The clinical component of the fellowship program is specifically tailored to meet the individual needs of each trainee. From nine to twelve months will be spent in clinical activities.
The fellow is the key member of the team which maintains an inpatient infectious disease service and provides consultative services for pediatric infectious diseases patients at Children’s Hospital & Health Center (CHHC) - San Diego . The patient populations served represent the great socioeconomic and ethnic diversity of the San Diego area. A wide spectrum of primary infectious diseases is encountered, in addition to the infectious complications of chronic illness, surgery and immunosuppression. CHHC is a 220-bed comprehensive tertiary care pediatric medical center. It has 33 Neonatal Intensive Care Unit (NICU), 24 Pediatric Intensive Care, and 24 Step-Down/Intermediate Care Unit beds. Each year, Children's Hospital serves nearly 10,000 inpatients and has approximately 35,000 visits to its ambulatory outpatient departments that are staffed by over 100 physicians practicing in 35 subspecialties. In addition, CHHC has the only pediatric emergency department in San Diego and Imperial Counties and is the sole designated pediatric trauma center in San Diego County. San Diego Children's Hospital Research Center was (est. 1982) promotes and conducts scholarly investigations in many disciplines of pediatric medicine.
Inpatient consults are performed daily by the fellow and pediatric residents and presented and discussed on rounds with the attending physician in pediatric infectious diseases. With attending backup, the fellow will also provide frequent phone consultation with physicians in the community seeking advice and up-to-date information on the diagnosis and management of pediatric infections. The fellow and consult team meets each day with the clinical laboratory staff for an update on culture and rapid diagnostic specimens in bacteriology, mycology and virology. These specimens are analyzed in perspective of the clinical case scenario. Microbiologic diagnosis made and those findings are communicated to the pediatric housestaff or attending staff as needed.
Children with certain infectious disease conditions are hospitalized as primary patients on the Infectious Diseases Service. This mechanism is often employed in situations requiring the special expertise of the Infectious Disease Faculty (e.g. meningitis, HIV infection, CNS or disseminated HSV infection, tuberculosis, etc). Primary patients on the Infectious Diseases Service are managed by the fellow and faculty member together with the support of the housestaff.
UC San Diego Medical Center - Hillcrest is the primary academic medical center for the University of California, San Diego School of Medicine. The center offers the full array of both primary care and specialized services in internal medicine, surgery, obstetrics/gynecology, emergency medicine and intensive care. The recently renovated 440-bed university teaching hospital at UCSD Medical Center - Hillcrest is also the primary site of such regional services as the comprehensive organ transplant program, the Regional Burn Center, the NIH-designated Clinical Research Center, and the 40-bed, Level III Infant Special Care Center (NICU). Pediatric Infectious Diseases fellows may assist faculty in consultative services provided to infants in the UCSD Medical Center NICU or children in the Region Burn Center ICU.
Outpatient Pediatric Infectious Diseases:
The Pediatric Infectious Diseases Fellows participate actively in the UCSD Mother/Child/Adolescent H.I.V. Program. The extent of participation is tailored to individual interest. Weekly outpatient pediatric H.I.V. clinics are held at the UCSD Treatment Center and the Ambulatory Care Center in Hillcrest. The program is a National Pediatric AIDS Clinical Trails Unit site and provides the Ryan White Title IV Program for San Diego. All fellows will also participate in the biweekly Children's Hospital General Pediatric Infectious Diseases Clinic. This clinic receives outpatient referrals from the community for specialized evaluation (e.g. fever of unknown origin, cervical lymphadenopathy, etc.), provides follow-up for care for infectious diseases patients discharged from the hospital, and coordinates long-term outpatient intravenous antibiotic therapy for patients with complicated infections. Additional outpatient experience can be arranged at the San Diego County Department of Public Health Pediatric Tuberculosis Clinic which follows a large population of patients with all stages of disease severity.
Clinical Teaching Conferences
Each week, all faculty and fellows participate in a citywide Pediatric Infectious Diseases Clinical Conference held at Children’s Hospital. Once per month, this conference is held jointly with the Adult Infectious Diseases Faculty at the San Diego VA Medical Center adjacent to the UCSD School of Medicine Campus. Recent and active cases are presented by the infectious diseases consult teams as well as by infectious disease physicians from other community hospitals. Clinical microbiologists and other pediatric subspecialists are invited to share their expertise in the discussion of challenging patients.
Direct Experience in Clinical Microbiology:
At UCSD Medical Center, the fellow may spend a one month period in the Diagnostic Microbiology Laboratory. There, hands-on experience is gained in a full array of culture-based, morphologic, biochemical and immunologic diagnosis of bacterial, mycologic, mycobacterial and parasitic infections. The fellow is directly responsible to laboratory directors Dr. Sharon Reed or Dr. Charles Davis during this rotation. At the UCSD Medical Center Viral Diagnostic Laboratory, a one month rotation is offered during which the fellow may directly participate with the laboratory staff in the preparation, analysis and final diagnosis of viral isolates from clinical material. This experience provides a complete update for the fellow in the methods of traditional viral culture diagnosis. At Children’s Hospital, the fellow may take an elective in the Molecular Diagnostic Laboratory, where sensitive analytical techniques including polymerase chain reaction (PCR) and IFA/EIA antigen detection employed to rapidly and accurately detect viral and bacterial infection in clinical samples. Pediatric Infectious Diseases faculty member Dr. Mark Sawyer is director of the laboratory.