The UMD ID division has multiple sub-specialized inpatient and outpatient clinical activities, which affords our fellows the opportunity to work one-on-one with attending physicians with expertise in each of these areas. The ID program is popular with our residents and students as well, so many inpatient consult services will have medical trainees and even PharmD’s in training present. Interacting with these trainees is a great way for our fellows to further develop their teaching skills.
- General Infectious Diseases Consult Service: This general ID service provides consultations for patients admitted to general internal medicine, family medicine, cardiology, OB-GYN, neurology, and psychiatry, and sees a wide array of infections. Common infections seen include infectious endocarditis, pneumonia, etc.
- Greenebaum Comprehensive Cancer Center Infectious Diseases Consult Service: This service consults on patients admitted to the Greenebaum Comprehensive Cancer Center. Most consults are related to opportunistic infections in immunocompromised patients on chemotherapy for solid tumors and hematologic malignancy, as well as patients in the bone marrow transplant unit. Common consults are febrile neutropenia, severe disseminated fungal infections, etc.
- Surgical Infectious Diseases Consult Service: The University of Maryland Medical Center has multiple specialized surgical services. The surgical ID consult service sees patients admitted to these primary surgical teams: general surgery, acute-care emergency surgery, minimally invasive surgery, neurosurgery, oral maxillofacial surgery, orthopedic surgery, otolaryngology, surgical oncology, vascular surgery, and urology. Common infections seen include osteomyelitis, septic arthritis and prosthetic joint infections, intra-abdominal infections, vascular graft infections, ventriculitis, C. difficile infection, surgical site infections, and many others.
- Transplant Infectious Diseases Consult Service: The University of Maryland Medical Systems has one of the largest solid organ transplant (SOT) services in the nation. This consult service provides consultations on SOT patients, and also for patients cared for in the cardiac-surgery ICU (as many lung and heart transplant patients require care here). Lung transplant and other patients requiring extracorporeal membrane oxygenation in the Lung Recovery Unit are seen as well. Common nosocomial infections are seen on this service in addition to more esoteric transplant infections such as Nocardia, CMV, PCP, and disseminated fungal infections.
- Critical Care Infectious Diseases Consult Service: The University of Maryland Medical Center has 29 intensive care beds in its closed medical intensive care unit (MICU). All patients on antibiotics in the MICU and select patients in the Intermediate Care Unit are followed by the Critical Care ID service. Common infections seen are septic shock from various sources and ventilator associated pneumonia. Given that UMMC is a tertiary care center with a wide catchment area, fellows on this service will also see patients presenting with critical illness from unusual infections.
- Shock Trauma Consult Service: The ID clinicians at the University of Maryland R. Adams Crowley Shock Trauma Center are an integral part of the team providing care for patients with severe trauma and round with the primary critical care teams in the Shock Trauma ICU. Fellows rotating on this service will see common ICU related nosocomial infections, necrotizing fasciitis, and other infections occurring due to direct trauma/ inoculation.
- Antimicrobial Stewardship Consult Service: Antibiotic stewardship is becoming a major requirement of the infectious disease specialist at both community and teaching hospitals. We have established a strong antimicrobial stewardship program (ASP) at the University of Maryland. The program uses a coordinated approach with daily interactions of ID physicians, infection control, and pharmacy to reign in inappropriate antimicrobial use. The ID fellows are often the ASP ambassadors, working closely with the primary services to promote the appropriate use of antimicrobial agents. Primary goals of the ASP are to improve patient outcomes by ensuring the most effective antibiotics are used and decreasing antimicrobial resistant organisms, to educate physicians, and to contain costs. In addition to working closely with the ASP team throughout fellowship, fellows will also rotate through the service and have the chance to serve an integral role in the ASP. There are opportunities for fellows to pursue continued research in the area of antibiotic stewardship as well.
- Infection Control and Hospital Epidemiology: The primary goal of this rotation experience is for infectious disease fellows to become facile with common infection prevention issues and to learn to apply epidemiologic principles to problems frequently encountered in the hospital setting. Additionally, fellows will develop expertise in the surveillance and prevention of common healthcare-associated infections and be able to educate others on these topics.
- General Infectious Diseases Consult Service: This general ID service provides consultations throughout the Baltimore Veterans Affairs Medical Centers on all primary inpatient services, including medical, surgical, and critical care. This approximates the experience in a community hospital, where an ID physician must have expertise in all areas of ID. Common infections seen here include osteomyelitis, diabetic foot infections, complicated urinary tract infections, as well as HIV-related opportunistic infections and complications.
- HIV/Infectious Diseases Consult Service: This service is located at UMMC Midtown Campus which is approximately a 10 minute drive north of the University of Maryland Medical Center. UMMC Midtown is a 200 bed hospital with approximately 8500 admissions each year. This rotation provides HIV and general infectious diseases experience in a community hospital setting.
- Med-ID - The HIV/ID Medical Ward: The Med-ID team is one of the major teaching services for the School of Medicine and UMMC. Patients are admitted to this primary inpatient team, which is staffed by ID faculty with expertise in the care of HIV patients. Most patients admitted to this service have advanced HIV infection and suffer from acute infectious complications (e.g. PCP, cryptococcal meningitis, CNS toxoplasmosis, community acquired pneumonia, skin and soft tissue infections, and bacterial endocarditis). Patients who are not HIV-infected but are admitted with other infectious diseases (such as endocarditis, meningitis, TB, and osteomyelitis) are also cared for on this service. The team consists of one ID attending, one ID fellow, one resident, three interns, one or two medical students, a pharmacist, and pharmacy trainees. A multidisciplinary team of nurses, social workers, physical therapists, substance abuse counselors, HIV counselors, and case managers meet daily with the team to find solutions for common psychosocial issues in this patient population.
- Penicillin allergy skin test service: Fellows rotating on Med ID are also responsible for consulting on patients with reported penicillin allergy who may benefit from allergy testing. Fellows are trained in this skill and perform the test with faculty supervision.
- HIV Post-Exposure prophylaxis pager: Fellows on Med-ID hold the ‘AIDS pager’ and handle calls related to HIV exposures, both for UMMC employees and for outpatients presenting to the UMMC and Mercy ED with non-occupational exposures. The fellows are responsible for determining if PEP is indicated and choosing an appropriate regimen, with faculty supervision as needed.
Fellows rotates through the UMMC microbiology laboratory for 2 weeks to attain bench level experience in clinical microbiology. This is done as part of a combined clinical microbiology/virology/immunology laboratory rotation including the Clinical Virology Laboratory and the Clinical Immunology Laboratory.
- Microbiology laboratory - the fellow rotates through each work area including bacteriology, anaerobic bacteriology, parasitology, AFB, and mycology. This bench rotation includes formal training by a bench technologist as well as (supervised) applications such as organism identification, antibiotic susceptibility testing, latex agglutination. The fellow is expected to work-up unknowns. In addition, the fellow is required to attend weekly "plate rounds" throughout the clinical year in the microbiology laboratories where specific clinical cases are presented. Dr. Johnson directs these rounds and they are considered superb learning opportunities. The fellow has contact with the microbiology laboratory on a daily basis throughout the year as clinical cases arise for discussion with the laboratory team.
- Clinical Virology Laboratory - the fellow obtains supervised bench training in virus, chlamydia, and mycoplasma inoculation, identification of viral cytopathic effects, and rapid antigen detection techniques for viral identification (immunofluorescence). The fellow is expected to learn proper specimen transport methods, what cell lines are used for viral cultivation, the limitations in tissue cultivation for "rapid" identification of organisms, and what specific immunostaining techniques are available for specific identification. During the clinical year, the fellow interacts with the Virology laboratory as needed in the care of his/her patients.
- Clinical Immunology Laboratory - the fellow will observe bench work in flow cytometry to quantitate CD4 and CD8 cells, specific immunologic assays for identification of infections, including ELISA and immunoblots. The fellow learns what these techniques entail, the types of immunoassays that are available for non-cultivatable or poorly cultivatable organisms, and how much time is needed to obtain results, and to get information on their specificity and sensitivity. This information is reinforced and applied throughout the rest of the clinical year with continued laboratory interactions of the fellow and attending during daily clinical rounds, as appropriate.
All fellows maintain an outpatient HIV continuity clinic during their fellowship. In the first year, fellows have continuity clinic at the VA or the Center for Infectious Diseases at the UMMC-Midtown campus. One to two week ambulatory clinic blocks are also scattered throughout the fellows' schedules, and include time at both HIV clinics, the general ID clinic, the hepatitis C clinic, cancer-ID clinic, transplant-ID clinic, and travel clinic. In the second year, the fellow may choose to spend additional time in any of the ID clinics listed below depending on the individual fellow's clinical and research interests.
- Evelyn Jordan Center(EJC): The EJC is a hospital-based clinic, which provides longitudinal comprehensive care for approximately 2000 adult HIV-infected patients. The clinic includes psychiatric services, social work services, nutrition support, and substance abuse counseling.
- Transplant ID Clinic: This clinic provides infectious diseases care for patients who have received solid-organ transplants.
- Cancer ID Clinic: This clinic provides care for cancer patients with infectious diseases including HIV-infected patients who have cancer.
- Travel Clinic: This clinic provides pre-travel infectious diseases evaluation and immunizations.
UMMC - Midtown Campus
Jacques Initiative (JI): The JACQUES Initiative is a community based clinic that provides comprehensive primary medical care to approximately 800+ HIV positive men and women. The JI model emphasizes the importance of a team approach to care and includes programs in treatment education and treatment support (including directly observed therapy).
IHV Clinic in the Family Health Center: The IHV Clinic at the UMMC-Midtown Family Health Center provides comprehensive primary medical care to approximately 900+ HIV-infected men and women. The clinic was based in the Family Health Center to provide high level HIV care in a community clinic setting not identified as an HIV clinic. This allows patients to receive needed care without concerns for stigma.
General ID Clinic: This clinic provides new consultation and follow-up of hospitalizations for all infectious diseases including returning travelers.
Hepatitis C Clinic: This clinic provides Hepatitis C care to patients with and without HIV coinfection.
Baltimore VA Medical Center
ID/HIV Clinic: The VA clinic provides comprehensive primary HIV care to approximately 700 HIV infected patients as well as general infectious diseases consultations and follow-up care.
Hepatitis C Clinic: This clinic provides Hepatitis C care to VA patients with and without HIV coinfection.