Harborview Medical Center

Infectious Disease Service

Faculty Contact
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

Address
Box 359931
325 9th Avenue
Seattle, WA 98104


Phone: (206) 744-3620
Email: worthy@uw.edu

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.

Team Structure

Principle Teaching Methods
Case discussion and review


Rounds
Microbiology Rounds
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.

Teaching Rounds
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.

Didactics
Attending physicians and senior fellows frequently provide didactic lectures on subjects of interest to the team based on recent case evaluations.

Conferences
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.

Educational Content
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.

Patient Characteristics
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
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.

Services
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 on-site pharmacy.

Rotation Specific Schedule

Monday


Tuesday


Wednesday


Thursday


Friday


Call and Weekend Responsibilities


Principle Educational Materials Used
Recommended Readings
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.

Pathologic Materials


Methods Used in Evaluating Resident and Program Performance
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 competence).

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 of consultation.

 

Last Revised May 5, 1998 by Walt Stamm, MD