specialties that frequently interface with ID (eg wound care, dermatology).
Fellows are expected to work on a research or quality improvement project during the course of their training, with the ultimate goal of communicating those results in a scholarly forum (whether as a poster, oral presentation, or publication). Our faculty have long mentored such projects and have an excellent track record helping fellows achieve their goals.
The “Standard” Day
Our aim is to create an environment that provides work-life balance in a demanding training program. Generally, during inpatient consult rotations, fellows arrive at the hospital between 7:30 and 8:00 and spend the morning rounding and seeing new consults. Attendings join the team in the afternoon with the goal of completing rounds and discussing recommendations with the primary teams by 5:00 to 6:00.
Weeknight and Weekend Call
Call responsibilities are shares by all fellows: fellows are on every 6th weekend on average (between 8 and 9 weekends per year). Weeknight call is approximately once per week and typically consists of occasional evening calls but rarely involves overnight calls. Fellow weekend call is only for the University campus (a separate faculty member covers Memorial).