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The Infectious Diseases Service at Memorial Sloan-Kettering is dedicated to the care of patients with infections, the training of physicians in the subspecialty of infectious diseases, the investigation of infectious disease therapies, and the study of immune defense against microbial pathogens.
The Infectious Diseases Service offers a two-year program providing comprehensive training to internists in both the clinical and research settings. Clinical training occurs predominantly on the inpatient infectious diseases consult service at Memorial Hospital and in the outpatient clinics. Fellows also receive extensive research training in clinical investigation or basic laboratory research in preparation for academic careers in infection and diseases. While the first year of fellowship is largely focused on clinical training, the second year of fellowship is designed to provide fellows with ample, contiguous blocks of time to pursue their research interests.
The Infectious Diseases (ID) Fellowship Program at Memorial Sloan-Kettering prepares fellows for the practice of general infectious diseases with emphasis on the treatment of infections in the compromised host. Infectious diseases fellows perform approximately 250 to 300 consultations on a wide range of infectious diseases, and receive supervision and instruction from faculty members on a daily basis. The majority of clinical training takes place on the inpatient infectious diseases consult service and in the outpatient clinics of Memorial Sloan-Kettering. Fellows also have the opportunity to spend time on the inpatient services and clinics of several area hospitals. The clinical experience — though general in terms of the breadth of infections seen in our patient population — is particularly focused on infections of the immunocompromised host.
The Infectious Diseases Service rounds on a daily basis, following complicated cases through the course of the infection. Formal attending rounds are conducted Monday through Friday. Weekend coverage is provided by the fellow and the attending on call for that weekend. At rounds, all new consultations are presented, and the management of each patient on the service is reviewed. Pertinent articles and teaching points are discussed as well.
At the end of morning attending rounds, the team rounds through the Clinical Microbiology Laboratory to review all new positive blood cultures, new viral cultures, significant cultures from non-sterile sites, and other findings pertinent to patient care. Charts of all patients with positive blood cultures are reviewed by fellows to make certain that patients are receiving appropriate antibiotic management.
An important responsibility of the infectious diseases fellow is providing consultative advice to Employee Health Services following needlestick or other occupational exposures. Issues such as beginning prophylaxis for an exposure to HIV are complex and are made with the input of the ID attending.
In addition, fellows spend one to two months on the inpatient services of NewYork-Presbyterian/Weill Cornell Medical Center and Bellevue Hospital Center.
Approximately 200 to 250 patients are followed in Memorial Sloan-Kettering's infectious diseases clinic, which meets regularly on Tuesday afternoons and Friday mornings. Additional clinic time is available if a patient needs immediate evaluation. HIV-infected patients are followed for primary management of HIV and second opinions. Other patients include those seen after inpatient consultation for such diseases as osteomyelitis, endocarditis, and tuberculosis. Finally, noncancer patients with possible Lyme disease, fever of unknown origin (FUO), fungal infections, or hepatitis are seen. The care of all outpatients is supervised by an attending physician.
During the second year of fellowship, fellows attend several sessions at the Infectious Diseases Associates/Travel Medicine Clinic affiliated with NewYork-Presbyterian Hospital /Weill Cornell Medical Center. Fellows attend several sessions at SUNY Downstate's STD Clinic in Brooklyn, under the supervision of the clinic's director, Michael Augenbraun, and other infectious diseases specialists. Fellows see and evaluate a range of STDs in men and women, and learn the differential diagnosis of common presenting complaints, such as genital ulcer and urethral discharge, as well as their diagnosis and management.
Clinical Microbiology Rotation
Infectious diseases fellows spend one month in the first year of fellowship rotating through the Clinical Microbiology Service, under the direction of Esther Babady, to learn the basics of bacterial, fungal, and viral identification and determination of antimicrobial susceptibility.
Clinical Research Methodology Course
Infectious diseases fellows are eligible to apply for the NIH-sponsored Clinical Research Methodology Course at Memorial Sloan-Kettering. This one-year course consists of educational programs designed to train fellows to be clinical researchers. A variety of topics are covered, including epidemiology, ethics, and biostatistics.
Hospital Infection Control and Epidemiology
All fellows attend the monthly meetings of Hospital Infection Control and, while on service, participate in daily infection-control-related decisions. In addition, interested fellows may participate in outbreak investigation, surveillance, employee-health-related problems, and other activities of the infection control group. Hospital Infection Control is directed by Janet Eagan and Kent Sepkowitz.
The Centers for Disease Control and Prevention offers an annual four-day course in conjunction with the Society for Healthcare Epidemiology of America titled “Training Course in Hospital Epidemiology.” Interested fellows may attend this course free of charge.
Memorial Sloan-Kettering Cancer Center has a long history of conducting research on the management of infectious diseases in immunocompromised patients. In the 1970s, our Infectious Diseases Service performed pioneering studies on the diagnosis of and therapy for infections in patients undergoing intensive chemotherapy for cancer, and in the 1980s we became a center for the study and therapy of AIDS. In recent years, the research focus of the Infectious Diseases Service has been extended to clinical and laboratory investigation of immune responses to bacterial, fungal, and viral infection. Our laboratory and clinical investigators are studying adaptive and innate immune responses to infection in patients undergoing cancer chemotherapy and stem cell transplantation.
Broadly speaking, clinical investigation within the Infectious Diseases Service focuses on diagnosis and therapy of infections in the compromised host and hospital infection control. Collaborative clinical research projects between the Infectious Diseases Service and other services within Memorial Sloan-Kettering focus on monitoring and augmenting antiviral immunity in transplant patients and patients receiving other forms of cancer therapy. Quantitative methods are being used to identify and characterize T lymphocyte populations that combat viral and fungal infections in immunocompromised patients. On a more basic research level, laboratories of the Infectious Diseases Service are studying infectious diseases in animal models to develop a deeper understanding of immune defenses against invasive microbes.
In January 2010, Memorial Sloan-Kettering created a multidisciplinary research center to shed light on the role that microbes and the body's inflammatory and immunological responses to them play in the development of cancer. The Lucille Castori Center for Microbes, Inflammation, and Cancer unites researchers in the areas of molecular biology, immunology, computational biology, and microbiology and members of the Infectious Diseases and Clinical Microbiology Services in Memorial Hospital. In addition to facilitating research among Memorial Sloan-Kettering's investigators and clinicians, the Castori Center provides grants for clinical and laboratory-based fellows to extend their research and training.
The fellowship director, service chief, and other faculty speak with each fellow individually regarding potential projects in the first months of fellowship. By fall of the first year of fellowship, fellows generally have identified a few areas of potential interest and a specific mentor for each area.
Infectious diseases fellows can become involved with and may initiate a broad range of clinical studies. Research projects may vary from clinical reports to case series to epidemiologic investigations. All research projects will be supervised by faculty members within Memorial Sloan-Kettering, or faculty members from The Rockefeller University or Weill Cornell Medical College who are associated with the Memorial Sloan-Kettering Infectious Diseases Service. Though most clinical studies typically occur within the Infectious Diseases Service they often cross borders into other disciplines. Thus, collaborative studies with other clinical services (lymphoma, leukemia, transplant, etc.) are commonplace and encouraged. The close relationship between the Clinical Microbiology Service and the Infectious Diseases Service also provides many opportunities for fellow-initiated research projects.
The research laboratories of the Infectious Diseases Service at Memorial Sloan-Kettering are focused on the immune response to infection by bacterial, fungal, and viral pathogens. The pathogenesis of mycobacterial infections is also actively investigated. Interested fellows are encouraged to work in the laboratory on research projects that characterize the interface between the mammalian immune system and pathogens in the setting of infectious disease. Fellows are provided with on-site training in laboratory investigation and also have opportunities to participate in basic science course work. Fellows with interest in microbiology, cell biology, and other fields have a panoply of research options at Memorial Sloan-Kettering along with opportunities at The Rockefeller University and Weill Cornell Medical College.