Fellows Survival Guide

Areas of Focus

The beauty of pediatric infectious diseases lies in the multitude of options one has when choosing their career. If you meet with some of the PIDS members, you will find physicians who have developed a focus within infectious diseases.

Some examples include:

  1. Clinical  Some ID physicians spend most of their time seeing patients. This can be in an academic setting or in the private sector, and can include inpatients, outpatients, or both. Clinics can include infectious diseases “bread and butter” such as bone and joint infections, and recurrent fevers; but you can also have clinics devoted to TB, MRSA, immune deficiency/HIV, transplant, refugees, international adoption, international travel, STIs, etc. If clinical medicine is your passion, you can work with your fellowship program director so that your curriculum has more focus on clinical time caring for a diverse group of patients. However, you are still required to complete a scholarly activity to complete fellowship and sit for boards.
  2. Research (clinical vs translational vs basic science) – Learn the skills to design a research project, write a project’s outline, submit a grant, and write papers. So many venues exist within the research world. Some of us choose to do purely clinical research or get involved in large clinical trials; others choose to do bench work; and some of us try to reconcile between the two and get involved in translational research. With endless options in pediatric infectious diseases, you’ll be able to find and meet your research interests. Your program directors should provide you with protected uninterrupted time to do your research during your fellowship.
  3. Infection prevention/ hospital epidemiology – The need for physicians proficient in infection prevention continues to increase day by day, as the joint commission has strict hospital standards. If this is your interest, ask your program to provide extra time for you to spend with your hospital epidemiologist/ infection prevention team, investigating outbreaks, discussing weekly updates from constructions to new guidelines to isolation policies. The Society for Health Care Epidemiology of America (SHEA) also offers a Fellows Course in Hospital Epidemiology & Infection Control.
  4. Antimicrobial stewardship – This is a newer area that has been gaining tremendous interest over the past few years, as pioneers have shown they can reduce antimicrobial use, and in some instances, cost to the hospitals with such programs. These programs encourage judicious use of antimicrobials with the goal of preventing development of resistance. Most hospitals have developed such programs lead by infectious diseases physicians and pharmacists. If your institution does not have a program, you can request electives at other institutions to develop your skills. PIDS offers an annual meeting (ASP held in St. Louis, MO in late spring every year) that may be of benefit, not to mention the many lectures and workshops held during IDWeek and a recent antimicrobial stewardship curriculum developed by the Infectious Disease Society of America.
  5. HIV – HIV infection still has a presence in pediatrics. As excited as we get with the decrease in the number of vertical transmissions, we still see new acquisitions of infections. Most institutions have excellent HIV programs where ID physicians work with nutritionists, psychologists, pharmacists, and social workers to improve lives of children with HIV. PIDS offers a biennial Pediatric HIV/AIDS Training Course in March and plenty of information is available on the HIVMA and AIDSinfo website including career opportunities in the USA and internationally. If you feel this is an area that interests you, consider spending elective time in an Adult HIV Clinic, to gain additional experience providing HIV care.
  6. Transplant – As the number of Solid Organ and Stem Cell Transplants increase, the number of specific diseases related to severe immune deficiencies created by such transplants increases as well, and physicians proficient at dealing with these diseases are needed. PIDS holds an annual pediatric transplant ID symposium in March. Infectious diseases transplant fellowships are rare, but currently there is a one-year host defense fellowship available at Nationwide Children’s Hospital and a 1-2 year fellowship in infections in immunocompromised patients at St. Jude Children’s Research Hospital. However, you may elect to spend time with your transplant teams, spend time rounding with an Adult Transplant ID service, or get an away elective at a place with strong transplant ID teams during your fellowship. Dedicated training in transplant ID, either within your ID fellowship training on as an advanced training after fellowship would be imperative should you choose to pursue this career path.
  7. Industry – Pharmaceutical companies are always looking for physicians to lead their teams, and training in infectious diseases could open up a lot of doors for you in the industry world. Industry positions would include those requiring expertise in both scientific and management issues. Pediatric ID experts play a role in every aspect of drug and vaccine development and evaluation process.
  8. Global health – When you say Global health, you say Infectious Diseases! Opportunities in global health are endless, from working within the US to improve the health of children throughout the world, to being physically present in the field helping underprivileged populations. USAID, CDC, and WHO, among many other agencies, open up doors for you to do what you love and help prevent and treat infectious diseases. Baylor International Pediatric AIDS Initiative is an example of an agency whose primary purpose is to provide pediatric and family-centered health care, health professional training and clinical research, focused on HIV/AIDS, TB, malaria, malnutrition among others. You can start during your fellowship and get a feel of what this entails. You can find a long list of meetings you can attend on Globalhealth.gov.
  9. CDC (Center for Disease Control and Prevention) – The CDC hires specialized medical officers who will help carry out their mission in the world. They need physicians that can provide care, help control and prevent diseases, as well as perform studies. From tracking the epidemiology of infectious diseases to monitoring vaccine preventable diseases and investigating unusual or emerging pathogens, an infectious diseases specialist can be a great addition to such programs. The CDC’s National Center for Immunization and Respiratory Diseases provides leadership for the planning, coordination, and conduct of immunization activities nationwide. For those specifically interested in epidemiology training and/or outbreak investigation, the Epidemic Intelligence Service is something to investigate – these medical officers serve as “disease detectives” for the CDC and other health departments.
  10. State/local public health departments – Many infectious diseases specialists dedicate their time to improving the public health in their city, state, or country by serving as the state epidemiologist. Public health departments promote the need for vaccination, assess vaccination coverage levels, evaluate outbreaks of disease, educate parents and providers, and purchase, distribute, and administer vaccines. You can see how an infectious diseases specialist could be a great addition to their department.
  11. NIH (National Institutes of Health) – The NIH is a federal agency whose primary mission is to support and conduct medical research and to improve the public health, in the nation and worldwide. National Institute of Allergy and Infectious Diseases (NIAID) researches some of the world’s top health issues including HIV/AIDS, influenza, Severe Acute Respiratory Syndrome (SARS), bioterrorism, and immune system research, among many others. Basic science and clinical research are promoted. The NIH offers summer internships for students, elective rotations for residents and fellows, in addition to multiple other opportunities you can find on their website, which has tons of information on how to pursue a career with them. Pursuing additional training in research (such a master’s degree in clinical research if you are interested in their clinical research) may be and excellent tool that would help you in this career choice.
  12. FDA (Food and Drug Administration) – The FDA, a federal agency of the US Department of Health and Human Services, is responsible for protecting the public health by assuring the safety, efficacy and security of drugs, food supply etc. It works on advancing the public health by helping to speed innovations that make medicines more effective, safer, and more affordable. As a pediatric infectious diseases physician, you may find opportunities within the FDA whether by drug regulation, food safety and food borne illness, as well as in research that would help advance therapies.
  13. Education – Many of us have a passion for teaching – your pediatric infectious diseases fellowship will provide you with tools to foster this interest. Through both undergraduate and graduate medical education, we have so much to offer, and students have so much to learn from us. Regardless of which track you decide to take, education will be a part of it. You can make this your primary interest if you elect to, by working on becoming a residency or fellowship program director, a clerkship director, getting involved in GME, etc.
  14. Quality and performance improvement –This is gaining significant interest as quality improvement in healthcare is working to catch up with other industries. Hospitals have been placing more importance on error prevention and performance improvement as it saves money and provides better care to patients. As a pediatric infectious diseases specialist, you can help improve the quality of the care delivered in your institution and in the world. Extra training is available through many programs such as LEAN/Six Sigma training, Healthcare Delivery Institute, Institute of Healthcare Improvement, Quality and Safety Education Academy and others.

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