Program Details
General training
- The clinical course and manifestations of major infectious diseases, including sexually transmitted diseases and AIDS
- Comprehensive training in the use of infectious disease therapeutics
- Basic concepts of immunology
- Training in the appropriate use of diagnostic testing for various infectious diseases and symptoms
- The theory and application of epidemiology
- Training in the prevention of infectious diseases
Areas of study
- Factors that determine the outcome of the interaction between host and parasite, the effects of disease states and immunosuppressive therapies on host responses to infectious agents, and mechanisms of enhancement of resistance by immunization
- Mechanisms of action and adverse reactions of antimicrobial agents, the conduct of standard pharmacologic studies to determine absorption and excretion of antimicrobial agents, methods of determining antimicrobial activity of a drug, and the appropriate use of antimicrobial agents in a variety of clinical settings, including the hospital, ambulatory practice, and in the home
- The utility of procedures for specimen collection relevant to infectious diseases
- Culture techniques and methods for identification in tissues and fluids of bacteria, mycobacteria, fungi, viruses, rickettsia, chlamydia, and parasites
- The sensitivity, specificity, efficacy, benefits, and risks of contemporary technologies
- Principles and practice of hospital epidemiology
- Quality assurance and cost containment in the clinical practice of infectious diseases
DHMC provides opportunities for Infectious Diseases consultations in the areas of General Medicine, General Surgery, Pediatrics (including Neonatology), Obstetrics and Gynecology, Critical Care Medicine, Emergency Medicine, Geriatrics, Hematology/Oncology, Neurology, Orthopedics, Neurosurgery, and Transplant and Cardiothoracic Surgery.
Trainees are exposed to the full spectrum of infectious diseases affecting normal and immunocompromised hosts. Experience in treating opportunistic infections is gained by seeing patients of the Solid Organ Transplant Service, Bone Marrow Transplant Service, the Norris Cotton Cancer Center, the Dartmouth HIV Program, and the Neonatal ICU.
Consultation rounds and clinics
The principal teaching component of the training program is daily consultation rounds, which are conducted by a member of the full-time Infectious Disease faculty. Trainees perform 10 to 14 new consultations per week, resulting in an active consultative service of roughly 15 to 20 patients at any given time. Trainees also provide comprehensive oversight of diagnosis and treatment for inpatients admitted to members of the Section, many of whom are individuals infected with HIV. Trainees work closely with members of the housestaff in the coordination of patient care, including management of social and economic issues and discharge planning.
Trainees see ambulatory patients in four settings at DHMC: the Dartmouth Hitchcock I.D. Clinic, the Urgent Care Clinic, the Traveler's Clinic, and the Emergency Department. The I.D. Clinic is used for the longitudinal care of HIV-infected individuals and other patients with chronic infectious diseases, for non-emergent outpatient consultations, and for follow-up of patients seen as inpatient consultations. Each first-year trainee participates in 125-175 outpatient visits during the course of the year: two to four patients per week as scheduled patients in the I.D. Clinic and the remainder as consultations in the Urgent Care Clinic and Emergency Department. Second-year fellows continue to follow primary care HIV-infected patients taken on during the first year.
Other activities
Trainees play an integral role in a variety of other clinical activities during the course of the fellowship, including:
- Traveler's Clinic
- Antibiotic Subcommittee of the Pharmacy and Therapeutics Committee
- Infections Committee
- Dartmouth HIV Program
- AIDS Education and Training Center (State of New Hampshire)
The following educational experiences at Dartmouth-Hitchcock Medical Center also augment those of direct patient care: - Course in Decision Making and Clinical Epidemiology (Department of Medicine)
- Rotation in Clinical Microbiology and Virology Laboratories (3-4 weeks)
- Course in Clinical Pharmacology
- Immunology Seminar Series
Trainees also attend and participate in regularly-scheduled conferences of the I.D. Section; a weekly review of new inpatient consultations, an Infectious Disease Housestaff Teaching Conference, the AIDS Seminar Group meeting, and the Infectious Disease Journal Club; and conferences of the Department of Medicine, such as Morbidity and Mortality Conference, Medical Grand Rounds, ICU Critical Care Conference, Solid Organ Transplant Group meeting, and the Bone Marrow Transplant Group meeting.
Research studies
Following their clinical year, fellows engage in one or two years of clinical or laboratory research under the supervision of a member of the Infectious Disease Section, the Immunology Program, or the Departments of Medicine and Microbiology.
Trainees have access to the modern facilities of the Geisel School of Medicine at Dartmouth and the HIV Research Laboratory at the V.A. Hospital, a new, state-of-the-art facility designed for basic research on HIV infection. Members of the Section occupy an Infectious Disease Laboratory complex in the new medical center. This complex includes a clinical virology laboratory; a research virology laboratory; a laboratory for the study of bacterial pathogenisis, including facilities for bacterial cultivation and tissue culture; and a research laboratory for the study of myco-bacteria.
Fellows may also be supervised and supported by members of the Immunology Program at the Geisel School of Medicine, a diverse group of scientists interested in cellular and molecular approaches to basic immunologic issues and their application to cancer and autoimmune diseases.
During their first year, trainees are asked to select a research laboratory or an area of clinical investigation in which to work for the ensuing year(s). Submission of grant proposals for salary support is encouraged.
