Diverse patient populations are present at the University Hospital and the Portland VA Medical Center, ensuring a wide variety of clinical experience and pathology is available for broadening one's knowledge in infectious disease. The University Hospital and Portland VA Medical Center have a combined total of greater than 700 beds. We have two clinical consultative services, the General Infectious Diseases service and the Transplant Infectious Diseases service. Both training sites are active transplant centers, with a high volume of hematopoietic stem cell and solid organ transplantation. The scope of the consultation experience is broad, with a mix of community-acquired and hospital-acquired infections. Immune suppressed hosts provide a wealth of clinical experience and include patients on the oncology wards, the transplantation programs, the intensive care units and the University's trauma center.
There is an option for a Transplant Infectious Diseases focus during year two of training. This track draws on diverse experiences to augment experiential learning in Transplant Infectious Diseases, including but not limited to:
- Inpatient and outpatient clinical experiences in managing solid organ and stem cell transplant candidates and recipients with infectious diseases issues
- Mentored clinical research on a transplant ID-related topic
- Participation in relevant conferences and didactic series sponsored by the Transplant ID group & by the medical and surgical transplant programs
- Orientation and overview on site at Pacific Northwest Transplant Bank (our OPO)
Both hospitals have comprehensive HIV/AIDS programs. There are roughly 1,400 HIV-positive patients who receive their care at either OHSU or the Portland VA Medical Center. Additionally, the ID consult service coordinates inpatient care for a large number of patients with HIV cared for by the Multnomah County HIV Program. The Research and Education Group, a federally-funded community-based non-profit research consortium, is closely affiliated with our centers, providing a channel for clinical trial enrollment.
The inpatient activities are complemented by ambulatory infectious disease specialty clinics, with a range of patient populations (HIV/AIDS, General Infectious Diseases, Outpatient Parenteral Antimicrobial Therapy, Transplant Infectious Diseases, Non-tuberculous Mycobacteria, etc.).
Program facilities and resources
OHSU Hospital and clinics
Oregon Health & Science University (OHSU) and the Portland VA Medical Center are the main teaching sites for the clinical program. OHSU Hospital is a major tertiary referral center and the only academic medical center in Oregon. OHSU has mature and active bone marrow transplant & solid organ transplant (kidney, liver, heart, pancreas) programs and is a referral center for complex surgical patients, trauma, advanced cardiac care and oncology. OHSU provides outpatient HIV and general ID care to a large population.
Portland VA Medical Center
VA Portland Health Care System (VAPORHCS) serves Oregon, Southwest Washington and acts as a referral center for Idaho, Alaska and Northern California. The Portland VA Medical Center has busy inpatient medical and surgical services with full subspecialty support. VAPORHCS provides care to a large population of HIV-positive veterans and is a designated VA transplant center for kidney and liver. The OHSU Hospital and the Portland VA Medical Center are connected by a sky bridge, and infectious diseases staff at the Portland VA have dual appointments with OHSU.
Microbiology is a key of the foundations of infectious diseases. To ensure our fellows have thorough and clear working knowledge of bench and molecular microbiology, our first-year fellows spend the first month of fellowship on focused microbiology education. This experience includes a practical experience in the laboratory accompanied by a series of learning sessions with core infectious diseases and microbiology teaching faculty. Additionally, microbiology "bench rounds" is held every week throughout the year.
Core clinical curriculum
The core inpatient rotations take place at OHSU Hospital and the Portland VA Medical Center. There are three inpatient consult teams –General ID Team A, General ID Team B and Transplant ID. The General ID teams are staffed by ID faculty, a fellow, medical resident(s) & student(s) and follow a census of roughly 15 patients, with an average of 3 to 5 new consultations per day. The Transplant ID team is typically staffed by Transplant ID faculty & a fellow and follows a census of roughly 10 patients, with an average of 2 new consultations per day. The scope of consultation is broad, with a mix of community-acquired and healthcare-associated infections, immunocompromised host/cancer infection, complicated surgical/implant & trauma and obstetric ID cases. Elective inpatient consult rotations in year two at Doernbecher Children's Hospital, Providence Portland Medical Center and Kaiser Permanente provide exposure to infectious diseases in the pediatric population and the community practice setting, respectively.
Well-staffed and efficient outpatient parenteral antibiotic therapy teams (OPAT) at OHSU and the Portland VA Medical Center support the smooth discharge and transition of patients on intravenous antibiotics.
Inpatient follow-ups and new consultations are seen at the outpatient clinics at OHSU and the Portland VA Medical Center. There is a dedicated fellows' clinic at both sites, allowing fellows to play an instrumental role in new consultation, follow-up and longitudinal outpatient care of a diverse patient population. Fellows' clinics are ½ day per week. Clinics are staffed by multidisciplinary teams and vary in workload, with the average clinic experience for fellows consisting of 4-5 patients per session. Separate clinics for HIV infection are conducted at both institutions, with fellows typically following a panel of 10-20 HIV-seropositive patients by the end of year one of training. In year two there are additional ID specialty clinic experiences at the primary teaching & affiliate sites, including Hepatitis C clinic and Travel clinic.
Conferences and other educational opportunities
The weekly Monday noon conference includes a comprehensive core lecture series that incorporates principles of active learning, guest speakers, basic science topics, infection control experiential exercises, and other learning activities. "Bench rounds" occurs every other week throughout the year at the Portland VA Medical Center microbiology laboratory, drawing on the rich clinical caseload and the expertise of our faculty. This conference is led once a month by our second year fellows, and once a month by the microbiology laboratory director.
Transplant ID and Gen ID case conferences are clinically-oriented, spirited conferences that allow our fellows and faculty the opportunity to share challenging and interesting cases.
Journal club is held monthly and led by two fellows, with an emphasis on critical review of the literature and presentation of key ID papers.
Citywide conference is a case-based conference that is hosted at rotating sites on a weekly basis. Cases and short discussions are presented, with lively participation from colleagues throughout the Portland metropolitan area.
The pre-clinic HIV conference is a weekly didactic series that comprehensively covers important HIV topics.
An antimicrobial tutorial series is led by our ID PharmD, Jim Lewis, at the outset of each year. This is a practical and interactive discussion of the major antimicrobial classes.
Our fellows participate in an Antimicrobial Stewardship Curriculum consisting of one week of didactic and small group learnings from our stewardship faculty and ID Pharmacists, followed by a week of mentored practical experience in antimicrobial stewardship.