Year Three Training Opportunities

Infectious Diseases Transplant fellowship

A one-year advanced fellowship program in Transplant Infectious Diseases (TID) is offered in the Division of Infectious Diseases, Department of Internal Medicine at Henry Ford Hospital. This program was established in 2012 and is one of a few dedicated one-year TID fellowships in North America. The trainee position requires the successful completion of formal fellowship training (minimum 2 years) in an ACGME-accredited Infectious Diseases Fellowship program. The program is structured to include clinical and research training. At completion of fellowship, the candidate is expected to have received adequate training to seek a consultant position in Infectious Diseases in a Transplant Program.

The major learning objectives of the curriculum are to: 

• Understand the role of ID in the context of transplant medicine, including pre-transplant evaluation and post-transplant management. 
• Assess the risk for infection in the transplant recipient and the impact of specific immune suppressive agents. 
• Recognize transplant related infections caused by nosocomial and opportunistic pathogens in solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients.
• Understand the principal diagnostic modalities and their effective utilization.
• Become familiar with management of infections in the transplant and with the strategies for prevention of these infections.
• Become confident in management and prevention of high-risk patients with hematologic malignancies.
• Become familiar with management of LVAD infections.

The fellowship is structured to provide 6 months of clinical training and 6 months of research. The fellow in Transplant ID provides consultative services in the inpatient and outpatient setting to solid organ transplant (SOT) and hematopoietic stem cell transplant (HCT) patients and high-risk patients with hematologic malignancies. In-patient consultations average 3-4 consults a day and the fellow does one-half day a week in the Transplant ID clinic.

The teaching faculty include transplant and infectious diseases specialists, transplant physicians and surgeons, immunologists and pharmacists. Training is conducted at Henry Ford Hospital and the Karmanos Cancer Institute. HFH is one of the leading solid organ transplant centers and performs approximately 300 (SOTs) and 100 HSCT each year. KCC is nationally recognized cancer center that performs approximately 250 HCTs annually.

The period of training begins July 1. Remuneration is at the level of a PGY 6 resident.

Additional information

• Henry Ford Transplant
• Henry Ford Cancer
• Karmanos Cancer Institute

Infection Control and Hospital Epidemiology fellowship

A one-year advanced fellowship program in Infection Prevention and Control, Hospital Epidemiology, and Antimicrobial Stewardship is offered in the Division of Infectious Diseases, Department of Internal Medicine at Henry Ford Hospital. This program is one of a few dedicated one-year fellowships in North America. The trainee position requires the successful completion of formal fellowship training (minimum 2 years) in an ACGME-accredited Infectious Diseases Fellowship program.

The program curriculum is structured to provide training in epidemiologic methods, infection prevention, quality improvement and antimicrobial stewardship. At completion of fellowship, the candidate is expected to have received adequate training to seek a consultant position in Infectious Diseases with responsibilities in infection control and antimicrobial stewardship.
The teaching faculty include: infectious diseases faculty that have leadership roles in infection prevention, quality improvement and antimicrobial stewardship, infection prevention personnel and pharmacy specialists.

The training is done at the Henry Ford Health, one of the largest integrated health systems in the country. The institution manages 3 million patient visits per year at five hospitals and numerous ambulatory clinics across southeast Michigan. The Infectious Disease fellowship program is one of the oldest in the country with a rich history of basic, translational, and clinical, quality improvement and public health research. Henry Ford Health is the recent recipient of the Baldrige Presidential Award for quality improvement.

The major learning objectives of the curriculum are to: 

• Understand the principles of surveillance for healthcare-associated infections, and epidemiologically important organisms.
• Manage and utilize healthcare data and metrics to develop and implement infection prevention and control strategies in various healthcare settings.
• Direct issues on exposure to communicable diseases. 
• Have an authoritative knowledge on the impact of healthcare-associated infections on patient safety and quality of care.
• Provide and communicate infection prevention and control measures to various audiences.
• Acquire a sound understanding of antimicrobial stewardship and quality improvement programs and their importance in improving patient care and safety.
• Develop and complete research projects related to fellowship related curriculum.

The fellowship offers high quality on-the-job training in infection prevention and control through a mentorship model. Training is activity- and competency-based (i.e., graduates will be expected to develop a core set of skills during the program). The fellowship provides cross-training in various areas, including antimicrobial stewardship, policy making, and research. The fellowship includes a small component of clinical responsibilities for maintenance of patient care skills. Flexibility is provided to meet the individual needs of the fellow.

The period of training begins July 1. Remuneration is at the level of a PGY 6 resident.

HIV Fellowship

General Information:

It is essential that younger providers continue to be trained as HIV specialists. A 2008 survey from the American Academy of HIV Medicine (AAHIVM) found that one-third of HIV specialists, most of whom confronted the AIDS epidemic in its early years, planned on retiring in the next 10-15 years. We continue to need a comprehensive approach to HIV prevention and treatment
to address the ongoing epidemic and increase community-level viral suppression to achieve the goal of ending the HIV epidemic by 2030.

In Michigan, the HIV epidemic continues to disproportionately affect the Detroit and the surrounding counties in southeastern Michigan. The city of Detroit had an HIV diagnosis rate of 33.7 new cases per 100,000 residents. This rate is over 3.5 times higher than the next highest jurisdiction ― Lenawee Co with 9.1 new cases per 100,000 residents. In Detroit there exist significant racial disparities in HIV disease. Young black MSM (YBMSM) are disproportionately affected. In 2018, 22% of new diagnoses were in YBMSM. Of the 26% of people living with HIV (PLWH) in the state in 2018 who were not suppressed, 32% were black. 38% of PLWH who were 20-39 years old were not suppressed.

Since many HIV patients not connected to care in the U.S. are among high-risk populations, training fellows in cities such as Detroit will have the greatest impact on all three national HIV/AIDS strategies. By promoting excellence in HIV care our trainees will become caregivers, leaders, and educators. Their influence will both increase HIV testing and education and thereby reduce new HIV infections. It will also narrow the patient care gap and diminish health care disparities for HIV patients.

Fellowship Structure: Fellowship Structure and Daily Schedule

Fellows perform a mix of inpatient and outpatient clinical work, inpatient teaching, self and collaborative study, didactics, conferences, research, and on-line tools, including the National HIV Curriculum.

Clinic

• HIV Clinic: Care is provided to over 1500 HIV positive patients in a multidisciplinary team, that includes health care providers, nurses, pharmacists, social workers and a Behavioral Health nurse practitioner. Fellows will have a half-day clinic of their own each week. Additionally, fellows will also work with one of the HIV faculty ½ day each week.
• Ruth Ellis Center: The Ruth Ellis Center (REC) was founded in 1999 and provides services for lesbian, gay, bi-attractional, transgender and questioning (LGBTQ+) youth and young adults. Care for young people of color, those experiencing homelessness, those involved in the child welfare system, and/or those experiencing barriers to health and wellbeing is emphasized. REC creates opportunities with LGBTQ+ young people to build their vision for a positive future. Fellows will work with a Henry Ford Provider ½ a day a week at REC to provide STD testing and treatment, HIV testing and guidance, HIV prevention services and care for transgender youth who are transitioning.
• Henry Ford Maplegrove Center: This is an addiction treatment facility in metro Detroit, offering residential rehabilitation, detoxification and the full scope of outpatient care. Fellow will work ½ a day a week with trained individuals in the outpatient setting to assess and manage treatment for adult or teen patients as a first step in addiction treatment.

Inpatient:

Fellows will round with an ID attending each week to review inpatient HIV cases, including the presentation, workup, diagnosis and treatment of opportunistic infections and other complications of HIV infection.

Teaching:

This will include clinical case conferences, journal club, and didactics.

Research:

As part of Henry Ford Health’s mission to advance HIV care, the Infectious Disease division has been involved in antiretroviral clinical trials. These have included Investigator initiated trials, Pharmaceutical trials and NIH funded trials. Our prior work includes involvement as a CPCRA site in the SMART trial, a key study showing the benefit of using continuous antiretroviral therapy over episodic therapy in order to prevent opportunistic infections and mortality in people living with HIV (PLWH). More recently, the division is a Insight site and was a site for the START trial, a large international trial showing the benefits of early initiation of antiretroviral therapy for PLWH. Opportunities to participate in clinical trials related to HIV care are available to interested trainees in our infectious disease program.

Fellows will also have the opportunity to design and implement quality improvement projects in the Ryan White HIV clinic to gain experience with improving outpatient system-based practice. Our clinic has a care coordination grant to help facilitate retention of PLWH in care and assist with uptake of antiretroviral therapy to achieve HIV suppression. Grants aimed at studying metabolic complications among HIV-positive patients and aiding in smoking cessation are also active at this time and are available for trainees to join to implement novel projects around these topics.

We have a strong collaborative relationship with the Michigan Department of Health and Human Services (MDHHS), and this collaboration has generated opportunities that can be used for fellow involvement in projects. Currently, we are looking to expand telemedicine services for PrEP and HIV treatment and would welcome trainee involvement as this project further develops.

Curriculum

Starting in the 2020-2021 academic year, infectious disease fellows will have the option of completing a post-graduate third year specializing in expert HIV care. Training will comprise a 12-month curriculum focused on the management of HIV-specific disease manifestations, HIV-related primary care, HIV pharmacotherapy, and common HIV co-infections. Fellows will complete the AIDS Education and Training Center’s online National HIV curriculum over the course of the year. By the end of their training year, they will prepare to take the American Academy of HIV Medicine (AAHIVM) credentialing exam to achieve certification as experts in HIV care.

12-Month Curriculum:

• HIV Pathogenesis, Transmission, and Epidemiology (1 month)
• HIV Clinical Manifestations (3 months)
• Antiretroviral Therapy (2 months)
• HIV & Primary Care (1 month)
• HIV Prevention (1 month)
• HIV in Special Populations: Geriatrics, PWID, Transgender Care, and Women’s Health (1 month)
• Tuberculosis (1 month)
• Viral Hepatitis (1 month)
• Public Health & Leadership Opportunities (1 month)

Combined Infectious Disease- Critical Care Fellowship

An additional year of training doing a Critical Care Medicine fellowship is another possible opportunity (need to apply through ERAS). As a tertiary and quaternary care hospital, Henry Ford Hospital has one of the largest Intensive Care Units in the country, providing opportunities to see a wide variety of patient presentations and diverse pathology. The goal of the fellowship is to provide trainees with an environment to acquire the skills, knowledge, and attitudes to practice Infectious disease/critical care in either a community or an academic setting. This Program is directed by Dr. Jayna Gardner-Gray, the Program Director of Critical Care Medicine. Candidates will need to apply for this position through ERAS after their first year of Infectious Diseases fellowship and go through the formal match process.