Inpatient Training

The inpatient clinical training experience includes opportunities to observe and manage adult and adolescent patients with a wide variety of infectious diseases through the ID consult service. Prior to participating in the care of hospitalized patients, trainees complete a one-month intensive course in the clinical microbiology laboratory, which provides comprehensive diagnostic services for the inpatient and outpatient wards and clinics of UVA Health System.

Fellows are expected to develop expertise in the prevention, evaluation, and management of infections, particularly in the core areas defined by national standards for infectious diseases specialist training.

The ID inpatient consultation service is comprised of the general ID consult service and the transplant/immunocompromised host service. Two fellows are assigned to the general ID service, and one fellow to the transplant/immunocompromised host service, for two to six weeks at a time.

While on the inpatient consult services, fellows lead the service, direct rounds, and supervise up to three internal medicine residents and two to four 4th-year medical students. Fellows independently complete all new inpatient consults and staff them with attendings, either on rounds the following morning if patient cases are of low acuity or less complex, or that evening if cases are higher acuity or more complex. Fellows evaluate patients on the service in the morning prior to rounds, conducting a thorough assessment and developing a treatment plan based on supporting data from recent literature; they present each of their patients to attendings at 10:00 a.m. rounds, with discussion of relevant data and teaching by the attending. Rounds also include an ID clinical pharmacist who assists the team in antibiotic dosing and management of medication interactions and side effects. The ID inpatient consult service gives fellows the autonomy to develop evaluative and management skills to properly care for a complex patient population while also providing adequate supervision and support from faculty.

Patients seen on this service are followed during both the acute and recovery phases of their illnesses. When necessary, outpatient follow-up is provided in one of the outpatient ID clinics.

The clinical microbiology lab staff includes approximately 30 full-time technicians and two faculty members — director Melinda Poulter, PhD, and associate director Amy Mathers, MD (ID physician and director of antimicrobial stewardship). Professional technologists in each of the lab areas (virology, molecular diagnostics, mycology, mycobacteriology, bacteriology) provide trainees with a detailed review of colony/gram stain morphologies, molecular testing, and drug susceptibility testing for infectious pathogens. Time is allotted for further study in areas of interest to trainees. Current areas of research and development in the lab include an assessment of molecular techniques for detection of pathogens directly from clinical specimens. The lab encourages and facilitates fellows’ infectious disease research projects and has had several publications from such collaborations. While on the inpatient service, fellows are encouraged to attend clinical microbiology rounds every weekday at 1:30 pm, which focus on lab work-ups of difficult pathogens and reviews of microbiologic and clinical data to facilitate patient care.

Fellows have direct access to the clinical microbiology labs, including diagnostic bacteriology, immunology, mycology and virology. Facilities for the isolation of patients with infectious diseases are available in collaboration with the inpatient epidemiology staff.