Infectious Diseases Fellowship

A service is the general infectious diseases consult service that covers MUSC Main Hospital. This service includes an attending, a fellow, and typically a resident and medical student. The infectious diseases pharmacist also frequently joins rounds. This service is our busiest with a patient population that includes general medicine admissions, orthopedic patients with bone and joint infections, neurosurgical patients, and patients in the surgical-trauma intensive care unit.

B service is the general infectious diseases consult service that covers Ashley River Tower and the Ralph H. Johnson VA hospital. This service includes an attending, a fellow, and typically a resident and medical student. The patient population here includes general medicine admissions, hepatology/GI patients, cardiology patients, patients with hematologic malignancies, and those in the medical-surgical intensive care unit.

C service is our transplant service, which covers Ashley River Tower and Main Hospital. This service is often attending only, with fellow involvement 4 months of the year. This service provides consultations for both solid organ transplant and bone marrow transplant recipients, as well as patients with left ventricular assist devices.

Ambulatory training includes one half-day weekly of fellow continuity clinic (HIV and general infectious diseases), VA infectious diseases clinic (HIV and general infectious diseases), and Friday fellows’ clinic (hospital discharge follow-up and new patient evaluations).

All fellows participate in rotations in the following subspecialty areas:

• Clinical microbiology.
• Antimicrobial stewardship.
• Hospital epidemiology and infection control.

Rotations in the following subspecialty areas are available to fellows with a particular interest:

• Sexually transmitted diseases.
• Pediatric infectious diseases.
• Outpatient antibiotic therapy.
• PICC line insertion.
• HIV transition clinic (transition from pediatric to adult HIV care).
• Hepatitis C clinic.

Case of the Week (COW) conference is held weekly and is led by a fellow on the inpatient consult service. The fellow presents an interesting case and challenges the faculty to generate a differential diagnosis and ultimately diagnose the patient. This is followed by a literature review of the topic. This conference is an infectious diseases division favorite, as it gives us a chance to work collaboratively, learn from each other, and most importantly, have fun while doing it.

Fellow didactics are lectures provided by experts among the infectious disease faculty and cover such topics as HIV management, antimicrobial resistance, transplant infectious diseases, central nervous system infections, etc. “High yield” topics are presented in a concentrated time period, lasting approximately one week, during orientation for new fellows. Didactics are otherwise provided once weekly throughout the rest of the year.

Other monthly to bi-monthly conferences include:

• Infectious Diseases Grand Rounds – Infectious diseases faculty or visiting speakers present their research or other timely topics of interest.
• HIV Collaborative Conference – This conference takes many forms and can include an update on HIV guidelines, introduction of newly available drugs, discussion of challenging cases, or outside speakers.
• Journal Club – Fellows generally present Journal Club once yearly, with faculty presentations 1-2 times per year.

Fellows are provided ample time and faculty mentorship to conduct research in an area of particular interest to them. Mentored research, including participation in quality improvement, is a required element of training. The goal is for fellow research projects to result in a presentation at a scientific meeting and submission of a first-authored manuscript. The program can be modified for fellows interested in additional research experience.

Examples of current fellow research projects include:

• Retrospective review of candidemia at our institution, with a focus on the impact of infectious diseases consultation on outcomes.
• Retrospective review of outcomes of Staphylococcus aureus bacteremia, before and after implementation of mandatory infectious diseases consults for this diagnosis.

Since 1976 the Medical University of South Carolina (MUSC) Infectious Diseases Fellowship has trained fellows to become experts in adult infectious diseases. This extensive training encompasses a broad range of areas within the discipline including general ID, transplant ID, HIV, clinical microbiology, OPAT, antibiotic stewardship, hospital epidemiology, and infection control. There are also specialized opportunities within the fellowship for travel medicine, STI training, and PICC line insertion.

The MUSC ID Fellowship offers excellent clinical training. As a regional referral hospital and highly ranked transplant center (the only transplant center in SC), MUSC exposes fellows to both common and less common pathology, including transplant and immunosuppressed populations, with a wide array of disease processes. South Carolina has a large HIV population and the infectious diseases division serves ~2,000 HIV patients. Currently, there is less exposure to travel medicine than in the past, but fellows still receive this training in the VA clinic.

Two-to-three fellows match each year.

The fellows’ schedule is divided into 13 separate 4-week blocks. Fellows will be on inpatient or outpatient, with accordingly different responsibilities. Blocks change every fourth Tuesday. Each fellow will have their own weekly continuity clinic on either Monday or Thursday morning. In addition, while on outpatient service, fellows are in VA clinic Wednesday morning and general fellows’ clinic on Friday mornings. Second year has more research time.

Inpatient consult services:

• Either A, B, or C service; rotate with attending and usually one resident, one medical student, +/- ID pharmacist.
• A and B service fellows alternate weekend coverage of all three services.
• A service (Main University Hospital) – more general ID, bone & joint infections, STICU.
• B service (Ashley River Tower and VA) – general ID, liver/GI patients, malignant hematology.
• C service (Main and Ashley River Tower) – transplant only (lung, liver, heart, kidney, bone marrow transplant).

Outpatient rotations:

• Blocks of research, microbiology, antimicrobial stewardship/infection control, other clinics.
• Staffed with various attendings.
• Weekly personal continuity clinic (Monday or Thursday a.m.).
• VA clinic (Wednesday a.m.), covered by both outpatient fellows.
• Fellows’ clinic (Friday a.m.), alternating coverage by one outpatient fellow.

Call for ID fellows consists of being available to answer pages after hours (5 p.m. to 8 a.m.). This is taken from home and only under extenuating circumstances do fellows need to physically return to the hospital. Coverage for the week (Tuesday – Tuesday) is provided by the inpatient fellow during the week encompassing their weekend coverage.

Three. MUSC Main Hospital, MUSC Ashley River Tower (ART), and the Ralph H. Johnson VA Medical Center. There are rarely consults at the Institute of Psychiatry (an inpatient psychiatry ward) covered by the B service. All are located within a 0.5 mile radius or less.

• Campus Map (PDF)
• Map of Medical District, Downtown Charleston

Inpatient days vary based on patient load. Usual fellow hours are 7 a.m. to  5 p.m., but this also depends on workload. Fellows will attend whatever clinic/conference is scheduled and then proceed with rounds. Fellows pre-round as able prior to bedside rounds with attendings. This is attending-dependent, but usually starts between 9 and 10 a.m. with a lunch break. Teams will see new consults as they are called and generally stop seeing new consults after 3 p.m. unless more urgent.

Average patient loads are 15 (A service), 12 (B service), and 10 (C service), but vary and can be significantly busier.

Yes. Fellows will generally have medical students/residents and sometimes pharmacy residents on service to teach. This is usually in an informal setting.

Incoming fellows have a crash course lecture series on HIV, drug resistance, and general common ID consults over orientation and the first month. Other monthly or bi-monthly conferences include monthly ID Grand Rounds, HIV Collaborative Conference, various didactic lectures by attendings, Journal Club, and Case of the Week (COW). Fellows generally present Journal Club once yearly and COW bi-monthly while on inpatient service.

There are numerous research opportunities available and attendings with a wide array of ongoing interests and projects to serve as mentors. Prior to your interview, you will be provided with more information about research opportunities with individual faculty members. First year fellows have ~3 blocks of dedicated research time and second year fellows have ~5.

Aside from our fellowship coordinator who organizes much of the behind-the-scenes operations, fellows have scheduling staff for clinics, outreach/social work, RNs/CNAs/MAs in clinic, and a close relationship with ID and HIV pharmacists.

Fellows are regularly evaluated electronically following rotations and bi-annually in person with their program director. Fellows submit evaluations of their peers, rotations and attendings regularly as well.

Traditionally, fellows have attended the George Washington ID Board Review Course during the first half of their second year. The cost is covered by the fellowship program.

Fellows have sought employment in a number of practice types and locations. This includes private, academic, public health, and industrial roles, generally located in the southeast U.S.

Yes. Fellows with appropriate licensing are eligible to moonlight in so far as it does not violate duty hours or fellowship obligations.

The MUSC ID Division has been integral in the MUSC and state of South Carolina response to COVID-19. Numerous aspects of this response are still in motion and there are ongoing efforts to continue to learn from and combat this pandemic. Operationally, the ID division has expanded its telehealth capacity and is conducting regular less-complicated office visits virtually. For select patients there are still face-to-face visits, but there are continued efforts to maintain this virtual coverage to hopefully reach expanded populations in the state.