Outpatient Rotations

Goals: To introduce the Fellow to the management of infectious diseases in the outpatient setting.

A large part of this experience will be the HIV/AIDS continuity of care clinic. The first year Fellow will receive the HIV (+) patients from the fellow completing his/her training and all new HIV (+) patients during the first year. The Fellow will follow these patients throughout the two years of training.

All levels of care including specialty and primary care are provided. The management of patients with general ID problems will also be taught to the first and second year Fellows. Issues include medical care, psychosocial assessment, drug and alcohol abuse,end of life care, medical insurance issues and patient-physician relationships.

Objectives: Care of the patient with HIV/AIDS

  • immune evaluation
  • recognition and management of opportunistic infections
  • prophylactic agents, vaccinations
  • antiretroviral therapy and monitoring; viral loads, genotypes, phenotypes
  • sexually transmitted disease
  • drug adherence
  • psychosocial, alcohol and substance abuse assessment
  • hospice care
  • family support, confidentiality
  • pain management
  • management of substance abuse

Outpatient management of:

  • the patient with FUO
  • the febrile patient with immune compromise
  • infections in the injection drug user
  • the ill-returning international traveler
  • the patient needing home intravenous antibiotic therapy
  • assessment and treatment of the patient with:
    • sexually transmitted diseases
    • pneumonia, bronchitis
    • upper respiratory infection
    • urinary tract infections
    • acute and chronic diarrhea
    • viral hepatitis
    • osteomyelitis and septic arthritis
    • endocarditis
    • cellulitis
    • infectious diarrhea and parasites
    • lyme disease
    • line infections
    • fever and rash
    • parasities
    • mycobacteria infection
      • M.Tb
      • Atypical AFB
    • other viral infections
      • HSV, CMV, HPV

Antimicrobial agents:

  • adverse reactions
  • drug monitoring
  • appropriate use and cost containment
  • home intravenous antibiotic management

Chemoprophylaxis, immune prophylaxis, cytokines, colony stimulating factors, monoclonal antibodies

Teaching environment: An ID attending is present throughout clinic. Each patient is reviewed with the attending and history and physical examination confirmed at the bedside. Assessment, plans and dictated note are reviewed. The fellow will also interact with the clinic nurse practitioner, social worker and regional AIDS service organization.

  • Monthly conferences. See below
  • Monthly lectures. See below

Mix of diseases: As above

Patient characteristics and types of clinical encounters, procedures and services:

  • Patients of all socioeconomic strata and ethnic mix.
  • Lumbar puncture and Gram stain

Reading list:

  • Mandell's text according to disease encountered
  • Journal club
  • Case conference
  • Medical Management of HIV Infection by John Bartlett and Joel Gallant

Pathological material: Gram stain and cultures

Evaluation: Immediate feedback on each patient presentation. Written evaluation by the ID attendings on service. The Fellow will also provide written evaluations of the rotation to the fellowship director.