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Infectious Diseases Fellowship Columbia - Clinical Experience

Clinical skill experiences

In addition to inpatient adult ID and outpatient clinic, fellows will be exposed to the following aspects of infectious disease:

Antimicrobial stewardship

The robust multidisciplinary program with infectious diseases, infection prevention, and pharmacy provides ASP services for three major hospitals in the PH system. The PH-Midlands ASP has received a designation of Antimicrobial Stewardship Center of Excellence by the IDSA. In addition, the Division of Infectious Disease ASP leads the statewide stewardship initiative in collaboration with the Department of Public Health, the School of Pharmacy, and the Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC).

  • Fellows gain an understanding of the hospital antimicrobial formulary, local antibiograms and antimicrobial stewardship protocols and procedures to optimize the use of antimicrobial agents.
  • Fellows have a 2-4 week rotation with the ASP team each year of their fellowship. During this rotation the fellows will work one-on-one with the ASP director and infectious diseases PharmD.
  • In addition to daily ASP rounds, fellows participate in interdisciplinary meetings, including monthly hospital wide ASP meetings, two weekly statewide ECHO meetings.
  • Fellows also participate in the development of ongoing projects, protocols, guidelines and clinical pathways.
  • Opportunities exist for a 3rd year ASP track.

The Antimicrobial Stewardship Program extends to the three major hospitals with the Prisma Health–Midlands System. In addition, the USC Division of Infectious Disease, in collaboration with the Department of Public Health and the School of Pharmacy, is the lead on the statewide stewardship initiative, Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC).

Hepatitis C

The Division of Infectious Diseases is the premier hepatitis C referral center of the Midlands. We possess the only publicly available FibroScan in South Carolina. Fellows spend a 2-week block with the clinical infectious disease pharmacist and ID attendings at the PHI and SCDC. On this rotation, fellows also participate in our telehealth initiatives. The Division of Infectious Disease houses the South Carolina AETC. Services include a rural hepatitis-C referral program as well as hepatitis C telehealth conferencing (SCHTI) which assists providers across the southeast with complex cases via video case discussion. Fellows will also manage a cohort of Hepatitis C patients as part of their ambulatory clinic cohort.

HIV

Prisma Health Immunology (PHI) is a combined HIV and general infectious diseases clinic. The on-site clinic is the state’s largest HIV care service center, and since 1993, the UofSC Division of Infectious Diseases has coordinated a partnership of over 20 member agencies that deliver care across an eight-county area. PHI has approximately 2000 HIV-infected individuals and provides medical care, medical case management, substance abuse screening, referral and treatment, medications assistance, mental health services, perinatal HIV prevention case management, and HIV discharge planning from the SC Department of Corrections.

Each fellow will have a continuity clinic throughout the fellowship consisting of 1-2 sessions per week where they will build a panel of patients. Over the course of the fellowship, trainees will manage a minimum of 25 HIV-positive patients. Fellows are responsible for managing the HIV, primary care with healthcare maintenance and a variety of opportunistic infections.

PHI is also an STI treatment site and heavily supports HIV prevention (PrEP) efforts across the Midlands. In addition to patient care, trainees will have an opportunity to participate in statewide PrEP education efforts via the South Carolina AETC PrEP Initiative.

Opportunities exist for collaboration with the South Carolina Health Department and UofSC School of Public Health.

LGBTQIA+ health

Trainees will have the opportunity to provide comprehensive healthcare to the LGBTQIA+ population. This will be done in collaboration with an interdisciplinary team of providers.

PHI has on-site mental health and PharmD support to assist with care. Within Prisma Health, we have a multidisciplinary group of providers (primary care, ID, gynecology, urology, plastic surgery, and psychiatry) who meet regularly to collaborate on LGBTQIA+ patient care, advocacy, and research. Trainees will have the opportunity to also participate in this group longitudinally and there is also an opportunity for a LGBTQIA+ third year fellowship.

Bone and joint infections

Prisma Health Richland Hospital, our primary training site, is a Level I Trauma Center as well as a premier orthopedic center. For any patient seen in consultation requiring outpatient IV antibiotic therapy, fellows are responsible for the continued monitoring and management of therapy in the outpatient setting.

Global health

Fellows are exposed to the challenges of managing patients with social and economic barriers as well as treating tropical infections. This is done locally at three sites (Survivor Clinic, Travel Clinic, South Carolina DHEC, and the South Carolina Department of Corrections). In addition, opportunities for international experiences are available.

South Carolina Department of Corrections

The UofSC Division of Infectious Diseases provides all HIV, hepatitis C, infectious disease (including tuberculosis) and antimicrobial stewardship care for persons within the South Carolina prison system. This includes services to over 20,000 inmates, of which approximately 300 are HIV infected and approximately 600 are hepatitis C infected.

The Carolina Survivor Clinic

The only refugee clinic in South Carolina, the Carolina Survivor Clinic is housed at the Prisma Health and is managed by an Infectious disease attending. Services include refugee screening examinations, diagnosis and treatment of multiple infectious diseases, survivor of torture screening, home visits, and supplemental supportive services including a Scholastic Soccer Project and the USC garden project.

Infection Prevention (IP)

A robust multi-hospital IP program covers both the inpatient hospital programs as well as affiliated ambulatory sites (several Prisma Health sites). Fellows gain practical experience in IP hospital epidemiology and procedures for outbreak investigation and preventative measures. Opportunities available for IP leadership coaching.

Microbiology

Prisma Health’s microbiology department in Columbia is a state-of-the-art lab which provides services to multiple hospitals within the Midlands. During the microbiology month, trainees will have the opportunity to experience on-site routine microbiologic procedures and state of the art rapid diagnostic tools including filmArray (blood-BCID, respiratory, meningitis and GI panels), Gene Xpert (C.diff, MRSA, and MTB), VITEK 2, Affirm, and BacTAlert. In collaboration with the clinical microbiologist at Prisma Health in Greenville, opportunities for twice-monthly plate rounds as well as a one-week away clinical microbiology rotation at our sister campus in Greenville are available.

Pediatric infectious disease

Fellows rotate with the pediatric infectious diseases faculty at our on-site pediatric hospital which serves the Midlands of South Carolina and offers exposure to a wide variety of pediatric infectious disease conditions.

Hyperbaric medicine training

This is an optional on-site hyperbaric training program which provides a comprehensive introduction to the role of hyperbaric oxygen therapy in modern medical practice

Interprofessional disciplines partnerships

  • Infectious Disease Pharmacy Residency – the infectious diseases fellow and the PharmD resident/fellow are trained side-by-side. They share the responsibilities of inpatient and outpatient care, conference preparation, and research projects.
  • Case management and social work – fellows work closely with these disciplines in both the inpatient and outpatient settings to coordinate patient care.
  • Mental health counselors and HIV peer advocates – these team members work in conjunction with the fellows to provide a comprehensive patient care plan. 

Transitions of care

  • Home health agencies – discharge planning and transition of care is coordinated with the assistance of the inpatient case management group. 
  • Outpatient antimicrobial therapy (OPAT) – discharge planning team works with infectious diseases service to coordinate discharge planning with infusion companies and management of OPAT.
  • Combined EMRs (inpatient and ambulatory) – software is used in both the outpatient and inpatient setting which has been merged into a combined electronci chart, allowing for ease of access to patient medical information.

Technologies

Rapid diagnostics

Prisma Health's state-of-the-art microbiology lab has implemented the use of rapid diagnostics which has led to improved patient care outcomes.

  • FilmArray® (comprehensive respiratory, GI, blood culture [BCID] and meningitis panels)
  • Gene Xpert® [C.diff, MRSA, and MTB]
  • VITEK 2®
  • Affirm® (A vaginitis DNA probe for Candida, Trichomonas and Gardnerella)
  • BacTAlert

FibroScan

FibroScan is a noninvasive method now used to determine the level of fibrosis in the liver. We house one of two FibroScan devices in the State of South Carolina. Fellows receive training on the use and indications for FibroScan technology either at the PHI or the Columbia VA.

Ultrasound

The USC Ultrasound Institute is currently the only one of its kind in South Carolina that offers an ultrasound fellowship for physicians. Fellows have the opportunity to advance their skills using handheld devices. Learn more about the Ultrasound Institute »

TheraDoc and NHSN reporting

Fellows have access to these systems for ASP, quality, insurance and research purposes.