Training infectious diseases fellows for a new era of hospital epidemiology

Training programs for infectious diseases fellows pursuing a career in infection prevention and control and hospital epidemiology are grounded in mentorship and organizational experience. In this commentary, we propose a competency-based framework for creating structured learning for infectious diseases fellows pursuing hospital epidemiology and related fields.

The effect of rapid diagnostic testing with Infectious Diseases fellow consultative intervention on the management of enterococcal bloodstream infection

BACKGROUND

Rapid diagnostics for enterococcal bloodstream infections (E-BSIs) can decrease the time to speciation and determination of vancomycin resistance but may not lead to improved antibiotic stewardship.

METHODS

Over 3 years, the time to administration of institutionally preferred antibiotics (IPT) for patients with E-BSI was evaluated and compared between 3 intervention groups: before (baseline) and after implementation of a rapid diagnostic (BC-GP), and the use of BC-GP with an Infectious Diseases (ID) fellow-driven consultative intervention (BC-GP + ID).

RESULTS

A total of 110 patients (63 baseline, 13 BC-GP, 34 BC-GP + ID) with E-BSI were evaluated. Evaluation of Enterococcus faecium BSI showed that the time IPT was significantly reduced with BC-GP + ID by 10.6 h from baseline (P = 0.02) and 5.4 h from BC-GP (P = 0.04).

CONCLUSIONS

An ID fellow-driven stewardship intervention was associated with a significant improvement in time to IPT for patients with E. faecium but not E. faecalis BSI.

Healthcare epidemiology practicum rotation for postgraduate physician trainees in medicine-infectious diseases

Practicum education in healthcare epidemiology and infection control (HEIC) for postgraduate physician trainees in infectious diseases is necessary to prepare them to be future participants and leaders in patient safety. Voss et al suggested that training in HEIC should be offered as a “common trunk” for physicians being trained in clinical microbiology or infectious diseases. A 1-month rotation has been recommended previously. A survey by Joiner et al indicated that only 50% of infectious diseases fellows found the infection control training adequate. The objective of this article is to report our 2-year experience with a 1-month practicum rotation we designed and implemented at our institution.

The setting is the Adult Infectious Diseases fellowship program at the University of Texas Southwestern Medical Center (UTSW), Dallas, Texas. The fellows have clinical rotations at the Parkland Health and Hospital System, UTSW University hospitals, North Texas Veterans Affairs Health Care System, and Children's Medical Center Dallas. The 2-year program recruits 7 fellows every 2 years. The 1-month core rotation was established in July 2011 and is ongoing. Fellows who completed the rotation during the period July 2011 to April 2013 are included in this study.