Curriculum - Infectious Diseases Fellowship Program

Children’s Hospital & Research Center Oakland’s Infectious Diseases (ID) fellowship program adheres to the criterion of the American Board of Pediatrics for board certification and the American Council of Graduate Medical Education for training in pediatric subspecialties. The program includes an additional core training curriculum which is essential to the clinical practice of Pediatric Infectious Diseases.

Infectious Disease Fellowship training includes:

• Clinical Care (direct and consultative)
  
• Didactic Core Curriculum (on related topics and in basic sciences)
  
• Continuing Care (responsibility for the continuing care of patients with acute and chronic infectious diseases, tuberculosis, diseases of host defense and HIV/AIDS, among many others)
  
• Medical Research

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First Year Fellows: The Clinical Year

During this first year of training, Infectious Disease fellows will primarily develop their clinical expertise. Fellows will evaluate and manage both inpatients and outpatients with complex infectious disease problems under the supervision of an ID attending physician. Fellows will be assigned rotations with primarily inpatient or outpatient duties on a monthly basis, but may be asked to assist in other areas based on educational opportunities that arise and/or resource needs.

Year 1: Clinical Training	Approximately 12 months
Inpatient Infectious Disease Consultations	8 Months (in 1 Month Blocks)
Infectious Disease Clinic/Continuity Clinic	Ongoing
Outpatient Infectious Disease Consultations	2 Months (in One-Month Blocks)
Pediatric Dermatology Clinic (Once Weekly)	1 - One-Month Block (with Immunology)
Pediatric Immunology Clinic (Once Weekly)	1 - One-Month Block (with Dermatology)
Telephone Consultations	Ongoing
Research Time	1 Month (with an Outpatient Block)
Call	Alternate Weekends (Average 1.5 Days Per Week) & Half the Holidays

After the first month of training, the pace of teaching accelerates aggressively for first year fellows . All attending physicians participate in presenting a structured, didactic educational program (a “mini-intensive”) that covers, in detail, many of the basic topics in infectious diseases including:

• Antimicrobials
• Antimicrobical Stewardship
• Pharmacokinetics
• Pharmacodynamics
• Basic Identification of Bacteria
• Normal Flora
• Introduction to HIV/AIDS
• Introduction to Tuberculosis

Also there are educational programs throughout the year including journal clubs, fellows’ conferences, case reviews, resident presentations, and quarterly attending forums, among others. Infection control issues are discussed regularly at both monthly meetings and during teaching and attending rounds.

During the first year of the program, each fellow begins to develop a research hypothesis. They will choose and start working with a research mentor. This research project is the focus of the educational experience in the second and third years of the fellowship. The development and timing of this project varies considerably, but is a critical part of the training program.

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Second and Third Year Fellows

Research Responsibilities (Year 2 & 3):
Early during the second year of training, ID fellows will attend the Training in Clinical Research (TICR) Workshop offered at the University of California, San Francisco. This program provides an introduction to the world of clinical research, including courses in design of, responsible conduct of, and career building in clinical research.

During their second or third year, fellows have the opportunity to participate in the Virology Laboratory basic course taught at the California Department of Public Health’s Viral and Rickettsial Diseases Laboratory. This course helps to train local public health laboratory and other medical personnel in state-of-the-art standardized laboratory procedures required for the diagnosis, investigation, and control of viral diseases.

During the second and third years of training, ID fellows will devote the majority of their time to fostering their skills in scholarly research. They will create and execute a research project under the guidance of a research mentor. Projects may range from clinical to basic science studies. Research opportunities include:

• Basic Science
  
• Clinical Projects
  
• Translational Research

Fellows are encouraged to participate in research at Children’s Hospital Oakland Research Institute (CHORI), which ranks 5th in the nation for National Institutes of Health pediatric research funding and has 6 different Centers of Research devoted to pediatric research. Opportunities exist for research fellows to participate in any of the centers with senior scientists providing direct mentorship, especially in the Center for Immunobiology and Vaccine Development (CIVD).

Our fellows are currently or have in the past conducted research projects at:

• CHORI
• University of California, Berkeley;
• University of California, San Francisco
• Viral & Rickettsial Disease Laboratory of the California Department of Health Services
• Centers for Disease Control & Prevention

—as well as in collaboration with private industry.

Clinical Responsibilities (Year 2 & 3):
Although second and third year fellows' primary focus is scholarly research, they continue to participate in clinical duties to further refine their clinical skills. Clinical duties during these two training years include approximately one to two months of clinical service and one weekend on-call, every four weeks.

• Inpatient Infectious Diseases Consultations   • Continuity Clinic    • Call

1-2 Months Per Year Twice Monthly (Approximately) 1 Weekend Per 4 Weeks (Average)

Summary of Fellowship Years 2 & 3:

Scholarly Research	Approximately 20-22 mos combined
Training in Clinical Research Workshop	Including 6 Weeks (Approx. ½ Time)
Virology Laboratory Basics Course	Including 4 Weeks (Approx. ½ Time)
Ongoing Clinical Training	Approximately 4 Months (total)
HIV/AIDS Clinic (2-3 x Weekly)	1-2 - One-Month Block (With TB)
Tuberculosis Clinic (1 x Weekly)	1-2 - One-Month Block (With HIV)
Teaching Curriculum	6-8 Week Course (2 Hours Per Week)

Specific Clinical and Teaching Experience (Year 3):
Toward the end of the academic year, third year fellows serve four to eight weeks on inpatient service as junior attending. They have full responsibility for the patients on the ID service, in addition to new consultations. At all times, fellows have back-up and supervision from attendings. This service reinforces the clinical experience and development of skills necessary for transition to independence in the clinical management of complex infectious disease patients.During this rotation, billing and coding skills will be reviewed and reinforced.

Fellows are encouraged to participate in national and international conferences, especially the St. Jude’s Conference and the Infectious Diseases Society of America’s conference, particularly for the Fellows’ Day Conferences. When possible, fellows are encouraged to submit scholarly work and participate in these and other national and international academic meetings pertinent to pediatric infectious diseases.

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