Trainees are supervised throughout the program and in the performance of technical procedures. Faculty supervision of trainees is intense by design. The average faculty contact time for infectious disease trainees, based on attendance at all conferences plus daily patient supervision, is 10-20 hours weekly. Rounds are held seven days a week on all inpatient services, at which time the faculty members see all new patients and most old patients.
Similarly, infectious disease clinics regularly have a staff member present, who supervises trainees, residents, and students rotating through the infectious diseases subspecialty program.
Trainees are required to maintain written records with names and diagnoses of all patients seen, with appropriate documentation of date, time, place and supervision. Facilities for microscopic examination of secretions, culturing, and other relevant aspects of infectious disease care are provided.
All new patients are personally examined by the supervising faculty member after presentation of history, physical examination and laboratory data by the trainee and joint review of x-rays and, where relevant, gram stains, pathology slides, etc.
All new data on every patient is reviewed daily on chart and x-ray rounds, which are part of the daily faculty review of patient status at the beginning of rounds. All patients are re-examined and their x-rays reviewed on a regular basis. Supervising faculty are always available for advice outside of normal rounding hours and are on-call with trainees on nights and weekends.
Teaching and management (work) rounds are generally conducted during the same session. For instance, the faculty member or fellow may begin rounds with a discussion of a topic, then proceed to work rounds, or the teaching may be intertwined with work rounds.
Fellows from the four New Orleans adult and pediatric ID training programs present cases once a month at the weekly New Orleans Citywide ID Conference, which is held Friday mornings at Ochsner Hospital. Each fellow has 15-20 minutes to present a cases as an unknown, followed by a faculty member discussion and then a literature review by the fellow. Gross and microscopic pathology from autopsies and biopsies is reviewed during these sessions.
A Fellow Didactic Lecture Series, part of the weekly New Orleans Citywide ID Conference, consists of one-hour presentations each week by authoritative clinical investigators or laboratory directors, which address the clinical and scientific aspects of infectious diseases.
A weekly Tulane ID Conference for faculty and fellows alternates between Journal Club, case presentations and special topics.
A weekly Microbiology Conference ("Plate Rounds") is held at Ochsner for all New Orleans ID fellows. Cases are presented and culture plates, microscopic slides, etc. are reviewed.
Trainees are expected to attend the three weekly regularly scheduled conferences described above, and they are encouraged to attend the weekly Medicine Grand Rounds.
Trainees are required to prepare formal material for clinical conferences, whose audience is composed of faculty, residents and students. Outlines, diagrams and literature citations are expected. Each trainee will present a minimum of 10 conferences during the first year. Additionally, trainees are expected to do literature searches on topics related to hospitalized patients and present the relevant information informally at rounds.
The Tulane University School of Public Health and Tropical Medicine (TUSPHTM) offers formal training in various aspects of epidemiology and biostatistics. Its Department of Tropical Medicine offers additional formal training in Tropical Medicine, which includes diagnostic parasitology laboratory experience. The most popular program has been the MPH&TM, but this degree requires 42 credit hours and is difficult to complete in 12 months. A more feasible option is the Diploma Course in Tropical Medicine and Travelers' Health, which can be completed in one semester. Our fellows currently receive a $10,000 per year HIV Stipend (total of $20,000 over two years) from LCMC (UMCNO) earmarked for tuition costs, covering just under 1/2 of the total cost of an MPH, and most of the Diploma course tuition. Fellows who are not restricted by a J-1 visa may moonlight to help make up the difference.
All departments have extensive field research programs with major overseas involvement. The Department of Tropical Medicine also has research laboratory programs in parasitology and related fields, which in several instances are coordinated with research programs at the Tulane Regional Primate Center on the Northshore.
The State of Louisiana Office of Public Health in the Department of Health and Hospitals, also located in New Orleans, offers field experience under the direct supervision of the Epidemiology Division and in conjunction with the Tulane School of Public Health and Tropical Medicine. Trainees may be eligible to work on projects related to AIDS, funded by either the Centers for Disease Control and Prevention (CDC) or other federal agencies, as well as on projects concerning tuberculosis, vector control, waterborne infections, or other communicable diseases.
Trainees choosing the advanced clinical pathway concentrate on the further development of clinical skills, teaching skills and scholarly work such as a retrospective chart review. Clinical activities in the second year include adult and pediatric infectious diseases consultation rotations and attendance at the Sexually Transmitted Disease, Wetmore Tuberculosis and Travel Clinics.
Some trainees have opted for off-site rotations to supplement their training. For example, National Jewish Medical and Research Center in Denver, Colorado offers a one-month clinical elective for advanced training in the care of patients with nontuberculous mycobacterial infections as well as MDR-TB. MD Anderson in Houston, Texas offers one-month rotations on their bone marrow transplant and hematologic malignancy ID services.
All Trainees with a special interest in clinical trials of antiretroviral strategies, involving minorities especially, are encouraged to participate in the NIH-supported Louisiana Community AIDS Research Program (INSIGHT, NIAID), which focuses on research in the primary care setting.