Fellowship Curriculum

Transplant Infectious Disease Track

The program accepts up to one fellow per year in our 1-year Transplant Infectious Disease and Immunocompromised host track following completion of a 2-year general infectious disease fellowship. This track provides a combination of additional clinical training in the management of infections related to solid organ transplant, stem cell transplant, CAR-T therapy and other cellular therapies and mentored scholarly work in these areas. The typical schedule is divided 50% clinical and 50% research over the course of the year.

Clinical Training

Fellows spend an additional 18-20 weeks of clinical time on the inpatient transplant infectious disease service combined with a choice of 4-6 weeks of inpatient elective experiences. As part of the inpatient clinical service, the transplant ID fellow will attend the SOT surgical rounds and listing meetings where listing is being discussed for patients for which Transplant ID has been consulted.

Inpatient elective experiences include:

• Stem cell transplant
• Lung transplant
• Hepatology and liver transplant
• Heart failure and heart transplant
• Renal transplant

Outpatient Blocks

The inpatient experience is supplemented by designated outpatient weeks that include:

• A continuity clinic focused on transplant ID
• Additional clinic time with transplant ID focused providers
• Transplant evaluations with the solid organ transplant services (heart, lung, liver, kidney, pancreas)
• Post-transplant follow-up clinics
• Clinics in the BMT Infusion Center

Outpatient follow-up clinics with partner services are scheduled following inpatient electives to provide an opportunity for continuity of care with patients seen during the inpatient blocks.

Fellows attend over the course of the year listing meetings for all solid organ transplant teams as well as transplant related Collaborative Case Review conferences.

To improve their understanding of the transplant surgeries and their complications, fellows are invited to attend both procurement procedures for all organ types, and transplant surgeries with and without the use of perfusion support devices.

The Transplant ID fellow will also participate in the Transplant ID boot camp for 1st years starting on transplant rotations and teaching conferences for transplant fellows from other departments and divisions.

Didactic and Educational Conferences

Didactic sessions are conducted as part of the Tuesday Transplant ID team meeting. This includes a monthly journal club with 4 journal club sessions presented by the fellow over the course of the year together with advanced topic discussions in key areas related to the diagnosis and management of infections in immunocompromised hosts. These sessions include:

• Management of resistant CMV
• Fungal infections and the use of novel antifungal agents
• Assessing the net state of immunosuppression
• Pre transplant infections and considerations for prophylaxis and treatment post transplant
• Complications of cellular therapies
• GVHD and its complications
• Adenoviral infections in transplant recipients

Education Training

Transplant ID fellows are encouraged to play a leadership role in education on the team particularly additional learners are present on the service. This includes providing feedback to other team members regarding clinical questions that arise and conducting brief educational sessions with the transplant team mentored by the Transplant ID attending.

Antimicrobial Stewardship and Infection Prevention Track

Training in Antimicrobial Stewardship and Infection Prevention is a core component of infectious disease training for all fellows. Fellows are given 2 weeks each of early exposure to Antimicrobial Stewardship and Infection Prevention in the first year. During this time they work with the hospital teams, attend meeting, participate in active projects in the respective areas. During this block they will additionally complete the online IDSA Bugs & Drugs training module. This experience is followed up by a second 4-week block in each during the second year. The core curriculum in Antimicrobial Stewardship and Infection Prevention is completed.

Fellows interested in pursuing careers focused on Antimicrobial Stewardship or Infection Prevention may pursue the clinical track in Antimicrobial Stewardship and Infection Prevention in their 2nd year of training which expands on these experiences with training in the core skills required to function as a specialist in each area and mentored support in the development of a scholarly project in their area of focus.

The University of Colorado IP/AS Fellowship Track's goal is to equip fellows with key skills, competencies, and experiences to successfully lead an infection prevention (IP) and/or antimicrobial stewardship (AS) program upon graduation. Participating fellows will have additional dedicated time in their F2 year for experiential learning while embedded within an IP and/or AS team, with a primary focus on:

• IP: applying NHSN surveillance definitions for hospital-acquired infections, managing occupation exposures and outbreak investigations, and evaluating IP implications of construction efforts and environments of care.
• AS: honing stewardship interventions (including handshake stewardship and audit-and-feedback), developing institutional guidelines, evaluating and presenting antibiotic use and resistance data (AU/AR), and implementing diagnostic stewardship.

Participating fellows will complete a longitudinal, mentored scholarly or quality improvement project. Funding is available to support fellows' participation in and presentation at national conferences including SHEA or IDWeek.

Orthopedic Infectious Disease Track

Orthopedic infections represent a significant component of the cases seen by infectious disease consultants in clinical practice. All fellows round on the Orthopedic Infectious Disease service for 4 weeks each year to assure exposure to the breadth of cases they may encounter in practice. The close partnership between the Orthopedic ID teams and the orthopedic surgical services also provides an opportunity to experience care in a team-based environment with our partner services which is invaluable to the success of infectious disease consultants in practice.

Fellows interested in a career focused on the management of orthopedic infections may elect to pursue the Orthopedic ID track in the 2nd year. Those who elect to pursue the Ortho ID track will be expected to spend additional time on both the inpatient ortho ID service and in outpatient Orthopedic ID clinic, as well as have scholarly involvement as noted below.

Clinical expectations

• At least 12 weeks inpatient Orthopedic ID consult service (over 2 years of fellowship)
• Weekly outpatient Orthopedic ID clinic (during research blocks)
• Participate in at least 70% of Orthopedic ID conferences
  • Limb Restoration (weekly)
  • Prosthetic Joint Infection Collaborative Case Review (monthly)
  • SIMBA spine infection multidisciplinary conference (weekly)
  • Orthopedic ID internal meeting (monthly)
• Become a member of Musculoskeletal Infection Society (MSIS) and attend at least 9 monthly virtual case conferences

Scholarly output (may vary based on fellow's other obligations)

• Present 1 Orthopedic ID journal club per year
• At least 1 longitudinal research project in Orthopedic ID
• Participate in Orthopedic ID quality improvement

Elective opportunities

• Procedural observation:
  • Debridement and Implant Retention (Ortho Trauma)
  • Prosthesis explant - 1 or 2-stage exchange (Reconstructive Ortho)
  • Osseointegration implantation or revision (Limb Restoration Team)
  • Diabetic foot debridement / amputation (Podiatry)
  • Vertebral osteomyelitis or epidural abscess debridement (Ortho Spine / Neurosurgery)
  • Fracture related infection hardware removal (Ortho Trauma or Limb Restoration)
• Musculoskeletal radiology