Infectious Diseases Clinical & Research Training
Our ACGME-approved Infectious Diseases (ID) Fellowship program trains physicians to become experts in the management of infections associated with cancer treatment, including allogeneic hematopoietic stem cell transplantation, checkpoint blockade treatment to enhance T cell-mediated clearance of tumors, and T cells expressing tumor-specific chimeric antigen receptors.
Our ID fellows complete clinical rotations at New York Hospital and other hospitals in New York City to round out their clinical experience. They also receive extensive research training in clinical investigation or basic laboratory research in preparation for careers in academic infectious diseases. Many of our fellows have gone on to careers in academia, research, and clinical medicine. See our list of previous fellows below.
Memorial Sloan Kettering is one of the world’s premier cancer centers and is committed to excellence in patient care, educating physicians-in-training, and conducting cutting-edge research. Our mission and commitment to on-site comprehensive medical care ensures that a sizable proportion of patients require treatment for nononcologic diseases, which is provided by specialists and subspecialists.
The goal of the MSK ID Fellowship Program is to provide a broad-based educational experience that includes the evaluation and management of a wide variety of infectious diseases occuring in medical and surgical patients, both adult and pediatric, in the inpatient and outpatient settings.
Infections in immunocompromised patients provide novel opportunities to investigate infectious disease pathogenesis, and MSK ID fellows have a long tradition of research productivity in this realm. Over the last decade, fellows have described opportunistic infections in cancer patients (such as PCP, Mycobacterium haemophilum, and 2009 H1N1 influenza), been involved in use of molecular tools for rapid diagnosis (for example, C. difficile) or hospital surveillance for resistant organisms (including VRE), or been actively engaged in bench research (such as immune responses to Aspergillus fumigatus).
The MSK ID Fellowship program has trained many distinguished ID specialists who have entered public health or academia and become leaders in the field. The academic programs and resources of Memorial Sloan Kettering, its tradition of clinical and scientific excellence, and the high quality of other subspecialty programs throughout the hospital have provided MSK ID fellows with a supportive environment for clinical learning and scholarship.
One of the obvious strengths is the breadth and depth of experience that MSK ID fellows develop in dealing with infectious complications occurring in the immunocompromised host, including those undergoing treatment for cancer, recipients of autologous and allogeneic hematopoietic stem cell transplant, and HIV-infected patients.
Inpatient consults for fellows are divided between two teams: the regular consult service (blue team) and the immunocompromised host service (red team), which consists of leukemia and transplant patients.
To unload the consult burden from fellows, there is also an attending only service, which staffs consults that are deemed of low educational value for fellows.
|Rotation in Clinical Micro/Infection Control/AMP||MSK# Inpatient Consults||NYPH-Cornell Inpatient Consults||Research|
|First Year^||1 month||6-7 months||1 month||2-3 months|
|Second Year^||N/A||2-3 months||N/A||8-9 months*|
#Fellows alternate between the regular consult service (blue team) and the immunocompromised consult service (red team).
*During one research block, fellows spend eight half-day sessions at SUNY-Downstate’s STD Clinic; during another research block, they spend six half-day sessions at the ID Associates/Travel Medicine Clinic affiliated with NYPH-Cornell.
^Fellows are assigned to Tuesday afternoon or Friday morning clinic during their fellowship training, during which they see patients infected with HIV, internal and external referrals for a range of infectious diseases, and patient follow-ups from in-house consultations. Fellows also attend the Employee Health and Wellness clinic approximately four to six times a year to become proficient at evaluation and management of employees with LTBI or exposure to blood-borne pathogens.
NYP/Cornell: To balance education and training, fellows rotate for one month on the inpatient service at NewYork Presbyterian/Weill Cornell Medical Center as first-year fellows. There, they encounter infectious problems occurring at a general hospital where patient populations include immunologically normal hosts, the elderly, patients with alcohol and/or drug abuse histories, returning travelers, and recent immigrants.
Ambulatory: To enhance the fellows’ ambulatory clinic experiences, second-year fellows do one-month rotations at the STD Clinic of SUNY-Downstate Medical Center in Brooklyn and the ID Associates/Travel Medicine Clinic of NYP/Cornell. All clinical rotations are under the supervision of an attending physician.
Elective/research time is offered to second-year fellows who wish to pursue additional clinical rotations at local New York hospitals if arranged beforehand with the program director and leadership at the hospital in question. Recent electives pursued by fellows include a solid organ transplantation elective at Mount Sinai and outpatient HIV clinic elective at NYP/Cornell
Specific responsibilities are distributed throughout the fellowship. In general, the first-year (junior) fellows provide the majority of inpatient care. Second-year (senior) fellows provide leadership and serve as role models for the junior fellows and other rotators to the ID service. The senior fellows are also responsible for organization and preparation of Intercity Rounds, hosted by MSK biannually; organization of monthly TransYork rounds; end-of-the-year presentation of research work at the “Advanced Topics in Infectious Disease” lecture series; supervision of the Blood Culture Quality Improvement (QI) Project and other QI projects; representation to the ID fellowship’s Program Evaluation Committee; and representation to the hospital’s Graduate Medical Education (GME) committee.
Additional Fellow Responsibilities
Microbiology Rounds: At the end of attending rounds, the ID consult team will round in the Microbiology laboratory to review all new positive blood cultures, significant cultures from nonsterile sites, and other significant microbiologic results relevant to patient care. Director Yi-Wei Tang and Assistant Director Esther Babady supervise the microbiology laboratory.
Antibiotic Approvals: The Antibiotic Management Program (AMP) handles antibiotic approvals six to seven days a week from 9:00 am to 5:00 pm. After hours (and also on some holidays and weekends), the approval pager is rolled over to the ID fellow on call. The bulk of night approvals generally occur before 11:00 pm.
Blood Culture Quality Improvement (QI) Project: As part of an ongoing QI project, the charts of all patients with one or more positive blood cultures (with the exception of coagulase-negative staphylococci recovered from a single blood culture) are reviewed by the on-service ID fellows to ensure adequacy of empiric antimicrobial therapy. The on-service attending serves as backup for the fellows. Formal consultation may be necessary to assist in the management of complicated bloodstream infections.
Needlesticks/splashes/other occupational exposures: After hours and on weekends and holidays, the ID fellow may be contacted regarding an employee who has or was exposed to an infectious agent or who had an accidental needlestick or splash exposure (varicella, measles, mumps, rubella, pertussis, and various respiratory viruses including influenza). There is always an Employee Health attending on call who can guide and maximize ID fellow learning through these situations.
Memorial Sloan Kettering 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 treatment 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 people 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 MSK’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 include clinical reports, case series, and epidemiologic investigations. Faculty members within MSK or from The Rockefeller University or Weill Cornell Medical College who are associated with the MSK Infectious Diseases Service will supervise all research projects.
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 (including lymphoma, leukemia, and transplant) 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 MSK along with opportunities at The Rockefeller University and Weill Cornell Medical College.
- Weekly ID Clinical Conference (Thursdays, 1:30 pm): On-service fellows are assigned responsibility for the weekly conference. Both fellows are expected to present a case followed by a discussion that encompasses a focused but thorough literature review and summation of the critical points of the case. Pertinent radiographs and important smears or biopsies should be shown. The target audience includes ID faculty, co-fellows, other rotators on elective, and allied healthcare personnel.
- Preparation for Intercity Rounds: Twice yearly, MSK hosts Intercity Rounds. These rounds have been ongoing in New York City and the surrounding area for more than 30 years. Generally, the host site presents six to eight cases as “unknowns” to ID attendings and fellows throughout the New York City/New Jersey area.
- Microbiology “plate” rounds (Wednesdays at 10:30 am)
- ID “Advanced Topics” in Infectious Diseases (Fridays at 1:30 pm): A shared conference with Division of Infectious Diseases at Weill Cornell. Guest speakers from other US and sometimes international academic institutions come to speak on topics of their expertise.
- Infection control meeting (weekly)
- MSK Department of Medicine Grand Rounds
- Research in Progress (monthly): Faculty and fellows present their latest projects and research finding; faculty presentations serve as introductions to their work so fellows can familiarize themselves with possible research areas of interest and mentors.
Many of our Infectious Diseases fellows have gone on to illustrious careers in academia, research, and clinical medicine, both in the United States and abroad. Our program has also trained many of our own current faculty members.
Esther Arguello Perez
Maria Del Castillo Garcia
Anabella Lucca Bianchi
Maria Antonieta Del Castillo
Cesar Figueroa Ortiz
Anabella Lucca Bianchi
Amar Safdar (Research)
Thank you for your interest in our Infectious Diseases Fellowship program. We accept applications via ERAS. We review all applications regardless of visa status.