Christa S. Zerbe, M.D.Assistant Program Director
Clinical training in the first year consists of rotations at the NIH Clinical Center and four outside affiliated academic medical centers (Johns Hopkins University Hospital, Washington Hospital Center, George Washington University Hospital, and Georgetown University Hospital), as well as a private practice ambulatory setting. This blend of general and specialized infectious diseases experiences offers a unique and unmatched array of diverse infectious disease pathologies, allowing fellows to gain comprehensive training in the pathophysiology of infectious diseases, including microbiology, mechanisms of pathogenesis and antimicrobial resistance, host immune response, and antimicrobial treatment.
First-year fellows spend the month of July building their knowledge base in preparation for their clinical rotations. During the month, fellows attend the Johns Hopkins infection control and hospital epidemiology course. The remaining three weeks of July are spent in a comprehensive course taught by NIH infectious diseases and microbiology faculty. Interactive and hands-on sessions cover a thorough overview of bacterial, viral, fungal, and parasitic microbiology. Faculty give didactic presentations and case-based discussions on topics such as common consult questions and dilemmas, pharmacology of antimicrobial drugs, transplant infectious diseases, and host immune response to infection.
During the first year, fellows attend a weekly HIV continuity clinic at the NIH Clinical Center. Each clinic session begins with an HIV-related case discussion or lecture. Clinic is precepted by a set of expert faculty and staffed with a multidisciplinary group including case managers, a social worker, and an HIV pharmacist.
In the second year, fellows attend a weekly infectious diseases clinic at one of the hospitals at which they rotated in the first year, usually George Washington University Hospital and Washington Hospital Center. In these busy urban clinics, second-year fellows see a high volume of patients and a great diversity of cases and, in each site, are precepted by full-time faculty.
There are four regular infectious diseases teaching conferences each week:
Because Wednesday and Friday conferences are broadcast, NIH fellows are able to participate in these conferences at three of their five rotation sites. In addition, fellows participate in teaching conferences specific to their outside rotations, including both didactic and case-based sessions.
In addition to the above scheduled weekly conferences/lectures, there are weekly teaching conferences centered on topics relevant to the NIAID inpatient ward, HIV clinic, and parasitology service. Additional clinical talks include the weekly NIAID Grand Rounds; the weekly NIH Clinical Center Grand Rounds; and the monthly meeting of the Greater Washington Infectious Disease Society (GWIDS), in which all infectious diseases programs of the metropolitan Washington, DC, area rotate in presenting their more interesting cases. Numerous other conferences and didactic lectures are offered on a wide range of research and clinical subjects on a daily basis at NIH.
During the first year, fellows have three weeks of vacation and one week dedicated to exploring potential research options for the subsequent years of the fellowship via meetings with potential research mentors.
Free parking is available (NIH fellows during the NIH rotations and at all outside hospital rotations. NIH, George Washington University, and Washington Hospital Center are easily accessible by public transportation (Metro rail and bus), and the other hospitals are accessible to varying degrees.
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Fellows rotate for two to three months on the NIH Infectious Diseases Consultation Service, which serves adult and pediatric patients undergoing stem cell transplantation, intensive and investigational chemotherapy, surgery, or immunomodulatory treatment for cancer, autoimmunity, or immunodeficiency at the NIH Clinical Center. The service is also consulted for patients with ophthalmic, neurologic, endocrine, pulmonary, cardiac, and genetic disorders.
The consult team consists of an ID fellow, visiting residents and/or students, and an attending physician and typically receive 40 to 60 consults per month on patients with neutropenic fever and a diverse array of opportunistic bacterial, viral, and fungal infections. Through the integrated daily rounds with the stem cell transplant service, the fellows acquire superior training in transplant medicine and become familiar with concepts such as conditioning regimens, types of transplantation, graft-versus-host disease, and the mechanism of action and immunomodulatory effects of commonly used immunosuppressive agents. By the end of the rotation, fellows feel confident in their ability to manage infectious diseases in the setting of stem cell transplantation, malignancy, and other immunocompromised states.
Daily microbiology rounds in the Clinical Center's outstanding Microbiology Service are the highlight of this rotation. The rounds enhance patient care and bolster the fellows' knowledge of medical microbiology. On a daily basis, these 30-minute microbiology rounds review all pertinent patient microbiology data and include daily teaching presentations, simulations, and demos prepared for the consult team. These clinically relevant and hands-on presentations teach fellows to recognize and identify common pathogens under the microscope by interpreting various microbiological stains and provide meaningful training in the range of diagnostic assays and techniques used in the clinical microbiology laboratory. The Microbiology Service has an incredible array of in-house expertise, including extensive molecular diagnostic capabilities, mycology, and mycobacteriology.
The two-month NIAID Inpatient Ward rotation at the Clinical Center affords the unique opportunity to evaluate and manage opportunistic infections in adult and pediatric patients with a range of inherited and acquired immune defects. The NIAID inpatient ward admits 40 to 60 patients per month who are enrolled in various infectious diseases and immunology clinical research protocols. Fellows on the ward service supervise and teach four internal medicine residents from the George Washington University and Georgetown University Hospital who have patient care and night call responsibilities.
Some of the conditions that fellows see during this rotation include but are not limited to HIV/AIDS and immune reconstitution syndrome; tuberculosis (drug-sensitive and -resistant); parasitic infections; chronic granulomatous disease and hyper-IgE (Job) syndrome with invasive bacterial and fungal opportunistic infections; immune disorders that cause susceptibility to disseminated mycobacterial infections; bronchiectasis disorders that lead to increased susceptibility to pulmonary mycobacterial infections; chronic active Epstein-Barr virus infection; X-linked agammaglobulinemia; X-linked severe combined immunodeficiency, leukocyte adhesion deficiencies; hyper-immunoglobulin (Ig)M syndromes; and GATA-2 mutations resulting in increased susceptibility to both infectious and hematopoietic complications.
The inpatient ward team also manages patients who have undergone stem cell transplantation for these immunodeficiencies and evaluates patients admitted with opportunistic infections due to as-yet-undefined immune defects. Through exposure to this unique array of conditions, fellows acquire an in-depth understanding of immunology and how dysregulation of specific arms of the immune system confer particular infection susceptibilities.
Fellows rotate for about seven months at four affiliated academic hospitals. The outside hospital rotations provide superb and complementary infectious diseases training experiences that expose fellows to a broad spectrum of cases spanning most disciplines of infectious diseases—from “bread and butter” to rare or specialized diseases, including transplant infectious diseases. The following is a brief description of the structure and characteristics of these rotations:
Fellows typically spend two months at this 1,059-bed tertiary care center, which provides an excellent case mix and outstanding teaching conferences. Fellows gain experience managing complex infectious diseases in neurosurgical, cardiovascular, intensive care, and orthopedic patients, as well as challenging consults from the medical subspecialties. The ID consultation service receives approximately 120 consults per month, and the consult team consists of two fellows, residents, students, and an attending physician who is a full-time faculty member. There is also an optional Transplant Infectious Diseases rotation available at this institution, which provides additional training in infectious diseases in the immunocompromised host.
Fellows spend up to two months at this 926-bed hospital, the largest private hospital in Washington, DC, and a major cardiovascular surgery center. Fellows see a broad case mix, including infections related to cardiovascular procedures (including LVADs), heart and kidney transplants, orthopedic surgeries, trauma, and burns. The ID consultation service receives approximately 120 consults per month, and the consult team consists of two fellows, residents, medical students, and an attending physician who is a full-time faculty member.
Fellows spend up to two months at this 385-bed tertiary care center. Fellows see an excellent case mix, including tropical infections and complications of HIV. Interactive teaching rounds in the microbiology laboratory provide additional training in clinical microbiology. The ID consultation service receives 100 to 120 consults per month, and the consult team consists of two fellows, residents, and an attending physician who is a full-time faculty member.
Fellows spend up to two months at this 396-bed tertiary care center. Fellows gain experience managing infections in solid organ transplant recipients (liver, kidney, small bowel) as well as infectious diseases in the returning traveler or patients with advanced HIV. The ID consultation service receives approximately 100 consults per month, and the consult team consists of two fellows, residents, and students.
Fellows may spend two weeks in a private ambulatory practice in order to gain exposure to the experience and challenges of managing infections in that setting.
Finally, there are opportunities for elective rotations in various inpatient and outpatient settings, such as the pediatric ID consultation service at Children’s National Medical Center, and the transplant service at Johns Hopkins Hospital. Other electives can be arranged on a case-by-case basis.
In the second and third years, fellows undertake clinical and/or bench projects under the direct supervision of faculty mentors. The goal of the research training is to produce academic infectious diseases physicians who will be prepared for careers involving clinical, basic, or translational research after the completion of their fellowship. Fellows spend a minimum of two years in research and often stay for additional years to continue work on their projects. We offer a spectrum from clinical to basic research opportunities, and fellows may choose to work in any of the NIAID research groups or laboratories.
The process of selecting potential research mentors begins in the fall of the first year of fellowship, when NIAID holds a retreat for fellows to meet researchers and senior fellows. The fellows hear about research in which they can participate, ranging in scope from clinical trials to overseas studies to the most basic aspects of cell and molecular biology. Following the retreat, fellows consult individually with NIAID and training program leadership and then meet with potential mentors during their NIH-based rotations, their clinic days, and the week dedicated to exploring potential research options. Fellows typically choose a research mentor by springtime of their first year.
Those who elect to do clinical research may apply for the Training Program in Clinical Research, an M.H.S. program offered at NIH in collaboration with Duke University. Graduate-level courses in microbiology, immunology, and molecular biology are offered onsite by the Foundation for Advanced Education in the Sciences. Coursework leading to an M.P.H. is available through Johns Hopkins Bloomberg School of Public Health.
Each fellow selects a career mentor from among the ID faculty, someone who is not involved with the fellow’s research area. The fellow and mentor meet quarterly and discuss the fellow’s career trajectory, including grant-writing possibilities and future job options.
In addition to individual research mentors, fellows in the second year and beyond participate in a program-wide research mentoring program. At mid-year, fellows submit formal summaries of their research projects, and at year-end they present their progress before the assembled infectious diseases fellows and faculty, including the individual research mentors. This program is designed to help keep fellows focused on their career trajectory.
Among our former infectious disease fellows graduating since 1979, approximately 60 percent are currently employed in academia (engaged in translational or clinical research), about 20 percent are in the pharmaceutical industry or government administration, and about 20 percent in private practice.
There are up to four positions available per year. Candidates are required to apply through ERAS and are selected through the National Residency Matching Program. The length of the fellowship program is three years; however, many fellows continue their research activities for one or more additional years. Fellows in the ABIM Research Pathway require four years of fellowship, and this can usually be accommodated in our program.
Nearly all ID fellows with significant educational (undergraduate, graduate, and medical school) debt have been able to receive substantial loan repayment under the NIH loan repayment program. Fellows may apply for one of several categories of loan repayment through this program, the amount most recently ranging from $17,000 to $35,000 per year. The repayment is a benefit provided in addition to the annual salary. For the 2014 – 2015 academic year, 100 percent of the applicants were able to receive loan repayment.
Qualified candidates must have completed three years of residency training in internal medicine in the United States or Canada prior to entering the fellowship program. Residents will be accepted after only two years of internal medicine residency only if they are accepted in the ABIM Research Pathway.
Upon receipt of the required materials, we will notify you as to whether an interview will be scheduled. If financial or other constraints prohibit you from attending an interview, you should notify Dr. Palmore as soon as possible. You may also contact the NIAID ID Fellowship Program office with questions.
Tara N. Palmore, M.D.Director, Infectious Diseases Fellowship Program
Ericka ThomasFellowship Program Coordinator
Last Updated February 23, 2016