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ACGME Clinical and Research Requirements
Training requirements for the American Board of Internal Medicine (ABIM) subspecialty board in Infectious Diseases include 2 years in an approved program with one year devoted to clinical care and 24 months of a continuity outpatient clinic. The Hopkins Fellowship Program is designed to satisfy current requirements with training in clinical or bench research.
Year I - Clinical
First year fellows rotate on each of the following 6 rotations, with the majority of the year (approximately 8-9 months) spent on the consult services. Each consult service has a parallel attending-only team in addition to the fellow team; this allows for an optimal balance between service and education for our fellows.
- The ID Consult team at Johns Hopkins Hospital: This team consists of 2 fellows and an attending. While on this service fellows obtain experience managing complex ID problems among surgical, medical, and obstetric patients. As JHH is a large tertiary care center that serves the local, national, and global community, the diversity of encountered clinical challenges is exceptional.
- The Johns Hopkins Bayview Medical Center (JHBMC) ID Consult Service: Bayview serves a different catchment area of Baltimore City than JHH, thereby enriching the range of clinical education opportunities for our fellows, with perhaps greater exposure to “bread and butter” ID problems. The team includes 1 fellow and an attending.
- The Transplant/Oncology Infectious Diseases Consult Service: This service is based at the JHH and provides care for patients with oncologic and solid organ or bone marrow transplant-related infectious diseases problems. The team consists of 1-2 fellows and an attending with expertise in transplant/oncology ID. Given that our NCI-designated cancer center and our solid organ transplant programs are some of the largest in the country, our fellows have an invaluable experience while on this rotation.
- The AIDS Service: Our division runs the Johns Hopkins AIDS Care Program, which includes a large outpatient HIV/AIDS clinic (approximately 3100 patients) and a 20-bed HIV/AIDS ward. First year fellows spend 2-6 weeks on the inpatient ward. While assigned to this rotation they serve in a supervisory and teaching role for four medical residents. This service has repeatedly been identified as one of the most popular rotations in the Department of Medicine by residents.
- Microbiology Rotation: Each fellow spends 2 weeks in our on-site microbiology lab. The fellow rounds with the director of the lab (who is also ID trained), rotates through each of the core areas of the lab, and participates in the workup of specimens.
- Subspecialty Outpatient Clinic elective: Each fellow spends 2 weeks rotating through subspecialty ID clinics. These include the Sexually Transmitted Diseases Clinic and Tuberculosis Clinics at the Baltimore City Health Department (both directed by members of our faculty), viral hepatitis clinic, and immunodeficiency clinic.
Additional aspects of the clinical year include:
10-12 days of elective time is built into the schedule for each fellow during the first two months of the year. This protected time permits fellows to meet with program leadership and prospective research mentors in order to begin a dialogue regarding possible research projects (see below); this dialogue continues throughout the year.
General ID Continuity Clinic: First year fellows participate in 12 months of general ID continuity clinic either at Greenspring Station or Bayview Medical Center.
Years II & III - Research
The second and third years are typically devoted to a research project under the direct supervision and mentorship of faculty selected by the fellow and approved by our Research Review Committee. The purpose of this training is to develop clinical, epidemiologic, or bench research skills for an anticipated career in academic medicine. Provided there is continued commitment and productivity, we do not require fellows to find funding for their salary support unless they stay beyond the 3-year contractual period.
As our division includes >70 faculty members (many of whom direct specialized research), the opportunities for projects are nearly limitless. In order to permit fellows sufficient time to meet our faculty and explore research ideas, we do not require fellows to define their area of research prior to their arrival in Baltimore; indeed, most of our fellows make these decisions after they get here and learn more about the many options available, including the possibility of co-mentorship with faculty from one of the many other schools at Johns Hopkins, or perhaps with a faculty member from a different DOM division or SOM department. Most often a fellow's primary mentor is a faculty member of the Infectious Diseases Division or the Department of Molecular Microbiology and Immunology in the School of Hygiene and Public Health. Given the depth of resources of the Johns Hopkins Medical Institutions, however, fellows are encouraged to seek "secondary mentors" as necessary to achieve their chosen research and academic goals.
Fellows are encouraged to pursue coursework through the SOM or the Bloomberg School of Public Health (JHBSPH) during the second and third fellowship years. Potential mechanisms to support this additional training include our fellowship’s Institutional National Research Service Award (T32 grant), the 16 free credits granted to post-doctoral fellows, or by applying to pursue a doctoral or master’s degree through the JHBSPH Graduate Training Programs in Clinical Investigation.
During their research years, fellows are expected to submit one training level grant (e.g. National Research Award or NRSA) guided by their mentor to begin to develop skills in grant writing and to facilitate their continued professional growth and development.
Clinical responsibilities during the second fellowship year include a continuity clinic in the Division's AIDS Service. Fellows who are interested in HIV care can also continue this clinic during the third year. Inpatient clinical responsibilities during years two and three are limited to weekend coverage (typically no more than eight weekends per year) and back-up (“jeopardy”) coverage (typically no more than eight weeks per year).
Elective opportunities during years two and three include work with the infection control/antimicrobial stewardship programs, pediatric infectious diseases, travel medicine and the Baltimore City Health Department (BCHD) TB and STD clinics.
While most of our fellows follow the above trajectory, we have mentored fellows who have successfully followed other paths:
- We encourage applications from physician-scientist trainees who have a clear commitment to academic careers and wish to “fast-track,” or reduce their Internal Medicine residency training to 2 years. These fellows typically add a required year of research to the fellowship (fellowship duration is usually 4 years).
- We occasionally select fellow candidates who have completed research projects at other institutions and require only the clinical year for eligibility for subspecialty boards.
- Some of our fellows pursue primarily clinically-oriented paths and complete their fellowship training in two years. The structure of the second year of fellowship for these trainees is developed in conjunction with the fellow’s mentor(s) and the program leadership in order to optimally suit the fellow’s needs and goals.