Infectious Diseases Residency Program

General ID Objectives

Introduction
General Objectives
Specific Objectives

 

Introduction

The specialty of Infectious Diseases concerns itself with human illness caused by microorganisms, other pathogens and with illnesses whose manifestations may be confused with those caused by an infectious agent. These diseases traverse the usual boundaries of organs and systems and thus specialists in Infectious Diseases must be prepared to deal with involvement in any region of the body. Infectious diseases remain the leading cause of morbidity and mortality throughout the world and are important contributors to illness and death in Canada today.

General Objectives

Only candidates certified by the Royal College of Physicians and Surgeons of Canada in Internal Medicine or Pediatrics may be eligible for the Certificate of Special Competence in Infectious Diseases

During the course of training in Infectious Diseases at the Hamilton Health Sciences and St. Joseph’s Hospital in both inpatient and outpatient settings, trainees must acquire clinical competence in the management of infections together with a sound background in the sciences of microbiology, immunology, pharmacology and epidemiology. In order to function effectively as consultants to other disciplines, trainees must also acquire the appropriate microbiology diagnostic skills and a highly developed ability to interpret data originating from the clinical microbiology laboratory, communication skills and attitudes relating to gender, culture and ethnicities. In addition, trainees must acquire expertise in the design and interpretation of research studies, and participate in the education of residents, interns and medical students.

Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Infectious Diseases. In addition, all residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.

On completion of the educational program, the graduate physician will be competent to function as a consultant in Infectious Diseases.

Specific Objectives

At the completion of training, the resident will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-Maker
Communicator
Collaborator
Manager
Health Advocate
Scholar
Professional

 

Medical Expert/Clinical Decision-Maker

As Medical Experts, infectious diseases physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician role in the CanMEDS framework.

Infectious diseases physicians possess a defined body of knowledge and procedural skills which are used to collect and interpret data, make appropriate clinical decisions, and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date, ethical, and cost-effective clinical practice and effective communication in partnership with patients, other health care providers, and the community. The role of medical expert/clinical decision-maker is central to the function of infectious diseases physicians, and draws on the competencies included in the roles of scholar, communicator, health advocate, manager, collaborator, and professional.

Key Competencies

  • Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centred medical care;
  • Establish and maintain clinical knowledge, skills and attitudes appropriate to their practice;
  • Perform a complete and appropriate assessment of a patient;
  • Use preventative and therapeutic interventions effectively;
  • Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic;
  • Seek appropriate consultations from other health professionals, recognizing the limits of their expertise

Enabling Competencies

1. Knowledge

a) Etiology, epidemiology, pathogenesis, natural history, pathology, clinical features, prevention and management of:

  1. acute and chronic infectious diseases;
  2. mycobacterial infections;
  3. sexually transmitted diseases;
  4. infections in immigrants/refugees and travellers;
  5. nosocomial infections;
  6. human immunodeficiency virus (HIV) infection and its complications;
  7. infections in the immunologically compromised host (other than HIV), transplant recipients, congenital immunodeficiency, other acquired deficiencies;
  8. specific to the McMaster Site and St. Joseph’s Hospital infectious diseases in pregnancy and the neonate;
  9. infections in surgical and gynecologic patients;
  10. skin and soft tissue infections: cellulitis, diabetic foot infection, wound infections, pressure ulcers
  11. specific to the General site infections occurring after burns and extensive trauma;
  12. infections occurring as a result of emerging pathogens and bioterrorism;
  13. viral hepatitis.
  14. bacteremia and sepsis
  15. respiratory: community/hospital acquired pneumonia, Tuberculosis
  16. cardiovascular infections: endocarditis
  17. gastrointestinal: gastroenteritis, intra-abdominal sepsis
  18. urinary and genital tract infections
  19. CNS: meningitis/encephalitis
  20. bone and joint
  21. medical device-related infections- lines, prostheses
  22. fungal infections including yeasts, molds, and dimorphics
  23. parasitic infections including protazoa and helminths
  24. spectrum of viral infections seen locally and internationally

b) Principles and practice of infection control to include:

  1. understanding the duties and responsibilities of the infection control practitioner and hospital epidemiologist;
  2. recognition and investigation of outbreaks;
  3. reporting requirements of outbreaks to local public health authorities;
  4. management of sporadic nosocomial infections, including the principles and methods of surveillance;
  5. economic implications of infection control;
  6. principles of prevention and implementation of infectious control interventions, including educational
    strategies;
  7. occupational health;
  8. role of infection control committees in the hospital setting;
  9. surgical chemoprophylaxis;
  10. water and foodborne illnesses in long term care or day care facilities;
  11. respiratory illnesses in long term care or daycare.

c) Clinical and laboratory approach and differential diagnosis of complex problems in which infections may play a role, such as:

  1. fever of unknown origin;
  2. acute rapidly progressive illness perhaps due to sepsis from an undefined site; sepsis, systemic inflammatory response syndrome and multiple organ dysfunction syndrome;
  3. pulmonary infiltrates of uncertain etiology;
  4. post-operative fever;
  5. recurrent/relapsing infections/fever.
  6. Febrile neutropenia

d) The study of microbes to include:

  1. an understanding of epidemiology and ecology, pathology, virulence factors, life cycles, taxonomy, structure/physiology, pathogenesis;
  2. proteinaceous infectious particles.

e) Microbiology and clinical laboratory testing as they relate to the following:

  1. the principles of molecular biology, microbial genetics, microbial physiology, and microbial structure
  2. specimen selecting, collection, transportation and assessment of specimen quality
  3. basic microscopy
  4. test performance and interpretation of results as these relate to the following:
    1. Gram stain
    2. acid-fast bacillus staining
    3. Mantoux testing
    4. rapid diagnostic tests
    5. antimicrobial susceptibility testing
    6. methods for isolation and identification of common organisms
    7. molecular methods for detection of micro-organisms

f) Immunology, including:

  1. details of innate and adoptive immunity
  2. pathogenic mechanisms by which immune responses facilitate or prevent disease
  3. principles and practice of immunization techniques together with
  4. adverse effects and efficacy of immunizing agents
  5. immunological evaluation of patient with recurrent infections

g) Principles and practice of prevention of infection by immunization and chemoprophylaxis. This should include the indications, contraindications, efficacy, effectiveness, and adverse effects of:

  1. passive and active immunization
  2. chemoprophylaxis including surgical perioperative chemoprophylaxis
  3. environmental and behaviour factors

h) Antimicrobial agents and other therapies in infectious diseases:

  1. classification
  2. spectrum of activity
  3. pharmacokinetics and pharmacodynamics in the normal and abnormal host
  4. mechanism of action
  5. mechanism of resistance
  6. toxicity and drug interactions
  7. clinical indications and use
  8. principles of pharmacoeconomics
  9. History of microbiology and infectious diseases with awareness of major changes that have occurred in disease epidemiology and pathogenesis over time.

2. Skills

a) Elicit a history that is relevant, concise, accurate and appropriate to the patient's problem(s), including the relevant epidemiologic and travel history related to particular infectious diseases.

b) Perform a physical examination that is relevant, detailed, appropriate and meets specialty specific standards.

c) Select medically appropriate investigational tools, including microbiologic tests, in a cost-effective, ethical and useful manner.

d) Retrieve and implement the information necessary to provide health care services to patients.

e) Access, retrieve, appraise and apply relevant information of all kinds to problem-solving and introduce new therapeutic options to the clinical practice of infectious diseases.

f) Anticipate short and long term complications of infectious diseases and their treatments.

g) Appropriately deliver patient/family education using the above-mentioned knowledge.

h) Demonstrate insight into his/her own limitations.

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Communicator

As Communicators, infectious diseases physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.

Infectious diseases physicians enable patient-centered therapeutic communication through shared decision-making and effective dynamic interactions with patients, families, caregivers, other professionals, and other important individuals. The competencies of this Role are essential for establishing rapport and trust, formulating a diagnosis, delivering information, striving for mutual understanding, and facilitating a shared plan of care. Poor communication can lead to undesired outcomes, and effective communication is critical for optimal patient outcomes.

Key Competencies

  • Develop rapport, trust and ethical therapeutic relationships with patients and families;
  • Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals;
  • Accurately convey relevant information and explanations to patients and families, colleagues and other professionals;
  • Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care;
  • Convey effective oral and written information about a medical encounter.

Enabling Competencies

a) Demonstrate the skills to impart infectious diseases-related knowledge to patients, colleagues, hospital staff and the general public. They should recognize that being a good communicator is an essential function of a physician, and understand that effective patient-physician communication can foster patient satisfaction and compliance as well as influence the manifestations and outcome of a patient's illness.

b) Establish relationship with the patient that should be characterized by understanding, trust, respect, empathy and confidentiality.

c) Be able to gather information about a particular infectious disease affecting a patient and to obtain information about the patient's beliefs, concerns and expectations about their illness, in a sensitive and caring manner. These should be considered within the context of the influence of age, gender, ethnic, cultural and socio-economic status and spiritual values. Wherever appropriate critical information in the above categories must be communicated to others who are involved in the care of the patient.

d) Be able to succinctly present key information to patients and families in a manner that enables them to be active participants in decision-making related to the infectious diseases affecting them.

e) Be aware of the potential for mixed messages to be delivered to patients and their families, particularly as this relates to choice of diagnostic procedures, antimicrobial agents and duration of antimicrobial therapy. They must communicate with other health professionals in a manner that facilitates the delivery of consistent messages to the patients and their families.

f) Know the basic principles that guide the provision of information to the general public and media about issues of local concern. Such issues may apply (but are not limited to) to natural communicable disease outbreaks, potential threats such as bioterrorism, antimicrobial resistance and inappropriate resource utilization.

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Collaborator

As Collaborators, infectious diseases physicians effectively work within a healthcare team to achieve optimal patient care.

Infectious diseases physicians work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. This is increasingly important in a modern multiprofessional environment, where the goal of patient-centred care is widely shared. Modern healthcare teams not only include a group of professionals working closely together at one site, such as a ward team, but also extended teams with a variety of perspectives and skills, in multiple locations. It is therefore essential for infectious diseases physicians to be able to collaborate effectively with patients, families, and an interprofessional team of expert health professionals for the provision of optimal care, education and scholarship.

Key Competencies

  • Participate effectively and appropriately in an interprofessional healthcare team, including laboratory personnel, infection control practitioners, and public health personnel;
  • Effectively work with other health professionals to prevent, negotiate, and resolve interprofessional conflict.

Enabling Competencies

a) Become familiar with the role and functions of an infectious diseases specialist in the hospital infection control committee and in the pharmacy and therapeutics committee.

b) Be aware of pivotal role of other health care providers in facilitating the activities of infectious diseases specialists. Such individuals include, but are not limited to those performing surgical and radiological diagnostic procedures for microbiological examination.

c) Demonstrate the ability to accept, consider and respect the opinions of other team members.

d) Be able to describe how health care governance influences the delivery of infectious diseases-related care, research and educational activities at a local, provincial, regional, and national level.

e) Be capable of assuming a decisive role while functioning as a member of a multidisciplinary team.

f) Understand the importance of interacting with ID specialists and microbiologists nationally and internationally to recognize variation in local epidemiology of organisms and resistance patterns

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Manager

As Managers, infectious diseases physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.

Infectious diseases physicians interact with their work environment as individuals, as members of teams or groups, and as participants in the health system locally, regionally, nationally and internationally. The need to balance interaction among these four levels is possibly more important for infectious diseases physicians than for any other medical specialty or subspecialty, and is a core requirement for the practice of infectious diseases. Infectious diseases physicians function as Managers in their everyday practice activities involving co-workers, resources and organizational tasks, such as care processes, and policies as well as balancing their personal lives. Thus, physicians require the ability to prioritize, effectively execute tasks collaboratively with colleagues, and make systematic choices when allocating scarce healthcare resources. The CanMEDS Manager Role describes the active engagement of all physicians as integral participants in decision-making in the operation of the healthcare system.

Key Competencies

  • Participate in activities that contribute to the effectiveness of their healthcare organizations and systems;
  • Manage their practice and career effectively;
  • Allocate finite healthcare resources appropriately;
  • Serve in administration and leadership roles, as appropriate.

Enabling Competencies

a) Demonstrate an understanding of the structure; financing and operation of the Canadian heath care system.

b) Demonstrate knowledge of:

  1. infection control to prevent diseases and investigate outbreaks of infectious illnesses in the hospital and community setting;
  2. pharmacotherapy that would enable one to participate in the selection for the hospital formulary of antimicrobial agents and immunization products, with consideration being given to cost-effectiveness of these agents/products;
  3. how to function effectively in the health care organisations at local region and national level;
  4. the different ways of delivering care to patients with a variety of infectious diseases in different settings, including the ability to participate in planning, budgeting and evaluation of special modes of delivering infectious diseases care (e.g., outpatient parenteral antibiotic therapy and directly observed therapy);
  5. practice and time management skills including punctuality, prioritization and triage.

c) Demonstrate the ability to:

  1. access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings, including knowledge of the most cost effective laboratory procedures;
  2. make and defend clinical decisions and judgements based on sound clinical evidence for the benefits of individual patients and the population served;
  3. use information technology as a tool in patient management.

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Health Advocate

As Health Advocates, infectious diseases physicians use their expertise and influence responsibly to advance the health and well-being of individual patients, communities, and populations.

Infectious diseases physicians recognize their duty and ability to improve the overall health of their patients and the society they serve. They identify advocacy activities as important for the individual patient, for populations of patients and for communities. Individual patients need physicians to assist them in navigating the healthcare system and accessing the appropriate health resources in a timely manner. Communities and societies need physicians’ special expertise to identify and collaboratively address broad health issues and the determinants of health. At this level, health advocacy involves efforts to change specific practices or policies on behalf of those served. Framed in this multi-level way, health advocacy is an essential and fundamental component of health promotion. Health advocacy is appropriately expressed both by individual and collective actions of physicians in influencing public health and policy.

Key Competencies

  • Respond to individual patient health needs and issues as part of patient care;
  • Respond to the health needs of the communities that they serve;
  • Identify the determinants of health of the populations that they serve;
  • Promote the health of individual patients, communities and populations.

Enabling Competencies

a) Apply knowledge of epidemiology, etiology and pathogenesis to prevent the development and facilitate the management of infectious diseases. In order to accomplish this, there should be demonstrated understanding of:

  1. determinants of health by identifying the most important determinants of health as these relate to the burden of illness from diseases caused directly or indirectly by micro-organisms;
  2. infectious diseases and public health-related public policy by describing how such policies are developed; identifying current policies that affect health, either positively or negatively, such as childhood immunizations, infection control, and antimicrobial utilization.
  3. the unique and far-reaching impact of antimicrobial choices which not only have implications for the individual patient, but also on the epidemiology of infections in the hospital and community
  4. the need to advocate for the appropriate and judicious use of antimicrobials to minimize the emergence of resistance

b) Have an understanding of the above concepts in order to identify:

  1. biologic, psychosocial, cultural, environmental and economic determinants of health and use this information in a management plan; ensuring that the patient accesses the relevant public health and social services required to manage their particular microbial disease(s). Examples of such diseases include HIV, sexually transmitted diseases, tuberculosis and vaccine-preventable diseases
  2. patient groups that are at risk of infectious diseases and their consequences in order to appropriately target primary and secondary preventive strategies (HIV, sexually transmitted diseases, tuberculosis and vaccine-preventable diseases);
  3. the key issues and opportunities to reduce or minimise the morbidity and mortality from infectious diseases in the community.

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Scholar

As Scholars, infectious diseases physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.

Infectious diseases physicians engage in a lifelong pursuit of mastering their domain of expertise. As learners, they recognize the need to be continually learning and model this for others. Through their scholarly activities, they contribute to the creation, dissemination, application and translation of medical knowledge. As teachers, they facilitate the education of their students, patients, colleagues, and others.

Key Competencies

  • Maintain and enhance professional activities through ongoing learning;
  • Critically evaluate information and its sources, and apply this appropriately to practice decisions;
  • Facilitate the learning of patients, families, students, residents, other health professionals, the public, and others, as appropriate;
  • Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.

Enabling Competencies

1. Clinical

a) Pose a clinical infectious disease question;

b) Recognize and identify gaps in knowledge and expertise around the clinical question;

c) Formulate a plan to fill the gap:

  1. conduct an appropriate literature search based on the clinical question;
  2. assimilate and appraise the literature;
  3. develop a system to store and retrieve relevant literature;
  4. consult others (physicians and other health professionals) in a collegial manner;
  5. Propose a solution to the clinical question;
  6. Implement the solution in practice. Evaluate the outcome and reassess the solution (re-enter the loop at c i) or c ii);
  7. Identify practice areas for research.

2. Research

a) Pose an infectious diseases research question (clinical, basic or population health);

b) Develop a proposal to solve the research question:

  1. conduct an appropriate literature search based on the research question;
  2. identify, consult and collaborate with appropriate content experts to conduct the research;
  3. propose a methodological approach to solve the question;
  4. Carry out the research outlined in the proposal;
  5. Defend and disseminate the results of the research;
  6. Identify areas for further research that flow from the results.

3. Education

a) Show an appreciation of the infectious diseases literature with the ability to critically evaluate it and apply the results thereof.

b) Demonstrate an understanding of preferred learning methods in dealing with students, residents, and colleagues.

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Professional

As Professionals, infectious diseases physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour.

Infectious diseases physicians have a unique societal role as professionals who are dedicated to the health and caring of others. Their work requires the mastery of a complex body of knowledge and skills, as well as the art of medicine. As such, the Professional Role is guided by codes of ethics and a commitment to clinical competence, the embracing of appropriate attitudes and behaviors, integrity, altruism, personal well-being, and to the promotion of the public good within their domain. These commitments form the basis of a social contract between a physician and society. Society, in return, grants physicians the privilege of profession-led regulation with the understanding that they are accountable to those served.

Key Competencies

  • Demonstrate a commitment to their patients, profession, and society through ethical practice;
  • Demonstrate a commitment to their patients, profession, and society through participation in profession-led regulation;
  • Demonstrate a commitment to physician health and sustainable practice.

Enabling Competencies

1. Discipline - Based Objectives:

a) Display attitudes commonly accepted as essential to professionalism;

b) Use appropriate strategies to maintain and advance professional competence;

c) Evaluate continually one's abilities, knowledge and skills and know one's limitations of professional competence and a willingness to call upon others with special expertise wherever appropriate.

2. Personal/Professional Boundary Objectives:

a) Adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships;

b) Strive consciously to balance personal and professional roles and responsibilities and to demonstrate ways of attempting to resolve conflicts and role strain;

c) Demonstrate flexibility and a willingness to adjust to changing circumstances.

3) Objectives Related to Ethics and Professional Bodies:

a) Know and understand the professional, legal and ethical codes to which infectious diseases physicians are bound; these include:

  1. confidentiality issues that are critical to the proper practice of infectious disease (e.g., HIV disclosure);
  2. appropriate conduct when interacting with industry, including the manufacturers and distributors of antimicrobials and diagnostics products.

b) Recognize, analyse and attempt to resolve in clinical practice ethical issues such as honesty, reliability, informed consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation, research ethics, etc.;

c) Understand and be able to apply relevant legislation that relates to the health care system in order to guide one's clinical practice;

d) Recognize, analyse and know how to deal with unprofessional behaviours in clinical practice, taking into account local and provincial regulations.

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