Infectious Diseases Residency Programme

Infectious Diseases Residency Programme Handbook

Infectious Diseases Residency Programme

Residency Handbook

Created by Kevin Woodward, MD, FRCP(C)

Table of Contents

Introduction to McMaster University Adult Infectious Diseases Residency Training Programme

Program Goals Statement

Program Overview

Faculty Listing

Who’s Who in the Residency Programme

Mentorship During Residency

Role of the External Programme Ombudsperson

Role of Academic Half Day Coordinator

Role of the Research Coordinator

Role of the Site Coordinators

Programme Academic Activities

Evaluations

Resident Progress Review

Resident Portfolio

Resident Safety Policy

Resident On Call, Vacation and Leave

General Residency Information for New Fellows

Reimbursement Guidelines

Moonlighting Policy

Introduction to McMaster University Adult Infectious Diseases Residency Training Programme

Welcome to the Infectious Diseases Residency Training Programme.

The Division of Infectious Diseases at McMaster University is a vibrant, collegial and academic division within the Department of Medicine. The Division of Infectious Diseases seeks to educate active minds in the fields of infectious diseases and medical microbiology.

We consider infectious diseases knowledge to involve a continuum of educational experiences, from the undergraduate MD level through residency training, and finally involving research and clinical scholarships. As such, we offer and support educational experiences at all levels of training.

The Adult Infectious Diseases Training Program is a two-year program accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC).

The program involves all four sites within the city, including McMaster Campus of Hamilton Health Sciences (HHS), the Hamilton General Hospital, the Juravinski Hospital and St. Joseph’s Healthcare, providing a rich and varied experience in Infectious Diseases training. In addition, Pediatric training is available at McMaster Children’s Hospital and at Hospital for Sick Children in Toronto.

Through inpatient and outpatient rotations as well as electives, trainees gain a broad exposure to both clinical Infectious Diseases and training in all CANMEDS competencies endorsed by the RCPSC.

The two years of training are divided into 13 blocks each. As outlined by the RCPSC, six months of laboratory training are mandatory (see training requirements). The remainder of the rotations isdivided between inpatient, outpatient and research activities. In addition, longitudinal clinics in general ID are a requirement for the first year of training, and in the second year of training the longitudinal experience can be in either general ID or subspecialty clinics. See below for an example outline of the training years.

1St year / Inpatient ID (2 blocks) / Bacteriology (2 blocks) / Inpatient ID
(2 blocks) / Infection
Control / Inpatient ID
(2 blocks) / Molecular / Virology / Research / Mycology
Longitudinal Clinic
2nd year / Inpatient ID
(2 blocks) / Pediatric ID (HSC)
(2 blocks) / Elective / PH Lab / Research / Community
(2 blocks) / Research
(2 blocks) / Outpatient Clinics
(2 blocks)
Longitudinal Clinic

During the two year training program, residents work closely with ID physicians whose interests span diverse areas of clinical infectious diseases, clinical research, and basic research. Basic science teaching is incorporated whenever possible into all aspects of laboratory and clinical training. Biostatistics and critical appraisal are emphasized throughout the teaching program and especially in the Fellows’ Journal Club. All rotations, as well as Multidisciplinary Academic Half-Days, address ethical issues. Quality control and quality assurance are covered in laboratory, clinical as well as research rotations and a large number of our faculty members have postgraduate degrees in Health Research Methodology.

The Infectious Diseases Residency Training Program is pleased to offer combined training in Medical Microbiology with the addition of one year of training for interested residents.Program Goals Statement for the Infectious Disease Resident Training Program.

Program Goals Statement

The goal of the McMaster Infectious Disease Program is to train residents who will demonstrate competency in the diagnosis, investigation and management of infectious diseases at the level of a consultant. The resident will master critical analysis of the scientific literature and apply it, both to providing compassionate patient centered care, and to maintaining lifelong learning skills. The resident will develop a multidisciplinary approach and foster interactions with other health professionals involved in infectious diseases including the microbiology laboratory, Infection Prevention and Control, Antimicrobial Stewardship and Public Health.

Program Overview

Training Sites and Site Coordinators:

HamiltonGeneralHospital Microbiology Rotation / Bacteriology Rotation – Dr. C. Main
Mycology Rotation – Dr. D. Yamamura
St. Joseph’s Healthcare Microbiology Laboratory / Virology – Dr. M. Smieja
Parasitology – Dr. M. Smieja
Molecular - Dr. P. Jayaratne
HamiltonGeneralHospital / Infectious Diseases – Dr. N. Singhal
Infection Control – Dr. D. Mertz
JuravinskiCancerCenter / Infectious Diseases/Transplant – Dr. D. Leto
Infection Control – Dr. D. Mertz
McMasterMedicalCenter / Pediatric Infectious Diseases – Dr. J. Pernica
Infection Control – Dr. D. Mertz
St. Joseph’s Healthcare / Infectious Diseases – Dr. K. Woodward
Infection Control – Dr. C. Lee
TorontoHospital for Sick Children / Pediatric Infectious Diseases- Dr A Wadhwa
Toronto Public Health Laboratory / Dr. Vanessa Allen

Inpatient Clinical Rotations:

During the two years of training, the residents are required to spend two blocks at each of the three core training sites: St. Joseph’s Healthcare Hamilton, Hamilton General Hospital and the Juravinski Hospital. In addition, two blocks of Pediatric Infectious Diseases are required. A minimum of eight blocks of inpatient experience is required.

Longitudinal Clinic (1st year):

During the first year of training, fellows will be placed in a longitudinal clinic with one of the faculty. The purpose of this experience is to have long-term exposure to outpatient clinical practice and to gain experience in the management of general Infectious Diseases consultations. While away on electives or vacation they are excused from the clinic.

Longitudinal Clinic (2nd year):

The residents have the option of choosing the faculty and subspecialty of the clinic in which they wish to work, in discussion with the Programme Director. While away on electives or vacation they are excused from the clinic. Residents must complete six blocks of longitudinal clinic during their second year.

Laboratory Rotations:

All residents must complete six blocks of laboratory rotations, with mandatory training experience in bacteriology, virology, molecular, parasitology, immunodiagnostics and mycology. The experience in parasitology is gained through the Toronto Public Health Laboratory rotation. These rotations are supervised by the associated Medical Microbiologist listed above.

Infection Control:

Infection control rotations may be completed at any of the four sites in Hamilton. This rotation is supervised by Dr. Dominik Mertz (and/or Dr. Jocelyn Srigley) at HHS and by Dr. Christine Lee at SJH. The resident will have daily rounds with the Infection Control Practitioners, as well as meetings with the medical leads.

Research:

All residents are required to do, at minimum, a quality assurance project, during their two years and present at a local resident research day. Residents are encouraged to do a more robust research project to present at national conferences and/or publish. Dr. Dominik Mertz is the resident research coordinator and meets with all incoming residents to establish research goals and work toward finishing projects.

Faculty Listing

The Division of Infectious Diseases at McMaster University provides clinical care for patients with infections at the four acute care sites in Hamilton. In addition, the Division has a robust research program, with interests ranging from basic science to participation in large clinical trials for HIV and Hepatitis C treatment. For a full listing of faculty members, academic appointments and research interests, please see:

Who’s Who in the Residency Programme

ID Residency Programme Director:
Site coordinator Laboratory rotations
Dr. Cheryl Main *
905-527-4322, Ext.46182
/ Site Coordinator – SJH
ID Half Day & ID Written Exam Coordinator
Dr. Kevin Woodward
905-522-1155, Ext.33998

Programme Assistant:
Ann-Marie Turner
905-527-4322,e Ext. 73928
/ Site Coordinator – JH
Dr. Daniela Leto *
905-521-2100, Ext.43251

Research Coordinator
Site coordinator for IC
Dr. Dominik Mertz *
905-521-2100, Ext.42007
/ Site Coordinator – HGH
Dr. Nishma Singhal *
905-521-2100, Ext.44160

Residency Mentorship Coordinator
Dr. Eva Piessens*
905-521-2100 Ext.43566
/ Site Coordinator – MUMC
Dr. Jeffrey Pernica*
905-521-2100, Ext.76947

External Programme Ombudsperson
Dr. Christine Ribic (Nephrology)
905-522-1155, Ext.35353
/ Division Education Coordinator (DEC)
Dr. P. El-Helou*
905-522-1155 Ext.33998

Division Director, Infectious Diseases
Dr. Mark Loeb *
905-521-2100, Ext.26679

* Denotes members of the Residency Education Committee (REC)

Mentorship During Residency

Within the first month of residency, all of the residents will be scheduled for a meeting with the Residency Mentorship Coordinator. The role of the Residency Mentorship Coordinator is outside of the evaluative structure of the Residency Education Committee and serves the dual purpose of providing advice on career goals and planning, as well as being an advocate within the program for the residents.

The Residency Mentorship Coordinator can assist with personal or professional difficulties that residents may have within the programme. She can also advocate on behalf of the resident to the Programme Director or REC if requested. The role includes confidential and independent information and advice for residents throughout their two years, as well as access appropriate resources if needed.

In addition, the Residency Mentorship Coordinator will help identify the career plans of the resident and suggest how they can meet those goals (i.e. specific elective or research experience, etc). She will also facilitate contact between the resident and other Division members to help the resident meet their learning needs.

Role of the External Programme Ombudsperson

The role of the External Programme Ombudsperson is to offer confidential, informal and independent information and advice. In addition, the Ombudsperson can intervene in difficult situations or provide referrals for support or counseling as needed. The Ombudsperson acts as an advocate for the Infectious Diseases residents on issues of equity and fairness. All discussions with the Ombudsperson are in confidence and she will only intervene if requested, or as required by law.

The Ombudsperson is a member of the Department of Nephrology and does not have an administrative role within the Residency Programme. Dr. Christine Ribic is the Ombudsperson for the Infectious Diseases Residency Programme.

Residents who are having either personal or professional problems and wish to discuss them with someone outside of the program are encouraged to contact Dr. Ribic. She can offer advice, assistance in conflict resolution, and if appropriate (and with the resident’s permission) act on behalf of the resident to assist in resolution of those issues.

For the Postgraduate policy on harassment:

Role of Academic Half Day Coordinator

The Academic Half Day Coordinator is responsible for assisting the Program Director in developing, monitoring and evaluation of the academic half day curriculum in the Infectious Diseases Residency Programme. A syllabus is outlined for each year by the Academic Half Day Coordinator and the Program Director.

Specific issues relating to the structure, content, and scheduling of the half-day sessions are reviewed by the Academic Half Day Coordinator and the Program Director as well as at the REC. The Academic Half Day Coordinator is also available as a resource for issues arising during the half-day sessions.

The Academic Half Day Coordinator collates resident evaluations for all half-day sessions and reviews these evaluations with the Program Director at the end of the year. The data is then analyzed annually for program review and faculty feedback.

Role of the Research Coordinator

The Research Coordinator is responsible for guiding and monitoring the research activity of ID residents.

Specifically, the coordinator ensures that each resident identifies a research project and supervisor during their first year, reviews their progress, and assesses their eligibility for research time. The Research Coordinator also ensures that residents meet the core productivity requirements of the research block.

All research blocks must be approved by the Research Coordinator and the Programme Director, and it is expected that a block for research will lead to presentation of work at some level, whether at the local Resident Research Day or national meetings.

The Research Coordinator meets with the residents at minimum yearly to review progress and plan for future research.

Role of the Site Coordinators

A site coordinator has been identified for each rotation. The roles of the site coordinators are:

1. Serves as a member of the ID Resident Education Committee& acts as site representative
2. Generates/maintains site specific rotation objectives for ID fellows
3. Responsible for orientation of fellows to rotation/site as needed
4. Acts as a point person for fellows to contact regarding any concerns about clinical rotations at their site
5. Ensures that fellows are getting at least the minimal amount of required teaching during the rotation block (as outlined in the “Expectations of Infectious Diseases Staff” document)
6. Performs an exit interview at the end of each 2 month block to gain resident feedback on the rotation
7. Follows up on any concerns or issues identified requiring improvement through discussion with the ID Program Director and, if necessary, attendings providing service at the site.
8. Receives and reviews site specific rotation evaluations
9. Coordinates the ID Fellow Journal Club sessions that are assigned to their site (clinical site supervisors only), ensuring appropriate faculty supervision & attendance.
10. Is responsible for finding volunteers or supervising the sessions themselves.

Programme Academic Activities

ID Regional Rounds – Wednesday 8am – 9am, SJH, Classroom B

Regional rounds in Infectious Diseases take place weekly, with the exception of July and August. These rounds alternate in format. Two rounds per month are one hour presentations by either faculty or residents on the topic of their choice. Residents presenting these rounds are expected to have reviewed the relevant literature on their topic and present any new data. One round monthly consists of a journal review; residents are expected to pick an article and present it both in terms of EBM characteristics and its impact on ID practice. For the journal review rounds, the resident is paired with a faculty member. Both the resident and the faculty member will each independently present a paper (the topics need not be coordinated), but the faculty member acts as a resource for the resident. Finally, one round per month is designated as case rounds. Again, residents and faculty are paired, and each should present a 30 minute case for discussion. This should include a review of the topic and literature.

ID Fellows’ Retreat

Each year in August, the University of Toronto hosts a week-long retreat for all Canadian ID trainees. This week consists of daily speakers and small group sessions covering a variety of topics and provides both a foundation in ID and an update on new issues. This week is mandatory for ID fellows. Fellows are excused from clinical service for the week to attend. This week is in lieu of the ID half-days for July and August, and as such, no vacation time or professional leave is required to attend.

ID Half Day – Thursday, 8:30am – 10:30am, HGH conference room 2

The Infectious Diseases Half day takes place weekly with the exception of July and August. The half days consist of a unique case-based Problem Based Learning (PBL) style. Residents will review a case and set learning objectives around the clinical entity, including non-Scholar CanMEDS roles. The following week the residents discuss the objectives they have reviewed. This format allows for resident participation and self-directed learning. A faculty member is present to facilitate discussion, moderate and evaluate process and content. The microbiology residents participate in the Infectious Disease Academic Half-day, providing an opportunity for rich discussion and collaboration.

Medical Microbiology Half Day – Thursday 10:30am-11:30, HGH conference room 2

The Medical Microbiology Half Day includes many topics of use to the ID fellows, especially around basic science and microbiologic issues. On days when the half-day topic is not relevant to ID fellows, an alternative learning activity is scheduled.6-8 sessions per year cover CanMEDs content.

Plate Rounds – Thursday 11:30 - 12:00pm, HGH Microbiology Lab

Plate rounds happen weekly at the lab with the Medical Microbiologist and residents. Interesting isolates are discussed and basic microbiology is reviewed.

ID Fellow’s Journal Club – Tuesdays (2 per month), 5pm – 6pm, alternating between the 4 hospital sites

Every two weeks we have the ID Fellow’s Journal Club. Two fellows are assigned to each date and they present ahigh impact journal article analyzing for both EBM and clinical utility. This is attended by one or two faculty maximum, in order to give the fellows a more informal environment than the regional rounds. Fellows receive feedback on their performance through written evaluations.

ID Specific CanMEDS – Tuesdays (2-3 per year), 5pm – 6pm, alternating sites

These presentations are given by faculty on a variety of topics relating to communicator, collaborator, manager, health advocate and professional roles of an Infectious Disease Consultant.

Subspecialty CanMEDS – Campbell Auditorium, 3-5pm

These rounds are open to all residents in a subspecialty of Internal Medicine and feature topics relating to the CanMEDS roles. There are 4 sessions per year.

CanMEDs assignments – 4 per year

These assignments are circulated to residents on a quarterly basis. These assignments are worked on over 3-4 weeks and submitted to the Program Director for review. They should also be incorporated into each resident portfolio.

Evaluations

Key Guidelines for the Evaluation of Postgraduate Trainees

1. At the beginning of the Rotation, the supervisor and trainee should meet to discuss objectives and how the trainee will be evaluated.
2. There should be regular informal feedback during the Rotation.
3. It is recommended that a mid-rotation evaluation occur. The trainee is responsible for scheduling a face-to-face evaluation at the mid-point of their Rotation. Regardless of the length of a Rotation; if concerns are identified by the faculty a formal mid-rotation evaluation must take place. This must be face-to-face and occur generally within 2 weeks of the midpoint date, so the trainee has an opportunity to address deficiencies.
4. At the end of the Rotation, the Clinical Supervisor should complete the ITER and then discuss the evaluation and ITER with the trainee prior to the end of the rotation.
5. If the supervisor is not able to meet these deadlines and has not met with trainee within 10 workingdays after the Rotation, the clinical supervisor should submit the ITER and send supportingdocuments to the Program Director.
6. It is expected that the trainee will review the evaluation within 20 working days from the end of rotation.
7. All appeals must be made within 15 days after the trainee becomes aware of the decision under appeal. Thefirst level of appeal is made to the Program (Level 1). If the issue is not resolved at Level 1, it can be directed tothe Postgraduate Medical Education (PGME) Office, which is Level 2. The PGME Office will convene a meetingof the Appeal Review Board. Level 3 is the final level of appeal and at this point the Dean, Faculty of HealthSciences will strike a Tribunal, whose decision is final. There is no access to University Senate.

Please see the Postgraduate policy on evaluations and appeals.