Harborview Medical Center
Infectious Disease Service
King Holmes, MD
Professor of Medicine
Director, Center for AIDS and STD Head, Infectious Diseases, Allergy &
Infectious Diseases / Center for AIDS and STD
Head, Infectious Diseases
325 9th Avenue
Seattle, WA 98104
Phone: (206) 744-3620
Overall Educational Purpose
To provide exposure to adult patients with a broad range of acute and
subacute infectious diseases.
To enhance diagnostic and therapeutic skills in the management of patients
with infectious diseases.
To foster communication, confidence, problem solving, and the delivery
of high quality care in a supervised academic environment.
Principle Teaching Methods
Case discussion and review
On a daily basis, the Infectious Disease consult team meets with selected
staff in the Clinical Microbiology Laboratory to review relevant microbiological
evaluations on patients being followed by the team. Instruction is provided
regarding the microbiological methods being used and their appropriate
interpretation in the clinical setting.
Review and discussion of individual cases seen in consultation in the
hospital. This occurs principally in two settings. First, daily work rounds
in which the team visits and reviews information about each patient. These
rounds are generally supervised by the infectious disease fellow, and
provide teaching to residents and students. Second, attending rounds are
held on a daily basis at which cases are reviewed by the entire team under
the direction of the attending physician.
Attending physicians and senior fellows frequently provide didactic lectures
on subjects of interest to the team based on recent case evaluations.
Weekly conferences are held by the Infectious Disease Division at which
problematic and instructive cases are reviewed. Cases are presented by
the attending physician and Infectious Disease fellow and resident for
discussion among all faculty, residents, students, and fellows.
Mix of Diseases
Patients referred for evaluation by the Infectious Disease consult team
encompass a full range of acute and chronic medical problems being seen
in hospitalized adults. Patients are referred from the Medical Service
as well as a broad range of other services, including surgery, surgery
subspecialties, neurology, and psychiatry. All HIV positive patients admitted
to the hospital are seen by the service. Patients with HIV infection and
AIDS constitute a major group of patients seen by the service. The mix
of diseases seen on the service thus ranges from acute or chronic community-acquired
infections to complicated hospitalized patients being seen on other services,
including infections in immunocompromised hosts.
At HMC, infections are frequently seen in refugee populations and undeserved
ethnic groups that include Native Americans, African-Americans and Asians.
Types of Clinical Encounters
Patients are seen in both the inpatient and outpatient settings. Most
commonly, consultations from other services are obtained for inpatients.
Occasionally, consultations are obtained because patients are being seen
in other subspecialty outpatient clinics. Patients are also seen in several
clinics under the direction of the Infectious Disease division. These
include: (1) The Madison Clinic, an HIV/AIDS clinic; residents, fellows,
and attendings provide consultative services and, in some cases, continuing
primary care for these patients; (2) A sexually transmitted disease clinic
at Harborview Medical Center offers rotations for residents, fellows,
and students on the Infectious Disease service; (3) A General Infectious
Diseases Clinic at HMC provides experience with a wide range of common
infectious disease problems.
Procedures are rarely performed by the Infectious Disease consult service,
but rather are undertaken by the primary care physician. Procedures such
as joint aspiration, skin biopsy, lumbar puncture, or lymph node aspiration
are occasionally performed on outpatients being seen by the Infectious
Disease team in HIV/AIDS or other clinic settings.
The Infectious Disease consult service provides round the clock on-call
evaluation of patients with known or suspected infectious diseases. Opinions
are rendered regarding recommendations for diagnosis and therapeutic intervention,
as well as for issues related to infection control. A full range of laboratory,
radiological and microbiologic support services are available, as in an
Rotation Specific Schedule
Call and Weekend Responsibilities
Principle Educational Materials Used
Selected references are maintained by attending physicians and provided
as needed to residents. Residents have access to literature searching
via computer terminals on the wards and in the libraries. Photocopying
is provided for residents and fellows on the Infectious Disease service.
Residents have access to libraries both at Harborview Medical Center and
UWMC that encompass most relevant texts and journals. The Infectious Disease
service maintains a library of relevant subspecialty journals and books
that are available to the housestaff team.
Methods Used in Evaluating Resident and
At the end of the rotation, the resident is evaluated in writing and their
performance reviewed with them verbally by every attending and fellow
he or she has interacted with for a significant amount of time. The evaluator
rates the resident on a nine-point scale in each component of clinical
competence (i.e. patient care, medical knowledge, practice based learning
improvement, interpersonal and communication skills, professionalism,
system based learning, educational attitudes, leadership, overall clinical
The resident is given the opportunity to evaluate in writing the quality
of the curriculum and the extent to which the educational goals and objectives
of the rotation have been met. The resident also evaluates the teaching
competence of each attending and fellow with whom s/he has interacted
for a significant amount of time.
Explicit Lines of Responsibility for Care
of Patients on this Service
Residents rotating on Infectious Diseases are expected to assume responsibility
for evaluation and recommendations made by the consult service on their
patients. In order to insure optimal patient care, residents evaluate
the patients, and discuss them with the supervising Infectious Disease
fellow and attending within 24 hours. Patients with acute illnesses are
discussed immediately upon evaluation. Attending physicians see patients
referred for consultation within 24 hours. Attending physicians are always
available to residents and fellows through paging and confer regularly
with senior residents. Attending physicians document their involvement
with patients by providing a written note on the chart within 24 hours
Last Revised May 5, 1998 by Walt Stamm, MD