Applicants must be ABIM board-eligible in Internal Medicine.
Tulane University is unable to host H-1 visa-holders at this time. J-1 visa-holders are welcome.
Application is made via the Electronic Residency Application Service (ERAS).
Contact Information:
David M. Mushatt, M.D., M.P.H. &T.M.
Fellowship Training Program Director
Infectious Diseases Section
Tulane University School of Medicine
1430 Tulane Avenue, SL-87
New Orleans, LA 70112
504-988-7316 (tel) 504-988-3644 (fax)
or e-mail Stephy Clark-Bethley at stephy1@tulane.edu.
The Training Program is available to qualified applicants who wish to pursue an academic, public health-oriented or clinical career in Infectious Diseases. Fellows spend one year in intensive clinical work before entering one of the following training pathways for one to two years:
The Infectious Diseases Section of the Tulane University Department of Medicine:
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Inpatient Facilities – Experience
Descriptions of the institutions:
Pediatric Infectious Diseases cases are taken care of by the Tulane Pediatric Infectious Disease Service, which has several full-time professional staff members. First- or Second-year fellows may elect to do a month of Pediatric ID.
Together, the three hospitals provide a full range of Infectious Diseases patients, and by rotation through them, an Infectious Diseases Fellow experiences a balanced range of clinical problems.
Average number of inpatients for whom each trainee is responsible at any given time:
Responsibilities of the trainee for acute and chronic care of inpatients:
Trainees acquire experience in treating a wide range of illnesses within the subspecialty:
Tulane University Hospital & Clinic has a diverse mix of patients, drawing from both the indigent population and its contractual health care plans, which include Tulane University students and faculty members, tourists staying at many New Orleans hotels, etc. In addition, active programs in renal and liver transplantation, bone marrow transplantation, cardiac surgery, neurosurgery, obstetrics and gynecology, orthopedic surgery, ENT, and ophthalmology, generate their own infectious diseases consultations. Tulane University Hospital & Clinics also acts as a regional tertiary referral hospital for Hospital Corporation of America (HCA), which own 80% of the hospital (the Tulane School of Medicine owns the other 20%) and operates numerous health care facilities in Alabama, Mississippi and Louisiana.
The Medical Center of Louisiana at New Orleans (MCLNO - University Hosptial [UH]) is the mother hospital for eight (8) other Charity hospitals distributed throughout Louisiana. As such, it concentrates the difficult and puzzling cases among the indigent population in Louisiana and provides extensive experience for trainees with tuberculosis, sexually transmitted diseases, complications of injection drug use, infectious complications of obstetrics and gynecology, and unusual infections such as Mycobacterium kansasii and other mycobacteria-other-than-TB (MOTT), Vibrio species, fresh water gram-negative pathogens, and the endemic mycoses, blastomycosis and histoplasmosis. As the trauma center for metropolitan New Orleans, extensive experience is gained with intensive care and surgical complications of head injuries, chest and abdominal trauma and the orthopedic complications of blunt trauma.
The Veterans Administration Medical Center is the regional hospital for Southern Mississippi and all of Louisiana. At present, only the outpatient clinics are open and the inpatient facility remains closed after Hurricane Katrina. All VA patients requiring inpatient care are now admitted to the VA Service at TUHC.
Differences between the responsibilities of the trainee, and those of the residents in the internal medicine program:
Ambulatory Care Facilities - Experience
Outpatient clinics and facilities utilized in the program:
Throughout their two years, trainees do their continuity clinic at the MCLNO HIV Outpatient Program (HOP), which serves both HIV patients as well as patients with general infectious diseases.
Fellows interested in learning to practice outpatient ID in a private setting may attend faculty clinics at Tulane University Hospital & Clinics.
Trainees first evaluate the patient's complaints and perform a physical examination independently before presentation of findings to faculty. Findings are then reviewed, confirmed or extended. Decisions on diagnostic and therapeutic steps are taken after joint discussion between trainee and faculty. Fellows are expected to see a minimum of 4 patients per clinic, and are required to follow a panel of 20 HIV patients over at least 12 months in order to gain longitudinal experience in the management of HIV infection.
First- and second-year fellows rotate through the metropolitan New Orleans OPH Region I Wetmore TB Clinic, where they gain experience in the prophylaxis, treatment, and diagnosis of tuberculosis.
First- or second-year fellows are also expected to attend at least 3 sessions at the City of New Orleans Delgado Sexually Transmitted Diseases Clinic. Trainees may also participate in the Travel Clinic at Tulane University Hospital.
Estimated number of outpatients seen by each trainee in a given year, and level of responsibility trainees have for patient care:
Educational Program
Trainees are supervised throughout the program and in the performance of technical procedures:
Similarly, infectious disease clinics regularly have a staff member present, who supervises trainees, residents, and students rotating through the infectious disease subspecialty program.
Trainees are required to maintain written records with names and diagnoses of all patients seen and of all technical procedures performed, with appropriate documentation of date, time, place and supervision. Facilities for microscopic examination of secretions, culturing, and other relevant aspects of infectious disease care are provided.
Faculty rounds:
All new data on every patient is reviewed daily on chart and x-ray rounds, which are part of the daily faculty review of patient status at the beginning of rounds. All patients are re-examined and their x-rays reviewed on a regular basis. Supervising faculty are always available for advice outside of normal rounding hours and are on-call with trainees on nights and weekends.
Teaching and management (work) rounds are generally conducted during the same session. For instance, the faculty member may begin rounds with a discussion of a topic, then proceed to work rounds, or the teaching may be intertwined with work rounds.
Conferences:
A Fellow Didactic Lecture Series, part of the weekly New Orleans Citywide ID Conference, consists of one-hour presentations each week by authoritative clinical investigators or laboratory directors, which address the clinical and scientific aspects of infectious diseases.
A weekly Tulane ID Conference for faculty and fellows alternates between Journal Club (twice per month), case presentations (1-2 per month) and research topics (once per month).
A weekly Microbiology Conference (“Plate Rounds”) is held at Ochsner for all New Orleans ID fellows. Cases are presented and cultures plates, microscopic slides, etc. are reviewed.
A Clinicopathologic Case Conference (CPC), at which autopsy and biopsy results are reviewed, is held in the ID Library every 1-2 months in collaboration with the Department of Pathology at Louisiana State University (LSU).
The Department of Microbiology and Immunology sponsors a seminar program with local and outside speakers, and fellows are encouraged to attend.
Trainees' responsibilities in preparing and presenting conferences:
Trainees are required to prepare formal material for clinical conferences and journal club, whose audience is composed of faculty, residents and students. Outlines, diagrams and literature citations are expected. Each trainee will present a minimum of 10 conferences during the first year. Additionally, trainees are expected to do literature searches on topics related to hospitalized patients and present the relevant information informally at rounds.
Progressive educational experiences accomplished within the program:
The first year is structured as follows:
The Ambulatory ID month is a new rotation developed at the recommendation of former fellows. This month allows first-year fellows to concentrate on the outpatient clinic experience: in addition to their weekly ID Continuity Clinic, fellows also attend 1-2 private TUHC ID clinics per week, 2-3 sessions of the Wetmore TB Clinic, 3 sessions of the STD clinic and 2-3 sessions of the Tulane Travel Clinic. Fellows are expected to do more reading this month, begin working on a case report or similar scholarly work, and work on the on-line courses (Infection Control, STDs, TB and Transplant Infections).
Fellows are encouraged to spend 2-4 weeks in Pediatric Infectious Diseases during the first or second year. They see inpatients and outpatients at TUHC, as well as attend the Wetmore TB Clinic pediatric clinic and the HOP Pediatric Clinic as the schedule permits. Fellows are also expected to do reading on specially assigned topics, such as Cystic Fibrosis, TORCH syndromes and other areas relevant to an overview of pediatric infectious diseases.
Trainees rotate through the Diagnostic Microbiology Laboratory at either Tulane University Hospital & Clinics or MCLNO as a formal part of the first year program. Trainees learn how to process clinical specimens, perform stains, interpret biochemical tests for identification of organisms and perform antimicrobial susceptibility testing. The daily experience in these busy diagnostic laboratories is directly supervised by the Laboratory Director and by the Chief Technician.
In the second year, three pathways are available to applicants after satisfactory completion of one year of intense clinical work:
Public Health Degree Program
The Tulane School of Public Health and Tropical Medicine (TUSPHTM) offers formal training in various aspects of epidemiology and biostatistics. Its Department of Tropical Medicine offers additional formal training in Tropical Medicine, which includes diagnostic parasitology laboratory experience. The most popular program has been the MPH&TM . Recently, the number of required credit hours for this degree has gone up from 36 to 42 hours. Our fellows currently receive a $10,000 per year HIV Stipend (total of $20,000 over two years) from MCLNO earmarked for tuition costs, covering just over 1/2 of the total cost. Fellows who are not restricted by a J-1 visa may moonlight to help make up the difference.
Another option is the Diploma Course in Tropical Medicine. Shorter than the MPH&TM, this course can be completed in one semester.
All departments have extensive field research programs with major overseas involvement. The Department of Tropical Medicine also has research laboratory programs in parasitology and related fields, which in several instances are coordinated with research programs at the Tulane Regional Primate Center.
The State of Louisiana Office of Public Health in the Department of Health and Hospitals, also located in New Orleans, offers field experience under the direct supervision of the Epidemiology Division and in conjunction with the Tulane School of Public Health and Tropical Medicine. Trainees may be eligible to work on projects related to AIDS, funded by either the Centers for Disease Control and Prevention (CDC) or other federal agencies, as well as on projects concerning tuberculosis, vector control, waterborne infections, or other communicable diseases.
Advanced Clinical Pathway
Trainees choosing the advanced clinical pathway concentrate on the further development of clinical skills, teaching skills and scholarly work such as a retrospective chart review. Clinical activities in the second year include adult and pediatric infectious diseases consultation rotations and attendance at the Sexually Transmitted Disease Clinic, Wetmore Tuberculosis Clinic and Travel Clinic.
Some trainees have opted for off-site rotations to supplement their training. For example, National Jewish Medical and Research Center in Denver, Colorado offers a one-month clinical elective for advanced training in the care of patients with nontuberculous mycobacterial infections as well as MDR-TB. MD Anderson in Houston, Texas offers one-month rotations on their bone marrow transplant and hematologic malignancy ID services.
All Trainees with a special interest in clinical trials of antiretroviral strategies, involving minorities especially, are encouraged to participate in the NIH-supported Louisiana Community AIDS Research Program (LaCARP), which focuses on research in the primary care setting.
Research
Resources available to the trainees for the conduct of research:
In addition, interested second year Fellows are encouraged to collaborate with investigators outside Tulane, particularly at the Hansen's Disease Center in Baton Rouge for those interested in mycobacteriology, and with the Infectious Diseases Section at Louisiana State University Health Sciences Center for those interested in sexually-transmitted disease research.
Tulane is also the central unit for the Louisiana Community AIDS Research Program (LaCARP), one of 17 units around the U.S., which comprise the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA), which is funded by the Division of AIDS at NIH. LaCARP extends clinical research programs to community-based organizations in New Orleans, Baton Rouge and Jackson, Mississippi.
The Department of Microbiology and Immunology in the Medical School has a number of basic scientists working on laboratory projects in mycology, bacteriology, molecular biology, vaccines, and virology which serve as suitable sites for supervised research experience.
The Tulane Regional Primate Research Center at Covington, Louisiana, offers several research opportunities in infectious diseases: malaria, microfilaria, simian AIDS (SAIDS), Lyme disease and other primate models of infectious diseases.
Participation of trainees in research studies with faculty:
Fellows pursuing the MPH in their second year carry out a Capstone research project as part of their formal education exercises.
Section Research Activities:
Evaluations
Procedure for evaluating the clinical competence of trainees including the frequency of evaluation:
The above evaluations are provided to the fellows for their review immediately after each rotation, and semiannually, at which time the Program Director discusses them with each fellow. During these discussions, the fellows are encouraged to respond to the evaluation. When significant problem areas are identified, evaluations are reviewed with fellows more frequently as the circumstances warrant.
Evaluation of Faculty Members:
Annually, the Section Chief evaluates each faculty member by means of personal observation, verbal reports, and written feedback from students, residents and fellows. He provides written comments and recommendations to the Department Chairman and to the individual faculty members. Faculty evaluations incorporate results of interviews of trainees by the Section Chief. Fellows complete anonymous faculty evaluations at the end of each rotation using the on-line MyEvaluations system. Faculty are also rated formally by residents rotating through the service in written reports compiled by the Residency and copied to the Section. Faculty lectures are evaluated by students and residents using written forms.
The performance of tenured faculty is reviewed by the Tenure and Promotions Committee of the Department of Medicine and then by the Dean's Tenure and Promotions Committee every five years.
Evaluation of the educational program:
The student honor society (Owl Club) rates individual sections and awards honors to those with excellence in teaching on an individual and overall program basis.
Relationship to the Internal Medicine Program
Trainee's responsibilities for teaching and/or supervision of medical students, and of residents in the Internal Medicine program:
Extramural Project Policy
Second-year fellows, especially those in the MPH&TM pathway, occasionally have arranged to participate in overseas projects. These arrangements need to take into consideration the following factors:
The Infectious Diseases Training Program at Tulane University Health Sciences Center (TUHSC) utilizes three hospitals:
Each hospital has medical, cardiac and surgical intensive care units. Dialysis programs are active at all three hospitals, as are most surgical specialties.
Trainees act as consultants at both teaching hospitals and in each instance under the direct, close supervision of faculty. At each of these sites, trainees actively follow between 5 and 15 in-patients. Note that trainees are assigned to only one hospital during any one time.
During the clinical portion of the Fellowship experience, Fellows can expect to consult on or manage approximately 300-400 in-patients.
Trainees develop a broad experience with recognizing and treating infectious diseases in this program because of the rich diversity of clinical material accumulated in three referral centers. TUHC and MCLNO have very active Emergency Rooms including a Level I trauma center at MCLNO.
Fellows share with faculty in the responsibility of teaching and supervising medical residents during their infectious disease clinical rotations. Fellows are responsible for being familiar with all patients being followed by residents and students on the service. To facilitate continuity of care despite monthly turnover of residents during the clinical year, fellows are often assigned to specific hospitals for longer terms, which also assures their opportunity for prolonged surveillance of hospitalized patients. 
Infectious Diseases out-patient clinics meet weekly at MCLNO, VAMC, and the Tulane University Hospital & Clinics.
Each trainee will see approximately 160-175 outpatients during the first year of the program. Trainees are responsible for patient evaluation, design of diagnostic and treatment programs, decisions about entry into studies, record keeping, and data assembly on groups, as well as assisting in supervision of residents and students who are rotating through the ID service for shorter periods of time.
Faculty supervision of trainees is intense by design. The average faculty contact time for infectious disease trainees, based on attendance at all conferences plus daily patient supervision, is 10-20 hours weekly. Rounds are held five to seven days a week on all inpatient services, at which time the faculty members see all new patients and most old patients.
All new patients are personally examined by the supervising faculty member after presentation of history, physical examination and laboratory data by the trainee and joint review of x-rays and, where relevant, gram stains, pathology slides, etc.
Fellows from the four New Orleans adult and pediatric ID training programs alternate presenting cases at the beginning of the weekly New Orleans Citywide ID Conference. Several short cases or one long case are presented as unknowns, followed by a faculty member discussion and then a literature review by the fellow. Gross and microscopic pathology from autopsies and biopsies is reviewed during these sessions.
Trainees are expected to attend the three weekly regularly scheduled conferences described above, and they are encouraged to attend the weekly Medicine Grand Rounds.
The Infectious Diseases Subspecialty Training Program at Tulane University Health Sciences Center is principally designed to train individuals interested in a career in academic medicine, including clinical practice, or public and international health. Consequently, clinical work for a two-year period is not the main focus of this program for all trainees, and clinical experience is deliberately heavily concentrated in the first year to allow opportunities for subsequent clinical research or non-clinical experiences during the second year.
The overall laboratory research resources include the Section's laboratories and programs in collaborating laboratories in the Tulane University Health Science Center and at the Tulane Regional Primate Research Center.
Second-year fellows are generally expected to submit a manuscript for publication, or to present an abstract or poster at a national meeting. This work may be from a specific case, chart or data review or laboratory research. When the opportunity arises, fellows are invited to co-author a book chapter with a faculty member. First-year fellows are encouraged to identify a faculty mentor who will supervise their research. Clinical Research: (clinical trials, chart reviews, data analysis, etc.)
Laboratory Research:
Other specific research activities of each trainee:
Clinical trainees in the Advanced Clinical Pathway participate in hospital epidemiology through Infection Control Committees, where data is presented and evaluated by committee members and policies are formulated.
Each trainee is evaluated by the supervising faculty member at the completion of the rotation, which occurs monthly. Forms used are the same as those recommended by the Residency Review Committee (RRC) and ABIM for this subspecialty and we are now using MyEvaluations for on-line evaluations.
The Chairman of Medicine requires annual reports of activities and publications of all faculty members in the Department. Occasionally the Chairman will conduct a formal "internal site visit" to Sections in the Department of Medicine.
Fellows evaluate each monthly rotation at the end of every month, and the overall fellowship program every 6 months using anonymous evaluation forms via the on-line MyEvaluations system. Residents and students rotating on service are also asked to complete an evaluation form designed to assess their overall experience during the rotation.
Fellows share in the responsibility of teaching and supervising residents in the internal medicine program during their infectious disease clinical rotations. Trainees are also directly responsible for supervising fourth-year medical students, who rotate through the program during one-month electives in infectious diseases. Occasionally, fellows also may assist in non-infectious disease teaching of medical students, for example, in second year Physical Diagnosis.