Specialty Tracks Offered During ID Fellowship

Overview

The Washington University Infectious Diseases Division will offer specialized training focused on Infections in Immunocompromised hosts and Transplant Recipients, designed to provide intensive clinical and research experience in all aspects of Transplant Infectious Diseases (TID).  We will offer an additional year/s of transplant focused training. This could be in the second year of ID fellowship (called – TID focused track) or in the second and third year (called TID fellowship). This would be open to interested current ID fellows at Washington University Infectious Diseases Division

WashU Advantage

A major advantage of training at a large academic medical center such as Washington University Medical Center is the volume of patients and readily available cooperation of various medical specialties that facilitate clinical training and research opportunities. The Infectious Diseases transplant service work closely with the heart, lung, liver, kidney, pancreas, and small bowel or bone marrow transplant teams to coordinate care for these complicated patients.

Training

We will offer two tracks that will aim to provide advanced training in transplant/immunocompromised host ID through didactics, hands-on practical training, and scholarly projects. This additional training program is intended for fellows who already have completed the first year of fellowship focused on clinical Infectious Diseases and want to consolidate and deepen their clinical experience in specific aspects of transplant infections by pursuing a clinical  (2 year) or academic career ( 3 year track) in this field. The duration of TID training will vary based on specific goals of trainees.

The 2-year TID focused track will include clinical training with additional transplant ID rotations, rotations through transplant nephrology, hepatology, lung transplant and BMT services.  There would be opportunities for mentored clinical research experience and scholarly activities within the standard 2 year of ACGME accredited fellowship.   The three-year research/fellowship track is designed for fellows interested in advanced training in clinical/translational/basic-science research through additional coursework/degrees while completing a mentored research project or design and execution of a longitudinal research project. TID Clinical service in the first 2 years will be counted towards total goal of 24 weeks of inpatient service as suggested by AST.

We are pleased to announce the ID – Critical Care Medicine (CCM) pathway, a collaborative program between the Divisions of Infectious Diseases and Pulmonary and Critical Care Medicine. Our approach meets a recognized national interest in combined training. Several of our recent fellows went on to continue their training in CCM.

At Washington University, we are also expanding the core faculty with dual training to provide clinical, professional development and research mentoring at the intersection of ID and CCM. Barnes Jewish Hospital is home to two large MICUs and one Immunocompromised ICU caring for patients with hematologic malignancies or HSCT and solid organ transplants. Research areas of expertise include risk stratification and long-term sepsis outcomes, antimicrobial resistance, hospital-acquired and ventilator-associated pneumonia, serious infections in the immunocompromised critically ill patients, and hospital epidemiology and infection prevention.

Fellows interested in this pathway will apply to the ID Fellowship Program first. At the end of their first ID year, they will apply to the Critical Care Medicine Program through ERAS/NRMP and, if they match into CCM, will begin Critical Care training after completing year 2 of ID fellowship.

Applicants who are interested in this joint experience will have their applications reviewed by both the ID and CCM programs, and interviews scheduled with both ID and CCM faculty.

Please note on your initial application your interest for this track. For further inquiries, contact Stephanie McManus.

Please note on your initial application your interest for this track. For further inquiries, contact Stephanie McManus.

The Global Health Track is available to current fellows with interests in global health research, program implementation or health policy.

Mission

To train fellows as future leaders and innovators in global health and infectious diseases.

Objectives are to

• provide experience conducting research and/or providing clinical care in resource-challenged settings and across international boundaries,
• introduce concepts in international development and policy,
• educate fellows on the unique ethical issues that arise in the practice of global health, and
• provide additional experience and training in global health tailored to the career goals of the individual fellow.

Application process

• Applications are due at the beginning of December, during the first year of fellowship.
• This track is open for fellows with an interest in global health research, program implementation or health policy.
• Fellows are expected to report and present their work by May of their second year.
• For more information about the global health track or application process, please email cmattar@wustl.edu

Activities

• Attendance at the Global Health Pathway Lecture Series after the start of the second year of the fellowship.
• Didactic coursework tailored to the individual fellow’s needs. Below are a few examples of courses which could be taken during 2nd year of fellowship:
  • Introduction to statistics for clinical research
  • Epidemiology for clinical research
  • Global burden of diseases
  • Comparative effectiveness research
  • Dissemination and implementation science
• At least one elective in a resource-challenged setting:
  • Guatemala
  • Haiti
  • Ethiopia
  • Thailand
  • Malawi
  • St. Louis partner organizations
  • Other sites may be discussed with the fellow’s mentor and the program director
• Participation in the annual Conference on Global Health and Infectious Diseases held by the Institute for Public Health.
• Participation in the Consortium of Universities for Global Health meeting if the fellow is scheduled to present an abstract.

Competencies

At the end of their training, fellows will be expected to have acquired an understanding of the following:

• Global burden of disease
• Globalization of health and health care
• Social and environmental determinants of health
• Collaboration, partnering and communication
• Ethics of global health work
• Health equity and social justice
• Program management
• Sociocultural and political awareness

• The purpose of the Healthcare Epidemiology Track is to prepare trainees for a career that includes healthcare epidemiology in academic and/or community settings. A major advantage of training at Washington University in St. Louis is the broad exposure to a variety of practice settings, including a large academic medical center, active research campus, multiple non-acute care/outpatient settings, community-based hospitals, and specialty exposure including infection prevention in design/construction. Upon completion of this 1-2 year training program, trainees will have the knowledge and skills to practice as a Healthcare Epidemiologist. 
• Participation in this track starts in the second year of fellowship and includes completing the Healthcare Epidemiology rotation followed by additional activities that are tailored to the fellows’ specific interests. Core elements include participation in operational hospital epidemiology and infection prevention meetings, participation in outbreak investigations, and participation in quality improvement projects. Expanded infection prevention settings/activities include outpatient settings, research programs, design/construction, educational programming, and large healthcare-system level healthcare epidemiology training.
• The program includes robust opportunities for clinical and translational research. Washington University has a strong track record of training in healthcare epidemiology, and internationally renown mentors with a wide gamut of infection prevention related research programs. Mentors include past presidents of the Society for Healthcare Epidemiology of America (SHEA), members of multiple SHEA and Infectious Diseases Society of America (IDSA) committees, and many faculty have been key authors in the research and guidelines at the core of this profession. Trainees can participate in research projects and or patient safety and quality improvement projects as interested, and under the guidance of a faculty mentor. Research areas of expertise include: transmission of multidrug-resistant organisms (MDROs), antimicrobial resistance, HAIS (CLABSI, CAUTI, VAP), informatics, large administrative data sets, infection prevention in resource limited settings, dissemination and implementation science, clinical decision making support, and antimicrobial stewardship. 

Section 1: Introductions to Healthcare Epidemiology

Section 2: Prevention and Management of Healthcare-Associated Infections

Section 3: Specialty Topics in Infection Prevention

Meet Key Faculty Specializing in Healthcare Epidemiology and Infection Prevention

• Hilary Babcock, MD, MPH
• Sumanth Gandra, MD, MPH
• Kevin Hsueh, MD
• Jennie Kwon, DO, MSCI
• Jonas Marschall, MD
• Abby Sung, MD
• David K. Warren, MD, MPH

Overview

The opioid epidemic and subsequent rise in injection drug use (IDU) has led to a well-described syndemic of substance use disorders (SUDs) and infectious diseases including serious injection-related bacterial/fungal infections (SIRI), HIV, viral hepatitis and sexually transmitted infections (STIs). Health systems continue to be ill-prepared to manage these conditions resulting in high rates of premature discharges with incomplete antimicrobial courses, 30-day readmissions or ED visits and increased cost. Not to mention missed opportunities for ongoing public health epidemics of HIV, HCV, STIs, especially syphilis, and overdoses.

Because of the syndemic nature of the substance use epidemic in America, infectious disease physicians are uniquely positioned to be leaders in the care and management of patients with infections and comorbid substance use. In 2020, there was a call for action published in Clinical Infectious Diseases articulating the case for the creation of ID/Addiction tracks within ID fellowships and promoting dual fellowship training.

Why WashU?

WashU/BJH are uniquely positioned as institutions serving both as a safety net hospital for an urban, local population and a tertiary care institution for a substantial rural population from its considerable referral base. This is in the midst of a rapidly evolving drug supply with toxicities that result in infections and high healthcare utilization (i.e., xylazine-related wounds complicated by SSTIs and osteomyelitis. We see a lot of infectious complications of substance use and serve both local patients in urban Saint Louis as well as patients living in rural Illinois and Missouri.

WashU ID has one of the only integrated ID-based bridge clinics in the country. We simultaneously manage SUD, ID and harm reduction needs through the Bridge to Health (BTH) program. BTH is an innovative program with physicians, social workers, and health coaches linking patients from the inpatient setting to the outpatient clinic. Fellows will also have the experience of rotating with the inpatient Toxicology service, which develops and utilizes novel buprenorphine and methadone induction techniques to help people get onto medications comfortably and quickly.

At WashU ID, you will work with ID faculty with demonstrated experience in management of SUDs, some of whom are either triple board-certified or eligible in Addiction Medicine. This group of faculty, and the Bridge to Health program, also have demonstrated robust QI/research capacity and publishing records. For interested fellows, we also have a strong relationship with Street Med STL, a non-for-profit dedicated to providing medical care for unhoused individuals in the St. Louis region. Street Med STL provides substance use and harm reduction care in a street medicine setting.

Sample schedule and training opportunities:

Key Faculty:

Track Director – Madeline McCrary, MD
Track Associate Directors – Nathan Nolan, MD MPH MPHE, Laura Marks, MD PhD

Other ID Faculty

Megan Curtis, MD
Michael Durkin, MD MPH
Steve Liang, MD MPHS
Aditi Ramakrishnan, MD MSc

Meet Key Faculty Specializing in Medical Education in Infectious Diseases

• Courtney Chrisler, MD
• Ige George, MD, MS
• Caline Mattar, MD
• Nigar Kirmani, MD
• Steve Lawrence, MD, MSc
• Nathan Nolan, MD, MPH, MPHE