Rochester General Hospital(RGH)is a seven-story general hospital with more than 500 beds. Inpatient facilities include 22 pediatric beds, with a 2-bed intermediate level care unit; 2 rooming-in units for 33 mothers and their newborn infants; and a 14 bed level II nursery. About 3,000 deliveries and 1,400 admissions occur annually. Most admissions to the inpatient unit are for acute, non-life-threatening illnesses or for elective medical and surgical procedures.

The RGH emergency room is one of the busiest in Rochester. Pediatric housestaff see approximately 9,200 patients annually. The Rochester General Pediatric Association (RGPA) provides primary care, as well as acute and urgent care, for children of all ages for more than 32,000 visits per year. Nearly half of the pediatric house officers have their Continuity Clinic practice in RGPA.

Pediatric Infectious Diseases

The Division of Pediatric Infectious Diseases provides inpatient and outpatient services for children with known or suspected infectious diseases. The Division conducts a monthly infectious diseases core curriculum conference for the housestaff and offers an elective. In this elective, one-on-one teaching experiences with faculty are supplemented by diagnostic microbiology, epidemiology, and the pharmacology of antibiotics. Streptococcus pneumonia, respiratory syncytial virus, influenza A, Pneumocystis carinii, HIV and HHV-6 are the pathogens currently being studied. Many house officers are involved in clinical research projects with the Infectious Diseases faculty.

Fellowship Training

The main focus of our training program is to provide research training for pediatric clinician-investigators in the area of opportunistic infections (OIs) and other infections in the immunocompromised host. ( Other areas of training are possible and interested individuals should not hesitate to contact us.) The need for such a training program is based on the following premises:

Premise 1: There are a large number of pediatric patients who are immunocompromised and at risk for OIs and other infections.

Premise 2: Because of developmental, physiologic, and disease specific differences between children and adults, researchers with specific pediatric expertise should be involved in basic investigations related to OIs and infection in the immunocompromised child.

Premise 3: There is a lack of pediatric physician-scientist involvement in the study of OIs and other infections in the immunocompromised host.

Premise 4: Training pediatric physician-scientists who can contribute substantive research in this field will require a rigorous laboratory-based training program.

Proposed Training

The overall goal of this training program is to train fellows in areas of basic research relevant to infections in the immunocompromised host. This fellowship is designed to be an intensive laboratory-based training program where fellows receive the training necessary to establish independent research careers in academic medical centers or federal institutions (NIH, FDA, CDC, etc.). To maintain our recently awarded accreditation as an ACGME-approved fellowship training program, fellows will also receive clinical training as mandated by the ACGME. Thus, the fellowship is designed as a mandatory 3-year training program with one year of clinical experience and two years of absolutely protected time dedicated to laboratory training.

Briefly, we are a tertiary care center for an 11-county area. We see about 40 consults per month on the inpatient service and in a large neonatal intensive care unit. The fellows also receive several phone consultations every day they are on service from pediatricians in our referral area. An extensive phone consultation system has become "standard operating procedure" for this community and thus, there is not a large need for "routine" outpatient infectious disease consults. We have an active HIV Clinic which follows approximately 40 HIV-infected children. There are approximately 25-30 infants born to HIV-infected women each year in our catchment area. Each fellow attends one half-day per week HIV Clinic to develop some experience with the longitudinal care of HIV-infected children. The HIV program is part of the Pediatric AIDS Clinical Trials Group funded by the NICHD. In addition to the usual tertiary care patients, the division also provides consultation for renal, liver, heart (after 2000), and bone marrow transplant services as well as to an active oncology program (about 50 new patients per year; 100 active patients). Thus, our fellows see a diversity of clinical problems and receive significant exposure to immunocompromised patients, which is the laboratory focus of this program.

For those fellows wishing additional exposure to infections in the immunocompromised patient, we are continuing our unique relationship with St. Jude Children's Research Hospital (SJCRH) in Memphis, TN, which allows our fellows to spend one month on the consult service at that institution. SJCRH is one of the leading and largest children's cancer centers in the world. Because of their large patient population, the infectious diseases group is able to provide rich and intensive exposure to infections in the compromised host.

Curriculum

In addition to the laboratory research training that each fellow will receive, the program has an organized series of graduate level courses, seminars, guest lecture series, and regularly scheduled conferences.

i. Graduate Level Courses

Fellows are expected to enroll in a graduate level course during each year of training. Fellows select courses with the aid of the program director and the laboratory mentor. All graduate level courses in the university are open to our fellows, but generally they choose courses in the Department of Microbiology and Immunology, additional course work will be encouraged but not required for those fellows holding a Ph.D. degree. All fellows, including those already holding an advanced degree, are required to take the Ethics in Research course.

ii. Introduction to Clinical Microbiology

This is a 2-week session held each July to orient our fellows to the various aspects of clinical microbiology. More extensive training is offered to those fellows who require it because of the nature of their research project.

iii. Joint Medicine-Pediatrics Research-in-Progress Seminars

These seminars are presented two times each month by infectious disease fellows and Infectious Disease faculty in the two departments. They provide an excellent forum for constructive criticism and discussion of ongoing research projects.

iv. Journal Club

A journal club, in which articles relevant to clinical infectious diseases are discussed, is held each week. Both faculty and fellows review papers from assigned journals. Fellows are required to participate in this exercise. This allows faculty and fellows to remain current with all major medical journals. This conference is also a joint conference held with members of the Department of Medicine's Infectious Disease Unit.

v. Clinical Conferences

Each week there is a joint internal medicine-pediatric case conference during which interesting cases are presented for discussion, followed by a didactic presentation on a relevant aspect of the case. This conference is organized and presented by fellows or residents rotating on the Division's clinical service.

vi. Lab Rounds

Three times a week the Department of Clinical Microbiology faculty and clinical microbiology postdoctoral fellows meet to discuss microbiologic aspects of current infectious diseases cases. Pediatric and Adult Infectious Diseases fellows and faculty attend this conference as their time and interest permit. In contrast to the other aspects of the curriculum, attendance at this conference is optional.

vii. Guest Speaker Series

The Departments of Microbiology and Immunology, Medicine, and Pediatrics each have an extensive outside guest speaker series. These lectures provide an opportunity for our trainees to be exposed to a wide variety of notable scientists and research areas relevant to infectious diseases and immunology.

viii. Laboratory Research

The foundation of this training program is basic research. Therefore, the program director's most important responsibility is to assure an appropriate laboratory placement for each trainee. Laboratory placement of each fellow is done after careful evaluation of: 1) the fellow's own interests and 2) the availability of an appropriate mentor who has space and time to take on a fellow. This process begins before the fellow arrives in Rochester. Each applicant is mailed a description of the laboratory activities of participating faculty, as well as other members of other relevant departments, such as microbiology and immunology. During this period of time, the program director keeps in phone contact with the fellow. As the fellow narrows the list of projects which appeal to him/her, the program director puts the appropriate faculty directly in contact with the fellow so that more detailed information can be exchanged. Our intention is that the fellows will have selected a mentor prior to arriving in Rochester so as to minimize "down time." After arriving in Rochester, the fellow may do a short (4-6 weeks) rotation in one or two laboratories, if necessary, to help finalize placement.

Once a potential mentor has been identified, the fellow and mentor will be asked to provide the following information regarding the proposed project: 1) the significance of the project; 2) specific goals for the individual fellow; 3) major techniques to be mastered; and 4) a description of how the fellow will fit into the ongoing activities in the laboratory. This information will be reviewed by the program director with the fellow and mentor to make sure there is a clear understanding of the research project planned for that individual. A scientific advisory board will be responsible for reviewing overall adequacy of laboratory placement of fellows to assure that each fellow receives the best training possible.

Click here to see the contacts: URMC Deparment of Pediatrics

This informaion is reposted with thanks to University of Rochester Medical Center.