Welcome to the Walter Reed Army Medical Center

Infectious Disease Elective

Overview
Medical students, interns, residents choosing an elective on the Infectious Disease service will learn about the diagnosis and treatment of many infectious diseases both in the inpatient and outpatient setting. Those selecting an ID rotation will generally be assigned to the medical inpatient consult team. In some circumstances, requests to rotate on the surgical inpatient ID consult service will be accommodated. You will also be expected to see patients in the ID clinic under the supervision of clinic attendings. Some guidelines for the rotation follow. Your additional comments are encouraged.
Goals
Decide what you wish to accomplish during the rotation. Define these goals and discuss them with the ID training coordinator during the first few days of the rotation. Your progress will be reviewed at midpoint and the end of the rotation with the consult fellow. In addition, residents taking the elective will perform a mini-CEX during the first week of the elective and during the final week of the elective. This CEX will be assessed by one the the ID staff.

Core Curriculum
Concentrate your learning around each consult patient's problem as well as the core curriculum listed below. Core curriculum lectures will be given on Monday, Wednesday and Thursday mornings and will cover the following topics:

Antibiotics	Fungal Infections	Viral Hepatitis
Antiviral agents	Emerging Pathogens	Tick-borne Infections
Antifungal Agents	Urinary tract Infections	Nosocomial Infections
Meningitis*	Food-borne Illnesses
Tuberculosis*	Travel medicine
Malaria	Septic shock
Endocarditis	Bacteremia
Osteomyelitis	Fever of Unknown Origin
Pneumonia*	Sexually Transmitted Infections

* Will be given every month

In addition, you will receive a packet of articles which represent a broad spectrum of the "classic" articles in Infectious Diseases.

Consultations
- Your maximal benefit from the rotation comes from evaluating selected patients and discussing them with your consult team. This requires your knowledge of all data pertinent to the case. Presentations should include history, physical examination, laboratory and imaging data and review of all available existing records (to include telephone contact with referring hospitals/microbiology laboratories if needed).
- You should gather and synthesize this data before presenting it to the fellow. We request that you form your own opinion regarding the differential diagnosis, the proposed evaluation and therapy.
- Expect to discuss each consultation TWICE; first with the consult fellow and later during consult rounds with the attending physician.
- You will be asked to provide consultative follow-up in concert with the ID fellow on most cases. Daily progress notes are required on each patient followed by the resident.
Reading
After seeing your new consult, read about the pertinent clinical problems in standard infectious disease textbooks. Superior performance would include using Grateful Med literature search to seek out and review primary source information (journal articles, clinical trials) pertinent to the cases seen.
Interpretation of the Gram's stain
You should develop and demonstrate familiarity and proficiency in the interpretation and performance of the Gram's stain technique.
Clinic
You will be assigned outpatient ID clinic two 1/2 days per week to work with an ID attending preceptor. You will see selected clinic patients and discuss them with the attending. You will be able to schedule your own clinic patients who have issues related to ID into these slots should you so desire. In addition, one 1/2 day per month, you will be assigned to work in the tuberculosis clinic. Depending on clinic workload, the opportunity to participate in 1/2 day per month travel clinic (pretravel consultation) will be available.
Conferences
The Infectious Disease service weekly conferences are:
Tuesday 0730 - Pathogenesis and clinical questions lectures
Friday 1300 - Journal club
Friday 0730 - Case management conference
Monday, Wednesday, Thursday 0700-Core curriculum lectures
Greater Washington Infectious Disease Society Meeting 1930-Meets the last
Monday of each month at NIH (this is an elective meeting)

You are also expected to attend the Department of Medicine morning report, management conference, grand rounds and resident conferences.

Resident Specific Information

Teaching Objectives: Upon completion of this rotation, each resident will be expected to be able to:
1. Perform a detailed infectious disease history
2. Perform a physical examination with ID emphasis
3. Collect and interpret pertinent laboratory data. Suggest appropriate follow up/further investigation for laboratory abnormalities.
4. Perform and interpret Gram’s stains correctly.
5. Develop and orderly approach to the use of antimicrobial agents.
6. Form a priority ranked problem list.
7. Formulate a 3-5 item differential diagnosis, in order of likelihood and be able to justify the diagnostic possibilities.
8. Plan an organized evaluation of case abnormalities and justify proposed testing to include risk benefit and cost containment issues.
9. Support treatment plans for the 3-4 most likely differential diagnosis possibilities.
10. Present the case concisely and accurately using the above objectives.
11. Read and learn about each patient’s infectious disease problems.
12. Learn and demonstrate increased knowledge about common ID problems as listed in the core curriculum.
Performance Standards: To attain above objectives the resident will:
1. Perform full patient evaluations to include history, physical examinations, collect laboratory and imaging data on at least two new patients per week.
2. Identify at least one journal article/week pertinent to the case evaluated a and provide copies to the consult team.
Evaluation:
1. Using standard WRAMC Department of Medicine forms, evaluation will be performed by the fellow and the consult service attending, as well as by the clinic attendings. The clinic chief will review the evaluations and prepare a written evaluation.
2. Self evaluation is facilitated by providing several sets of past internal medicine MKSAP ID questions at the beginning of the rotation and making available opportunities to review these questions during the rotation.
Educational Resources:
1. The ID consult fellow room has a library of standard reference texts which may be used.
2. Grateful Med service is available on the computer in the fellows’ room
3. Many ID topic videotapes are available for review during the rotation.
4. A packet of articles representing a broad spectrum of the "classic" articles in Infectious Diseases will be provided.

Intern Specific Information

Teaching Objectives: Upon completion of this rotation, each resident will be expected to be able to:
1. Perform a detailed infectious disease history
2. Perform a physical examination with ID emphasis
3. Collect and interpret pertinent laboratory data. Suggest appropriate
  - follow up/further investigation for laboratory abnormalities.
4. Perform and interpret Gram's stains correctly.
5. Develop and orderly approach to the use of antimicrobial agents.
6. Form a priority ranked problem list.
7. Formulate a 3-5 item differential diagnosis, in order of likelihood and be able to justify the diagnostic possibilities.
8. Plan an organized evaluation of case abnormalities and justify proposed testing to include risk benefit and cost containment issues.
9. Support treatment plans for the 3-4 most likely differential diagnosis possibilities.
10. Present the case concisely and accurately using the above objectives.
11. Read and learn about each patient's infectious disease problems.
12. Learn and demonstrate increased knowledge about common ID problems as listed in the core curriculum.
Performance Standards: To attain above objectives the resident will:
1. Perform full patient evaluations to include history, physical examinations, collect laboratory and imaging data on at least two new patients per week.
2. Identify at least one journal article/week pertinent to the case evaluated and provide copies to the consult team.
Evaluation:
1. Using standard WRAMC Department of Medicine forms, evaluation will be performed by the fellow and the consult service attending, as well as by the clinic attendings. The clinic chief will review the evaluations and prepare a written evaluation.
2. Self evaluation is facilitated by providing several sets of past internal medicine MKSAP ID questions at the beginning of the rotation and making available opportunities to review these questions during the rotation.
Educational Resources:
1. The ID consult fellow room has a library of standard reference texts which may be used.
2. Grateful Med service is available on the computer in the fellows' room
3. Many ID topic videotapes are available for review during the rotation.
4. A packet of articles representing a broad spectrum of the "classic" articles in Infectious Diseases will be provided.