Schulich school of Medicine and Dentistry logo Infectious Diseases Schulich School of Medicine & Dentistry

Postgraduate

Classroom

The Division of Infectious Diseases provides a very broad educational experience in the management of patients with common infectious diseases problems. The following educational objectives have been developed for core Internal Medicine trainees during their time on the Infectious Diseases Service.  These have been formulated to guide provision of an educational experience which will encourage and allow the trainee to develop the knowledge, skills, and attitudes of a specialist in Internal Medicine.  These attributes will be developed within the framework of the CanMEDS 2005 roles as outlined by the Royal College of Physicians and Surgeons of Canada.

Objectives

Medical Expert

At the end of the rotation, the resident will be able to:
1.  Elicit a history relevant to the immune system and infectious etiologies. This should include:
a)  symptoms suggestive of an infectious process, including identification of potential anatomic foci of
     infection.
b)  symptoms suggestive of a non-infectious process.
c)  recreational or occupational exposures posing a risk of infection.
d)  an assessment of the risks for TB and HIV.
e)  travel history (including prophylactic medications/vaccinations).
f)   risk factors for immunosuppression, including an assessment of which arms of the immune system
     may be impaired.
g)  prior antimicrobial use and drug allergies.

2. Perform a physical exam to detect infectious and non-infectious causes of the symptoms. This should
    include:
    a)  examination of the skin, looking for viral exanthems, syphilis, toxic shock syndromes, drug         
            reactions, and signs of endocarditis.
b)  head and neck examination, including assessment of the oral cavity, lymph nodes, eyes, and ears.
c)  cardiac, respiratory, neurological, and abdominal exams.
d)  examination of the limbs and joints.
e)  assessment of other anatomic sites (e.g. urogenital tract, perineum, perianal region) as
     appropriate.
f)  an understanding of the diagnostic value of the above physical signs

3. Order investigations appropriately, including cultures, serology, radiological tests, and blood work.
    The resident will interpret these tests in the context of the patient’s problem.

4. Order and justify initial management, including empiric therapy, taking into account the patient’s  
    immune status, and data gathered from history, physical examination and preliminary investigations.
    The resident should be able to modify initial treatment plans as further laboratory and microbiological
    information becomes available, and to justify the duration of therapy.

5. Develop evidence-based approaches to the investigation and management of patients presenting with:
     a) fever or hypothermia
     b) leukocytosis
     c) septic shock
     d) stiff neck and headache
     e) heart murmurs
     f)  lymphadenitis/lymphadenopathy
     g) soft tissue inflammation
     h) inflamed joints
     i)  cough and sputum production
     j)  embolic lesions
     k) sore throat, ears, and sinuses

6.  Develop evidence-based management strategies for the following diseases:
     a) fever of unknown origin
     b) septicaemia
     c) meningitis, encephalitis, brain abscess
     d) pneumonia, bronchitis
     e) mediastinitis
     f)  endocarditis, pericarditis
     g) intraabdominal abscess/sepsis, peritonitis, hepatitis, biliary tract infections
     h) cystitis, pyelonephritis
     i)  osteomyelitis, septic arthritis
     j)  HIV infection, AIDS
     k) viral syndromes
     l)  infections in neutropenic and transplant patients
     m) pharyngitis, otitis, sinusitis
     n)  soft tissue infections
     o)  sexually transmitted diseases

7.  Demonstrate proficiency in the following procedures:
     a) use and interpretation of microbiology investigations including stains, cultures, and serology
     b) TB skin testing
     c) monitoring HIV infection with laboratory tests

Communicator

By the end of the rotation, the resident will have demonstrated:
     1. the ability to obtain a thorough yet relevant history from patients with a proven or suspected    
         infectious disease
     2. effective presentation of clinically relevant information at the bedside.
     3. appropriate communication with patients and their families about the patient’s disease and its
         proposed management.
     4. the ability to communicate clearly with colleagues verbally, through consultation notes, and
         discharge summaries.
     5. skill in presentation and discussion of infectious diseases topics at teaching, Infectious Diseases
         specialty rounds, and Medical Grand Rounds.

Collaborator

During the rotation, the trainee will:
     1. participate effectively in the management of infectious diseases patients.
     2. recognize the roles of the following team members
               a) clinic nursing staff
               b) infection prevention and public health staff
               c) clinical microbiology laboratory staff
               d) pharmacists
               e) secretarial and support staff.

Manager

During the rotation, the resident will:
     1. participate in and be given appropriate leadership responsibilities for the management of infectious
         diseases patients.
     2. be able to triage consultations and investigations appropriately according to the level of acuity when     
         asked to assess several new patients simultaneously.
     3. be able to manage his/her time so that clinical responsibilities do not interfere/overlap with
         mandatory participation in educational activities.
     4. demonstrate appropriate use of available resources including diagnostic tests, inpatient and
         consultative services, and be aware of the economic implications of his/her decisions.
     5. develop his/her understanding of treatment costs including antibiotics and infection control
         procedures.

Health Advocate

On completion of the rotation, the resident will:
     1. understand the impact of economic and social factors which predispose to or exacerbate infectious
         diseases.
     2. understand the principles of infection prevention and control, including hand hygiene, use of
         personal protective equipment, and isolation precautions (contact, droplet, respiratory).
     3. understand the importance of preventive strategies in Infectious Diseases including the prophylaxis
         of certain communicable diseases.
     4. have demonstrated appropriate attention to prevention counseling in patient encounters.
     5. understand the principles of public health including immunization and mandatory reporting ot certain
         infectious diseases as required by law.

Scholar

By the end of the rotation, the resident will:
     1. understand the physiology of microbial virulence factors in bacterial, viral (including HIV infection),
         mycobacterial, fungal, and parasitic infection; understand host defense mechanisms and the effects
         of immunosuppressive therapies or conditions.
     2. understand the pathophysiology of selected Infectious Diseases.
     3. understand the pharmacology of selected anti-infective agents.
     4. understand the scientific evidence supporting investigation and management strategies in
         Infectious Diseases.
     5. have demonstrated critical review of the literature surrounding management of patients with
         Infectious Diseases.

Professional

During the rotation, the resident will:
     1. recognize his/her professional obligations to patients and colleagues.
     2. be punctual for rounds and educational events.
     3. follow through on assigned tasks.
     4. be aware of the responsibility of the profession to society.
     5. demonstrate understanding of the ethics of consent to treatment and ethical issues surrounding the
         treatment of Infectious Diseases, including HIV infection.
     6. maintain confidentiality

Consultation Service

The Infectious Diseases Service provides comprehensive inpatient consultations to a wide variety of clinical services, including various surgical disciplines (Cardiac Surgery, General Surgery, Obstetrics and Gynaecology, Orthopaedic Surgery, Plastic Surgery, Neurosurgery, Thoracic Surgery, Vascular Surgery, Urology) as well as Critical Care, General Internal Medicine, Internal Medicine subspecialty services, various subspecialties of Internal Medicine, Neurology, Palliative Care, Transplant Medicine, and a variety of other disciplines. Consultation services are provided for patients admitted to University Hospital and Victoria Hospital.

During the rotation on the inpatient service, Residents will be working in a team setting with one Infectious Diseases consultant, resident physicians, and clinical clerks. An Infectious Diseases pharmacist is an integral part of the team.  On average, the team at each site will be asked to see approximately 3 to 5 new patients each day. 

Ambulatory Care

During rotations Residents have an opportunity to attend a variety of outpatient clinics, including General Infectious Diseases Clinics, HIV Clinics, Transplant ID Clinics, Cellulitis and Diabetic Foot Clinics.

Transplant ID Clinics are held at University Hospital.

Educational Rounds and Semsinare

Infectious Diseases Care Program Rounds are held monthly at St. Joseph’s Hospital.  Presentations focus on the care of patients with HIV.

Residents will also attend Microbiology and Laboratory Teaching Rounds (offered by the Division of Microbiology).
Medical Grand Rounds are held at University Hospital and Victoria Hospital  Residents and clinical clerks are encouraged to attend these rounds at their assigned hospital site during their rotation.

Infectious Diseases Journal Club meetings are held once per month. For more information, please contact Dr. Kaveri Gupta.

Microbiology Laboratory

The Microbiology Laboratory (for London Health Sciences Centre and St. Joseph’s Hospital) is located at Victoria Hospital.