Fellowship Rotations

Tampa General Hospital (TGH): Inpatient ID Consult Services

• Regional Trauma Center - Tampa General Hospital is the only Level I Trauma Center in West Central Florida.
• Regional Burn Center - TGH is one of just three burn centers in Florida. This self-contained unit treats critically burned patients from initial emergency admission through reconstructive surgery and follow-up care.
• Transplantation Program - TGH is one of the busiest organ transplantation centers in the nation and the only hospital in West Central Florida performing adult heart, lung, kidney, liver and pancreas transplants.
• Childbirth Center, Children’s Medical Center - An array of services including: pediatric surgery, neurosurgery, kidney transplantation, dialysis, and rehabilitation care.
• Digestive Disorders Center - TGH is a referral center for routine and complex disorders of the digestive system.
• Neurosciences Services - A full range of neurosurgical services.
• Orthopedic Services

Patient Population at TGH

This assignment offers the fellow a varied and busy educational experience in infectious diseases. The mix of infections include community-acquired diseases such as:

• Pneumonia
• Mycobacterial disease
• Skin/soft tissue infection
• Urinary tract infections
• Ocular/head-and-neck infection
• Bacteremia and endocarditis

Fellows will encounter patients with sepsis syndrome, ventilator-associated pneumonia, post-surgical infections, and device-related infections. Several patient populations are unique to the TGH ID rotations, including solid-organ transplant patients, multiple trauma and burn patients, patients with neurological injury following stroke, intracranial bleed or surgery, pregnant and post-partum patients, patients with gynecologic infections, and orthopedic patients suffering from either native or prosthetic joint infections. The facility is also the referral hospital for patients followed in the HIV continuity clinic at the Hillsborough County Health Department.

Educational Purpose

James A. Haley Veterans' Hospital: Inpatient ID Consult Service

The James A. Haley Veterans' Hospital is a 415-bed tertiary care teaching hospital serving over 400,000 veterans in Central Florida. The facility provides a full spectrum of ambulatory primary and specialty care, an on-campus 180-bed nursing home, and inpatient services. Unique to this facility are its national recognition as a Center of Excellence in Rehabilitation and Spinal Cord Medicine and its selection as one of four VHA Polytrauma Rehabilitation Centers in the nation. The Polytrauma Rehabilitation Centers were established in 2005 to address the emerging patterns of polytraumatic injuries and disability encountered by military personnel in modern combat.

Patient Population at James A. Haley Veterans' Hospital

The mix of infections include community-acquired diseases such as pneumonia, mycobacterial disease, skin and soft tissue infections, urinary tract infections, ocular/head-and-neck infections, bacteremia and endocarditis. In addition, with over 30 medical, cardiac, and surgical intensive care beds, fellows may expect to encounter patients with:

• Sepsis syndrome
• Ventilator-associated pneumonia
• Post-surgical infections
• Device-related infections of various types

The Polytrauma Center adds its unique population and pathogens. Since the facility also serves over 2,000 HIV-infected veterans, the assignment also offers significant experience in managing ambulatory and hospitalized patients with a full spectrum of HIV disease. The facility serves a predominantly male population ranging from 18 years old to a few centagenarians, with a small but rising enrollment of female veterans.

Moffitt Cancer Center: Inpatient ID Consult Services and Microbiology Rotation

Moffitt's clinical facilities include a 206-bed hospital with a 36-bed blood and marrow transplant unit, 11 operating rooms, diagnostic radiology, MRI, PET and digital mammography capabilities, plus radiation therapy with five linear accelerators.

Educational Purpose

The Moffitt ID inpatient consultation rotation will enable fellows to prevent and manage infectious diseases in patients with solid tumor and hematologic malignancies. They will be capable of recognizing and treating patients with febrile neutropenia and infections related to hematopoetic stem cell transplantation. The immunodeficiency associated with various malignancies and its treatment, as well as the opportunistic pathogens likely to infect an oncologic patient during various stages of cancer treatment will be understood.

Additionally, second year fellows take part in a clinical microbiology rotation during one of their assigned months at Moffitt. Fellows work half days in the clinical microbiology laboratory for one month. During this time fellows will be involved in pathogen isolation, sensitivity testing, advanced diagnostics including PCR and molecular techniques, and interface with the Infection Control Department. While on the Microbiology laboratory rotation fellows will continue to have outpatient clinic responsibilities.

Florida Department of Health - Hillsborough County: Outpatient HIV Continuity Clinic

Educational Purpose and Goals

The purpose of this rotation will allow the fellow to develop an in-depth understanding of the basic and clinical science aspects of HIV disease and its co-morbid conditions; understanding the diagnostic, therapeutic, social, ethical, and research considerations involved in the care of patients infected with HIV.

Principal Teaching Methods

Supervised direct patient care: Fellows are supervised by one of our rotating attending physicians at the Health Department's Specialty Care Clinic. Fellows train in the HIV Clinic ½ day every week. As appropriate, fellows will perform literature reviews for the problems present. Teaching will be related to the care of each patient and will address the various care strategies that may be employed for each. Additionally, periodic lunchtime didactic lectures will take place between the morning and afternoon clinics. This is an ongoing rotation through the two year program.

Educational Content

Mix of diseases: Fellows will see a minimum of twenty patients with HIV infection persons in various stages of disease. Most fellows will average a continuity clinic population of approximately fifty patients. Most patients in the Specialty Care Clinic receive their primary care in this clinic. In this setting fellows will assume progressive primary care for persons living with HIV.

Patient Characteristics

A diverse patient population is served at the Florida Department of Health - Hillsborough County. Patients include both gender groups as well as individuals of a broad spectrum of ethnic, racial and socioeconomic backgrounds.

Florida Department of Health - Hillsborough County: Clinical Research Unit

The purpose of this rotation is to allow the fellow to develop an in-depth understanding of clinical research. Fellows will understand the role of the investigator in ensuring patient safety and valid research results. Special emphasis is placed on the importance of investigator initiated research and epidemiology research regarding the HIV clinic population.

Principal Teaching Methods

Supervised care of patients on research protocols: Fellows are supervised by principal investigators taking part in research at the clinical research unit. The primary supervisor is the Director of Clinical Research at the Florida Department of Health - Hillsborough County. Fellows will rotate at the clinical research unit two-three months annually. Fellows will assist in the preparation of protocol submissions for review by the Institutional Review Board for each of their investigator-initiated trials. Fellows will learn the process of obtaining informed consent through observation followed by supervised patient encounters.

This is an ongoing rotation through the two year program.