Infectious Diseases Sub-Internship

Department of Medicine and Medical Specialties

  • Course Information

    Course Number: RMDN682

    Prerequisites: Completion of all Phase 2 clerkships

    Length of Time: 4 weeks

    Phase Availability: Phase 3

    Credit Type: Physician Assessed Patient Facing (PAPFE), Sub-Internship (Sub-I), or Open

    Call: Saturday or Sunday rotation every week for the first three weekends. No overnight call.

  • Contact Information

    Program Director: Geoffrey Tsaras, MD

    Coordinator/Scheduling: Allison King (aking75@uic.edu)

    Location: UW Health ID Clinic (1340 Charles St, Suite 404, Rockford, IL 61104) and UW Health Hospital (1401 E. State St, Rockford, IL 61104)

Narrative Description: The overarching goal of this Sub-I is for the student to develop the appropriate skills to be ready for the transition to residency. As such, he/she will work directly with the attending physicians on the Infectious Disease Service on a daily basis, learning the skills and responsibilities of a resident physician and may follow-up patients in the clinic.

  • Medical Students (Sub Interns) will develop an appreciation of the scope of care provided by infectious disease service:
    • Recognition and definition of infectious disease syndromes.
    • Diagnosis and treatment of infectious disease syndromes.
    • Referral of patients requiring other specialty intervention and/or counseling.
  • Technical Skills (Procedures): Sub Interns will learn the indication, interpretation, and complications of the following procedures:
    • Blood and other body fluids stains, and cultures, and antibiotic sensitivity.
    • Spinal, pleural, peritoneal and synovial fluid taps
    • Skin tests
    • Serological tests
  • The Sub Intern will independently evaluate adult patients referred for infectious disease consultation and recommend appropriate work up and care of the patient, under the supervision of an Infectious Disease Attending Physician / Specialist / Consultant.

Learning Objectives:

  1. Time management skills
    1. Organize a daily patient care task list for each patient in a structured and systematic way so that required tasks (e.g., daily notes, orders, etc.) are not overlooked.
    2. Prioritize daily patient care task list according to degree of importance/urgency.
    3. Prioritize patients’ clinical problems according to degree of clinical importance/urgency.
    4. Recognize one’s own limitations and call on other team members to help.
  2. Communicating effectively within healthcare teams
    1. Write accurate, concise, and well-organized consult and progress notes; and where applicable, transfer notes, discharge summaries, and cross-cover notes
    2. Provide an oral presentation of a clinical encounter, tailoring length and content according to context.
    3. Give and receive patient handoffs (both in writing and verbally) to transition care responsibility.
    4. Speak with specialist/subspecialist colleagues to request consultation.
    5. Communicate collaboratively with nursing and pharmacy staff to enhance patient care.
    6. Communicate effectively with team case manager, social worker, and outpatient care providers including ID clinical staff, to facilitate ID discharge planning
  3. Patient evaluation skills—recognizing sick vs. non-sick patients
    1. Gather appropriate clinical data from all appropriate sources (e.g., patient, family, nurse, medical records) in hypothesis-driven fashion to address the main clinical problems (Reporter function of RIME)
    2. Analyze and synthesize the collected clinical data set to formulate a prioritized differential diagnosis for the main undifferentiated problems (Interpreter function of RIME)
    3. Recognize which clinical situations require additional assistance from upper level resident, faculty attending, and/or specialty consultants.
    4. Develop initial diagnostic and/or therapeutic management plans for the main clinical problems (Manager function of RIME)
    5. Prioritize problem list according to degree of clinical importance (Interpreter function of RIME).
  4. Knowing when to ask for assistance
    1. Recognize various techniques that can enhance and develop metacognitive skills
    2. Generate clinical questions and retrieve evidence to advance patient care
    3. Identify clinical and contextual situations that require assistance from clinical supervisors
    4. Utilize a communication framework when calling for clinical support

Daily Responsibilities:

  1. Performing a full history and physical on initial consultation, formulating a differential diagnosis, and developing preliminary evaluation and treatment plans for all new patients assigned to him/her, with review by the attending physician [ the sub intern may consult on no more than 2 new patients a day].
  2. Bedside presentation of his/her patients and written daily SOAP /ID progress notes and orders [the sub intern may provide continuity of care to no more than 5 patients per day].
  3. He/she may call for consults consistent with hospital policy.
  4. Review of daily orders with the attending ID physician.
  5. Night call not currently scheduled
  6. Communicating with his/her patients, their families, nurses, ancillary staff and other providers about the day-to day needs and action plans as reviewed with the attending ID physician.
  7. Beginning ID discharge planning, discussing with discharge planners [case managers, social workers] regarding outpatient parenteral antibiotic therapy (OPAT) and assisting in the process of obtaining the resources and referrals needed for a safe discharge.
  8. Generating an ID discharge summary for his/her patients which will be reviewed and signed by the responsible attending physician.
  9. Contacting the PCP at discharge re: follow-up plans if requested by the attending.
  10. Participate fully in family meetings, end of life and code discussions, and emergent bedside management of his/her patients.
  11. Perform ID consultations and assessments at the discretion and under the guidance of the attending ID physician.
  12. Participate in all educational sessions scheduled during the sub-Internship.
  13. Keep a log of patients seen and lessons learned from the patients.

Specific Infectious Disease Responsibilities:

  1. Able to perform a focused infectious disease evaluation; obtain relevant past/family/social/occupational and travel history that may be pertinent to the infectious disease syndrome.
  2. Learn the indication and interpretation of blood, body fluid or tissue gram stain and special stains, cultures and antibiotic sensitivity, skin tests, serological tests and novel molecular methods for the diagnosis of infectious diseases.
  3. Learn the management of commonly encountered infectious diseases through patient-based learning and review of the literature.
  4. Participate in bedside procedures such as cerebrospinal fluid taps, synovial fluid aspiration, incision and drainage of abscesses, under supervision of credentialed physicians.
  5. Attend all didactic seminars and recommended conferences:
    1. Student seminars; two-hour didactic sessions, twice a week (Mondays and Fridays), with a 15-20-minute presentation by student, followed by ID physician-led discussion of case vignettes (from selected ID categories, below) *. Six sessions during the 4-week rotation.
    2. Infection Prevention meeting, Antimicrobial Stewardship meeting or Case-management conference – at least once during the 4-week rotation.
    3. ID journal club – review of a contemporary ID article from a reputable national/international journal – once during the 4-week rotation.
    4. End of Rotation Antibiotic Quiz / Round Table Discussion.

Method of Assessment:

  1. The student will be evaluated by the ID attending physicians in areas of professionalism, history taking and physical examination skills, differential diagnosis skills, management planning skills, oral and written communication skills, and interpersonal collaboration.
  2. Patient Log will be reviewed by supervising attending physician.
  3. Standard UIC evaluation form completed and submitted.
  4. Additional evaluation forms for cross-cover notes and discharge summaries may be used for formative evaluation.

Required Reading: Essentials of Clinical Infectious Diseases by William F. Wright (ISBN-13: 978-0826127822).

Educational Resources: Students are expected to utilize appropriate online sources, medical textbooks, and medical journals in researching and learning about the patients they see.

  • Recommended Resources/Reference Material
    • ID Textbooks such as Mandell’s Principles and Practice of Infectious Diseases, 9th Edition (2019)
    • ID section of Internal Medicine Textbooks such as Harrison’s Principles of Internal Medicine, 19th Edition, Part 8 (2015)
    • ID Review Articles from journals such as NEJM, Clinical Infectious Diseases, Lancet, JAMA and Annals of Internal Medicine
  • UpToDate, as a point of care reference
  • MEDLINE, PUBMED and GOOGLE SCHOLAR online literature search
  • IDSA Guidelines
  • CDC website

Additional Resources:  

*Major disease/ID categories for student seminars.

  1. Septic arthritis/Osteomyelitis
  2. Soft tissue infections, diabetic foot infections and complications
  3. Community-acquired and hospital-acquired pneumonia including ventilator-associated pneumonia
  4. Community-acquired and health care associated urinary tract infections (UTI), including prostatitis.
  5. Bacteremia, sepsis, septic shock and endocarditis
  6. Infectious diarrhea and intra-abdominal infections
  7. Meningitis-encephalitis, and other CNS infections
  8. HIV disease and related opportunistic infections
  9. Infections in non-HIV immunocompromised patients
  10. Viral infections – HSV, influenza, mononucleosis etc.
  11. Viral hepatitis
  12. Surgical site infection and trauma associated infection
  13. Sexually transmitted diseases: genital ulcer diseases, cervicitis, vaginitis, pelvic Inflammatory disease (PID)
  14. Superficial and deep fungal infections
  15. Tuberculosis and other mycobacterial diseases
  16. Immunization and prophylaxis
  17. Isolation patterns and infection prevention and control measures
  18. Emergence and management of multidrug resistant organisms
  19. Understanding of utility of different antimicrobial agents for various infections.
  20. Antimicrobial stewardship
  21. Fever of unknown origin
  22. ENT infections – sinusitis, otitis media/externa, pharyngitis

Miscellaneous Information: Students will attend didactics on Mondays and Fridays from 8-9am.