The fellowship is a 2-year program. Of the 2 years training, 6 months is for training in research and antimicrobial stewardship while the remaining is clinical. Clinical training includes training in the diagnosis and management of infections among hospitalized patients and in the ambulatory clinics. Patient advocacy, teamwork and professionalism are emphasized as part of bed side rounds. Fellows also get an opportunity to be involved in teaching the house staff and medical students, as well as work closely with infectious disease pharmacy staff and residents.
The fellows lead and run the Infectious Diseases consultation service team with a team of house staff in close coordination with a supervising faculty member. Throughout the clinical training, fellows learn management of patients admitted to various services such as critical care, burn, surgery, medicine, oncology, orthopedics, obstetrics, and gynecology. In addition, fellows participate in ambulatory care with 1 dedicated half day clinic for HIV patients and another clinic for general infectious diseases and coccidioidomycosis.
Central California is endemic in Valley Fever or Coccidioidomycosis. Fellows get advanced training in the management of Valley Fever, both in inpatient and ambulatory settings. In addition, fellows have opportunity to take part in Valley Fever research as well as participate in Coccidioidomycosis Study Group Annual Meetings and present in their conferences.
Fellows get robust training in the care of immunocompromised patients such as HIV/AIDS and cancer patients. The infectious disease fellow’s continuity clinics is located in the Special Services clinic in the Family Healthcare Network Ambulatory Care Center. Special Services is a Ryan White grant funded clinic where comprehensive health care is provided to people living with HIV (PLWH). The clinic utilizes a patient centered medical home consisting of Social Workers, RN Case Managers, Psychiatry, Dietician, fellows and physicians. The clinic is one of the largest in central California providing HIV care and currently care fort more than 1500 patients which include women, children, infants, youth and adults. Fellows are provided with their own panel of patients that they can provide longitudinal care over the period of their fellowship training. In addition, fellows get vast experiences for other immunocompromised hosts such as cancer patients on chemotherapy in the inpatient setting.
Fellows have opportunities to participate in diverse research and quality improvement projects under the supervision of faculty members. They have protected time during their first and second year of training as research blocks. Our fellows present in various regional and national meetings and have published multiple case reports, book chapters, reviews, and research papers in collaboration with faculty. Fellows are encouraged to take part in scholarly activities such as publications, presentations in department, local, regional, and national meetings.
CMC’s Antimicrobial Stewardship Program (ASP) has been designated as a center for excellence by IDSA. As active members of the ASP team with designated ASP rotations/blocks, fellows review patients identified through the ASP module embedded in the electronic medical record to provide prospective feedback and interventions to providers to optimize antimicrobial therapy. Interventions include antimicrobial de-escalation, intravenous to enteral conversion, bug-drug mismatch, antimicrobial dose adjustment and laboratory monitoring. Fellows become members of the Antibiotic Subcommittee, a multidisciplinary subcommittee of the Pharmacy & Therapeutics Committee that oversees the ASP, to learn about the core elements of antimicrobial stewardship. Fellows work closely ID pharmacy team and are involved in ASP- related performance improvement and quality assurance projects. These learning experiences will train fellows for leadership roles in antimicrobial stewardship, which are unique to ID practitioners.
CMC’s robust Infection Prevention Department focuses on preventing healthcare-associated infections, including CAUTI, CLABSI, and surgical site infections, emerging infectious disease preparedness and response, multi-drug resistant organism surveillance and providing infection prevention education to healthcare workers, among many other initiatives. The department provides fellows the opportunity to participate in multi-disciplinary committees addressing healthcare-associated infections, collaborate with infection preventionists on quality improvement projects, and play a role in developing hospital policies, protocols, and best practices. Fellows also complete IDSA’s Primer on Healthcare Epidemiology, Infection Control & Antimicrobial Stewardship.
The Department of Microbiology at CMC is one of the largest in Central California providing services to a majority of the communities’ medical facilities. State-of-the-art technology including MALDI-TOF, advanced susceptibility capabilities along with multiple PCR platforms are used to provide thorough and rapid results. The microbiology department works closely with the ID fellows and ID physicians. During the first month of fellowship, all fellows’ complete introductory courses in Microbiology, provided through IDSA/CDC. The microbiology department provides an in person introductory course to the fellows in the beginning of their fellowship. Monthly plate rounds conducted by the microbiology staff at the bench-side is well appreciated by all fellows and faculty.