Infectious Diseases Training Program
National Institutes of Health - Bethesda, MD

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Infectious Diseases Training Program

Overview

Structure of Clinical Training

Structure of Research Training

Current ID Fellows and Program Graduates

Grant Writing/Vacation/Transportation/Loan Repayment

Application Information
Overview

The National Institute of Allergy and Infectious Diseases (NIAID) offers an intensive, three-year clinical and research training program in infectious diseases. The purpose of the program is to develop outstanding clinical and research skills in physicians who are already well rounded in clinical medicine and who intend to pursue academic careers in infectious diseases. Trainees work under a world-class team of accomplished faculty members and gain hands-on experience that will prepare them for successful careers in a rapidly evolving field. They also have opportunities to engage in collaborative research projects at various locations around the world. The first year of the program is spent exclusively in clinical rotations. In the second and third years, trainees pursue their individual research interests under the direction of a faculty research mentor. Fellows attend a weekly continuity clinic during the first two years of the program.

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Structure of Clinical Training

Overview: The First Year
Clinical training in the first year of the Infectious Diseases Training Program consists of a 2-month rotation on the Infectious Diseases Inpatient Consultation Service within the NIH Clinical Center, a 2-month rotation on the NIAID Inpatient Ward, and 7 months of rotations at four outside affiliated academic medical centers (Johns Hopkins University Hospital [JHH], Washington Hospital Center [WHC], George Washington University Hospital [GWU], and Georgetown University Hospital [GUH]). In addition, the fellows spend 2-3 weeks at a privative practice. This blend of general and specialized infectious diseases experiences offers a unique and unmatched array of diverse infectious disease pathologies. These rotations are designed to provide fellows with both a broad case mix and comprehensive and well-rounded training in the pathophysiology of infectious diseases, including microbiology, mechanisms of pathogenesis and antimicrobial resistance, host immune response, and antimicrobial treatment.

Orientation
Prior to beginning the clinical rotations, all fellows attend a hospital epidemiology course and a comprehensive 3-week introductory course taught by the Infectious Diseases and Microbiology faculty. These lectures cover a variety of disciplines in infectious diseases including common consultation questions and dilemmas that the fellows will encounter throughout the year, a thorough overview of bacterial, viral, fungal and parasitic microbiology, pharmacology of antimicrobial drugs, and key components of the immune response to various infectious agents.

The NIH Infectious Diseases Consultation Service Rotation
The Infectious Diseases Consultation Service oversees the infection management of immunocompromised patients undergoing allogeneic stem cell transplantation, intensive and investigational chemotherapy for solid tumors and hematological malignancies, or immunomodulatory treatment for cancer, autoimmunity, or immunodeficiency at the NIH Clinical Center, a 234-bed clinical research hospital. In addition, the Infectious Disease Service receives consultations from a large surgical service with patients undergoing intensive experimental chemotherapeutic, surgical, and immune therapies.

The consult team consists of the NIH fellow, often a visiting ID fellow from an area hospital, occasional visiting residents and/or students, and the attending physician. During this 2-month rotation, the fellows typically receive 40-60 consults per month on patients with neutropenic fever and a diverse array of opportunistic bacterial, viral and fungal infections. Through the integrated daily rounds with the stem cell transplant service, the fellows acquire superior training in transplant medicine and become familiar with concepts such as conditioning regimens, types of transplantation, graft-versus-host disease, and the mechanism of action and immunomodulatory effects of commonly used immunosuppressive agents.

Daily microbiology rounds in the NIH Clinical Center's outstanding research and diagnostic laboratory with the microbiology faculty enhance patient care and improve the fellows' knowledge of microbiology. On a daily basis, these 30-minute microbiology rounds review all pertinent patient microbiology data and include daily teaching presentations and quizzes prepared by the microbiology faculty that are designed for the fellows’ education. Hence, by the end of the 2-month rotation, fellows are able to recognize and identify common pathogens under the microscope by interpreting various microbiological stains and are familiar in some depth with the range of diagnostic assays and techniques used in the clinical microbiology laboratory. The Microbiology Service has an incredible array of in-house expertise, including extensive molecular diagnostic capabilities, mycology, and mycobacteriology.

A representative list of consults/cases that fellows typically see during this 2-month rotation is attached here for a more detailed description of entities that are encountered during this rotation.

Sample of NIH rotation consultations (133 KB)

The NIAID Inpatient Ward Rotation
The 2-month NIAID Inpatient Ward rotation at the NIH Clinical Center affords the unique opportunity to evaluate and manage patients with a range of inherited, acquired, and iatrogenic defects in immunity leading to infection susceptibility. The NIAID inpatient ward admits ~40-60 patients/month enrolled in various infectious diseases and allergy/immunology clinical research protocols. Fellows on the ward service supervise and teach 4 internal medicine residents from the George Washington University and Georgetown University Hospital Internal Medicine Residency Programs who have patient care and night call responsibilities.

Some of the entities that fellows typically see during this rotation include (but are by no means limited to): chronic granulomatous disease with a variety of invasive bacterial and fungal opportunistic infections; hyper-IgE (Job) syndrome; HIV/AIDS (with opportunistic infections or manifestations of immune reconstitution syndrome); disorders of the interferon-gamma/interleukin-12 axis that lead to heightened susceptibility to disseminated mycobacterial infections; bronchiectasis disorders that lead to increased susceptibility to pulmonary mycobacterial infections; primary ciliary dyskinesia with recurrent sinopulmonary bacterial infections; chronic active EBV infection; systemic mastocytosis; RAG mutations; monocytopenia disorders that lead to susceptibility to disseminated mycobacterial infections; idiopathic CD4 lymphocytopenia; leukocyte adhesion disorder (LAD); X-linked agammaglobulinemia; parasitic infections, and hyper-IgM syndromes.

Fellows also have the opportunity to evaluate patients admitted with opportunistic infections due to as-yet undefined immunodeficiency syndromes. Through exposure to the unique array of rare disorders and conditions, fellows acquire a comprehensive understanding of basic immunological parameters and are able to associate the susceptibility to specific infectious diseases to dysfunctions of specific arms of the immune system.

Outside Affiliated Hospital Infectious Diseases Rotations
Fellows rotate for 7 months at four affiliated academic hospitals; following is a brief outline of the structure and characteristics of these rotations.
The fellows spend 2 months at Johns Hopkins Hospital (JHH), a 945-bed tertiary care center. The JHH Infectious Diseases service typically receives ~100 consults per month and the consult team consists of 2 fellows (1 JHH and 1 NIH fellow), 1-2 medical residents, 1-3 students, and an attending physician.

Sample of JHH rotation consultations (23 KB)

The fellows spend 1-2 months at the Washington Hospital Center (WHC), a 926-bed hospital, the largest private hospital in Washington, D.C., and a major cardiovascular surgery center. The WHC Infectious Diseases service typically receives ~100 consults per month and the consult team consists of 2 fellows (1 WHC and 1 NIH fellow), 1 medical resident, 1 student, and an attending physician who is a full-time faculty member.

Sample of WHC rotation consultations (145 KB)

The fellows spend 1-2 months at the George Washington University Hospital (GWU), a 315-bed tertiary care center. The GWU Infectious Disease service typically receives 100-120 consults/month and the consult team consists of 2 fellows (1 GWU fellow and 1 NIH fellow), 1-2 medical residents, 1-2 students, and an attending physician.

Sample of GWU rotation consultations (135 KB)

In addition, the fellows may spend 1-2 months at Georgetown University Hospital (GUH), a 535-bed tertiary care center. The GUH Infectious Disease service typically receives ~100 consults/month and the consult team consists of 2 fellows (1 GTH fellow and 1 NIH fellow), 1-2 medical residents and 1-2 students.

Sample of GUH rotation consultations (143 KB)

Fellows spend 2-3 weeks at a bustling infectious diseases private practice, learning the challenge and reward of non-hospital based ambulatory infectious diseases care. There are opportunities for elective months in various inpatient and outpatient settings such as the Pediatric Infectious Diseases Service at Children’s National Medical Center. Other electives can be arranged on a case-by-case basis.

The rotations at the four outside hospitals provide superb and complementary infectious diseases training experiences that, in aggregate, expose fellows to a broad spectrum of cases spanning most disciplines of Infectious Diseases:

Solid organ transplantation – renal at WHC, small bowel, liver and kidney at GUH; JHH elective for liver, kidney, heart, pancreas, and lung transplantation

Advanced HIV/AIDS patients with opportunistic infections and AIDS-associated malignancies/other pathologies at all 4 affiliated hospitals

Large volume of “bread-and-butter” infectious disease cases such as community acquired pneumonia, bacteremia, endocarditis, acute and chronic osteomyelitis, cellulitis and soft-tissue infections, necrotizing fasciitis, prosthetic joint infections, diabetic foot infections, septic arthritis, meningitis, brain abscess, post-surgical infections, wound infections, urinary tract infections, intraabdominal infections, fungemia, neutropenic fever, at all 4 outside hospitals.

Tropical infections in the returning traveler at GUH and GWU

Burn-related infections at WHC, whose burn unit cares for all burn patients in the metropolitan Washington DC area.

Continuity Clinic
All infectious diseases fellows are required by the ACGME to participate in 24 months of continuity clinic during the first two years of fellowship. HIV continuity clinic is held at the NIH Clinical Center during the first year. During the second year, fellows attend the infectious diseases clinics at either the Washington Hospital Center or the George Washington University. The NIH clinic is staffed by experts in HIV management and pathogenesis and each week is accompanied by a didactic session that covers an HIV-related topic such as antiretroviral medications (mechanisms of action, side effects, resistance, drug-drug interactions, results of clinical trials), opportunistic infections (clinical presentation, diagnosis, treatment, primary/secondary prophylaxis), immune reconstitution syndrome, neoplastic, neurologic, and metabolic complications of HIV/AIDS, coinfection with hepatitis B or C, and preventive care issues such as vaccination.

In the second year, fellows also have the opportunity to see parasitology patients that are followed at the NIH Clinical Center by the Laboratory of Parasitic Diseases (LPD). Parasitology patients have such diverse diagnoses as Loa-Loa, onchocerciasis, and other filarial infections, strongyloidiasis and other gastrointestinal parasitic infections, leishmaniasis, neurocysticercosis, as well as patients with undiagnosed parasitic infections who present with eosinophilia.

Lectures, Core Curriculum, and Conferences
There are three regular infectious diseases teaching conferences each week. Every Wednesday, journal club and core curriculum lectures occur on alternating weeks. The lectures are viewed and heard remotely by the Washington VA and WHC, whose fellows and faculty give some of the talks. NIH fellows rotating at WHC are thus able to participate in these lectures.

Each Thursday, the weekly meeting of the Infectious Disease Consultation Service takes place with the participation of the Infectious Diseases and Microbiology faculty, most available fellows, and representatives of other departments (hospital epidemiology, nursing, critical care medicine, e.g.) In this conference, interesting, difficult, or controversial cases that are seen in consultation are presented and their management is discussed.

Every Friday, fellows, faculty, and a multidisciplinary group attend a noon case conference in which the WHC and GUH fellowship programs also participate remotely. The three programs alternate presenting cases as unknowns for the others to discuss. NIH fellows are thus able to participate in the case conferences at three of their five rotation sites.

In addition to the above scheduled weekly conferences/lectures, there are weekly teaching conferences centered on topics relevant to the NIAID inpatient immunodeficiency ward, HIV clinic, and parasitology service. Additional clinical talks include the weekly NIAID Grand Rounds, the weekly NIH Clinical Center Grand Rounds, and the monthly meeting of the Greater Washington Infectious Disease Society (GWIDS) in which all Infectious Diseases programs of the metropolitan Washington D.C. area rotate in presenting their more interesting case, and citywide quarterly tropical medicine meetings. Numerous other conferences and didactic lectures are offered on a wide range of research and clinical subjects on a daily basis at the NIH.

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Structure of Research Training

Overview
The goal of the research training arm of the fellowship program is to produce investigators, whether they focus on clinical, basic, or translational research, who will be effectively trained to pursue their own academic careers after the completion of their fellowship. Fellows spend a minimum of two years in research, and often stay for additional years to work on their projects. We offer both basic and clinical research opportunities, with a strong emphasis on translational research. Fellows typically decide what kind of research they will be conducting by the middle of the first year. Those who elect to do clinical research may apply for the Training Program in Clinical Research offered at NIH in collaboration with Duke University that leads to a Master of Health Sciences in Clinical Research.

Graduate-level courses in microbiology, immunology and molecular biology are offered on site by the Foundation for Advanced Education in the Sciences. In the second and third years, fellows undertake clinical, bench, or combined clinical and bench research projects under the direct supervision of senior staff members. Fellows may choose to work in any of the laboratories of the NIH. Laboratories in the NIAID are involved in investigations of all aspects of infectious diseases and immunology. Research projects range in scope from clinical trials to overseas research projects to the most basic aspects of cell and molecular biology.

Research Opportunities and Mentors
Fellows have a diverse and extensive pool of research mentors, laboratories and opportunities from which they can choose their research projects of interest.
Areas of Research Interest of the Clinical ID Faculty

John Bennett, M.D. : pathogenesis, diagnosis, treatment, prevention, and epidemiology of mycoses, particularly cryptococcosis and candidiasis.

Jeffrey Cohen, M.D. : molecular genetics, pathogenesis, and clinical aspects of human herpesviruses, especially Epstein-Barr virus (EBV), varicella-zoster virus (VZV), and herpes simplex virus (HSV).

Robert Danner, M.D. : septic shock and multiple organ failure, nitric oxide, and functional genomics of critical illness and injury.

Sandip Datta, M.D.: immune regulation in bacterial infection.

Lesia Dropulic, M.D. : clinical transplant infectious diseases; herpesvirus clinical research.

Karen Frank, M.D., Ph.D.: medical microbiology.

Alexandra Freeman, M.D. : pediatric infectious diseases, infections in primary immunodeficiency syndromes.

Juan Gea-Banacloche, M.D. : clinical transplant infectious diseases.

Colleen Hadigan, M.D., M.P.H. : Metabolic effects of HIV infection and HIV therapy.

Steven Holland, M.D. : immune defects of phagocytes, including chronic granulomatous disease, hyper IgE (Job) syndrome, leukocyte adhesion deficiency; susceptibility to disseminated mycobacterial infections.

Amy Klion, M.D. : mechanisms of eosinophil activation and eosinophilia; host immune responses to parasitic helminth infections.

Joseph Kovacs, M.D. : Pneumocystis jiroveci infection and toxoplasmosis in HIV patients.

Mihalis Lionakis, M.D.: pathogenesis of fungal infections.

Frank Maldarelli, M.D., Ph.D. : HIV resistance mechanisms.

Adriana Marques, M.D. : Lyme disease.

Henry Masur, M.D. : critical care, catheter-associated infections, HIV infection.

JoAnn Mican, M.D. : HIV clinical studies.

Stephen Migueles, M.D. : mechanisms of immunologic restriction of HIV replication; long-term nonprogressors or “elite controllers” of HIV infection.

Caryn Morse, M.D. : metabolic and skeletal complications of HIV infection.

Robert Munford, M.D. : Immune response to bacterial lipopolysaccharides.

Thomas Nutman, M.D. : mechanisms of eosinophil activation and eosinophilia; clinical expression, diagnosis, treatment and control of human helminth infections; host immune responses to parasitic helminth infections.

Kenneth Olivier, M.D. : mechanisms of airway dysfunction, primary ciliary dyskinesia, bronchiectasis, pulmonary mycobacterial infections.

Tara Palmore, M.D. : Hospital epidemiology.

John Powers, M.D. : Design and interpretation of clinical trials.

Irini Sereti, M.D. : HIV immune reconstitution syndrome; role of interleukin-2 and interleukin-7 in the management of HIV; HIV and tuberculosis.

Michael Sneller, M.D. : HIV clinical studies, hepatitis C cryoglobulinemia.

Peter Williamson, M.D. : Host-pathogen genetics in fungal infections.

NIAID Laboratories
Explore the research of NIAID laboratories at our Info About Labs page .

International Research
The NIAID has clinical investigators engaged in collaborative research projects in Mali, Peru, Thailand, South Korea, Nigeria, South Africa, and India. Several fellows are currently principal investigators on their own international research projects at some of these sites. A typical fellow project involves translational studies of infectious diseases that are endemic to a given site where there is a preexisting NIH research infrastructure and/or collaboration with a local academic center

Examples of Current and Recent ID Fellow Research Projects

B-cell immunity to malaria in Malian children

Genetic polymorphisms leading to susceptibility to mycobacterial infection

Genetics of 1918, seasonal, and novel H1N1 influenza

Pulmonary hypertension in Malian children with severe malaria

Filarial and HIV co-infection in Indian adults

Host factors in susceptibility to pulmonary nontuberculous mycobacterial infection

Autoantibodies against cytokines and consequent susceptibility to chronic infections

MDR- and XDR-TB clinical study

Chemokine responses to fungal infections

Role of Th17 cells in protection against opportunistic infections

Chemokine responses to staphylococcal infections

Preclinical studies of live, attenuated influenza vaccines

HIV and hepatitis B coinfection in Mali

NK cell immunity to herpesvirus infections, and potential for adoptive transfer of immunity in stem cell transplantation

Cell biology and genetic studies of HIV long-term nonprogressors

Large-scale epidemiology of nontuberculous mycobacterial infections

Clinical and laboratory aspects of IRIS in HIV

Brugia malayi IL-5 receptor binding protein studies using RNAi

Identification of new epitopes for Strongyloides stercoralis vaccine.

Microscopic observation drug susceptibility (MODS) assays in a Malian TB-infected cohort

Career Mentors
Each fellow selects a career mentor from among the ID faculty, someone who is not involved with the fellow’s research area. The fellow and mentor meet quarterly and discuss the fellow’s career trajectory, including grant-writing possibilities and future job options.

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Current ID Fellows and Program Graduates

The pass rate for the Infectious Diseases Board Exam over the past 11 years has been 100 percent. Among our former infectious disease fellows graduating since 1979, approximately 60 percent are currently employed in academia (engaged in translational or clinical research), about 20 percent are in the pharmaceutical industry or government administration, and about 20 percent in private practice.

Current ID Training Program Fellows (109 KB)

ID Training Program Graduates (176 KB)

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Grant Writing

During the second and third years of the fellowship, the fellows are encouraged to apply for K awards/grants that are specially designed for NIH clinical fellows transitioning to extramural academic careers. Grant-writing workshops are offered at least annually.

Mentored Clinical Scientist Research Career Development Award (K08) (Government site)

Mentored Patient-Oriented Research Career Development Award (K23) (Government site)

Vacation
During the first year, fellows have a 4-week block of nonclinical time, during which three weeks are vacation and one week is dedicated to the search for their research environment for the subsequent years of the fellowship via meetings with potential research mentors.

Transportation
Free parking is available for NIH fellows during the NIH rotations and at all outside hospital rotations. The NIH and GWU are easily accessible by public transportation. The other hospitals are somewhat accessible, to varying degrees.

Loan Repayment
Most ID fellows with significant school debt have been able to receive substantial loan repayment under the NIH loan repayment program . Fellows may apply for one of several categories of loan repayment through this program, the amount most recently ranging from $20,000 to $35,000 per year.

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Application Information

The NIH Infectious Diseases Training Program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). After successful completion of the second year, fellows are eligible to take the examination for the subspecialty Board of Infectious Diseases given by the American Board of Internal Medicine (ABIM).

There are up to four positions available per year. Candidates should apply through ERAS and are selected through the National Residency Matching Program. The length of the fellowship program is 3 years; however, many fellows continue their research activities for 1 or more additional years. Fellows in the ABIM Research Pathway require 4 years of fellowship and this can usually be accommodated in our program.

Eligibility Criteria
Qualified candidates must have completed 3 years of residency training in internal medicine in the United States or Canada prior to entering the fellowship program. Residents will be accepted after only 2 years of internal medicine residency if they are accepted in the ABIM Research Pathway.

Please read our requirements below:
We ONLY accept applications via ERAS [ disclaimer ] .

Through ERAS, applicants will be asked to supply USMLE scores for Steps 1 and 2, a personal statement of career goals, medical school transcripts, and three letters of recommendation, one of which should be from the internal medicine program director. We appreciate but do not require photographs because photos help us remember applicants after the interview during the discussions of the candidates.

We accept applications up to 3 weeks before the deadline for the National Residency Matching Program.

We do not accept J1 applicants.

Applicants must have passed USMLE Step 3 in order to begin fellowship training here.

Upon receipt of the required materials, we will notify you as to whether an interview will be scheduled. If financial or other constraints prohibit you from attending an interview, you should notify Dr. Palmore as soon as possible. You may also contact Dr. Palmore's office to verify receipt of your application, via phone, e-mail, or fax.

Tara N. Palmore M.D. , Director, Infectious Diseases Training Program

or

Ericka Thomas , Training Program Coordinator

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