Education


Hillcrest Hospital 

The UCSD Medical Center Hillcrest Hospital is located on the north side of downtown San Diego on the Hillcrest neighborhood campus. This rotation includes a busy infectious disease inpatient consult service, emergency department consults, and the weekly I.D. outpatient clinic held in the adjacent Ambulatory Care Center on the Hillcrest campus. The I.D. Consult Service receives on average 1-4 new consult requests per day from all inpatient services at Hillcrest. The hospital houses an urban trauma center, the regional burn center, a busy emergency department that receives walk-ins and transports from all over San Diego County, medical, surgical, and neurosurgical intensive care units, a coronary care unit/step down unit, and obstetrical delivery suites, in addition to general medical, surgical, and inpatient psychiatric wards. The UCSD MC Hillcrest also houses the solid organ transplant programs including renal, liver, pancreas, heart and lung transplants. This service provides the fellows with a broad experience with infections related to medical, surgical, and other acute illnesses, viral, bacterial, mycobacterial, fungal, and parasitic infections. The hospital serves an urban patient population from the immediate area, as well as the surrounding metropolitan area of southern, central, and eastern San Diego County and the border with Mexico. Its geographic location near the Mexico border also provides access to patients who seek care for infectious diseases that are endemic to tropical and subtropical regions of Mexico and Central America. The third party payer mix includes individuals with private insurance, managed care coverage, Medicare and Medi-Cal, and self-pay.

At the end of these rotations, fellows are expected to master the ability to recognize, diagnose, treat and manage complications associated with the following infectious diseases and to demonstrate an understanding of the following specific topics:
  1. The febrile patient with a rash
  2. Pleuropulmonary and bronchial infections
  3. Urinary tract infections
  4. Peritonitis and other intra-abdominal infections
  5. Cardiovascular infections
  6. Central nervous system infections
  7. Skin and soft tissue infections
  8. Infections related to trauma and bites
  9. Infections in burned patients
  10. Infections in patients on chronic renal dialysis
  11. Gastrointestinal infections
  12. Bone and joint infections, including chronic osteomyelitis
  13. Infections of the reproductive organs including obstetrical infections
  14. Neurological and neurosurgical infectious complications
  15. Infections of the eye
  16. Viral hepatitis
  17. Sepsis syndromes
  18. Nosocomial pneumonia and other nosocomial infections
  19. HIV and AIDS and its complications, including opportunistic infections
  20. Tuberculosis
  21. Infections in solid organ transplant recipients
  22. Infections in injecting and non-injecting drug users
  23. Hospitalized patients with sexually transmitted infections
  24. Mechanisms of action and adverse reactions to antimicrobial agents
  25. Epidemiology and pathogenesis of major viral, bacterial, mycobacterial, fungal, and parasitic diseases and their clinical manifestations and treatment

Thornton Hospital

The UCSD Medical Center Thornton Hospital is located on the La Jolla campus of UCSD, 8 miles north of the Hillcrest campus. Thornton is a general medical hospital located adjacent to the UCSD Moore's Comprehensive Cancer Center, and also serves as the primary inpatient facility for patients hospitalized with malignancies or for bone marrow transplantation. This service sees on average 1-3 new consultations per day. The service provides the fellows with experience in the care of infections in immunocompromised hosts undergoing cancer chemotherapy or treatment, infections in bone marrow transplant recipients, and general infectious diseases similar to those previously described, referred from clinicians staffing the adjacent Perlman Outpatient Center and surrounding communities. The hospital serves a more suburban patient population from the immediate area, as well as the surrounding north and coastal San Diego County region, although tertiary and quaternary referrals from the southern California area are also seen. In addition, the outpatient travel clinic, staffed by the Infectious Disease faculty at the Perlman Outpatient Center also attracts inpatient consultations for travel-related infectious diseases.

At the end of these rotations, fellows are expected to master the ability to recognize, diagnose, treat and manage complications associated with the following infectious diseases and to demonstrate an understanding of the following specific topics:
  1. Management of infections in patients with acute leukemia and lymphoma
  2. Management of infectious complications of cancer chemotherapy for solid organ, hematopoietic, and other malignancies
  3. Management of infections in bone marrow transplant recipients
  4. Travel-related infections and tropical diseases
  5. Other infectious diseases as described in the narrative for UCSD Medical Center – Hillcrest above.

Veteran's Administration Medical Center

The VAMC is located on the UCSD La Jolla campus approximately 1.5 miles from the UCSD MC Thornton Hospital and immediately adjacent to the UCSD School of Medicine campus. This rotation includes consult services for inpatients at the VAMC and the weekly outpatient I.D. Clinic. The VAMC is a general medical hospital without obstetrics or pediatrics. The I.D. Consult Service receives on average 1-4 new consult requests per day from all inpatient services at the VAMC. The hospital houses a busy emergency department that receives walk-ins and transports eligible for VAMC care from the San Diego metropolitan area. The VAMC houses medical and surgical intensive care units, and a coronary care unit/step down unit, and obstetrical delivery suites, in addition to general medical, surgical, and inpatient psychiatric wards. This service provides the fellows with a broad experience with infections related to medical, surgical, and other acute illnesses, viral, bacterial, mycobacterial, fungal, and parasitic infections occurring in a primarily male veteran population. The I.D. Consult Service participates in the care of all HIV-infected patients who are admitted to the medical or surgical services, controls the utilization of certain restricted antibiotics, and consults on all patients with medically important bacteremia. All HIV-infected inpatients are primarily managed by the house staff teams in consultation with the I.D. service. The VAMC also houses a large spinal cord injury service and a hemodialysis service for which infectious disease consultations are frequently sought for management of difficult infectious complications.

At the end of this rotation, fellows are expected to demonstrate an understanding of the following specific topics:
  1. Methods of determining antimicrobial activity of drugs
  2. Techniques to determine the concentration of drugs in serum and other body fluids
  3. Proper specimen collection for various types of cultures
  4. How to make and read Gram’s stains and acid fast stains
  5. Identification of common bacterial pathogens including obligate anaerobes

Owen Clinic

The Owen Clinic is UCSD’s primary program responsible for care of HIV-infected persons. Although administratively housed within the Division of General Internal Medicine, the Owen clinic is closely intertwined with the Division of Infectious Diseases. Several Owen Clinic faculty members are jointly appointed in the Division of Infectious Diseases, and several members of the I.D. Division actively participate in clinical programs of the Owen Clinic. Members of the Owen Clinic faculty participate both as attending physicians on the I.D. Inpatient Consult service and in the Infectious Disease clinical and research conferences held weekly alternating at Hillcrest and the VAMC as well as weekly HIV/AIDS Clinical Rounds held at the Antiviral Research Center (AVRC). The Owen Clinic and I.D. Division maintain a joint journal club that meets on the second Thursday of each month at the Ambulatory Care Center as described below. First year I.D. fellows will rotate on the inpatient Owen Clinic HIV Service, and will be responsible for providing inpatient consultative and primary service care for all HIV/AIDS inpatients hospitalized on the Owen Clinic Service in conjunction with the Owen Clinic faculty member attending on the service. Although the bulk of the activities during this rotation will be focused on inpatient care, at least one-half day per week the fellow will attend Owen Clinic Outpatient Practice activities. The Owen Clinic is an extremely active Ryan White Care Act-funded comprehensive care program that provides primary and specialty medical care to over 2,000 HIV-infected persons. The clinic is fully staffed with internists, infectious disease specialists, psychiatrists and other mental health workers, a hepatologist, an oncologist, an obstetrician-gynecologist, pharmacists, nurse practitioners, social workers, and other staff critical to the multidisciplinary care required of HIV-infected individuals.
  1. To develop expertise in the hospital management of HIV infected patients who present with:
    1. HIV-related opportunistic infections
    2. Serious complications and toxicities associated with antiretroviral therapy
    3. Serious co-morbid conditions and complications of HIV disease that require hospitalization
    4. Surgical conditions that require hospitalization and inpatient consultation
  2. To learn the comprehensive multidisciplinary approach to ambulatory care of HIV-infected adults and adolescents including: 
    1. Initial medical evaluation and staging of HIV disease 
    2. Monitoring of HIV disease outcomes and antiretroviral therapy
    3. Initiation and follow-up of antiretroviral therapy
    4. Management of antiretroviral toxicity and complications, including metabolic complications and mitochondrial toxicities
    5. Understanding major drug interactions involving antiretroviral agents and other drugs
    6. Management of common HIV-associated comorbid conditions such as: 
      1. Hepatitis B and C
      2. HPV associated dysplasia of the cervix or anogenital regions
      3. Psychiatric comorbidities
      4. Hematological and oncological complications 
      5. Substance abuse
      6. Other sexually transmitted infections
    7. Understanding and modeling the principles of secondary prevention of HIV transmission
    8. Management of HIV infection during pregnancy
    9. Measurement of and promotion of medication adherence
    10. Interpretation of genotypic and phenotypic antiretroviral resistance tests
    11. Management of tuberculosis in HIV-infected patients

Scripps Green Hospital

At the end of this rotation, fellows are expected to master the ability to recognize, diagnose, treat and manage complications associated with the following infectious diseases and to demonstrate an understanding of the following specific topics:

  1. Workup of patients with fever of unknown origin
  2. Management of the febrile patient with a rash
  3. Pleuropulmonary and bronchial infections
  4. Urinary tract infections
  5. Peritonitis and other intra-abdominal infections
  6. Cardiovascular infections
  7. Central nervous system infections
  8. Skin and soft tissue infections
  9. Gastrointestinal infections
  10. Bone and joint infections
  11. Infections in patients with acute leukemia and lymphoma
  12. Infections of the eye
  13. Infections in bone marrow and stem cell recipients
  14. Sepsis syndromes
  15. Nosocomial infections
  16. Infections in solid organ transplant recipients
  17. Mechanisms of action and adverse reactions to antimicrobial agents
  18. Quality assurance and cost containment in the clinical practice of I.D.