I. POLICIES AND PROCEDURES........................................................................................ 1A. Prerequisites.................................................................................................................. 1B. Fellowship Selection Process.........................................................................................1C. Duration of Program...................................................................................................... 1D. Duties............................................................................................................................ 1E. Call Schedule................................................................................................................. 2F. Compensation................................................................................................................ 2G. Moonlighting Policy....................................................................................................... 2H. Work Hours Policy......................................................................................................... 3I. Malpractice Insurance…………………………………………………………………....3 J. Curriculum..................................................................................................................... 4K. Self Instruction.............................................................................................................. 4L. Documentation of Training............................................................................................ 4M. Conduct......................................................................................................................... 4N. Policy on Professionalism and Learning Environment...................................................5

Process for implementing Professionalism Policy......................................................6Monitoring Implementation of the Policy on Professionalism....................................6

O. Policy on Effective Transitions 6

P. Policy on Alertness Management / Fatigue Mitigation Strategies.................................8Q. Supervision and Progressive Responsibility Policy........................................................9

Oversight................................................................................................................ 10R. Policy on Mandatory Notification of Faculty...............................................................12S. Policy on trainees staying longer than 24+4.................................................................12

Policy and Process................................................................................................... 12How Monitored:....................................................................................................... 12

T. INSTITUTIONAL POLICY ON DUTY HOURS and Work Environment.................13Maximum Hours of Work Per Week........................................................................13Mandatory Time Free of Duty.................................................................................. 13Maximum Duty Period Length.................................................................................13Minimum Time Off between Scheduled Duty Periods.............................................14Maximum Frequency of In-House Night Float.........................................................14Maximum In-House On-Call Frequency..................................................................14

U. Policy on Moonlighting...............................................................................................15V. Policy Ensuring Fellows Have Adequate Rest.............................................................16W. Department and Institutional Policies and Procedures..................................................17

II. CURRICULUM AND FACILITIES..................................................................................18Clinical Curriculum - Touro........................................................................................18ILH............................................................................................................................ 19

Ochsner Kenner and Ochsner Main Campus................................................................25 Ambulatory Care Clinics............................................................................................. 21

Research Curriculum................................................................................................... 26Research Activities................................................................................................... 26Optional Programs................................................................................................... 27

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DEPT OF INFECTIOUS DISEASES

HOUSE OFFICER MANUAL

LSU HEALTH SCIENCES CENTER

2015-16

General Curriculum as outlined by ACGME competencies.........................................28Program Experiences Listed by Specific ACGME-Identified Focus Areas..................31

III. EDUCATIONAL RESOURCES.....................................................................................34IV. EVALUATION OF FELLOWS...................................................................................... 35

A. ACGME Six Clinical Competencies............................................................................35Patient Care.............................................................................................................. 35Medical Knowledge.................................................................................................35Practice-based Learning and Improvement...............................................................36Interpersonal and Communication Skills..................................................................36Professionalism........................................................................................................ 36Systems-based Practice............................................................................................37

B. Clinical Evaluation...................................................................................................... 39C. Research Activity........................................................................................................ 39D. Advancement to succeeding training year....................................................................39E. Disciplinary Actions.......................................................................................................39

V. EVALUATION OF FACULTY......................................................................................... 40VI. EVALUATION OF THE PROGRAM...............................................................................40VII. APPENDIX............................................................................................................................40 Disclosure of Outside Employment (PM 11 Form A)....................................................42-44

The Section of Infectious Diseases of Louisiana State University Health Sciences Center in New Orleans offers a training program for graduates of Internal Medicine residency programs designed to produce experts in the area of Infectious Diseases (ID). The successful trainee will be prepared to pass the ABIM test to become a Board-certified ID physician. The program is designed to give the candidate a wide exposure to the principles and practice of both clinical ID and research techniques in ID. The program consists of 2 integrated years in which the candidate is exposed to clinical material, didactic teaching, reading material and research experiences necessary to pursue a career either as a clinician or academician. This document outlines the specifics of this program.Any and all questions concerning this fellowship, this manual or other professional issues can be directed either to the Chief of the Section (Dr. David Martin) or the program director.

I. POLICIES AND PROCEDURES

A. PrerequisitesFellows must hold a MD or DO degree from an accredited medical school. Graduates of foreign medical schools must be graduates of schools recognized as accredited by LSUHSC. Fellows must have satisfactorily completed a residency program in Internal Medicine or Medicine-Pediatrics.

B. Fellowship Selection ProcessThe Section participates in the Electronic Residency Application Service (ERAS) and the Medical Specialty Match Program (MSMP) through the Association of American Medical Colleges (AAMC). Potential fellow applicants must submit an application consisting of updated curriculum vitae, 2 letters of recommendation, and a personal statement prior to consideration for a personal interview. After the personal interview with the program director and at least 3 other faculty, this faculty submits a candidate evaluation form. After completion of the interviews of all potential candidates, a committee consisting of the program director and 3 faculty involved in the interview process rank the candidates according to interview evaluation ratings. The rank list is submitted to the MSMP. If fellowship slots are available after the match, the potential candidates are asked to submit applications and are interviewed by the faculty on a first-come-first-serve basis. After each applicant is interviewed and evaluated, the fellowship selection committee meets to discuss whether to offer the position on a first-come-first-serve basis.

C. Duration of Program The program lasts a minimum of two years. A third and fourth year are available for candidates wishing to pursue an academic career.

D. DutiesThe fellowship includes both clinical, research, and quality improvement/patient safety responsibilities. It will be the duty of the fellow to carry out the clinical responsibilities of the services to which the fellow has been assigned. This includes not only clinically evaluating

patients, following their progress and implementing therapy but also teaching of medical students and residents. Specific duties for each rotation are outlined in separate guidelines that are distributed to the fellows, other trainees, and attending staff prior to the beginning of the rotation. Each fellow also obtains copies of these guidelines at the beginning of the fellowship.

In the area of research the fellow must carry out a project under the guidance of a faculty mentor. This project should culminate in both publications and scientific presentations accomplished by the fellow. It is recognized that in all of these duties the fellow is a trainee and thus must discuss all plans and actions with the appropriate faculty member. In all cases of disagreement the judgment of the faculty will take precedence.

In the area of quality improvement/patient safety, the fellow will be assigned to an ongoing hospital or clinic QI committee at the beginning of the fellowship. The fellow will attend committee meetings, develop a QI project in conjunction with the faculty mentor and the committee leadership, and present the results of that project by the end of fellowship.

E. Call ScheduleFellows will be on call when he/she is on an inpatient service. The fellow who is on the inpatient consultation will take the call as outlined in the rotation-specific guidelines. If they are taking call, they will be the first call on all clinical cases referred to the infectious diseases service. They will be allowed to take call from home in the evenings and on weekends. They will be expected to see the patient consulted in a timely manner. This may occasionally involve coming into the hospital at any time of the day or week. Duty hour rules will apply if rounds or after-hours consults go past 9PM to assure that fellows have 10 hours of off time between shifts. The fellow who is taking call will be completely off the call schedule one 24 hour period in seven days (averaged over the 4 week rotation). Call on that day will be taken by the attending with the resident on the service. Further guidelines for beeper call are outlined in the rotation-specific guidelines.

F. CompensationCompensation is set by the Department of Medicine. The first year the fellow is considered at the PGY 4 and the second year they are PGY5. Other benefits are those designated by the Department of Medicine for residents of the same level. These are provided by the Department of Medicine. Vacation and sick leave are as provided by the Department of Medicine.

G. Moonlighting PolicyProfessional activity outside of the scope of the fellowship program, which includes volunteer work or service in a clinical setting, or employment that is not required by the program (moonlighting) shall not jeopardize any training program of the University, compromise the value of the trainee's education experience or interfere in any way with the responsibilities, duties and assignments of the fellowship program. It is within the sole discretion of the Section Head and/or Program Director to determine whether outside activities interfere with the responsibilities, duties and assignments of the fellowship program. Before engaging in activity outside the scope of the House Officer Program, House Officers must receive the written approval of the Department Head and/or Program Director of the nature, duration and location of the outside activity.

Fellows while engaged in professional activities outside the scope of the fellowship are not provided professional liability coverage under LSA-R.S. 40:1299.39 et seq., unless the professional services are performed at a public charity health care facility. A fellow providing services outside the scope of the fellowship program shall warrant to University that the fellow is and will remain insured during the term of any outside professional activities, either (1) insured against claims of professional liability under one or more policies of insurance with indemnity limits of not less than $500,000 per occurrence and $1,000,000 in the aggregate annually; or (2) duly qualified and enrolled as a health care provider with the Louisiana Patient's Compensation Fund pursuant to the Louisiana Medical Malpractice Act, LSA-R.S. 40:1299.41 et seq. or (3) that the fellow is provided such coverage by the person or entity who has engaged the fellow to provide the outside professional services.

Fellows shall not provide outside professional activities to any other state agency (e.g., Department of Health and Hospitals, Department of Public Safety and Corrections, Office of Mental Health, etc.) by means of a contract directly between the fellow and the other state agency. Should a fellow desire to provide outside professional services to another state agency, the contract must be between the LSU School of Medicine in New Orleans and the other state agency for the fellow's services, and the fellow will receive additional compensation through the LSU payroll system. Fellows should speak with the Medicine Departmental Business Administrator to arrange such a contract.

H. Work Hours PolicyThe fellowship program strictly adheres to the ACGME requirement concerning work hours as reflected in the LSU Institutional Policy. To this end, fellows will not work more than 80 hours/week during any rotation. As fellows do not have in-house call, these provisions do not apply to the ID fellowship. Moonlighting hours will be included in this calculation. The program director will monitor work hours by monthly rotation surveys performed by the fellows and at the semi-annual evaluation conducted with each fellow. In addition, questions about work hours will be added to the end on month rotation survey. Moreover, the GME office will conduct semi-annual surveys of all trainees at LSU.

All clinical faculties have been instructed on the work hours policy and the detection of fatigue in trainees at the annual section retreat. Supervising faculty will monitor fellows for signs of fatigue and report these findings to the program director as soon as possible. Appropriate action (e.g. relief of duties for rest, modification of duties to insure adequate rest, cancellation of moonlighting privileges) will be instituted by the program director after discussion with the fellow and faculty. The LSU Ombudsman is available to field questions or complaints by trainees about duty hours or remediation. The fellow can be completely anonymous in this interaction.

I. Malpractice InsuranceMalpractice insurance is that provided by the State of Louisiana to the medical residents for medical practice related to the fellowship training. This coverage does NOT cover outside moonlighting practice as noted in the Moonlighting section.

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J. CurriculumThe majority of the clinical teaching occurs during clinical service months in the form of teaching rounds and case conferences. Thus, the material discussed will depend upon the clinical material that presents itself. Both the inpatient consult services and the inpatient HIV/TB ward over the two year fellowship period provide a broad exposure to all aspects of ID. The specific rotations and experiences that the fellow will partake in are described in a subsequent section. In addition to these clinical exposures, there are also research experiences and didactic sessions to provide a well-rounded experience. These too are described in the curriculum section.

K. Self InstructionIt is the philosophy of the program that fellows should be highly motivated and develop lifelong habits of self-instruction. Thus, fellows are expected to use the medical literature to solve clinical problems before the cases are presented to the faculty. Further, although most disorders seen in ID will eventually be seen during the two-year fellowship, some disorders will not. Thus, it is expected that the fellow will identify these areas and obtain articles from the medical literature so that they at least have a conceptual understanding of these disorders. Of course, the faculty is always available for guidance and suggestions.

L. Documentation of TrainingThe program will keep a folder on each fellow which will include copies of their evaluations, copies of their summaries, letters of recommendation and any other document pertinent to their training and performance. The fellow may view this folder at any time.

M. ConductIt is imperative that the fellow learns appropriate behavior of a professional during their experience. It is recognized that health care is best delivered when physicians are collegial, yet frank with each other and respectful and caring of their patients. It is thus the responsibility of the fellow to be dressed appropriately. Faculty should be notified if the conduct of the fellows is ever considered less than professional. The section chief will discuss such incidents with the fellow in question.

The use of illicit drugs will not be permitted at any time and alcohol shall not be consumed by anyone who is on call or on active duty. Anyone found in violation of these rules will be treated in accordance with departmental and school policy.

Sexual harassment by fellows of anyone at the university will not be tolerated and will be grounds for referral to the department's administration. At the same time no fellow should ever be the subject of sexual or other harassment. Any complaint of such behavior should be reported to the section chief, the program director, or the department chairman.

Finally, the section recognizes the advantages of diversity amongst its members and supports their rights to different religious, political, economic, and artistic beliefs. Thus, any discrimination or harassment of a fellow, or any other member of the section, because of these differences should be reported.

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These policies and procedures are supplemented by the policies and procedures outlined for the Department of Medicine and the LSU Graduate Medical Education Office. These manuals are provided at the beginning of the fellowship and available on the Infectious Diseases web site, in the Department office, or the Graduate Medical Education Office.

N. Policy on Professionalism and Learning EnvironmentIn keeping with the Common Program Requirements effective 7/1/2011 our GME programs wish to ensure:

1. Patients receive safe, quality care in the teaching setting of today.2. Graduating fellows provide safe, high quality patient care in the unsupervised practice of medicine in the future.3. Fellows learn professionalism and altruism along with clinical medicine in a humanistic, quality learning environment.

To that end we recognize that patient safety, quality care, and an excellent learning environment are about much more than duty hours. Therefore, we wish to underscore any policies address all aspects of the learning environment not just duty hours. These include:

1. Professionalism including accepting responsibility for patient safety2. Alertness management3. Proper supervision4. Transitions of care5. Clinical responsibilities6. Communication / teamwork

Fellows must take personal responsibility for and faculty must model behaviors that promote:1. Assurance for fitness of duty2. Assurance of the safety and welfare of patients entrusted in their care3. Management of their time before, during, and after clinical assignments4. Recognition of impairment (e.g. illness or fatigue ) in self and peers5. Honest and accurate reporting of duty hours, patient outcomes, and clinical

experience dataThe institution further supports an environment of safety and professionalism by:

1. Providing and monitoring a standard Transitions Policy as defined elsewhere.2. Providing and monitoring a standard policy for Duty Hours as defined elsewhere.3. Providing and monitoring a standard Supervision Policy as defined elsewhere.4. Providing and monitoring a standard master scheduling policy and process in New

Innovations.5. Adopting and institution wide policy that all fellows and faculty must inform patients

of their role in the patient’s care. 6. Providing and monitoring a policy on Alertness Management and Fatigue Mitigation

that includes:a. On line modules for faculty and fellows on signs of fatigue.b. Fatigue mitigation, and alertness management including pocket cards, back up

call schedules, and promotion of strategic napping.7. Assurance of available and adequate sleeping quarters when needed.

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8. Requiring that programs define what situations or conditions require communication with the attending physician.

(Professionalism and Learning Environment policy adopted from ACGME Quality Care and Professionalism Task Force AAMC Teleconference July 14, 2010.

1. Process for implementing Professionalism PolicyThe programs and institution will assure effective implementation of the Professionalism Policy by the following:

1. Program presentations of this and other policies at program and departmental meetings.2. Core Modules for faculty and fellows on Professionalism, Duty Hours, Fatigue

Recognition and Mitigation, Alertness Management, and Substance Abuse and Impairment.

3. Required LSBME Orientation.4. Institutional Fitness for Duty and Drug Free Workplace policies.5. Institutional Duty Hours Policy that adopts in toto the ACGME Duty Hours Language.6. Language added specifically to the Policy and Procedure Manual, the House Officer

manual and the Fellow Contract regarding Duty Hours Policies and the responsibility for and consequences of not reporting Duty Hours accurately.

7. Comprehensive Moonlighting Policy incorporating the new ACGME requirements. 8. Orientation presentations on Professionalism, Transitions, Fatigue Recognition and

Mitigation, and Alertness Management.

2. Monitoring Implementation of the Policy on ProfessionalismThe program and institution will monitor implementation and effectiveness of the Professionalism Policy by the following:1. Evaluation of fellows and faculty including:

a. Daily rounding and observation of the fellow in the patient care setting.b. Evaluation of the fellows’ ability to communicate and interact with other members of

the health care team by faculty, nurses, patients where applicable, and other members of the team.

c. Monthly and semi-annual competency based evaluation of the fellows.d. By the institution in Annual Reviews of Programs and Internal Reviews.e. By successful completion of modules for faculty and fellows on Professionalism,

Impairment, Duty Hours, Fatigue Recognition and Mitigation, Alertness Management, and others.

f. Program and Institutional monitoring of duty hours and procedure logging as well as duty hour violations in New Innovations.

O. Policy on Effective TransitionsThe transitions policy is created in recognition that multiple studies have shown that transitions of care create the most risk or medical errors (ACGME teleconference July 14, 2010.) In addition to the below specific policies, promotion of patient safety is further ensured by:

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1. Provision of complete and accurate rotational schedules in New Innovations2. Presence of a back up call schedule for those cases where a fellow is unable to complete their

duties. 3. The ability of any fellows to be able to freely and without fear of retribution report their

inability to carry out their clinical responsibilities due to fatigue or other causes.

1. Policy and ProcessFellows receive educational material on Transitions in Orientation and as a Core Module.

In any instance where care of a patient is transferred to another member of the health care team an adequate transition must be used. Although transitions may require additional reporting than in this policy a minimum standard for transitions must include the following information:

1. Demographicsa. Nameb. Medical Record Numberc. Unit/room number d. Agee. Attending physician – Phone numbers of covering physicianf. Allergiesg. Admit date

2. History and Problem List a. Primary diagnosis(es)b. Chronic problems (pertinent to this admission/shift)

3. Current condition/status4. System based

a. Pertinent Medications and Treatments especially Antibiotics5. Pertinent lab data6. To do list: Check x-ray, labs, wean treatments, etc - rationale 7. Contingency Planning – Next step in work-up or follow-up8. Code status/family situations

This information is found on pocket cards delivered to each house officer. The process by which this information is distributed is via Core Modules and Orientation presentations to fellows and via a Compliance Module for faculty. In addition this information is presented in program/departmental meetings.

Outgoing fellows at the end of Interim Louisiana Hospital (ILH), Touro, and Ochsner-Kenner rotations will use consult team patient lists containing the information noted above to check out to the incoming fellows on those services. Attending faculty at ILH and Ochsner-Kenner will similarly use these patient lists to check out to Incoming faculty. At Touro Infirmary, the attending physician remains the same throughout the year; therefore, continuity is maintained. At Ochsner-Jefferson, Ochsner faculty perform hand-offs.

The program retains samples of the printed handoff documents for the services at ILH and Ochsner-Kenner. The program director during the course of his attending supervision samples transitions personally.

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2. How monitored:Faculty is required to answer a question on effectiveness of witnessed transitions on each evaluation. The process and effectiveness of each program’s system is monitored through the Annual Program Review and the Internal Review process. The institution and program will monitor this by periodic sampling of transitions, as part of the Annual Review of Programs and as part of the Internal Review Process.

P. Policy on Alertness Management / Fatigue Mitigation Strategies

1. Policy and ProcessFellows and faculty are educated about alertness management and fatigue mitigation strategies via on line modules and in departmental conferences. Alertness management and fatigue mitigation strategies are outlined on the pocket cards distributed to all fellows and contain the following suggestions:

1. Warning Signsa. Falling asleep at Conference/Roundsb. Restless, Irritable w/ Staff, Colleagues, Familyc. Rechecking your work constantlyd. Difficulty Focusing on Care of the Patiente. Feeling Like you Just Don’t Caref. Never drive while drowsy

2. SLEEP STRATEGIES FOR HOUSESTAFFa. Pre-call Fellows

1. Don’t start Call w/a SLEEP DEFICIT – GET 7-9 ° of sleep2. Avoid Heavy Meals / exercise w/in 3° of sleep3. Avoid Stimulants to keep you up4. Avoid ETOH to help you sleep

b. ON Call Fellows1. Tell Chief/PD/Faculty, if too sleepy to work!2. Nap whenever you can á > 30 min or < 2°)3. BEST Circadian Window 2PM-5PM & 2AM- 5AM 4. AVOID Heavy Meal5. Strategic Consumption of Coffee (t ½  3-7 hours)6. Know your own alertness/Sleep Pattern!

c. Post Call Fellows1. Lowest Alertness 6AM –11AM after being up all night 2. Full Recovery from Sleep Deficit takes 2 nights3. Take 20 min. nap or Cup Coffee 30 min before  Driving

In addition programs will employ back up call schedules as needed in the event a fellow can’t complete an assigned duty period.

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2. How Monitored:Fellows are encouraged to discuss any issues related to fatigue and alertness with supervisory fellows, chief fellows, and the program administration. Supervisory fellows will monitor lower level fellows during any in house call periods for signs of fatigue. Adequate facilities for sleep during day and night periods are available at all rotation sights and fellows are required to notify Chief Fellows and program administration if those facilities are not available as needed or properly maintained. At all transition periods supervisory fellows and faculty will monitor lower level fellows for signs of fatigue during the hand off. The institution will monitor implementation of this indirectly via monitoring of duty hours violations in New Innovations, the Annual Fellow Survey (administered by the institution to all fellows and as part of the annual review of programs) and the Internal Review process.

Q. Supervision and Progressive Responsibility Policy

1. Policy and Process:Several of the essential elements of supervision are contained in the Policy of Professionalism detailed elsewhere in this document. The specific policies for supervision are as follows.

a) Faculty Responsibilities for Supervision and Graded Responsibility:

Fellows must be supervised in such a way that they assume progressive responsibility as they progress in their educational program. Progressive responsibility is determined in a number of ways including:

1. GME faculty on each service determines what level of autonomy each fellow may have that ensures growth of the fellow and patient safety.

2. The Program Director and faculty assess each fellow’s level of competence in frequent personal observation and semi-annual review of each fellow.

3. Where applicable, progressive responsibility is based on specific milestones. 4. Examples of milestones monitored:

Milestones Training stage for milestone

Requirements for increasedresponsibility

Demonstration of competency

Lumbar puncture Early PGY 4 Lumbar puncturesimulation

Successful completion of lumbarpuncture simulation

Gram stain reading Early PGY 4 Clinical microbiologyrotation

Successful completion of gramstain testing

Inpatient consultation first beepercall at OMCK and ILH

PGY4 after 6 monthsof fellowship

Approved by PD at 6 monthevaluation

Evaluation by attending faculty and approval of promotion to PGY5

ILH inpatient consultation rotationcovering both LSU and Tulane consults

PGY5 Approved by PD at annualreview for promotion to PGY5

Evaluation by attending faculty andapproval of graduation from theprogram

Touro infection control/ quality rotation PGY5 Approved by PD at annual review for promotion to PGY5

Evaluation by attending faculty andapproval of graduation from the program

HIV-hepatitis clinic PGY5 Approved by PD at annualreview for promotion toPGY5

Evaluation by attending faculty andapproval of graduation from the program

5. Use of simulation labs and OSCEs where applicable before allowing the fellows to perform procedures on patients. Successful completion of the lumbar puncture simulation is required prior to performance of lumbar puncture on patients.

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The expected components of supervision include:1. Defining educational objectives.2. The faculty assessing the skill level of the fellow by direct observation.3. The faculty defines the course of progressive responsibility allowed starting with close

supervision and progressing to independence as the skill is mastered. 4. Documentation of supervision by the involved supervising faculty must be customized to the

settings based on guidelines for best practice and regulations from the ACGME, Joint Commission, and other regulatory bodies. Documentation should generally include but not be limited to:

a. progress notes in the chart written by or signed by the facultyb. addendum to fellow’s notes where neededc. counter-signature of notes by facultyd. a medical record entry indicating the name of the supervisory faculty.

5. In addition to close observation, faculty are encouraged to give frequent formative feedback and required to give formal summative written feedback that is competency based and includes evaluation of both professionalism and effectiveness of transitions.

2. The levels of supervision are defined as follows:o Direct Supervision by Faculty - faculty is physically present with the fellow being

supervised.

o Direct Supervision by Senior Fellow – same as above but fellow is supervisor.

o Indirect with Direct Supervision IMMEDIATELY Available – Faculty – the supervising physician is physically present within the hospital or other site of patient care and is immediately available to provide Direct Supervision.

o Indirect with Direct Supervision IMMEDIATELY Available – Fellow - same but supervisor is fellow.

o Indirect with Direct Supervision Available - the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.

3. Oversight The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

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ILH Inpatient Consultation Services PGY Direct by Faculty Direct by sr fellows Indirect but immediately available - -facultyIndirect but immediately available

- fellowsIndirect available

IV X X XV X X X

Touro Inpatient Consultation Services PGY Direct by Faculty Direct by sr. fellows Indirect but immediately available - facultyIndirect but immediately available –

fellowsIndirect available Oversight

IV X X X XV X X X X

OMCK Inpatient Consultation Services PGY Direct by FacultyDirect by sr. fellows Indirect but immediately available - facultyIndirect but immediately available-

fellowsIndirect available Oversight

IV X X X XV X X X X

OMC Inpatient Consultation Services PGY Direct by FacultyDirect by sr. fellows Indirect but immediately available - facultyIndirect but immediately available -

fellowsIndirect available Oversight

IV X X X XV X X X X

All Ambulatory SettingsPGY Direct by FacultyDirect by sr fellows Indirect but immediately available - facultyIndirect but immediately available -

fellowsIndirect availableOversight

IV X X X XV X X X X

4. How Monitored:The institution will monitor implementation of the policies through Annual Review of Programs and Internal Reviews. Furthermore the institution monitors supervision through a series of questions in the Annual Fellow Survey. The program will monitor this through feedback from fellows and monitoring by Chief Fellows and Program Directors. Supervision will be added to the annual review of programs.

R. Policy on Mandatory Notification of Faculty

1. Policy and ProcessIn certain cases faculty must be notified of a change in patient status or condition. The table below outlines those instances in which faculty must be called by PGY level.Condition PGY 4 PGY 5Care of complex patient X X

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Transfer to ICU X XAcute drastic change in course X X

2. How monitoredFaculty and programs will monitor by checking for proper implementation on daily rounds and other venues as well as solicitation of reports from faculty on lack of appropriate use of the policy. The monthly evaluation will ask whether the fellow properly notified the attending for these conditions during the rotation. The program director will review these evaluations and provide feedback to the fellow at the semi-annual meeting or earlier if a problem develops.

S. Policy on trainees staying longer than 24+4

1. Policy and ProcessPGY 1 residents’ duty periods may be no longer than 16 hours and there are no exceptions allowed. Upper level residents are not allowed to stay longer than 24 hours with 4 hours for transitions. In those rare and extenuating cases where a resident absolutely must remain after 24+4 the resident must contact the Program Director for a specific exemption. If that is permitted verbally then the resident must communicate by email with the Program Director telling:

1. the patient identifying information for which they are remaining, 2. the specific reason they must remain longer than 24+4 , 3. assurance that all other patient care matters have been assigned to other members of

the team, 6. assurance that the resident will not be involved in any other matter than that for which the

exemption is allowed and 7. assurance that the resident will notify the program director when they are complete and

leaving.

In the event that the Program Director does not hear from the resident in a reasonable time (2 hours) , the Program Director or designee will locate the resident in person and assess the need for any further attendance by the resident. Residents caught in violation of this policy or who abuse this rare privilege will be subject to disciplinary action for unprofessional behavior.

2. How Monitored:The program director will directly monitor each of these cases. It is anticipated these requests will be infrequent at most. The Program Director will collect and review the written requests on a regular basis on each case and all cases in aggregate. The institution will monitor numbers and types of exceptions of this during annual reviews of programs and Internal Reviews.

T. INSTITUTIONAL POLICY ON DUTY HOURS and Work Environment(Passed June 11, 2003; Revised Nov 20, 2008; Feb 17, 2011)– GMEC)

The institution through GMEC supports the spirit and letter of the ACGME Duty Hour Requirements as set forth in the Common Program Requirements and related documents July 1, 2003 and subsequent

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modifications. Though learning occurs in part through clinical service, the training programs are primarily educational. As such, work requirements including patient care, educational activities, administrative duties, and moonlighting should not prevent adequate rest. The institution supports the physical and emotional wellbeing of the resident as a necessity for professional and personal development and to guarantee patient safety. The institution will develop and implement policies and procedures through GMEC to assure the specific ACGME policies relating to duty hours are successfully implemented and monitored. These policies may be summarized as:

1. Maximum Hours of Work Per WeekDuty hours must be limited to 80 hours per week, averaged over a four week period, inclusive of all in-house call activities and all moonlighting.

2. Mandatory Time Free of DutyFellows must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.

3. Maximum Duty Period LengthDuty periods of PGY-1 residents must not exceed 16 hours in duration.

Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested.

It is essential for patient safety and resident education that effective transitions in care occur. Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.

Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.

In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family.

Under those circumstances, the resident must:

appropriately hand over the care of all other patients to the team responsible for their continuing care; and,

document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.

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The program director must review each submission of additional service, and track both individual resident and program-wide episodes of additional duty.

4. Minimum Time Off between Scheduled Duty PeriodsPGY-1 resident should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

Intermediate-level residents [as defined by the Review Committee] should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.

Residents in the final years of education [as defined by the Review Committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.

This preparation must occur within the context of the 80-hour, maximum duty period length, and one-day-off-in seven standards. While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances [as defined by the Review Committee] when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.

Circumstances or return-to-hospital activities with fewer than eight hours away from the hospital by residents in their final years of education must be monitored by the program director.

5. Maximum Frequency of In-House Night FloatResidents must not be scheduled for more than six consecutive nights of night float. [The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee.]

6. Maximum In-House On-Call Frequency PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).

At-Home Call

Time spent in the hospital by residents on at-home call must count towards the 80-hours maximum weekly hour limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for on-day-in-seven free of duty, when averaged over four weeks.

At-home call must not be as frequent or taxing as to preclude rest or reasonable personal time for each resident.

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Residents are permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period”.

Residents are required to log all duty hours in New Innovations Software Program or its replacement program. Those who fail to log duty hours or log erroneous duty hours are subject to disciplinary action.

The institution as well as each program is required to monitor and document compliance with these requirements for all trainees. This policy applies to every site where trainees rotate.

U. Policy on MOONLIGHTING

Professional activity outside of the scope of the House Officer Program, which includes volunteer work or service in a clinical setting, or employment that is not required by the House Officer Program (moonlighting) shall not jeopardize any training program of the University, compromise the value of the House Officer’s education experience, or interfere in any way with the responsibilities, duties and assignments of the House Officer Program. It is within the sole discretion of each Department Head and/or Program Director to determine whether outside activities interfere with the responsibilities, duties and assignments of the House Officer Program. House Officers must not be required to moonlight. Before engaging in activity outside the scope of the House Officer Program, House Officers must receive the written approval of the Department Head and/or Program Director of the nature, duration and location of the outside activity. (revised 4/2001) All moonlighting activities must be tracked in New Innovations Software Program. PGY1’s may not moonlight. All internal and external moonlighting must be counted in the 80 hour maximum weekly hour limit. Fellow must not schedule moonlighting that will cause the 80 hour maximum. Fellows who schedule moonlighting activities resulting in violation of the 80 hour work rule will be subject to disciplinary action including but not limited to loss of moonlighting privileges.(revised 2/17/2011) The house officers’ performance will be monitored for the effect of these moonlighting activities upon performance and that adverse effects may lead to withdrawal of permission to continue. All documentation will be kept in the house officer’s program file. (Revised 7/1/2005)

House Officers, while engaged in professional activities outside the scope of the House Officer Program, are not provided professional liability coverage under LSA-R.S. 40:1299.39 et seq., unless the professional services are performed at a public charity health care facility. A House Officer providing services outside the scope of the House Officer Program shall warrant to University that the House Officer is and will remain insured during the term of any outside professional activities, either (1) insured against claims of professional liability under one or more policies of insurance with indemnity limits of not less than $500,000 per occurrence and $1,000,000 in the aggregate annually; or (2) duly qualified and enrolled as a health care provider with the Louisiana Patient’s Compensation Fund pursuant to the Louisiana Medical Malpractice Act, LSA-R.S. 40:1299.41 et seq. or (3) that the House Officer is provided such coverage by the person or entity who has engaged the House Officer to provide the outside professional services.

House Officers shall not provide outside professional activities to any other state agency (e.g., Department of Health and Hospitals, Department of Public Safety and Corrections, Office of Mental Health, etc.) by means of a contract directly between the House Officer and the other state agency. Should a House Officer desire to provide outside professional services to another state agency, the

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contract must be between the LSU School of Medicine in New Orleans and the other state agency for the House Officer’s services, and the House Officer will receive additional compensation through the LSU payroll system. House Officers should speak with the Departmental Business Administrator of the House Officer Program to arrange such a contract.

House Officers may not moonlight at any site without a full and unrestricted license. Occasional exceptions may be granted by the LSBME only after a specific request by a program and are largely limited to moonlighting which is in the same institution as the program, is under the supervision of program faculty and similar to activity the trainee might have in the program. In addition, fellows on J-1 visas may not moonlight (revised 1/2008).

The LA State Board and the DEA will independently investigate and prosecute individual fellows if they so desire regarding the following:

To moonlight all house officers must be fully licensed and have their own malpractice and DEA number.

Moonlighting in pain and weight loss clinics is not allowed by the LSBME. Pre-signing prescriptions is illegal. Using MCLNO prescriptions outside MCLNO is prohibited – your “MCLNO” number is site

specific. Don't ever sign anything saying you saw a patient if you didn't see the patient. All narcotics prescriptions must be put in the patient's name and address plus the date.

Don’t "let the nurse do it”. House officers are held accountable for all things signed - read the fine print. Follow accepted practice guidelines for everything especially weight loss and pain patients. All house officers should be cognizant of Medicare fraud and abuse guidelines.

V. Policy Ensuring Fellows Have Adequate RestIn order to ensure fellows have adequate rest between duty periods and after on–call sessions we adopt the following policies:

1. Our Duty Hours Policy contains the following relevant language:a. PGY-1 fellow should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

b. Intermediate-level fellows [as defined by the Review Committee] should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.

c. Fellows in the final years of education [as defined by the Review Committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. This preparation must occur within the context of the 80-hour, maximum duty period length, and one-day-off-in seven standards. While it is desirable that fellows in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances [as defined by the Review Committee] when these fellows must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.

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1. Circumstances or return-to-hospital activities with fewer than eight hours away from the hospital by fellows in their final years of education must be monitored by the program director.

All of this is in the context of the other duty hours requirements.

2. All employees of LSUHSC are under Chancellors Memorandum 37 which is the LSUHSC Fitness for Duty Policy. This describes the expectations for employees to report to work fit and safe to work. It further defines what are considered unsafe/impaired behaviors, the requirement for self or supervisor referral to the Campus Assistance Program, and what steps are taken thereafter.

3. The institutional Policy of Professionalism and Learning Environment further amplifies the expectations for fellows to be fit for duty and to take it upon themselves to be well rested with the following language:

Fellows must take personal responsibility for and faculty must model behaviors that promote:1. Assurance for fitness of duty.2. Assurance of the safety and welfare of patients entrusted in their care.3. Management of their time before, during and after clinical assignments.4. Recognition of impairment (e.g. illness or fatigue ) in self and peers.5. Honest and accurate reporting of duty hours, patient outcomes, and clinical

experience data.4. The moonlighting policy anticipates potential trouble areas and describes a method for monitoring the effects of moonlighting on fellows.

5. Adequate sleep facilities are in place at each institution and our alertness management / fatigue mitigation policy and process encourages good sleep hygiene as well as recommending such strategies and pre-call strategies, strategic napping and post-call naps.

6. Foremost our Professionalism and Learning Environment Policy requires faculty to model behaviors that encourage fitness for duty as noted above and our Supervision Policy requires faculty to observe for signs of fatigue especially during transitions.

W. Department and Institutional Policies and ProceduresThis manual is in addition to the policies and procedures manuals in place at the departmental and institutional level. These manuals are review at general house staff orientation. Copies of these materials are available from the program director, department administration, or the dean's office. They are also available on the LSUHSC web site (www.lsuhsc.edu).

II.CURRICULUM AND FACILITIESThe 2-year program curriculum is designed to provide fellows with training which is balanced between clinical and research activities. Clinical activities provide the skills and exposure required for the practice of ID. Research activities are tailored to suit an individual fellow's

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interests, whether they are in clinical or basic science research, and are designed to prepare him/her for and an entry-level academic position.

Upon successful completion of this curriculum fellows should be capable of passing the ID board certification test. The ID Section will provide appropriate support documentation of the fellow's experience in order for them to take this test.

A. Clinical Curriculum

1. Patient Care

a) Touro Inpatient ConsultsDuring the first year, fellows spend 3-4 months assigned to the inpatient consult service at the Touro Infirmary, which maintains the medical, gynecological, and surgical services. This institution offers exposure to a large number of patients with a broad spectrum of infectious diseases including those listed in the appendix.

While on service at Touro, the fellow will work closely with Drs. Figueroa and Coco, the Infection Control office, and the Pharmacy committee to learn the salient aspects of infection control and antibiotic management in a community hospital setting. Please see section entitled Hospital Administration for details.

On the consult service, the fellow sees an average of 1-2 new patients per day and follows approximately 4-10 inpatients at any given time. During the first year, the fellow sees approximately 200 inpatient consults. After evaluating the patient independently, the fellow presents the case to the attending faculty. The attending then sees the patient with the fellow to review findings and to formulate a plan for further diagnosis and therapy.

During these rotations the fellow will serve as second call for any consult. The attending, who is holding the consult pager, will call the fellow for every consult during duty hours. The fellow will help in the training of students and residents on the service by supervising these trainees and aiding them in reviewing the medical literature pertinent to the problem. When the junior trainee presents the case to the attending, the fellow will ensure that no aspect of the case is omitted and that any suggestion of the attending is dutifully instituted.

During the second year, the fellow will be on the inpatient consult service for 1-3 months. The format will mirror that of the first year.

(1) Goals and objectives Patient care: via history & physical exams, daily notes, interaction with patients, differential

dx, diagnostic test ordering, treatment decisions, nosocomial infection prevention. Special emphasis on: Infections in geriatric populations Infections in hematology-oncology patients Infections in rehabilitation patients Infections in indigent and non-indigent inner city populations Infections in critically-ill surgical and medical patients

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Infections in obstetrics and gynecology Education: via text reading, journal articles, reports to the team (keep a list of your

contributions for evaluation purposes) Improve antimicrobial selection including limiting unnecessary usage Improve the diagnosis and management of hospitalized patients with infectious

diseases Principles of infection control including hand washing/sterilization/isolation Spectrum of inner-city community hospital practice including geriatrics and HIV

b) Interim Louisiana Hospital (ILH) Inpatient ConsultsDuring the first year, fellows spend 1-2 months assigned to the inpatient consult service at the University Hospital. Most of our inpatient consults are seen at University Hospital, which maintains the medical, gynecological, and surgical services. This institution offers exposure to a large number of patients with a broad spectrum of infectious diseases including those listed in the appendix.

On the consult service, the fellow sees an average of 1-2 new patients per day and follows approximately 8-10 inpatients at any given time. During the first year, the fellow sees approximately 200 inpatient consults. After evaluating the patient independently, the fellow presents the case to the attending faculty. The attending then sees the patient with the fellow to review findings and to formulate a plan for further diagnosis and therapy.

During these rotations the fellow will serve as first call for any consult. The fellow will help in the training of students and residents on the service by supervising these trainees and aiding them in reviewing the medical literature pertinent to the problem. When the junior trainee presents the case to the attending, the fellow will ensure that no aspect of the case is omitted and that any suggestion of the attending is dutifully instituted.

During the second year, the fellow will be on the inpatient consult service for 2-3 months. The format will mirror that of the first year.

(1) Goals and objectives Patient care: via history & physical exams, daily notes, interaction with patients, differential

dx, diagnostic test ordering, treatment decisions, nosocomial infection prevention. Special emphasis on: Trauma Infections in indigent populations HIV and AIDS Tuberculosis

Education: via text reading, journal articles, reports to the team (keep a list of your contributions for evaluation purposes)

Improve antimicrobial selection including limiting unnecessary usage Improve the diagnosis and management of hospitalized patients with infectious

diseases Principles of infection control including hand washing/sterilization/isolation Spectrum of inner-city public hospital practice including trauma, tuberculosis, and

HIV

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c) Ochsner Medical Center - Kenner inpatient consultsFor 1-2 months during the first year of fellowship, each fellow rotates through the Ochsner Medical Center - Kenner consult service that contains the LSU hospitalist service (serving Medicare patients), orthopedic services, and wound care center. In addition, this hospital houses a significant portion of the LSU private practice patients for general medicine, subspecialty medicine, and subspecialty surgery. Therefore, the fellow receives intensive exposure to this aspect of infectious diseases.

During the second year, the fellow will be on the inpatient consult service for 1-2 months. The format will mirror that of the first year.

(1) Goals and Objectives

Patient care: via history & physical exams, daily notes, interaction with patients, differential dx, diagnostic test ordering, treatment decisions, nosocomial infection prevention. Special emphasis on: Wound care Orthopedic infections Infectious diseases consultation in a managed-care private setting Management of long-term outpatient antibiotics

Education: via text reading, journal articles, reports to the team Improve the diagnosis and management of hospitalized patients with infectious

diseases Improve anti-microbial selection including limiting unnecessary usage Exposure to wound care including outpatient/inpatient management Principles of infection control including hand washing/sterilization/isolation

d) Ochsner Medical Center - Main CampusFirst-year fellows will rotate through the Ochsner Medical Center - Main Campus Hospital inpatient ID consult service that has a very busy organ transplantation program. During this month, the fellow acts as a consultant on routine ID consults as well as complex transplantation patients. Therefore, the fellow receives intensive exposure to this aspect of infectious diseases.

(1) Goals and Objectives

Patient care: via history & physical exams, daily notes, interaction with patients, differential dx, diagnostic test ordering, treatment decisions, nosocomial infection prevention. Special emphasis on: Infections in transplantation; immunosuppression Infections in non-HIV immunocompromised patients Infectious diseases consultation in a managed-care private, tertiary referral setting Management of long-term outpatient antibiotics

Education: via text reading, journal articles, reports to the team Improve the diagnosis and management of hospitalized patients with infectious

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diseases Improve anti-microbial selection including limiting unnecessary usage Exposure to transplantation infectious diseases including outpatient/inpatient

management and pre-transplantation evaluation Principles of infection control including hand washing/sterilization/isolation Improve anti-microbial selection including limiting unnecessary usage Principles of infection control including hand washing/sterilization/isolation

e) Ambulatory Care Clinics

(1) ID continuity clinicEvery Thursday morning throughout their training, fellows see patients in a general ID clinic at the HIV Outpatient Program (HOP). This patient population consists of new and continuing adult patients with HIV/AIDS and/or a broad spectrum of infectious diseases. Outpatient consults are also evaluated in this clinic. Fellows perform history and physical examination, interpretation of laboratory and radiological tests. After seeing the patient the fellow presents the case to a faculty who then sees the patient with the fellow to review pertinent points and the therapeutic plan. The fellows in this setting also do HIV counseling, if appropriate. Fellows see continuing patients to allow the observation of long-term outcomes. Each fellow sees approximately 80-100 patients per year in this clinic with at least 1 new and 3 return patients seen per clinic.

(2) Outpatient clinic rotationFellows will have at least one month of outpatient clinics based at the Medical Center of La. HIV outpatient clinic and the Orleans Parish STD clinic. This rotation emphasizes clinic populations not routinely seen in the ID continuity clinic: 1) HIV-infected patients with neurological problems and 2) patients with sexually transmitted diseases.

Fellows are scheduled for the HIV women's and adolescent clinics; they function as in the ID continuity clinic. After seeing the patient the fellow presents the case to a faculty who then sees the patient with the fellow to review pertinent points and the therapeutic plan. These clinics emphasize women's health care issues and adolescent medicine.

Fellows have 30 hours in the Orleans Parish STD clinic under the supervision of Dr. Stephanie Taylor. The fellows examine patients, perform laboratory test unique to this clinic setting (e.g. dark field examinations and wet mounts), and discuss the case with the attending physician. Discussion about public health and epidemiology take place in this context.

Fellows also have an opportunity to rotate through the Tulane Travel Clinic with Dr. Susan McLellan, a noted expert in this field at Tulane School of Medicine and School of Tropical Medicine.

Fellows will be working on the research didactic curriculum during this rotation as outlined in the research training section.

(3) Goals and objectives

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Patient care: Outpatient diagnosis, management, and longitudinal follow-up of individuals with a

number of conditions including: HIV – all stages Fever in the midst of an outpatient workup Osteomyelitis Septic arthritis Viral hepatitis (especially in conjunction with HIV infection) Sexually transmitted diseases

Outpatient Infectious Diseases consultation Follow-up from inpatient consultation from other medical services Outpatient consultations/referrals from other medical services Post-exposure consultation and prophylaxis (e.g. HIV, HBV, HCV) Management of out-patient antibiotics for sub-acute or chronic infections Screening of individuals for infectious diseases of epidemiological importance (e.g.

West Nile virus, influenza, etc) Travel Medicine (both pre-travel consulting and post-travel evaluation)

Education: via text reading, journal articles, and presentations to clinic attendings Principles and practice of state-of-the-art care of HIV-infected patients

Antiretroviral regimens Prophylaxis of opportunistic infections Diagnosis and management of HIV-related co-morbidities Diagnosis and management of treatment-induced morbidities

Cost-effective work-up and management of outpatient consultations Natural history and effective management of sub-acute or chronic infectious disease

problems Natural history and effective management of emerging infections in the outpatient setting Travel Medicine Research Training

f) ProceduresDuring the first year, fellows become proficient in clinical microbiology through a month rotation in the Clinical Microbiology laboratory at the Medical Center of La. under the supervision of Jeffrey Wall, director of the laboratory. Diagnostic tests performed include, but are not limited to, Gram stains, Giemsa stains, AFB stains, KOH preps, bacterial, viral, and fungal cultures, parasite identification, and non-culture molecular diagnostic techniques. Mr. Wall or his designee assesses the fellow's progress and reports to the program director in writing upon completion of the rotation.

g) Call ScheduleFellows are on call only on months during which they are assigned to the clinical service (8 months in year 1 and 4 months in year 2). Consults are routinely made during the day Monday through Saturday except in emergency situations. For these consults, assigned fellows and faculty are on beeper call. Fellows have no in-house call. All consults will be answered in a timely manner. Call policies are outlined in the rotation-specific guidelines.

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2. Didactic Training

a) Lecture Series

(1) Citywide ID didactic lecturesLocal and invited experts give weekly didactic sessions to ID specialists and trainees at Children's Hospital. The topics include basic immunology, host defenses, basic microbiology, antibiotic development and pharmacology, ethical issues in ID, economics, quality assurance, and epidemiology. Review of clinical entities and new treatment and diagnostic modalities are also topics.

(2) HIV/TB inpatient didactic lectures

b) Conferences

(1) ID section meetingEvery week, the section meets to have journal club, case conference, research conference, or business meeting. This meeting is held on the LSUHSC campus. On average, there are two journal clubs, one research conference, and one case conference per month. A business meeting is scheduled approximately quarterly. Faculty and fellows are expected to attend.

A journal club is held twice monthly in order to critically review the current literature based on a core curriculum topic list to be covered over a two-year period. One monthly journal club is the responsibility of the faculty and will be topic-driven. In the other journal club, a fellow is paired with a faculty member and present one or two clinical and basic science studies on the assigned topic. Articles should be distributed prior to the presentation so that all may prepare. The fellow discusses study design, results, and interpretation. The section's epidemiologist also reviews the studies with the fellow. In this forum, biostatistics, ethics, medical economics, and principles of scientific investigation are addressed.

The presentation of case conference is rotated among the four clinical services (ILH, Touro, Ochsner, and Kenner Regional). At this conference, the service presents one interesting case with clinical material if available and an extensive review of the literature. These conferences follow a similar format to the citywide Infectious Diseases case conference.

Dr. Martin schedules monthly research conferences. Invited speakers from LSU and other institutions as well as our faculty and fellows present their research.

(2) Clinical Microbiology conferenceFellows attend a weekly microbiology conference directed by Dr. Julio Figueroa. He reviews the week's interesting organisms isolated from patients at the various teaching hospitals. Residents and students on ID rotations also attend. Scientific and quality control issues are discussed in this conference.

(3) Medicine Grand RoundsBi-weekly department meetings are held where 1 or 2 faculty or guest speakers provide case presentations or updates covering any aspect of internal medicine.

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(4) Citywide ID case conferenceWeekly conferences are given by the fellows from the four ID training programs in the city (LSU, Tulane, Ochsner, and Ped ID). Interesting cases are presented as unknowns and discussed by a designated faculty member. The fellow then reviews the medical literature on the topic demonstrated by the case and leads a discussion among the conference attendees about issues brought up by the case. At the beginning of the year, current fellows should make a written schedule for the presentations for which they are responsible. This schedule should be forwarded to the program director as soon as possible. It is also their responsibility to remain up-to-date with scheduling changes that may occur.

c) Scientific MeetingsFellows typically attend 1-2 scientific meetings per year including but not limited to the ICAAC, IDSA, ASM, and Southern Society for Medical research. At each of these the fellow is encouraged not only to attend, but also to present a portion of the research they have accomplished. In addition, the Department of Medicine holds an annual Research Day. Fellows are expected and encouraged to use this opportunity to present aspects of their research.

d) Fellow TeachingFellows are responsible for supplementing the teaching of residents and medical students during consult and inpatient ward months. Fellows, in addition, teach faculty and other trainees during journal club, research conferences, and case conferences. Finally, fellows participate in the Physical Diagnosis course. They mentor second year medical students in physical diagnosis. The fellows are evaluated by the students.

B. Hospital Administration Curriculum

1. Touro InfirmaryDuring the Touro inpatient month, the fellow will work closely with Dr. Figueroa, the Infection Control Office, and the Pharmacy committee to learn the salient aspects of infection control and antibiotic utilization in a community hospital setting. Specific topics to be covered include:

Isolation precautions Prevention of nosocomial infections Effective use of antibiotics/ antibiotic stewardship

o Antibiotic pharmacologyo Antibiotic selection and restrictiono Formulary developmento Cost containmento Risk managemento Medical economicso Utilization review

Hand hygiene promotion Hospital surveillance for sentinel events Investigation of sentinel events Development of hospital policies Occupational health including post-exposure prophylaxis (including

immunoprophylaxis and chemoprophylaxis)

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The role of the clinical microbiology laboratory in infection control and pharmacy

Management of hospital outbreaks Quality assessment and improvement

The written materials for these topics will include: Infection Control manuals from Touro Infirmary CDC guidelines available at: http://stacks.cdc.gov/cbrowse/?parentId=cdc

%3a100&pid=cdc%3a100&type=1&facetRange=960 The Institute for Healthcare Improvement at http://www.ihi.org/ihi IDSA guidelines available at:

http://www.idsociety.org/idsa_practice_guidelines/ IDSA/SHEA online course AHRQ evidence-based practice guidelines

http://www.ahrq.gov/clinic/epcix.htm

2. Committee assignmentsThe fellow is assigned to the Infection Control committee at the Interim Louisiana Hospital under the direction of Dr. Maffei. Fellows are expected to actively participate in the monthly meeting.

Topics discussed include hospital epidemiology, quality assurance, risk management, isolation procedures, outbreak investigations, immunoprophylaxis, and chemoprophylaxis.

Fellows may also serve on several other university and ILH hospital committees as openings and time allow. These include the Graduate Medical Education committee, the House Staff association,

C. Research Curriculum

1. Research Activities

a) Conducting ResearchFellows are required to play a major role in at least l research project during their training, which is suitable for publication in a peer-reviewed journal. This includes the development of a protocol, collection of data, interpretation of results, and manuscript preparation. After guidance from the section chief and the program director, fellows may pick a project related to ongoing studies within the section or develop an independent project with the approval of a mentor. Projects may be either clinical or basic science research.

The Louisiana State University campus includes a National Institutes of Health sponsored General Clinical Research Center. This facility is functionally freestanding with its own inpatient and outpatient facilities, ancillary staff, and laboratory. AIDS clinical research through the ACTG takes advantage of this facility. Our HIV faculty has an active research interest in HIV/AIDS clinical trials under the auspices of several multi-center study groups including the ACTG, CPCRA, CDC spectrum of disease centers, and local HIV/AIDS groups. Many of these

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protocols are performed in the HIV outpatient clinic at the Interim LSU Hospital. In addition, there are numerous ongoing clinical trials in which the fellows can participate.

Our section has 3 basic science laboratories and designated animal-housing facilities for the purpose of bench research. We also use other laboratories in collaboration with other departments (e.g. pulmonary section and microbiology) within ILH.

Dr. Martin is the program director for an NIH-sponsored STD clinical research center. This center encompasses many of the STD research opportunities in New Orleans as well as cooperative projects with other academic health centers. Fellows who are considering an academic research career are strongly encouraged to work within the center.

b) Supervision/EvaluationSupervision of research activity is provided by a member of the ID section with possible assistance from faculty of other departments. Faculty members work very closely with fellows on research projects and are always readily available for assistance. Monthly work-in-progress meetings are held where the progress of the projects is reviewed and input gained from other faculty members.

c) Publication/PresentationOnce adequate data is collected, the fellow assumes the role of primary author for the preparation of his/her work for publication in a peer- reviewed journal. The mentors of the project will assist in this process. Fellows also present their findings at scientific meetings such as the American Federation of Medical Research, ICAAC, IDSA, ASM, and LSU Research Day.

d) Didactic Training in ResearchEach fellow will view and submit CME credits using the online lectures at the University of North Carolina School for Public Health Preparedness, NIH, and BMJ sites listed below:

UNC Center for Public Health Preparedness http://cphp.sph.unc.edu/training/training_list/ Principles of Clinical Research NIHhttp://clinicalcenter.nih.gov/training/training.html

BMJStatistics at Square Onehttp://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one

http://ocw.mit.edu/courses/mathematics/18-05-introduction-to-probability-and-statistics-spring-2014/

In addition, to strengthen our research curriculum, our faculty biostatistician/epidemiologist will review the basics of epidemiology and research during short didactic sessions throughout the year. In addition, she will be involved in all fellow research projects to give them hands-on research training experience. We offer the Masters of Public Health degree to interested fellows.

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During the fellowship, discussions are held to review the approach to conducting research. Fellows are also taught to critically review the work done by others. This training is done during research conferences held monthly as well as basic science journal clubs. Many of the aspects of clinical and basic science training are performed with the research mentor from our section. Numerous seminars and conferences are given around the Medical Center on topics of basic science and clinical research, and the fellows are strongly encouraged to attend those seminars of relevance. If addition, the citywide didactic lecture series frequently explores the areas of basic science and clinical research as it pertains to investigations of infectious diseases. The ACTG meeting also enhances the basic science and clinical investigation training of the fellows. Finally, research aspects of clinical microbiology are discussed in the weekly Clinical Microbiology conference.

2. Optional Programs

a) Masters of Public Health programInterested fellows can receive a Masters of Public Health degree from the LSU School of Public Health during their fellowship. The section will help defray the costs of tuition. This program will be coordinated with Dr. Figueroa and the School of Public Health so that the fellow will meet all the requirements of clinical fellowship and receive the MPH degree at some point during the fellowship. This may require a third year of study.

b) Advanced Research TrainingFellows with academic interests can continue training as a research fellow for a third year. Fellows in this tract can continue to see their clinic patients in the HIV outpatient program. Funding for subsequent years of training will depend on research funding for the fellow's salary.

D. General Curriculum as outlined by ACGME competenciesThe table below outlines the overall curriculum structure, site, experiences, and evaluation instruments for the fellowship. Also noted here is the increased responsibilities outcomes expected of second year fellows in addition to those of first-year fellows.

Please see the specific rotation guidelines for more detailed elaboration of the specific topic areas to be covered and evaluated in each experience.

Educational Goals Location Learning Activity Evaluation Methods

Patient Care F11. Obtain complete

H/P with ID focus2. Write concise,

informative notes with ID focus

3. Develop differential diagnosis

4. Develop cost-

Inpatient consultsHIV clinic

Direct patient careTeaching rounds

Attending evaluationsDeveloping outpatient outcome measures

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effective diagnostic work-up

5. Develop rationale, evidence-based treatment

F21. F1 goals2. Management of

HIV/HCV patientsMedical Knowledge F1

1. Understand the indications, limitations, and cost effectiveness of diagnostic serologic tests for infectious diseases

2. Understand the indications, limitations, and cost effectiveness of diagnostic tests for immune system

3. Understand the indications, limitations, and cost effectiveness of microbiological and histopathological tests

4. Understand the indications, limitations, side effects, and cost effectiveness of antibiotic therapy in common infections

5. Understand the indications, limitations, side effects and cost effectiveness of antibiotic therapy for uncommon infections

6. Understand the

Inpatient consultsOutpatient clinicsClinical Micro LabConferences

Teaching RoundsConferencesClicker exercisesHIV jeopardyID jeopardy

Attending evaluationsIn-service examsClicker exercises

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indications, limitations, side effects and cost effectiveness of immuno-modulators

7. Understanding the interactions between microbes and normal human hosts

8. Understanding the interactions between microbes and compromised human hosts

F21. F1 goals2. Emphasis on

knowledge for diseases that are less common locally

Practice-based Learning and Improvement

F11. Identify gaps in

knowledge2. Review literature

and present to ID team

3. Review literature and present to citywide ID group

F21. F1 goals2. ETC teaching

events3. PI projects

Attending RoundsCase ConferencesJournal ClubsClin micro conferenceETC presentations

Direct Patient CareTeaching RoundsCase Conference presentationsJournal club presentationsPI project presentationsETC presentations

Attending evaluationsConference Attendees EvaluationsIn-service examAcceptance of abstract at regional or national conference

Communication F1/F21. Communicate

effectively with patients and family

2. Communicate effectively with MDs in writing

3. Communicate effectively with

Attending roundsClinicPresentations

Direct Patient CareTeaching RoundsConsult NotesClinic NotesConference Presentations

Attending evaluationsAllied professional evaluationsPatient clinic evaluationsConference

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other health professionals

4. Clear and concise presentation to ID group

5. Clear and concise consultation notes

attendee evaluations

Professionalism F1/F21. Appropriate dress

on service2. Truth-telling3. Hand hygiene4. Maintaining patient

confidentiality on rounds

5. Respectful communication with patients

6. Respectful communication with other health professionals

7. Respectful communication with other MDs

Attending roundsClinicPresentations

Direct Patient CareTeaching RoundsConsult NotesClinic NotesConference Presentations

Attending evaluationsAllied professional evaluationsPatient clinic evaluationsConference attendee evaluations

Systems-based practice

F11. Working with

social workers and case managers in inpatients or HIV outpatients

2. Working with case managers to establish outpatient antibiotics

F21. Analysis of

performance measures and interventions in inpatient or outpatient settings

Attending RoundsHIV clinicOther outpatient clinicsInfection Control at Touro (or Kenner)Pharmacy/Therapeutics at Touro (or Kenner)

Direct Patient CareTeaching RoundsConsult notesClinic NotesETC presentationsPI project presentations

Attending evaluationsAllied professional evaluationAcceptance of abstract at regional or national conference for PI project

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E. Program Experiences Listed by Specific ACGME-Identified Focus Areas

In accordance with the ACGME requirements, we have addressed the following topics areas with these particular materials or experiences:

Basic Science ID Research Conference and Clinical Microbiology conferences

Clinical ethics ACP Pier Ethics documents on ID core CDROM; discussions on clinical rotations and case conferences

Medical genetics ID journal club; articles on ID CDROMQuality assessment Touro rotation; articles on ID CDROMQuality improvement Touro rotation; articles on ID CDROMPatient safety Touro rotation; articles on ID CDROMRisk management Touro rotation; articles on ID CDROMPreventive medicine Touro rotation; HOP clinic; travelers clinic;

discussions on clinical rotations and case conferences; Journal Club; articles on ID core CDROM

Pain management HOP clinic; DAETC clinical course; articles on ID CDROM

End-of-life care HOP clinic; DAETC clinical course; discussions on clinical rotations and case conferences; articles on ID core CDROM

Name of Special Clinical ExperiencePatients who are neutropenic Inpatient rotations at UH, Touro, Kenner,

OCFPatients with leukemia, lymphoma, or other malignancies

Inpatient rotations at UH, Touro, Kenner, OCF

Patients following solid organ or bone marrow transplantation

Inpatient rotations at OCF, Kenner

Patients with HIV/AIDS or patients immunocompromised by other disease or medical therapies

Inpatient rotations at UH, OCF, Touro, Kenner,HOP clinic

Evaluation and management of infections of the reproductive organs

Inpatient rotations at UH, OCF, Kenner,HOP clinic; STD clinic

Evaluation and management of infections in solid organ transplant patients

Inpatient rotations at OCF, Kenner

Evaluation and management of infections in bone marrow transplant recipients

Inpatient rotations at OCF

Evaluation and management of sexually transmitted diseases

HOP clinic; STD clinic

Evaluation and management of viral hepatitis, including B and C

HOP clinic;Inpatient rotations at UH, OCF, Touro, Kenner,

Evaluation and management of infections in Tulane Travel Clinic

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travelersPleuropulmonary infections Inpatient rotations at UH, OCF, Touro,

Kenner, HOP ClinicInfections and other complications in patients with HIV/AIDS

Inpatient rotations at UH, OCF, Touro, Kenner, HOP Clinic

Cardiovascular infections Inpatient rotations at OCF, Touro, Kenner, UH

Central nervous system infections Inpatient rotations at UH, OCF, Touro, Kenner, HOP clinic

Gastrointestinal and intra-abdominal infections Inpatient rotations at UH, OCF, Touro, Kenner, Children’s

Bone and joint infections Inpatient rotations at UH, Kenner, OCF, Touro, Children’s;

Infections of prosthetic devices Inpatient rotations at Kenner, OCF, Touro, HOP clinic

Infections related to trauma Inpatient rotations at UHSepsis syndromes Inpatient rotations at UH, OCF, Touro,

KennerNosocomial infections Inpatient rotations at UH, OCF, Touro,

KennerUrinary tract infections Inpatient rotations at UH, OCF, Touro,

Kenner, HOP clinic

Mechanisms of action and adverse reactions of antimicrobial agents

Touro rotation; Clinical Microbiology conference; clinical rotations; ID journal club; Case conference; Citywide didactic conferences

Antimicrobial and antiviral resistance Touro rotation; Clinical Microbiology conference; clinical rotations; ID journal club; Case conference; Citywide didactic conferences;

Drug-drug interactions between antimicrobial agents and other compounds

Touro rotation; clinical rotations; ID journal club; Case conference

The appropriate use and management of antimicrobial agents in a variety of clinical settings, including the hospital, ambulatory practice, non acute-care units, and the home

Touro rotation; Kenner OP antibiotics; HOP clinic; inpatient rotations

Methods of determining antimicrobial activity of a drug

Touro rotation; Kenner rotation; Clinical Microbiology conference; ID journal club; Citywide didactic conference

Techniques to determine concentration of antimicrobial agents in the blood and other body fluids

Touro rotation; Kenner rotation; Clinical Microbiology conference; ID journal club; Citywide didactic conference; inpatient rotations

Interpretation of antibiotic levels in blood Touro rotation; Kenner rotation; Clinical Microbiology conference; ID journal club;

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Citywide didactic conference; inpatient rotations

Appropriate procedures for specimen collection relevant to infectious disease, including but not limited to bronchoscopy, thoracentesis, arthrocentesis, lumbar puncture, and aspiration of abscess cavities

Clinical Microbiology conference; ID journal club; ID case conference; Citywide case conference; Citywide didactic conference

Principles of prophylaxis and immunoprophylaxis to enhance resistance to infection

Touro rotation; Kenner rotation; ID journal club; Citywide didactic conference

Characteristics, use, and complications of antiretroviral agents, mechanisms and clinical significance of viral resistance to antiretroviral agents, and recognition and management of opportunistic infections in patients with HIV/AIDS

HOP clinicID Journal club; ID case conference; Citywide case conference; Citywide didactic conference

Methods for accessing databases of relevance to the care and management of individuals with infectious diseases

Touro rotation; Kenner rotation; ID case conference; ID Journal club; citywide case conference;Clinical rotations

The epidemiology, clinical course, manifestations, diagnosis, treatment and prevention of mycobacterial infections and major parasitic diseases

Inpatient rotations at UH, OCF, Touro, Kenner;ID journal club; Citywide didactic conference; Clinical Microbiology conferenceHOP clinic; Tulane Travel clinic

Opportunities to manage adult and geriatric patients with a wide variety of infectious diseases in both an inpatient and ambulatory basis

Inpatient rotations at UH, OCF, Touro, Kenner

Opportunities that encompass longitudinal experiences in a continuum of care that allow fellows to observe the course of illness and the effects of therapy

HOP clinic

Therapeutic modalities include management of antibiotic administration in settings such as the acute care hospital, the office, and in conjunction with the non-acute care facility or home-care services

Inpatient rotations at UH, OCF, Touro, Kenner;HOP clinic

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III. EDUCATIONAL RESOURCES

A. LSU Library Online ResourcesThe LSU library offers a variety of online resources available to the fellows from any computer with internet access. In addition, the LSU library maintains online subscriptions for many of the relevant journals available through Pub Med.

1. Infectious Diseases Books and other relevant books are available online athttp://www.lsuhsc.edu/library/databases/default.aspx

B. Citywide ID specific resourceCitywide ID presentations are recorded on CD and available for viewing. Contact the Fellowship Coordinator to check out CDs.

IV. EVALUATION OF FELLOWSTo meet the goals of the Outcomes Project of the ACGME, several evaluations will be performed during each rotation and over the course of the fellowship to provide objective assessments of the following competencies based on the Internal Medicine Subspecialty Milestones: Patient Care and Procedural Skills, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice.

A. ACGME Six Clinical Competencies

1. Patient CareFellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Fellows are expected to: communicate effectively and demonstrate caring and respectful

behaviors when interacting with patients and their families gather essential and accurate information about their patients make informed decisions about diagnostic and therapeutic

interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment

develop and carry out patient management plans counsel and educate patients and their families use information technology to support patient care decisions and

patient education perform competently all medical and invasive procedures considered

essential for the area of practice provide health care services aimed at preventing health problems or

maintaining health

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work with health care professionals, including those from other disciplines, to provide patient-focused care

2. Medical KnowledgeFellows must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Fellows are expected to: demonstrate an investigatory and analytic thinking approach to clinical

situations know and apply the basic and clinically supportive sciences which are

appropriate to their discipline

3. Practice-based Learning and ImprovementFellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Fellows are expected to: analyze practice experience and perform practice-based improvement

activities using a systematic methodology locate, appraise, and assimilate evidence from scientific studies related

to their patients’ health problems obtain and use information about their own population of patients and

the larger population from which their patients are drawn apply knowledge of study designs and statistical methods to the

appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness

use information technology to manage information, access on-line medical information; and support their own education

facilitate the learning of students and other health care professionals

4. Interpersonal and Communication SkillsFellows must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Fellows are expected to: create and sustain a therapeutic and ethically sound relationship with

patients use effective listening skills and elicit and provide information using

effective nonverbal, explanatory, questioning, and writing skills work effectively with others as a member or leader of a health care

team or other professional group

5. Professionalism Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Fellows are expected to:

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demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development

demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices

demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

6. Systems-based Practice Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Fellows are expected to: understand how their patient care and other professional practices

affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice

know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources

practice cost-effective health care and resource allocation that does not compromise quality of care

advocate for quality patient care and assist patients in dealing with system complexities

know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance

B. Clinical EvaluationThe fellow will be evaluated in a variety of forums including clinical rotations, didactic presentations, and conference participation. The methods of evaluation will include formal testing and written evaluations based on direct observation by other trainees, attending physicians, allied health personnel and patients. In addition, over the course of the fellowship, each fellow will engage in self-examination of his/her progress in each competency area.

1. Evaluation instruments Clinical competencies self-evaluation form Monthly evaluation form - This form will be completed by the

attending and filed with the Fellowship Coordinator. New Innovations is the web-based software program to perform these evaluations

Peer evaluation survey - This web-based survey will be performed by each member of the ID team (except the attending) at the end of the month.

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Allied health professional evaluation survey - This web-based survey will be performed by each allied health professional who interacts with the fellow over the last quarter.

Patient evaluation form – This form is given to patients in the HOP clinic and returned anonymously.

ID presentation evaluation form – An evaluation form will be completed by all members present at the Citywide Conference and filed in the fellow’s folder. Weekly Case Conference evaluations will be sent electronically to attendees and filed in the fellow’s folder.

IDSA in-service examination – This test is given yearly and used for assessment of knowledge and areas for improvement

HOP clinic patient outcomes – The fellow’s panel of HIV-infected patients will be assessed for the following outcomes at least annually and compared with local and national benchmarks:

STD screening rate PPD screening rate CD4 count (median and range) Viral load (median and range) Rate of appropriate PJP prophylaxis Rate of appropriate MAC prophylaxis Patient attrition rate

2. Evaluations policy When evaluating residents, program directors and faculty should use

the following definition as their standard — the level of knowledge, skills, and attitudes that is expected from a clearly satisfactory resident at this stage of training.

Using a nine-point scale, a clearly satisfactory resident should receive a rating of “5”. A rating of “4” should be considered “marginal.” A rating of "7" or above should be reserved for exceptional performance and should not be the norm. Any rating lower than "4" should be reported to the program director as soon as possible.

As much as possible, evaluations should contain specific examples to detail the basis for the rating.

3. House staff evaluations timing

a) Rotation-based evaluations All evaluations must be completed prior to the end of the

rotation. All trainees will perform a baseline self-assessment form for the

six general competencies at the beginning of the month. These assessments should be handed to the attending and may be reviewed at that time for the purposes of outlining expectations for the rotation.

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The trainees will meet with the attending at least once toward the middle of the month to review the clinical competencies self-evaluation and to provide feedback with a general competencies mini-evaluation form.

The house staff will meet with the attending at the end of the month to go over the final monthly evaluation form.

b) Other evaluations Semi-annual surveys will be performed by allied health personnel

and the continuity clinic attending. Patients from clinic experiences will be surveyed on a regular basis

about the performance of the fellow in this setting. Colleague surveys will be performed by students and residents on

the service monthly as well as semi-annually by other fellows in our program and those from other programs in the city.

The program director will meet with the trainee on a semi-annual basis to review fellow progress.

4. Other testing modalities The fellow will take the IDSA in-service examination yearly. The fellow will submit copies of any CME certificates from online

courses performed during the fellowship.

5. Evaluation files Files will be maintained in the fellowship coordinator's office. Any fellow can access the file during business hours.

C. Research ActivityResearch efforts are evaluated routinely while working with faculty and during sectional work-in-progress meetings. In all cases the faculty is dedicated to the success of the fellow and will offer suggestions and appropriate aid in seeing that fellows have a rewarding and successful experience.

D. Advancement to succeeding training yearIf the fellow fails to perform adequately in any of the six competencies at any time during the academic year, he/she will be immediately counseled by the program director or the section chief using the format outlined below in appendix. At the end of each academic year, the program director will review the progress over the year with each fellow. At that time, if the fellow has shown adequate progress in the six competencies, he/she will be promoted to the next year.

E. Disciplinary ActionsIn the event that the performance of a fellow is not up to the ethical, technical or intellectual standards of the section, the fellow will be counseled. Any such problem will first be discussed with the fellow by either the program director or the section chief. If this is not sufficient to remedy the situation sanctions and /or limitations of the fellow's activities may be imposed by the section chief. This move will only be taken after consultation with the other members of the

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faculty. The fellow has a right to bring his case before the section chief for further discussion and consideration. If this is not sufficient, or if the offense is so egregious, it may be necessary to dismiss the fellow from the program. In this case the section chief will first discuss the action with the other faculty members of the section. The fellow will have the right to sit in front of the faculty of the section and present his side of the case. After due deliberation, the section chief will be responsible for making the decision to dismiss the fellow. The fellow has the right to appeal this decision to the assembled full-time faculty of the ID section. After due deliberation the faculty will decide by secret vote and the ruling of this group is final. At each step of this process, the fellow will receive written notification of the complaint lodged against him, the decisions of the section and the right they have to appeal.

V. EVALUATION OF FACULTYWeb-based evaluations are kept on file, which evaluate faculty with respect to their teaching ability, clinical knowledge, and scholarly activity. These are completed by students, residents, and fellows at the conclusion of each month they are assigned to the consult or inpatient service. Fellows also evaluate the faculty on a yearly basis. These evaluations are anonymous.

VI.EVALUATION OF THE PROGRAMThe faculty and fellows meet quarterly to review whether educational goals are being met. Any shortcomings are discussed amongst the faculty and potential improvements are considered. Discussions with the fellows on how to improve the performance of all those in the section is encouraged. The fellows and the faculty also anonymously evaluate the rotations yearly using a web-based survey. In addition, the section conducts an annual retreat during which the faculty reviews the training program and discusses improvements. Fellows are asked to attend this retreat for the fellowship portion. Moreover, graduates of the fellowship program are periodically sent evaluations to assess the usefulness of the program in their present careers. These evaluations are discussed at the section retreats as well as at quarterly faculty meetings.

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VII.APPENDIXFollowing this is a compendium of forms pertinent to the program.

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