Fellowship Curriculum

Sample Schedule

Year 1 Schedule - 13 Four-week Blocks
6.5 Blocks of Inpatient ID Consults at Vidant Medical Center
2 Weeks of an Elective Block A
2 Weeks of Microbiology
2 Weeks of Antimicrobial Stewardship
1 Week of Infection Control
3 Weeks of Vacation
4 Blocks of Research B
Year 2 Schedule - 13 Four-week Blocks
6.5 Blocks of Inpatient ID Consults at Vidant Medical Center
1 Block of Immunocompromised Host ID at University of North Carolina at Chapel Hill
2 Weeks of an Elective Block A
2 Weeks of Travel Medicine
1 Block of Vacation (3 weeks)
3.5 Blocks of Research B

A Private Practice ID, Wound Care, Oral Medicine, Pediatric ID, off-site elective if given 3 months' notice. 2-4 weeks in length

B Research project is longitudinal throughout fellowship. Research blocks are utilized to have protected time to accomplish goals, however, research should occur throughout the year.

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Inpatient General ID Consultative Services

Vidant RoundsOne of the most important aspects of the educational experience is rotation through the inpatient consultative services comprised of two ID fellows, internal medicine residents, PharmD's, and occasionally 3rd and 4th year medical students.

The fellows spend half their time each year on the Vidant ID consult service. The consult service sees approximately 140 inpatient consults per month, 70 per fellow.

Consultations include patients with a wide variety of infectious disease pathology including a large number of patients with AIDS and opportunistic complications, as well as solid organ transplant recipients (kidney and pancreas) and those with leukemia, lymphoma, and solid malignancies.

There are also weekly "plate rounds" with our in-house director of microbiology. The presence of multiple surgical services including a separate cardiac center offer unique consult opportunities. Read more about Vidant Medical Center.

Immunocompromised Host ID Consultative Services

UNC Health CareEach second year fellow will spend 1 block at University of North Carolina (UNC) on their Immunocompromised Host ID (ICHID) Consult service. Patient populations encountered include solid organ transplant recipients (lung, heart, kidney, liver and pancreas), allogeneic and autologous stem cell transplant recipients, patients with hematologic malignancies, and patients with burn injuries who are being cared for in the NC Jaycee Burn Center.

Fellows are provided lodging for this 4 week rotation at The Residence Inn Chapel Hill with shuttle service to and from UNC hospitals.

UNC Hospital

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Outpatient Experiences

Dr. Lagasca

HIV Continuity Clinic

Each fellow will participate in an HIV continuity clinic over the course of the two years of their training. The clinic is one of the largest Ryan White funded comprehensive HIV clinics in the southeastern US with a 1500 patient base, social workers, case managers, two on-site pharmacists and adherence counselors.

On average, fellows will follow 80 HIV patients through their training time. This clinic occurs one half day per week.

General ID Clinic

The fellows' general ID clinic occurs one half-day per week when not on inpatient consults. In this clinic fellows will see infectious diseases referrals from within ECU/Vidant and the outside community.

Dr. CookSpectrum of patients includes tuberculosis, FUO, osteomyelitis, infective endocarditis, Lyme disease, complicated pneumonias, UTI, STDs, prosthetic joint infections, workup of the solid organ transplant patient and many more.

Additionally, this clinic serves as the fellow's hospital follow-up clinic. Fellows will also have an opportunity to interact with social workers and home health agencies regarding follow-up and care of patients who are on home intravenous antibiotics.

Hepatitis C Clinic

Our ID clinic is a major referral center for patients living with Hepatitis C in the region. We uniquely have our fellows participate in a dedicated fellow hepatitis C clinic one half-day per week throughout approximately half of their research blocks. We have an on-site Hepatitis C pharmacist who processes drug applications and prior authorizations.

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Microbiology

microplateFellows will spend a required two weeks in the microbiology laboratory at Vidant Medical Center Hospital. During this period of time, the fellow will learn clinical microbiology techniques, including routine gram staining methods, fungal staining methods, stains for acid-fast organisms, culture of specimens for clinically significant viruses, including Herpes Simplex, Varicella, Cytomegalovirus, Influenza virus, and Adenovirus. Culture methods for fungi and acid-fast bacilli will be discussed as well as hands-on experience with these methods.

microplateIn addition to the one month rotation, plate rounds occur each week. In this 30 minute microbiology rounds, cultures and pathology specimens of patients on the consult service are reviewed together with the microbiologist followed by a short didactic session.

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Antimicrobial Stewardship

Antibiotic stewardship is an integral part of our Infectious Diseases training given our robust stewardship team. Fellows will participate in a two week rotation with the stewardship pharmacists where an individualized curriculum is created based on individual fellow goals.

antimicrobial stewardshipThere will be dedicated time for the Fellow to focus on specific areas including adherence to infectious disease guidelines, de-escalation, IV to PO conversion, pharmacokinetic and pharmacodynamic drug properties, drug dosing, dose adjusting based on renal function and weight, monitoring parameters of antimicrobials, drug cost, and drug-drug interactions.

There is also a lecture devoted to the development, implementation and management of an antimicrobial stewardship program. In addition, the stewardship team provides didactic lectures, case based discussions, and services on the inpatient hospital consult service. Fellows are members of the antimicrobial utilization stewardship subcommittee and are encouraged to attend the monthly meeting.

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Infection Control

Fellows will learn Infection Control Practices during their inpatient and outpatient services but in addition, they will participate in a 1 week rotation with Vidant's Infection Control department. Here they will have a lecture series and meet with Vidant Medical Center's Medical Director of Infection Control and hospital epidemiologist. They will review and understand how Infection Control performs surveillance for each of the devices and surgical site infections by meetings with Infection Preventionists for VAPs, CLABSIs, CAUTIs, and Surgical Site Infections.  They will also regularly attend the monthly Infection Control Committee meetings when not on the hospital consult service or vacation.

Fellows will also receive formal infection control training via the IDSA/SHEA infection control fellows' course.  Fellows will take this course in the second year of the program.  The cost of the course is covered by the program

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Travel Medicine

East Carolina University International Travel Clinic offers pre-travel counseling, immunizations, and health advice for adults and children who are planning to travel out of the U.S. The clinic is a North Carolina State Department of Health-designated center for yellow fever vaccine. Fellows are expected to attend travel clinic during designated clinic times during a required two week elective block (approximately three half-days per week).

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Elective Opportunities

Private Practice

Physicians EastFellows will gain private practice experience in an Infectious Diseases practice in an office setting evaluating high numbers of referrals from the eastern North Carolina community. This clinical experience will include but not be limited to diagnosis and treatment of prosthetic joint infections, diabetic foot infections, mycobacterial pulmonary infections, recurrent urinary tract infections, chronic hepatitis C, fever of unknown origin, pre-travel medicine, and endemic fungal infections.

The fellow(s) will expand clinical experience with management of antimicrobial agents in ambulatory practice through an office infusion center. The fellow will gain a better appreciation for the daily activities and set up of a private practice office. They will learn about the role of the private Infectious Diseases consultant in the community as well as in a multi-specialty clinic and explore differences in private and academic practice types.

Fellows will be directly supervised by Dr T. Ryan Gallaher, participate in the total management of patient care, assist with in-patient and out-patient evaluation and care, and review medical charts and records. Read more about Dr Gallaher's practice.

Wound Care

Fellows will have the opportunity to rotate with Dr Clinton Faulk, Vice Chairman and Residency Program Director of ECU/Vidant's Physical Medicine and Rehabilitation residency program at Vidant's Wound Healing Center. Here they will learn the basics of wound care management from wounds resulting from various etiologies including diabetes, pressure, arterial disease, and venous disease.  Fellows will enhance their ability to utilize proper assessment techniques, distinguish among various types of ulcers, select and apply wound dressings and topical agents, and employ various techniques of debridement.

Oral Medicine

School of Dental Medicine
School of Dental Medicine

This rotation will occur at ECU's School of Dental Medicine which is a new, state-of-the art center. Fellows will rotate with Dr. Iquebal Hasan exploring oral infections among other medical disorders of the mouth that are associated with systemic diseases.

Pediatric Infectious Diseases

Fellows have the opportunity to rotate with ECU's Pediatric Infectious Disease service at ECU/Vidant.

Off-site Away Electives

Fellows may participate in any off site away elective pending approval from the Program Director. Three months' notice minimum is required.

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Research

All fellows are required to participate in a scholarly project during their fellowship training. The fellow is expected to submit an abstract for submission to IDWeek by May of their 1st year of training. There is funding provided to attend IDWeek during the fellow's 2nd year of training if an abstract is accepted for presentation.

The division has a monthly research conference where divisional projects will be discussed and reviewed. In the first few months of fellowship training, the research conference will focus on presentations to fellows to allow them to select a research mentor and project by September of their first year. Additionally, this conference will be devoted to a research curriculum (topics including but not limited to IRB process, research design, REDCap, and statistical analysis).

The fellow will present their research with updates twice annually at this conference.