Clinical tracks

Track Director: David Pegues, MD

This track is designed for second-year infectious diseases fellows who are interested in gaining expertise and skills needed to prepare for a career in healthcare epidemiology, including leading and collaborating with infection prevention and control and antimicrobial stewardship teams. Healthcare epidemiologists work to prevent and control healthcare-associated infections and other adverse outcomes by translating research into practice. Their expertise and activities include epidemiologic and laboratory investigation, infection surveillance, policy development and implementation, education and information dissemination, implementation of interventions to prevent infections, cost-benefit analyses of interventions, and patient oriented research to inform and improve the science of healthcare epidemiology and infection control and to improve quality-of-care. This practical training in healthcare epidemiology may be combined with an advanced degree research training program such as the Master of Science in Clinical Epidemiology (MSCE) or the Master of Science in Health Policy Research (MSHP), if desired.

Clinical Training

The trainee will gain experience and practical skills relating to healthcare epidemiology including: infection surveillance and informatics, outbreak management, communicable disease control, isolation and hand hygiene, sterilization and disinfection, construction and environmental control, product evaluation, occupational health, regulatory and public reporting compliance, performance improvement, and patient safety. S/he will also gain experience and practical skills relating to antimicrobial stewardship, including formulary decision making, treatment guideline development, analysis of antimicrobial utilization and resistance trends, and patient-level audit and provider feedback. The trainee will also learn to design and conduct healthcare epidemiology research utilizing appropriate study design and methods, including data collection and analysis, outcomes measurement, risk factor assessment, and quantitative and qualitative measures. Further, s/he will learn to translate findings into effective recommendations and practices using implementation science and communicating results to providers, leadership, and researchers through policy development, presentations and publications. The trainee will also develop administrative and collaborative skills necessary to become a leader in healthcare epidemiology.

Practicum Experience:

• HUP Healthcare-Associated Infections Review meeting (weekly).
• HUP and UPHS Infection Control Committees (monthly).
• HUP Antibiotic Subcommittee of Pharmacy and Therapeutics (monthly).
• HUP and Department of Medicine Clinical Effectiveness and Quality Improvement Committees (monthly).
• Penn Medicine Healthcare Epidemiology Research Group (quarterly).
• Other committees, including Evidence-Based Practice HAI Working Groups, Hand Hygiene Committee, Unit-Based Clinical Leadership Committees, U Penn Biosafety Committee, as appropriate.
• Shadowing programs, including work rounds with Infection Preventionists and Antibiotic Stewardship Pharmacists, Environment of Care Rounds, Construction Rounds, Central Processing, and off-site inspection of ambulatory care sites and Penn Home Infusion Services, as appropriate.

Research Experience

The fellow will design and conduct an independent clinical research project with support from their primary mentor and other collaborators on a stewardship or infection control topic. For fellows who do not intend to pursue training in a degree granting program (e.g., MSCE, MSHP), but would like to learn the fundamentals of research methodology, there is the opportunity to obtain a certificate in clinical research. Fellows may work with members of the ID division or other faculty at the University of Pennsylvania in other specialties as appropriate for their interests. In addition, there are a number of ongoing clinical trials, including those within Penn’s CDC Prevention Epicenter Program, and fellows may choose to participate in those as well.

Mentorship

The fellow will be assigned a primary mentor to help develop career goals and design research project(s), and identify potential additional mentors.

Additional Training Opportunities

It is recommended that fellows attend at least one of the following:

• Clinical Research Certificate Program, Center for Clinical Epidemiology and Biostatistics, UPenn (summer-spring semester, http://www.cceb.upenn.edu/education/non-degree/certificate.php)
• Basic and/or advanced training track in healthcare epidemiology, Society of Healthcare Epidemiologists of America Course (spring, http://sheaspring.org/)
• Healthcare epidemiology track, ID Week (fall, http://www.idweek.org/)

Core Faculty Mentors

• David Pegues, MD, Antimicrobial Stewardship and Infection Prevention Fellowship Track Director
• Kathleen Degnan, MD
• Keith Hamilton, MD
• Jerry Jacob, MD, MS
• Ebbing Lautenbach, MD, MPH, MSCE
• Judith O’Donnell, MD
• Naasha Talati, MD, MS
• Matthew Ziegler, MD

Track Director: Blair C. Weikert, MD

Given the growth of transplantation in the United States, there is increasing interest in specialized training in transplant infectious diseases. The University of Pennsylvania is well-positioned to provide this training. The Hospital of the University of Pennsylvania, with its Transplant Institute, is a national leader in the field of solid organ transplantation with very active programs in cardiac, lung, liver and kidney, pancreas and composite graft transplants that attract recipients and living donors from around the world. Similarly the Abramson Cancer Institute at the Hospital of the University of Pennsylvania provides world renowned care and research in the field of hematological malignancies and stem cell transplantation. Fellows will benefit from the long standing clinical and research partnerships between these institutions and the Division of Infectious Diseases. This practical training in transplant infectious diseases also may be combined with an advanced degree research training program such as the Master of Science in Clinical Epidemiology (MSCE) or the Master of Science in Health Policy Research (MSHP), if desired.

Clinical Training

The Transplant ID track combines diverse experiences in both inpatient and outpatient management of transplant candidates and recipients with infectious diseases issues with exposure to other transplant subspecialties and donor management.

The out-patient experience emphasizes both pre and post transplant management as fellows participate in screening candidates as well as living donors for transplant, and manage infectious diseases complications in the post transplant setting. Unique experiences include the management of HIV infection in transplant recipients, complex mycobacterial disease management, treatment of resistant bacterial and viral infections and chronic fungal infections, management of hematopoetic stem cell transplants, and treatment of patients with infections related to ventricular devices. Fellows will also be involved in the diagnosis and treatment of the full range of general ID in the immunocompromised host.

The inpatient consult service will be divided between the solid organ transplant ID service and the hematological malignancy/stem cell transplant service. During these rotations, the fellow will work closely with non-ID transplant providers in the other transplant programs. In addition, fellows will also have the opportunity to rotate on non-infectious disease services involved in transplantation.

In addition to these patient-focused rotations, fellows will have enhanced exposure to pertinent diagnostics, including microbiology, virology, and immunology. In addition, fellows will spend time at Gift of Life (one of the oldest and largest organ procurement organizations in the country), where they will have the opportunity to experience first hand the complexities of screening donors rapidly and effectively for communicable diseases.

In addition to the full array of conferences sponsored by the ID division, Transplant ID focused fellows will be invited to participate in conferences pertaining to transplant, including those sponsored by our division and those organized by medical and surgical transplant programs. These include recipient selection conferences, guideline development meetings (e.g., vaccines, prophylaxis antimicrobial use as it pertains to transplant), journal clubs, case conferences, and morbidity and mortality presentations.

Research Experience

The fellow will design and conduct an independent clinical research project with support from their primary mentor and other collaborators on a transplant ID-related topic. For fellows who do not intend to pursue training in a degree granting program (e.g., MSCE, MSHP), but would like to learn the fundamentals of research methodology, there is the opportunity to obtain a certificate in clinical research.

Fellows may work with members of the ID division or other faculty at the University of Pennsylvania in other specialties as appropriate for their interests. In addition, there are a number of ongoing clinical trials of particular interest for transplant recipients and fellows may choose to participate in those as well.

Mentorship

The fellow will be assigned a primary mentor to help develop career goals and design research project(s), and identify potential additional mentors.

Core Faculty Mentors

• Blair Weikert, MD
  Transplant ID Fellowship Director
• Emily Blumberg, MD
• Kathleen Degnan, MD
• Ingi Lee, MD, MSCE
• Sarah Longworth, MD
• Mindy Schuster, MD
• Kathryn Whitaker, MD

Track Director: Judith O’Donnell, MD

This track is designed for second year infectious diseases fellows to become an expert in the clinical management of patients in the critical care setting. There are high rates of infection, antibiotic use and antibiotic resistance in intensive care units (ICUs), which underscores the need to train infectious diseases specialists to work with critically ill and complex patients in order to drive antimicrobial stewardship and infection control in this setting. This practical training in critical care infectious diseases also may be combined with an advanced degree research training program such as the Master of Science in Clinical Epidemiology (MSCE) or the Master of Science in Health Policy Research (MSHP), if desired.

Clinical Training

Inpatient

The fellow will spend a minimum of 12 weeks during his/her second year of fellowship on inpatient rotations, with majority of the clinical experience at PPMC. Ideally, two to three week blocks should be spent in each of the following units: Medical Intensive Care Unit (MICU), Heart Vascular Intensive Care Unit (HVICU), Trauma Surgical Intensive Care Unit (TSICU), and Neurology Intensive Care Unit (NICU). The second-year fellow will be responsible for antimicrobial stewardship and infection control related issues as well as consultative services with the support of an attending physician.

Antimicrobial Stewardship

Antibiotic use in the critical care setting is prevalent. Many times antibiotics prescribed in the ICUs are unnecessary, inappropriate or suboptimal. The fellow will have the opportunity to work along with the ICU pharmacists and the antibiotic stewardship team to learn how to perform effective stewardship in the ICU setting. Working closely with the pharmacists, the fellow will also become more comfortable with the pharmacokinetic and pharmacodynamics of antimicrobial therapies in critically ill patients, particularly adjusting for patients with septic shock and renal injury requiring continuous veno-venous hemodialysis. The fellow will also participate in monthly hospital-based meetings to discuss antimicrobial related issues such as drug shortages, microbiology reports, antibiotic guidelines, and formulary changes. It is an expectation that the fellow will be an active participant in developing some of these guidelines and reports as they pertain to the critical care track.

Infection Control

ICUs carry a high risk of nosocomial infections leading to increase morbidity and mortality. Catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonias (VAP) and central line associated blood stream infections (CLABSI) are just a few of the hospital-associated infections that are commonly seen in critical care units. Multidrug-resistant organisms and Clostridium difficile are also major issues in this setting. Fellow participation in reducing the risk of transmission of these infections, implementing treatment and prevention protocols, and educating house staff will be an essential part of this track.

In this rotation the fellow will learn the basics of how an Infection Control (IC) department works: what National Healthcare Safety Network (NHSN) definitions are, round in units with infection preventionists (IPs), assess unit Hospital-Acquired Infection (HAI) data and hand hygiene data. He/she will also round as part of Environment of Care Rounds and attend several ICU-related meeting including (but not limited to) the Critical Care Committee, Infection Control Committee, and patient safety.

Transplant/Oncology

The fellow will have one to two week rotations in at least two of the above mentioned consult services to increase exposure to the immunocompromised patients and the unique issues related to the management of the critically ill transplant and oncology patients. This includes complications of opportunistic infections, device related infections (e.g. ventricular assist devices and extracorporeal membrane oxygenation), and both community and health care related infections in these populations. The inpatient consult service will be divided between the solid organ transplant ID service and the hematological malignancy/stem cell transplant service. During these rotations, the fellow will work closely with non-ID transplant providers in the other transplant programs.

Long-Term Acute Care Facility

The fellow will have the option to spend one to two weeks at the Long-Term Acute Care Facility (Good Shepherd, Penn Partners) to learn more about the infectious diseases complications associated with long term ventilator management/ventilator wean programs.

Research Experience

The fellow will design and conduct an independent clinical research project with support from their primary mentor and other collaborators on an ICU-related topic. For fellows who do not intend to pursue training in a degree granting program (e.g., MSCE, MSHP), but would like to learn the fundamentals of research methodology, there is the opportunity to obtain a certificate in clinical research. Fellows may work with members of the ID division or other faculty at the University of Pennsylvania in other specialties as appropriate for their interests. In addition, there are a number of ongoing clinical trials of particular interest for critical care infectious diseases and fellows may choose to participate in those as well.

Mentorship

The fellow will be assigned a primary mentor to help develop career goals and design research project(s), and identify potential additional mentors.

Core Faculty Mentors

• Judith O’Donnell, MD, Critical Care Fellowship Track Director
• Jerry Jacob, MD
• Brendan Kelly, MD, MSCE
• Ebbing Lautenbach, MD, MPH, MSCE
• Naasha Talati, MD, MS

Track Director: Sara Clemens, MD

This track is designed for upper year infectious disease fellows to become experts in the clinical management of people living with HIV and viral hepatitis. Our division has a wide range of faculty for mentorship with many opportunities in clinical care and research in HIV and viral hepatitis. There are opportunities to work with complex, underserved patient populations both locally and abroad. Fellows in the track will have the chance to pursue scholarly work, quality improvement projects, or participate in medical education on core topics in these fields. This practical training may also be combined with an advanced degree research training program such as the Master of Science in Clinical Epidemiology (MSCE) or the Master of Science in Health Policy Research (MSHP), if desired.

Clinical Training

Outpatient

The outpatient experience will consist of the fellow’s weekly continuity clinic and various optional specialty HIV/viral hepatitis clinics. Fellows will become experienced in the longitudinal care of persons living with HIV including complications of advanced HIV and viral resistance, and treatment of viral hepatitis. Sites for continuity clinics include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Philadelphia Veterans Affairs Medical Center. Track fellows will serve as their clinic “HIV/Viral hepatitis fellow” and embed into multidisciplinary teams who manage Ending the HIV Epidemic programs and Ryan White grant supported clinic activities.

Inpatient

Second year fellows will spend twelve weeks on inpatient rotations. This will include experience on the ID primary service, which focuses on the inpatient care of persons living with HIV. The second year fellow will be responsible for conducting rounds with Internal Medicine residents and making management decisions with the support of the attending physician. Other inpatient rotations which offer experience serving complex populations affected by HIV and viral hepatitis include HUP Cedar, a community hospital in West Philadelphia staffed by Penn physicians, and Penn Presbyterian Medical Center.

Medical Education

Track fellows will present ID division grand rounds and HIV grand rounds on a topic of their choice. While on the HIV primary service, track fellows will be responsible for once weekly morning lectures for Internal Medicine residents and medical students. Many additional medical education activities are available at undergraduate and graduate medical education levels for interested fellows.

Optional Clinical Opportunities

Specialty Clinics

During the second year, fellows may participate in additional clinical experiences in community and academic settings.

Opioid Use Disorder

Fellows can rotate on the inpatient addiction medicine service at PPMC and spend time at Prevention Point, a nonprofit public health organization in North Philadelphia. Prevention Point provides medical services for people affected by OUD including HIV treatment and prevention, management of viral hepatitis, syringe services programs, and overdose prevention.

HIV Sub-specialty Clinics

Fellows can gain clinical experience in many sub-specialty areas of HIV, including but not limited to: adolescents, pregnant persons, gender affirming care, and anal pap/anoscopy.

Philadelphia Department of Public Health

Fellows can spend additional time beyond their first year in the health department’s tuberculosis and STI clinics, which serve HIV-positive patients and those at risk of developing HIV..

Global HIV

Fellows can spend a clinical rotation at Princess Marina Hospital in Gaborone, Botswana through the Botswana-UPenn Partnership. For more information visit our Botswana-UPenn Partnership.

Research Experience

Fellows will have the option to design and conduct independent clinical research or quality improvement projects. For fellows who do not intend to pursue training in a degree granting program (e.g., MSCE, MSHP) but want to learn the fundamentals of research methodology, there is the chance to obtain a certificate in clinical research. Fellows can also participate in clinical trials, working with mentors in the AIDS Clinical Trials Unit (ACTU), the Penn Center for AIDS Research (CFAR), or the Penn Botswana program.

Mentorship

The track director will facilitate connections to faculty who can serve as research or career mentors.

Core Faculty

• Sara Clemens, MD – HIV Viral Hepatitis Fellowship Track Director
• Val Amorosa, MD
• Jillian Baron, MD, MPH
• Cedric Bien-Gund, MD
• Greg Bisson, MD, MSCE
• Ian Frank, MD
• Robert Gross, MD, MSCE
• Helen Koenig, MD, MPH
• Vincent Lo Re, MD, MSCE
• Jessica Meisner, MD, MSHP
• Florence Momplaisir, MD, MSHP
• Arianne Morrison, MD
• Anne Norris, MD
• Aaron Richterman, MD MPH
• William Short, MD
• Zsofi Szep, MD, MSCE
• Pablo Tebas, MD
• Jessie Torgersen, MD, MHS, MSCE
• Dovie Watson, MD, MSCE

This 12 week clinic covers the clinical rotations focused on opioid use disorders in relation to infectious diseases.

Key Required Clinical Experiences

• 12 weeks clinical ID rotations (preference to HIV primary service and HUP Cedar)
• Second ID clinic
  • Potential sites include: Lax/FIGHT, Prevention Point Philadelphia, Center for Viral Hepatitis at PPMC, PWID/ID discharge clinic at HUP
• Rotation with Addiction Medicine team (at PPMC)
• May be substituted for addiction rotation at VA or Addiction Psych at HUP
• Buprenorphine prescribing clinic experience
• 1-week rotation at Prevention Point
  This will include both clinical and non-clinical experiences

Elective/Optional Clinical Experiences

• Shadowing experience with CORE navigators
• Shadowing experience with methadone clinic/NA if possible
• Attending weekly Endocarditis huddles with CT surgery about the PWID admitted
• Attending Opioid Task Force meetings (HUP/UPHS)
• Outpatient wound care rotation at Prevention Point
• Rotation at the Center for Viral Hepatitis at PPMC
  May involve work with Advocacy and HepCAP
• ID Care Integration in SUD Inpatient and Outpatient Programs
  This is a potential opportunity for fellows beyond this period to imbed themselves within these programs for a week to understand challenges/barriers in care cascades.
• Involvement with EHE meetings and PEP COE
• Toxicology shadowing for drug screens

Key educational experiences

• Research or QI project related to Substance use/ID topic
• Goal of project is to submit ID week abstract/publication
• Attend Addiction fellowship didactics when possible
• Gain comfort with buprenorphine prescribing and all forms of MOUD
• Applying for the fellowship immersion training in addiction at BU

Core Faculty

• Jessica Meisner, MD
  Track Director
• Jillian Baron, MD, MPH
• Zsofi Szep, MD
• Jessie Torgersen, MD