Infectious Disease Fellowship

Contents:

• Clinical Training

  • Clinical Training Settings

  • Clinical Training Elements

  • Curriculum
    Fellows Lecture Curriculum

• Research Training

  • Research Training Elements

  • Sample Research Trajectory

  • Research Opportunities

Clinical Training

Clinical Training Settings

Inpatient Care: The core of the training program is the inpatient service at Seattle Children's Hospital, a quaternary care center with a referral base including five states. Find more data on our patient demographics here. The spectrum of disease is broad, ranging from infections in healthy children to those in bone marrow or solid organ transplantation recipients.

Outpatient Care: Fellows participate in the outpatient management of patients in the General Infectious Diseases, HIV/Virology and Immunology Clinics. Fellows evaluate new consults and provide continuity of care for patients discharged from the inpatient services.

Clinical Laboratory Training:Fellows participate in formal laboratory training sessions in the microbiology and virology labs during their first year. This intensive training experience is complemented by regular interaction with the microbiology labs during the inpatient rotations at Seattle Children's Hospital.

Teaching Conferences: Weekly teaching conferences include clinical cases in pediatric infectious diseases (twice monthly), interactive teaching sessions focused on a core clinical topics (twice monthly), all-city infectious diseases clinical case conference (weekly) and Infectious Diseases board review (weekly), journal club (monthly), pediatric infectious disease board review course, and integrated quality improvement/antimicrobial stewardship conferences (monthly).

An example clinical schedule during fellowship can be found here.

Clinical Training Elements

The majority of clinical training for fellows occurs in the first year of fellowship, but some clinical training can occur during all three training years. This training includes:

Inpatient Consultative Service:

• 32-40 weeks on inpatient consult service at Seattle Children's Hospital
• 4 weeks of training may be spent at University-affiliated hospitals including Harborview Medical Center (where the regional trauma and burn units are located) and University of Washington/Fred Hutchinson Cancer Research Center (FHCRC) Bone Marrow Unit
• Additional elective rotations are arranged on an individual basis
• Weekly clinical schedule

Outpatient Clinics:

• 4 months of outpatient virology / infectious diseases & immunology clinics

Clinical laboratory training:

• 2 weeks of rotations in diagnostic bacteriology, mycology and virology laboratories

Teaching conferences:

• Two-week orientation to the management of patients with infectious diseases
• Ongoing teaching conferences including:
  • Clinical Case conferences
  • Fellow and faculty led interactive teaching sessions on core topics in Pediatric Infectious Disease
  • Weekly City-Wide clinical case discussions in infectious diseases

Fellows Lecture Curriculum

In addition to discussion of clinical cases, fellows will receive formal didactic training covering a broad range of issues in pediatric infectious diseases guided by the content specifications of the American Board of Pediatrics, including (but not limited to) the following:

• Antifungal agents: Pharmacology, uses of different agents in different scenarios
• Anti-microbial prophylaxis: Rationale for antimicrobial prophylaxis and choice of antimicrobials in endocarditis, rheumatic fever, urinary tract infections, sickle cell anemia, Antimicrobial Stewardship Program
• Catheter & VP shunt infections: Medical management, fungal shunt infections, indications for shunt removal, intrathecal antibiotics
• Congenital/Neonatal: Management of the pre-treated infant, ill infants, high-risk infants who have been pre-treated, adequately or inadequately
• Cost-containment and quality improvement: How policies related to cost-containment and quality control are developed and implemented
• Cystic Fibrosis ID issues: Burkholderia and atypical mycobacterial infections, resistant pseudomonas infections
• Equity, diversity, and inclusion
• Fungal infections in BMT patients: Aspergillus, candida
• Fungemia in non-BMT patients
• Herpes Simplex virus infections: Neonatal HSV, HSV encephalitis, diagnosis and management
• HIV & antiretrovirals
• Infection control and bioterrorism
• Infectious endocarditis: Culture-negative endocarditis, prosthetic valve endocarditis, fungal endocarditis, complications of endocarditis
• Public health and quarantine issues: How infectious diseases expertise is brought to bear in the public health department
• Respiratory tract infections
• Surgical infections: Necrotizing fasciitis, complicated post-operative wound infections, infections post-dirty bowel surgery
• Sexually Transmitted Diseases: Diagnosis and management of common STD's in the U.S. and the developing world, additional didactic lectures/board review is provided in conjunction with the Internal Medicine training program at the University of Washington
• Transplant related concerns
• Travel medicine and food-borne illnesses: Tick-borne infections, malaria
• Tuberculosis: Gastrointestinal TB, tuberculous osteomyelitis, tuberculous meningitis, and complicated pulmonary tuberculosis, indications for steroid usage
• Vaccines: Rationale for use of vaccines, and historical perspective, adverse reactions
• Viral infections in BMT patients: Herpesviruses, parainfluenza, RSV

Research Training

An individualized program is developed to provide each fellow a strong research foundation to build an investigative career.

Research Training Elements

Mentor Selection: Selection of a research project prior to acceptance to the fellowship program is not required. During the interview process, applicants are exposed to the breadth of faculty expertise available in our program and potential research projects. Upon acceptance into our program, fellows work with the research director to develop their research focus further, identify specific mentors of faculty at the University of Washington, Seattle Children’s Hospital, Seattle Children’s Research Institute, or the Fred Hutchinson Cancer Research Institute. The fellowship director and research director discuss training expectations with both the mentor and fellow to optimize the research project selected by the fellow. The research mentor will foster the ultimate development of an independent research program for the fellow.

Project Scope: Fellows may work with any University of Washington faculty member including our core pediatric infectious disease faculty listed below. Fellows may select projects related to basic research, patient-oriented research or population-based research. Our fellowship is supported by a training-grant from the NIH that supports training of fellows in basic and/or translational research. The research project work should be able to be completed within two years and result in a publication in a peer-reviewed journal by the completion of fellowship. The project should also provide a foundation for a career development grant and future research programs. When needed, our program works closely with fellows to secure funding for a third year of focused research time immediately following fellowship completion..

Coursework: Research is supplemented by coursework at the University of Washington as necessary. Fellows may pursue an MPH if the coursework is appropriate for their career goals. Degree completion takes approximately two years.

Sample Research Trajectory

The following sample assumes a fellow without prior research experience who will complete clinical training over three years.

Before starting fellowship

Fellowship acceptance--December

• Investigate expertise of interest in Seattle
• Discuss potential research projects with Fellowship Director/Research Director
• Contact potential mentors and discuss possible projects (contact facilitated by the fellowship program)
• Narrow scope of research projects prior to starting fellowship

Year 1:

July/August:

• Interview potential research mentors if needed and select a research project
• Begin reading relevant background material to become familiar with the field
• Begin research and form a scholarly oversight committee
• Review format and process of grants and papers during orientation

September-December:

• Continue reading and conducting initial studies
• Clearly state research questions and specific aims of your project; Begin generating data
• Present research plan to your scholarly oversight committee
• Write the background section of future papers/grants
• Begin career planning

January-June:

• Present first research conference at Pediatric ID Research Conference
• Continue to generate data, identify data needed for grants/publications and begin acquiring these data, troubleshoot research approach
• Begin planning/submission process of abstracts to national meetings
• Meet with scholarly oversight committee to discuss career progress, presentation at meetings, writing grants and papers

Year 2:

July-December:

• Continue acquiring data; write methods sections for grants/publications
• Identify and submit to national meetings appropriate for presentation of research
• Identify the data required for a publication, and continue acquiring these data

January-June:

• By the middle of the 2nd year of training, fellows should begin to design their own research plan in conjunction with their research mentor
• Write a preliminary outline of the publication of work done in fellowship (more if you are able)
• Submit publication by end of second year if possible
• Present work at the Pediatric Infectious Disease Research Conference
• Present preliminary data at a national meeting
• Begin organizing preliminary data and drafting Hypotheses and Aims for a career development award from the NIH or a private foundation
• Discuss career plans with program director, SOC and research mentor
• Plan to submit Career Development Awards

Year 3:

July-December:

• Submit initial proposal for a Career Development Award
• Continue to generate data for publications and focused on Aims in grant proposals
• Submit publication if not done or complete additional papers as appropriate
• Discuss next steps in career planning with program director, and research mentors
• Present work at a national meeting, network, continue to explore career opportunities

December-June:

• Finalize career plans including funding options, additional grant submissions if necessary

Research Opportunities

RESEARCH OPPORTUNITIES in Virology

• Marta Bull, PhD (Research Assistant Professor, Pediatrics): Primary research interest includes HIV at mucosal sites and the role that immune responses of other chronic viruses – herpes simplex virus (HSV) 1, HSV-2, and cytomegalovirus (CMV) play in HIV persistence in tissues
• Janet A. Englund, MD (Professor of Pediatric Infectious Diseases) Respiratory virus vaccines, respiratory viruses in immunocompromised patients, respiratory viruses in children and pregnant women in developing countries, maternal immunization, new antivirals for respiratory viruses
• Lisa Frenkel, MD (Professor of Pediatric Infectious Diseases and Laboratory Medicine; Co-Director of Pediatric Infectious Diseases Virology Clinic) Viral evolution of HIV during infection and treatment
• Ann Melvin, MD, MPH (Associate Professor of Pediatric Infectious Diseases) Clinical studies of HIV infection (emailed)
• Timothy M. Rose, PhD (Professor of Pediatric Infectious Diseases) Molecular biology of tumor viruses, cytokines, cell growth, differentiation & transformation (emailed)
• Alpana Waghmare, MD (Assistant Professor, Pediatric Infectious Diseases) Clinical and laboratory studies of respiratory viruses
• Thor Wagner, MD (Assistant Professor of Pediatric Infectious Diseases): Pediatric HIV infection which accounts for 15% of all HIV deaths
• Danielle Zerr, MD, MPH (Division Chief, Professor of Pediatric Infectious Disease, Affiliate Investigator at the Fred Hutchinson Cancer Research Center, and the Medical Director of Infection Prevention at Seattle Children's Hospital) Dr. Zerr's research focuses on the epidemiology and prevention of healthcare-associated infections, with a particular focus on multi-drug resistant organisms. Dr. Zerr is also involved in studies of the epidemiology, diagnosis, and prevention of HHV-6 infections in healthy and immune compromised hosts
• Don Sodora, PhD Research on understanding 1) HIV transmission and 2) HIV-induced disease and immune factors that impact progression to AIDS.

RESEARCH OPPORTUNITIES in Bacteriology

• Rafael Hernandez, MD, PhD : (Acting Instructor, Pediatric Infectious Diseases): Host pathogen interactions in tuberculosis and other mycobacterial infections.
• Lakshmi Rajagopal, PhD (Associate Professor of Pediatric Infectious Diseases and Microbiology) GBS infection associated fetal injury and preterm birth
• Kevin Urdahl, MD, PhD (Assistant Professor of Pediatric Infectious Diseases) Immune response to Mycobacterium tuberculosis infection
• Scott Weissman, MD (Associate Professor of Pediatric Infectious Diseases) Emergence and transmission of multi-drug resistance in extraintestinal pathogens including Escherichia coli and Klebsiella pneumoniae
• Christoph Grundner, PhD Research on mapping the signaling pathways that underlie the adaptability and pathogenesis of tuberculosis.
• David Sherman, PhD Research focused on developing novel drugs, diagnostics, and vaccines to combat tuberculosis.

RESEARCH OPPORTUNITIES in Parasitology

• Wesley C. Van Voorhis, MD, PhD (Professor and Head, Allergy and Infectious Disease) Drug discovery for treatment of parasitic infections.
• Stefan Kappe, PhD Research on understanding the complex biology of the malaria parasite and the immune responses to infection.
• Alexis Kaushansky, PhD Research on malaria host-parasite interaction; host-based drug discovery; cross-pathogen studies and co-infections.
• Peter Myler, PhD Research on Leishmania and trypanosomatids.
• Marilyn Parsons, PhD Research on human African trypanosomiasis (also known as African sleeping sickness) and toxoplasmosis.
• Joe Smith, PhD Research to characterize malaria-host binding interactions and to better understand malaria disease mechanisms.
• Ken Stuart, PhD Research investigating molecular and cellular processes of Trypanosomes and Leishmania, because this can lead to the development of drugs for these parasitic diseases, and immune responses in clinical trials of malaria vaccines.

RESEARCH OPPORTUNITIES in Immunology

• David J. Rawlings, MD (Professor of Pediatrics; Adjunct Professor of Immunology; Director, Center for Immunity and Immunotherapies; Chief, Division of Immunology) Lymphocyte signal transduction, development and function and the genetic basis for immune diseases; gene therapy and gene repair for immune and blood disorders
• Andrew Scharenberg, MD (Professor of Pediatrics, Adjunct Professor of Immunology) Gene editing technology, adoptive immunotherapy, gene correction for blood disorders
• Kevin Urdahl, MD, PhD (Assistant Professor of Pediatric Infectious Diseases) Immune response to Mycobacterium tuberculosis infection
• Alan Aderem, PhD Research on the innate immune system.
• John Aitchison, PhD Use of high-throughput quantitative ‘omics technologies with computational biology to interrogate, map, and model pathogens, host responses, and the interface between hosts and pathogens.
• Noah Sather, PhD Research on interactions between invading pathogens and the host immune system, with the goal of leveraging these discoveries toward the development of novel vaccines and vaccination regimens.

RESEARCH OPPORTUNITIES in Antimicrobial Stewardship and Infection Prevention

• Matthew Kronman, MD, MSCE (Associate Professor of Pediatric Infectious Diseases, Fellowship Program Director): "Epidemiology and antimicrobial use and antimicrobial stewardship, primarily employing administrative data"
• Scott Weissman, MD (Associate Professor of Pediatric Infectious Diseases) Peer-to-peer and technological interventions to reduce preventable harm associated with inappropriate antibiotic use and collateral damage to the intestinal flora.
• Danielle Zerr, MD, MPH (Division Chief, Professor of Pediatric Infectious Disease, Affiliate Investigator at the Fred Hutchinson Cancer Research Center, and the Medical Director of Infection Prevention at Seattle Children's Hospital) "Antimicrobial stewardship as it relates to acquisition of multi-drug resistant organisms"

RESEARCH OPPORTUNITIES in Global Health

• Janet A. Englund, MD (Professor of Pediatric Infectious Diseases) Respiratory virus vaccines, respiratory viruses in immunocompromised patients, respiratory viruses in children and pregnant women in developing countries, maternal immunization, new antivirals for respiratory viruses
• Lisa Frenkel, MD (Professor of Pediatric Infectious Diseases and Laboratory Medicine; Co-Director of Pediatric Infectious Diseases Virology Clinic) Persistence of HIV infection; HIV resistance to antiretrovirals
• Jairam Lingappa, MD, PhD (Associate Director, International Clinical Research Center (ICRC); Associate Professor of Global Health and Medicine; Adjunct Associate Professor of Pediatrics; Co-Director of CFAR Repository): "Epidemiologic and molecular factors mediating host resistance to HIV"
• Judd Walson, MD, MPH (Associate Professor, Division of Allergy and Infectious Diseases, Co-Director, AIDS Associated Infections and Malignancies Scientific Working Group, CFAR University of Washington) clinical trials evaluating the treatment and prevention of intestinal worms, malaria and diarrheal disease in delaying HIV progression; epidemiology of non-typhoidal salmonella among African children.

RESEARCH OPPORTUNITIES available with other University of Washington Faculty:

• Michael Boeckh, MD, PhD
• Ferric C. Fang, MD
• David N. Fredericks, MD
• Deborah H. Fuller, PhD
• Michael Jr. Gale, PhD
• Thomas R. Hawn, MD PhD
• Simon I. Hay, D.Sc, D.Phil
• Lucas R. Hoffman, MD, PhD
• Keith R. Jerome, MD, PhD
• Grace C. John-Stewart, MD, PhD
• David M. Koelle, MD
• Jaisri Lingappa, MD, PhD
• Samuel I. Miller, MD
• James I. Mullins, PhD
• J. Lee Nelson, MD
• Marion Pepper, PhD
• Peter M. Rabinowitz, MD, MPH
• David J. Rawlings, MD
• Nina R.Salama, PhD
• Andrew Scharenberg, MD
• David R. Sherman, PhD
• Joseph Smith, PhD
• Donald L. Sodora, PhD
• Leonidas Stamatatos, PhD

ADDITIONAL RESOURCES

• AID website: http://depts.washington.edu/daid/
• SCRI website: http://www.seattlechildrens.org/research/global-infectious-disease-research/
• CGIDR website: http://www.seattlechildrens.org/research/global-infectious-disease-research/
• CCTR website: http://www.seattlechildrens.org/research/clinical-and-translational-research/
• FHCRC website: https://www.fhcrc.org/en.html
• Global Health website: http://globalhealth.washington.edu/faculty-and-staff
• Institute of Health Metrics and Evaluation:  http://www.healthdata.org
• Additional Educational Programs at the University of Washington: http://depts.washington.edu/uwpeds/fellowships/?p=1608

• EPI – Master of Science Degree (MS)

• HSERV - MS Program in Health Services