Infectious Disease

Description of Responsibilities

Acceptance into the Virginia Tech Carilion Infectious Diseases Fellowship Program requires eligibility to take or having passed the certifying examination in Internal Medicine given by the American Board of Medicine or by the American Osteopathic Association. It is expected that Fellows will become Board Certified both in Internal Medicine and Infectious Diseases before or after completion of their subspecialty training.

After acceptance into the training program, Fellows will have the following responsibilities:

  • Provision of inpatient consultations for suspected Infectious Diseases in the various medical and surgical disciplines, including some pediatric and geriatric experience, at the Carilion Roanoke Memorial Hospital, Carilion Roanoke Community Hospital and the Veterans Affairs Medical Center in Salem, Virginia
  • Provision of ambulatory Infectious Diseases care and consultation, to include a one half-day per week infectious diseases continuity and consultative clinic, with a panel of HIV-1 infected continuity care patients. There will also be ambulatory experience with a sexually transmissible disease clinic and a travel clinic. New patients for the continuity clinic are not pre-selected by disease type, but consist of a mix of HIV-1 infected continuity patients, home health care patients, patients with sexually transmitted diseases, and patients with general infectious diseases problems. Fellows are assigned new patients and expected to follow these patients during the entire training period. Additionally, fellows will follow patients whom they have seen as inpatients while on the Infectious Diseases consult service. Examples of patients for ambulatory clinic may include but are not limited to patients with osteomyelitis, septic arthritis, infective endocarditis and post surgical infections, among others. The program will assure that there is a gender balance among these patients.
  • Rotation in the Microbiology laboratory, inclusion on the Infection Control Committee and involvement in the ongoing program of antibiotic stewardship. The detail of these responsibilities follow.
  • Attendance and participation by each fellow in the weekly clinical case conference and the weekly core curriculum didactic conference, the monthly research conference and journal club. In addition, attendance at the weekly Internal Medicine Grand Rounds is recommended.
  • Proficiency at procedures commonly utilized as part of the evaluation of patients with Infectious Diseases problems. Infectious Diseases consultants rarely do procedures and, when performed, these are procedures for which the trainee is already certified after completion residency training in Internal Medicine. Occasionally trainees may do lumbar punctures, skin biopsies, or aspiration of abscesses; in these procedures the trainee should be competent and certified. Trainees are expected to review Gram stains, histopathology of biopsy specimens, cytology, and pertinent radiographs of the patients whom they are managing or for whom they are providing consultation. Fellows are expected to follow the department’s procedure protocols in performing these procedures (see attached protocols).
  • Availability for call from home with a faculty member serving as a back up. Fellow trainees and faculty are expected to respond to pages within 15 minutes, unless exceptional circumstances prevail. All trainees have at least one day in seven (on average) free from clinical duties and without pager call.
  • Participation in research is expected for each trainee. The Infectious Disease Section expects preparation of at least one manuscript suitable for publication, submission of at least one abstract to a regional, national, or international meeting prior to completion of the two-year training period. Each fellow will have up to 6 months protected time (or more if needed) throughout the two year training period intended for research and scholarly activity. The long term goal of the Fellowship Program is for most fellows to be so involved with scholarly / research pursuits that they will remain in the Program for a third year of dedicated research effort.
  • Effective communication regarding patient care between faculty and fellows is essential. When complex decisions are addressed, fellows are required to contact faculty in person or by phone. Faculty supervision occurs continuously. At least during the initial half of the first year of training, fellows must review all changes in therapy or recommendations for invasive procedures with the faculty attending prior to making the recommendation to another physician. By the second year of fellowship, assuming that the trainee has made satisfactory progress, fellows are given graduated levels of responsibility enabling them to make recommendations if he/she is comfortable and confident in the recommendation. Despite this graduated responsibility, fellow recommendations must be reviewed with the supervising faculty member within 24-hours. Trainees are encouraged to contact the attending physician at any time, day or night. This type of supervision applies to inpatient and outpatient care, home health care management, phone calls from outside physicians or family members. Direct or indirect supervision by a faculty member is expected for all procedures.