Infectious Diseases Residency Program
Objectives for Internal Medicine Residents on ID
I. IntroductionII. Structure of the Rotation – Weekly Schedule
III. Knowledge Guidelines for Internal Medicine Residents
IV. On-call Schedule
V. Evaluation
VI. Communications & Important Attending Information
I. Introduction
The Infectious Diseases rotations at the Hamilton Henderson and General sites, focuses on familiarizing the Internal Medicine resident with various aspects of this subspecialty. This rotation is comprised of an educational component and a service component centered primarily on inpatient consultation services. Additionally, residents are encouraged to attend at least one half-day outpatient clinic a week.
The main sources of consultations at the Henderson Site include General Internal Medicine patients, patients with nosocomial infections (particularly in the ICU), orthopedic infections, infections in surgical patients and infections in immunocompromised hosts with malignancies. The main sources of consultations at the General Site are the General Internal Medicine Clinical Teaching Unit, patients with nosocomial infections in the ICU setting, and surgical infections in patients from general surgery, neurosurgery, plastics, orthopedics, and cardiovascular surgery.
Residents are expected to gain familiarity with various microbiologic diagnostic techniques employed in the clinical microbiology laboratory. Expertise in obtaining appropriate specimens, interpreting serology and culture results, and understanding antibiotic susceptibility testing are key components of the clinical microbiology experience.
The medical resident’s learning experience is supplemented through daily attending rounds, literature reviews and conferences. The objectives for the rotation are outlined below.
II. Structure of the Rotation – Weekly Schedule
Most mornings will be dedicated to patient follow-up and performing new consultations. At the General site, residents may visit the clinical microbiology laboratory to obtain pertinent microbiology information. Most afternoons will be occupied by attending rounds, reviewing new consults and follow-ups.
Residents are encouraged to attend outpatient Infectious Diseases clinics. Opportunities to do so should be discussed with your infectious diseases attending at the beginning of the rotation, as arrangements may need to be made with another specialist.
Paperwork
Residents are responsible for dictating all inpatient and outpatient consultations, as well as outpatient encounters. It is expected that residents will periodically complete appropriate inpatient progress notes. Outpatient parenteral antibiotic therapy documentation should be completed as part of the discharge.
Teaching rounds
Regional Infectious Diseases – these take place on Wednesday mornings from 8:00-9:00 at St. Joseph’s hospital in Classroom B on the 2nd floor of the new tower. Residents rotating through ID are encouraged and expected to attend.
Medical Grand Rounds – these take place Fridays at 8:00 a.m and alternate between the Henderson and General campuses. Details on weekly topics can be found at http://www.fhs.mcmaster.ca/medicine/frameset_dom.htm
Microbiology Laboratory orientation - a monthly session will be arranged. This will usually take place on the 2nd Tuesday of the month at the Hamilton General (located on the 1st floor – same level as cafeteria). Details will be sent to your attending. Attendance is expected from trainees rotating through ID from all sites.
III. Knowledge Guidelines for Internal Medicine Residents
The specialty of Infectious Diseases concerns itself with human illness due to microorganisms. These diseases traverse the usual boundaries of organs and systems, and cross all specialties. During this rotation, the resident will develop a better understanding of the diagnosis, management, and prognosis of infections, along with the rudiments of epidemiology, microbiology, immunology, pharmacology and infection control. The resident will also learn to interpret data originating from the clinical microbiology laboratory.
The resident will demonstrate sufficient medical knowledge and clinical acumen to formulate an appropriate differential diagnosis in Infectious Diseases and prepare a plan of investigation and management. The medical resident should demonstrate the ability to act as a consulting internist.
Medical Expert
Scholar
Manager
Communicator & Collaborator
Professional & Health
Advocate
The medical resident will demonstrate the ability to describe the etiology, epidemiology, pathophysiology, clinical features, relevant laboratory knowledge, and the therapeutic options for major infectious disease entities. This will include disease entities that are caused by bacteria, fungi, viruses, protozoa and helminths. The medical resident should develop and demonstrate competence in the following:
- Pathophysiology, diagnosis and management of acute and chronic infections including (but not limited to):
- Respiratory – community/hospital acquired pneumonia
- Bacteremia & sepsis
- Skin & Soft tissue – cellulitis, diabetic foot infections, wound infections, pressure ulcers
- Cardiovascular – endocarditis
- Gastrointestinal – gastroenteritis, intra-abdominal sepsis, hepatitis
- Urinary tract infections
- CNS – meningitis/encephalitis
- Bone & Joint
- Medical device-related infections – lines, prosthese
- An approach to:
- Post-operative & undifferentiated fever
- Leukocytosis
- Enhanced knowledge of the microbiology of common infectious diseases and how this influences empiric antimicrobial choices
- An understanding of the basic antimicrobial pharmacology including their mechanisms of action & resistance, indications and adverse reactions and demonstrate an ability to utilize them appropriately
- Understand the basic principles of infection control with emphasis on practices to reduce nosocomial transmission and understand when to suspect resistant organisms
- Site specific:
- Henderson
- Prosthetic joint infections and extrapolate this knowledge to management of other hardware/medical device related infections
- Infections in the immunocompromised – especially those with hematological and solid organ malignancies, febrile neutropenics (and understand how and why the microbiology in such circumstances differs)
- General
- Complicated CNS infections in neurosurgical patients (including brain/epidural abscesses) & post-operative infections in cardiovascular surgery patients
- Understand the unique microbiology and challenges of treating infections in the IVDU population
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- Residents should demonstrate a knowledge base that is consistent with a review of the current medical literature on a particular Infectious Diseases topic & the capability to review and analyze current literature and apply the information gained in therapeutic encounters
- Attend weekly ID rounds
- Provide brief, informal presentations on a pre-chosen infectious diseases topic to the ID team
- Residents will demonstrate timeliness in completing assignments & performing consultations (which should typically be completed and reviewed on the day received)
- Residents will demonstrate the ability to prioritize and perform necessary follow-up
- Residents should understand how the microbiology laboratory can be optimally utilized to provide patient care in a cost effective manner
- Residents will develop an understanding of when additional information is required by the microbiology laboratory to ensure appropriate specimen collection/processing and data interpretation
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- Residents will demonstrate the ability to effectively provide verbal & written communication as a consultant to the consulting team as it pertains to diagnostic & therapeutic recommendations
- Residents will ensure patients have a understanding of their illness and the proposed diagnostic and/or treatment plan
- Residents will collaborate with other specialists to discuss/arrange non-antimicrobial related interventions important in a patient’s care (eg. debridement/wound care/line placement & removal etc)
- Learn to arrange appropriate discharge follow-up and home care services for ID-related issues and understand the vital role, and appropriate management, of home parental antibiotics
Professional & Health Adovcate:
- Residents will demonstrate appropriate non-judgmental behaviour when dealing with patients/peers
- Residents will demonstrate an understanding of the determinants of health pertaining to infectious diseases (eg. socioeconomic status, IVDU, sexual health, travel & immigration)
- Residents should display an appreciation of the societal impact/public health implications of infectious diseases due to the potential for transmission (nosocomially & in the community) & understand how this may play a role in treatment decisions of individuals
IV. On-call Schedule
Due to the fact that during the Infectious Diseases rotation at both the Henderson and General sites Internal Medicine residents must take general medicine call, there will be no call responsibility in Infectious Diseases.
V. Evaluation
Evaluations should be done on an ongoing basis and residents should ensure they receive and provide verbal mid-rotation feedback to discuss strengths & weaknesses and ensure objectives are being met. At the end of the rotation, a written evaluation will be completed by the attending, with whom the resident spent the majority of their rotation. It is also expected that the residents will complete evaluations on all attendings with whom they have worked.
VI. Communications & Important Attending Information
| Dr. Lionel Mandell Henderson Site Hamilton Health Sciences 711 Concession St. Hamilton, ON L8V 1C3 Phone: 905-574-8520 or 905-527-4322 , ext 42467 Pager: 2437 |
Dr. Nishma Singhal Henderson Site Hamilton Health Sciences 711 Concession St. Hamilton, ON L8V 1C3 Phone: 905-527-4322 ext 43952 Pager: 3020 |
| Dr. Mark Loeb McMaster University Medical Center 1200 Main Street West, ON Phone: 905-521-2100, ext. 42065 Pager: 905-777-6131 |
Dr. Atreyi Mukherji General Site, Hamilton Health Sciences 237 Barton St. E. Hamilton, ON L8V 1C3 Phone: 905-527-4322 ext 46373 Pager: 2361 |
| Dr. Cheryl Main General Site Hamilton Health Sciences 237 Barton St. E. Hamilton, ON L8L 2X2 Phone: 905-527-4322 ext. 46182 Pager: 905-540-0621 |
Dr. Debbie Yamamura General Site Hamilton Health Sciences 237 Barton St. E. Hamilton, ON L8L 2X2 Phone: 905-527-4322 ext. 46197 Pager: 416-713-4779 |
Resources & References
Texts:
- Harrison’s Principles of Internal Medicine
- Principles and Practice of Infectious Diseases, Mandell, Douglas and Bennett’s
- Handbook of Antibiotics, Third Edition. Reese RE.
- Medical Management of HIV Infection, Bartlett and Gallant
- Clinical Microbiology Made Ridiculously Simple, Gladwin M, Trattler B
- The Sanford Guide to Antimicrobial Therapy
- Redbook – American Academy of Pediatrics
Websites:
