Factors associated with infectious diseases fellowship academic success.

BACKGROUND: A multitude of factors are considered in an infectious disease (ID) training program's meticulous selection process of ID fellows but their correlation to pre and in-fellowship academic success as well as post-fellowship academic success and short-term outcomes is poorly understood. Our goal was to investigate factors associated with subsequent academic success in fellowship as well as post-fellowship short-term outcomes. METHODS: In 2022, we retrospectively analyzed deidentified academic records from 39 graduates of the Mayo Clinic Rochester ID Fellowship Program (1 July 2013- 30 June 2022). Data abstracted included demographics, degrees, honor society membership, visa/citizenship status, medical school, residency training program, United States Medical Licensure Exam (USMLE) scores, letters of recommendation, in-training examination (ITE) scores, fellowship track, academic rank, career choice, number of honors, awards, and abstracts/publications prior to fellowship, during training, and within 2 years of graduation. RESULTS: Younger fellows had higher USMLE step 1 scores, pre and in-fellowship scholarly productivity, and higher ITE performance. Female fellows had significantly higher USMLE step 3 scores. Prior research experience translated to greater in-fellowship scholarly productivity. Higher USMLE scores were associated with higher ID ITE performance during multiple years of fellowship, but USMLE step 2 clinical knowledge and 3 scores were associated with higher pre and in-fellowship scholarly productivity and receiving an award during fellowship. The USMLE step 1 score did not correlate with fellowship performance beyond year 1 and 2 ITE scores. CONCLUSIONS: Multiple aspects of a prospective fellow's application must be considered as part of a holistic review process for fellowship selection. USMLE step 2 CK and 3 scores may predict fellowship performance across multiple domains.

The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) Fellowship, a Novel Training Program in Public Health for Infectious Diseases Physicians.

The severe acute respiratory syndrome coronavirus 2 pandemic demonstrated a critical need for partnerships between practicing infectious diseases (ID) physicians and public health departments. The soon-to-launch combined ID and Epidemic Intelligence Service fellowship can only address a fraction of this need, and otherwise US ID training lacks development pathways for physicians aiming to make careers working with public health departments. The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship is a model compatible with the current training paradigm with a proven track record of developing careers of long-term collaboration. Established in 2017 by the ID Society of America, Society for Healthcare Epidemiology of America, Pediatric ID Society, and supported by the Centers for Disease Control and Prevention, LEAP is a single-year in-place, structured training for senior trainees and early career ID physicians. In this viewpoint, we describe the LEAP fellowship, its outcomes, and how it could be adapted into ID training.

Training in infectious diseases across Europe in 2021 - a survey on training delivery, content and assessment.

OBJECTIVES: To define the status of infectious diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery and evaluation of postgraduate training in ID in different countries. METHODS: Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses. RESULTS: In responses received from 33/35 (94.3%) countries, ID is recognized as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in eight, but it is not recognized in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million inhabitants. Median length of training is 5 years (interquartile range 4.0-6.0 years) with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75.8% (25/33) and assessed by final examinations in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries. CONCLUSIONS: There are substantial gaps in modernization of ID training in many countries to match current European training requirements. Joint training with clinical microbiology (CM) and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.

Training and assessment of medical specialists in clinical microbiology and infectious diseases in Europe.

BACKGROUND: There is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe. OBJECTIVES: To describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) Microbiology (CM/MM) and Infectious Diseases (ID). SOURCES: Narrative review of developments over the past two decades and related policy documents and scientific literature. CONTENT: Responsibility for curricula and examinations lies with the European Union of Medical Specialists (UEMS). The ID Section of UEMS was inaugurated in 1997 and the MM Section separated from Laboratory Medicine in 2008. The sections collaborate closely with each other and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Updated European Training Requirements (ETR) were approved for MM in 2017 and ID in 2018. These comprehensive curricula outline the framework for delivery of specialist training and quality control for trainers and training programmes, emphasizing the need for documented, regular formative reviews of progress of trainees. Competencies to be achieved include both specialty-related and generic knowledge, skills and professional behaviours. The indicative length of training is typically 5 years; a year of clinical training is mandated for CM/MM trainees and 6 months of microbiology laboratory training for ID trainees. Each Section is developing examinations using multiple choice questions to test the knowledge base defined in their ETR, to be delivered in 2022 following pilot examinations in 2021. IMPLICATIONS: The revised ETRs and European examinations for medical specialists in CM/MM and ID provide benchmarks for national authorities to adapt or adopt locally. Through harmonization of postgraduate training and assessment, they support the promotion and recognition of high standards of clinical practice and hence improved care for patients throughout Europe, and improved mobility of trainees and specialists.

Future developments in training.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of highly skilled and extensively trained specialists in clinical microbiology (CM) and infectious diseases (ID). Training curricula in CM and ID must constantly evolve to prepare trainees for future pandemics and to allow trainees to reach their full clinical and academic potential. OBJECTIVES: In this narrative review, we aim to outline necessary future adaptations in CM and ID training curricula and identify current structural barriers in training with the aim of discussing possibilities to address these shortcomings. SOURCES: We reviewed literature from PubMed and included selected books and online publications as appropriate. There was no time constraint on the included publications. CONTENT: Drawing from the lessons learnt during the pandemic, we summarize novel digital technologies relevant to CM and ID trainees and highlight interdisciplinary teamwork and networking skills as important competencies. We centre CM and ID training within the One Health framework and discuss gender inequalities and structural racism as barriers in both CM and ID training and patient care. IMPLICATIONS: CM and ID trainees should receive training and support developing skills in novel digital technologies, leadership, interdisciplinary teamwork and networking. Equally important is the need for equity of opportunity, with firm commitments to end gender inequality and structural racism in CM and ID. Policy-makers and CM and ID societies should ensure that trainees are better equipped to achieve their professional goals and are better prepared for the challenges awaiting in their fields.

Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation.

PURPOSE: Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD: In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS: The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS: Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.

A Piece of History: The Legacy of George W. Counts and Underrepresented Populations.

The fight for social justice and diversity in medicine stems from racial inequalities and discrimination that have permeated our society for centuries. As America has become more diverse in recent years, African American physicians remain largely underrepresented in the healthcare workforce and academic medicine. In the field of infectious diseases, one man, George W. Counts, has shouldered the struggle to end disparities in education, training, research, and academic advancement. This article celebrates his legacy and rekindles the discussion about inclusion, diversity, access, and equity in infectious diseases.

Formalization of a Specialty-Specific Military Unique Curriculum: A Joint United States Army and United States Air Force Infectious Disease Fellowship Program.

INTRODUCTION: There are many unique aspects to the practice of military Infectious Diseases (ID). San Antonio Uniformed Services Health Consortium Infectious Disease (ID) Fellowship is a combined Army and Air Force active duty program. Program leadership thought ID military unique curriculum (MUC) was well integrated into the program. We sought to verify this assumption to guide the decision to formalize the ID MUC. This study describes our strategy for the refinement and implementation of ID specific MUC, assesses the fellow and faculty response to these changes, and provides an example for other programs to follow. METHODS: We identified important ID areas through lessons learned from personal military experience, data from the ID Army Knowledge Online e-mail consult service, input from military ID physicians, and the Army and Air Force ID consultants to the Surgeons General. The consultants provided feedback on perceived gaps, appropriateness, and strategy. Due to restrictions in available curricular time, we devised a three-pronged strategy for revision: adapt current curricular practices to include MUC content, develop new learning activities targeted at the key content area, and sustain existing, effective MUC experiences.Learners were assessed by multiple choice question correct answer rate, performance during the simulation exercise, and burn rotation evaluation. Data on correct answer rate were analyzed according to level of training by using Mann-Whitney U test. Program assessment was conducted through anonymous feedback at midyear and end of year program evaluations. RESULTS: Twelve military unique ID content areas were identified. Diseases of pandemic potential and blood borne pathogen management were added after consultant input. Five experiences were adapted to include military content: core and noon conference series, simulation exercises, multiple choice quizzes, and infection control essay questions. A burn intensive care unit (ICU) rotation, Transport Isolation System exercise, and tour of trainee health facilities were the new learning activities introduced. The formal tropical medicine course, infection prevention in the deployed environment course, research opportunities and participation in trainee health outbreak investigations were sustained activities. Ten fellows participated in the military-unique spaced-education multiple-choice question series. Twenty-seven questions were attempted 814 times. 50.37% of questions were answered correctly the first time, increasing to 100% correct by the end of the activity. No difference was seen in the initial correct answer rate between the four senior fellows (median 55% [IQR 49.75, 63.25]) and the six first-year fellows (median 44% [IQR 39.25, 53]) (p = 0.114). Six fellows participated in the simulated deployment scenario. No failure of material synthesis was noted during the simulation exercise and all of the fellows satisfied the stated objectives. One fellow successfully completed the piloted burn ICU rotation. Fellows and faculty reported high satisfaction with the new curriculum. CONCLUSIONS: Military GME programs are required by congress to address the unique aspects of military medicine. Senior fellow knowledge using the spaced interval multiple-choice quizzes did not differ from junior fellow rate, supporting our concern that the ID MUC needed to be enhanced. Enhancement of the MUC experience can be accomplished with minimal increases to curricular and faculty time.

Hospitalist Infectious Disease Service in Academic Medical Centers: A Win-Win for Hospitalists and Fellows.

Supplemental digital content is available in the text.

Factors Influencing Selection of Infectious Diseases Training for Military Internal Medicine Residents.

Background: Applications to infectious diseases fellowships have declined nationally; however, the military has not experienced this trend. In the past 6 years, 3 US military programs had 58 applicants for 52 positions. This study examines military resident perceptions to identify potential differences in factors influencing career choice, compared with published data from a nationwide cohort. Methods: An existing survey tool was adapted to include questions unique to the training and practice of military medicine. Program directors from 11 military internal medicine residencies were asked to distribute survey links to their graduating residents from December 2016 to January 2017. Data were categorized by ID interest. Result: The response rate was 51% (n = 68). Of respondents, 7% were ID applicants, 40% considered ID but reconsidered, and 53% were uninterested. Of those who considered ID, 73% changed their mind in their second and third postgraduate years and cited salary (22%), lack of procedures (18%), and training length (18%) as primary deterrents to choosing ID. Active learning styles were used more frequently by ID applicants to learn ID concepts than by those who considered or were uninterested in ID (P = .02). Conclusions: Despite differences in the context of training and practice among military trainees compared with civilian colleagues, residents cited similar factors affecting career choice. Interest in global health was higher in this cohort. Salary continues to be identified as a deterrent to choosing ID. Differences between military and civilian residents' desire to pursue ID fellowship are likely explained by additional unmeasured factors deserving further study.

Augmenting Fellow Education Through Spaced Multiple-Choice Questions.

Background: The San Antonio Uniformed Services Health Education Consortium Infectious Disease Fellowship program historically included a monthly short-answer and multiple-choice quiz. The intent was to ensure medical knowledge in relevant content areas that may not be addressed through clinical rotations, such as operationally relevant infectious disease. After completion, it was discussed in a small group with faculty. Over time, faculty noted increasing dissatisfaction with the activity. Spaced interval education is useful in retention of medical knowledge and skills by medical students and residents. Its use in infectious disease fellow education has not been described. To improve the quiz experience, we assessed the introduction of spaced education curriculum in our program. Materials and Methods: A pre-intervention survey was distributed to assess the monthly quiz with Likert scale and open-ended questions. A multiple-choice question spaced education curriculum was created using the Qstream(R) platform in 2011. Faculty development on question writing was conducted. Two questions were delivered every 2 d. Incorrectly and correctly answered questions were repeated after 7 and 13 d, respectively. Questions needed to be answered correctly twice to be retired. Fellow satisfaction was assessed at semi-annual fellowship reviews over 5 yr and by a one-time repeat survey. Results: Pre-intervention survey of six fellows indicated dissatisfaction with the time commitment of the monthly quiz (median Likert score of 2, mean 6.5 h to complete), neutral in perceived utility, but satisfaction with knowledge retention (Likert score 4). Eighteen fellows over 5 yr participated in the spaced education curriculum. Three quizzes with 20, 39, and 48 questions were designed. Seventeen percentage of questions addressed operationally relevant topics. Fifty-nine percentage of questions were answered correctly on first attempt, improving to 93% correct answer rate at the end of the analysis. Questions were attempted 2,999 times. Fellows consistently indicated that the platform was "highly enjoyed," "beneficial," a "fun format," and "completely satisfied." Fellows additionally commented that they desired more questions and considered the platform helpful in board preparation. Formal survey data post-intervention found that the fellows were satisfied with the new approach, found it to be useful in board preparation, overall educational value, and in-line with their personal learning style (median Likert score of 4 for all queries). Fellows were satisfied with time commitment, spending a mean of 47 min on the spaced education curriculum questions per month. Conclusions: Introduction of a spaced education curriculum resulted in a sustained positive learner experience for >5 yr with demonstrated mastery of material. Spaced education learning is a viable addition to augment training experience, especially in areas of curricular gaps such as operational medicine. Correct answer data may also be useful to perform Accreditation Council for Graduate Medical Education-required objective assessment of knowledge.

Teaching Antimicrobial Stewardship to Infectious Disease Fellows Through Simulated Interdisciplinary Scenarios.

Introduction: While several approaches have been described to teach antimicrobial stewardship (AS) practices, fewer have been aimed at infectious disease physicians. We developed a series of simulated AS meetings to train infectious disease fellows in the synthesis of AS interventions. Methods: Three simulated AS committee scenarios were developed. Background lectures were given 1 week prior to the simulation during which multidisciplinary roles were assigned. Precourse work included review of primary literature pertinent to the scenario. Simulations were conducted over 1.5 hours. Individual and team performances were evaluated. Pre- and postsurveys were collected from fellows and faculty members to assess the format. Results: Six infectious disease fellows participated in the series. Fellows demonstrated information synthesis and improvements in individual and team performance. Eighty-three percent of fellows before the simulation series and 100% postseries reported educating others on AS principles in the previous month. Fellows were satisfied with the series and requested more scenarios. Eight faculty members completed surveys. Thirty-eight percent of faculty before the series and 63% after completion reported that fellows viewed antimicrobial preauthorization as useful or necessary. Faculty supported the format, found it useful in evaluation of learners, and perceived that fellows benefited from the approach. Discussion: Simulation is an effective and enjoyable way to train infectious disease fellows in AS and team utilization. Fellows demonstrated improvement in AS knowledge, skills, and attitudes and developed evidence-based interdisciplinary plans to solve AS challenges. Faculty also viewed this strategy as effective and sustainable.

Training should be the first step toward an antifungal stewardship program.

The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA). The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16±1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved.

[What place and what future for the pathology of infectious and tropical diseases in France?]. / Quelle place et quel avenir pour l'anatomo-cyto-pathologie des maladies infectieuses et tropicales en France?

The management of tissues and cellular samples by the pathologists in the infectious and tropical diseases pathology field in 2014 needs a strong knowledge of both morphological and molecular domains which includes the good control: (i) of the taxonomy of infectious and tropical diseases pathology leading to the pathogens identification and (ii) of the ancillary methods which can be used in fixed samples in order to detect or better identify these pathogens. There is a recent paradox in France concerning the frequency of infectious diseases to be diagnosed in pathology laboratories and the progressive loss of pathologist's expertise in this domain. Different reasons could explain this statement including the omnipresence of the tumour lesions to be managed in a pathology laboratory as well as the recent constraints associated with the different biomarkers that are mandatory to be detected by immunohistochemistry and/or by molecular biology. Even if the microbiologists play a pivotal role for identifying the different pathogens as well as for the assessment of their sensitivity to the anti-microbial drugs, a large number of infectious diseases can be diagnosed only on fixed tissue and/or cells by the pathologists. The purpose of this review is to describe the current and future issues of infectious and tropical diseases diagnoses in pathology laboratories, in particular in France.

Knowledge, attitudes, and beliefs of French medical students about antibiotic prescribing and resistance.

OBJECTIVES: We had for aim to learn about medical students' knowledge and perspectives on antibiotic prescribing and bacterial resistance. METHODS: Penultimate and final year students at a French medical school were invited to participate in an anonymous online survey in summer 2012. RESULTS: The response rate was 20% (60/297). Penultimate and final year students gave similar answers. Students felt more confident in diagnosing an infection, and less confident in choosing the correct dose and interval of antibiotic administration. Seventy-nine percent of students wanted more training on antibiotic treatments. Sixty-nine percent of students knew that antibiotic prescriptions were inappropriate or unnecessary in 21-60% of the cases, and 95% believed that these prescriptions were unethical. Only 27% knew that more than 80% of antibiotic prescriptions were made in community practice. Students believed that the most important causes of resistance were that too many prescriptions were made and broad-spectrum antibiotic use; 27% believed poor hand hygiene was "not at all important". Ninety-four percent believed resistance was a national problem, and 69% mentioned it as a problem in their hospital. Sixty-three percent thought that the antibiotics they would prescribe would contribute to resistance, and 96% thought resistance would be a greater problem in the future. Twenty-two percent knew MRSA bacteremia rates had decreased over the past decade in France. CONCLUSIONS: Medical students are aware that antibiotic resistance is a current and growing problem. They would like more training on antibiotic selection.