Antimicrobial stewardship is a vital component of infectious diseases clinical practice, and pharmacists have a critical role in implementing and evaluating stewardship practices. Fellows interested in antimicrobial stewardship may choose to rotate with the antimicrobial stewardship pharmacy teams. This is a two-to-four-week experience where fellows will work with the antimicrobial stewardship pharmacist at both TUKHS and KCVA. Fellows on this rotation will further develop their understanding of antimicrobial stewardship by reviewing restricted antimicrobial use and assisting with optimizing antimicrobial choices for hospitalized patients. This is a required elective for fellows on the Hospital Administrative Infectious Disease Pathway.

The field of infectious diseases is vast and while we strive to expose our fellows to all areas of ID there may be certain areas that fellows may want to explore at other institutions. Fellows who have a particular ID interest have the opportunity to self-design a rotation at a facility outside of the KU ID fellowship program. For example, if a fellow would like further NTM experience, a rotation at National Jewish Health Center could be arranged. If a fellow is interested in such an elective, this would be discussed with fellowship leadership in the second half of their first year to coordinate.

Consultative patient care requires collaboration with variety of medical providers, and it is important for ID physicians to have an understanding of disease management from the perspective of non-ID providers. Fellows interested in a particular area of ID may also choose to rotate on a medicine subspecialty related to that interest. During this two-to-four-week custom clinic rotation, fellows may rotate with a subspecialty service at TUKHS. Examples include dermatology, pulmonary medicine, cystic fibrosis, etc.

Fellows who are interested in ambulatory infectious diseases/HIV practice can spend two to four weeks in the Ambulatory setting working in the Gender Diversity Care clinical practice. The goal of the gender diversity care rotation is for the fellow to gain experience and understanding of the management of health issues pertaining to transgender and gender diverse patients from both a medical and surgical prospective. The fellow will focus on understanding the hormone management of patients undergoing transition, familiarize themselves with surgeries such as hysterectomy or genital reconstruction for patients undergoing transition, and learn how to recognize and diagnose, order appropriate tests, and to formulate treatment plans for patients having complications from these treatments. As clinic schedules vary, fellows will spend some time in additional outpatient ID clinic sessions during this elective when Gender Diversity Care clinic is not in session.

Fellows interested in HIV care may choose an elective rotation at the KC Care Clinic. Providing care to patients with HIV can be a large component of an ID physician’s practice, and how this practice is structured can vary widely between clinical facilities. HIV patients face many health care disparities, and it is important for providers to have knowledge of the various resources available to their patients. During this four-week elective fellows will rotate at the KC Care Clinic which provides care to underserved HIV patients in the Kansas City Metro area. Fellows will have the opportunity to learn about the additional resources the clinic offer PLWHIV. In addition, each week the fellow will meet with one of the KUMC HIV focus group providers or KU HIV pharmacists to review a challenging patient case.

This is a four-week rotation where fellows would have the opportunity to rotate at an international site. The fellow would work with Dr. Bahr and fellowship leadership to set up the rotation depending on their clinical and research interests. If a fellow is interested in an international elective, they will need to meet with Dr. Bahr and fellowship leadership by the second half of their first year of training to arrange the rotation as there is a six-month window to organize this experience with the KU Medical Center Office of International Programs.

Fellows interested in community health systems (development and enforcement of health facility regulations, administration of aid-to-local grants and supporting quality primary care retention), disease control and prevention (STDs, TB, vaccine-preventable diseases), epidemiology/public health informatics (collecting, analyzing and interpreting data to provide information on conditions of public health importance and the health status of the population) and health promotion (prevention and/or management of chronic diseases, violence and injury in Kansas) may choose to apply for an elective block with the Kansas Department of Health and Environment in Topeka, KS. Interested fellows will work with Dr. Kelli Wark to orchestrate this experience. 

Fellows in the ID Fellowship Clinician Educator Pathway may complete a four-week dedicated Medical Education elective. During this elective, fellows will complete an asynchronous online medical education didactic series, participate with faculty in the Division of ID/Dept. of IM in both UME/GME small and large group teaching activities, and round with teaching teams to provide feedback on junior learner presentations, documentation, and clinical skills. Fellows will also use time in this elective to work on a medical education scholarly activity and will actively contribute to continuous quality improvement of the Fellowship, Internal Medicine Residency and KU School of Medicine ID-related curriculum.

Fellows interested in ambulatory infectious diseases can spend additional time in the KU Infectious Diseases Outpatient Clinic. Outpatient ID practices can vary in structure and distribution of new outpatient infectious diseases consults. During this two-to-four-week rotation fellows will see new consults with the KU ID physician on the outpatient team (Team “O”). Fellows will work with the Team O faculty to review and prioritize outpatient consult referrals. In addition, fellows will see new and follow-up patients with a faculty outside of their assigned continuity clinic.

Fellows interested in pediatric infectious diseases may choose to rotate at Children’s Mercy Hospital. Depending on where infectious diseases providers practice, they may provide care to pediatric patients, therefore it is important for these fellows to have familiarity with this unique patient population. During this 4-week rotation fellows will rotate with the Pediatric ID Physician Group at Children’s Mercy Hospital, providing clinical care on their inpatient and outpatient services. Children’s Mercy has 2 inpatient consult services, general ID and immunocompromised ID. In the ID clinic, fellows will have the opportunity to see new referrals and hospital follow-ups.

Exposure to and understanding of principles of quality improvement and patient safety efforts are vital to fellows interested in hospital administration and are advantageous for all ID fellows, no matter which area of practice they intend to enter. In this QI/PS elective at The KU fellows are given access to attend institutional quality and safety meetings with a member of TUKHS leadership, perform a root cause analysis (RCA), and consider other quality improvement/patient safety scholarship efforts.

Fellows interested in advancing their knowledge of radiology diagnostic imaging reading may choose to rotate with TUKHS radiology service. Reviewing radiologic imaging is an important skill for ID physicians to possess to provide comprehensive care their patients. This is a two-to-four-week rotation where ID fellows rotate with TUKHS radiology service lines. During this rotation fellows are anticipated to spend up to 2 weeks reading with Chest and/or Musculoskeletal teams. If there are additional areas the fellow would like to experience, this can be discussed with the fellowship leadership program and radiology department.

Each fellow has three research elective blocks in their second year. Depending on their project, they can utilize up to three additional blocks after reviewing this with the research mentor and program leadership. Fellows on the Research Pathway will generally utilize three additional months of training to complete their scholarly work.

Management of chronic wounds and wound infections are commonly encountered problems by both community and academic ID physicians. Wound care management requires collaboration with wound care teams and surgical specialties. During this two-week rotation fellows will rotate in the TUKHS wound clinic with the wound care APRNs and physicians. Fellows will learn about various wound care techniques and materials used by these providers and will assess patients presenting with both new and chronic wounds to the clinic.