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MGH/BWH Combined ID Fellowship
Clinical Training
Training in the Second Year and Beyond
Application Process
Faculty Research Interests - MGH / BWH

MGH/BWH Combined ID Fellowship

The Massachusetts General and Brigham and Women's Hospitals have integrated their Infectious Disease Fellowship Training Programs to offer unparalleled opportunities for clinical and research training in Infectious Diseases at Harvard Medical School.

The central mission of the program is trainee career development. The joint faculties are committed to providing each trainee with the educational opportunities, mentoring support, and resources necessary for the trainee's objectives in infectious disease clinical care, teaching, and research in clinical and laboratory settings. We view the training of future teachers and investigators as our most enduring contribution to medical science. We are eager to assist in the training of women and minority candidates.

Fellows usually come for between two and four years of training, depending on background and career interest. Occasionally, fellows come for one year of training as part of a training plan involving other institutions. Typically, fellows spend the first year in clinical training and subsequent years in further preparation for a career as a clinician teacher, as a clinical investigator, or as a laboratory investigator (see below).

Clinical Training

Each fellow has a "home base" either at the Brigham and Women's Hospital (BWH) or at the Massachusetts General Hospital (MGH). During the clinical training year, fellows spend slightly more time at the home institution than at the other institution, but all fellows participate in all rotations at both hospitals over the course of the year. Extensive and intensive interactions between each fellow and the faculty of both institutions are the cornerstone of the program. Fellows arrange their program so that it meets the requirements of the Subspecialty Certifying Examination in Infectious Diseases of the American Board of Internal Medicine. Foreign Certification Board requirements can also be met frequently.

The MGH and BWH are acute care general hospitals with large outpatient clinics, affiliated primary care providers, and active emergency rooms. The MGH and BWH have 1051 and 793 beds, respectively, devoted to primary, secondary, and tertiary inpatient care. Inpatients include those on general medical, medical subspecialty, general surgical, surgical subspecialty, neurological/neurosurgical, obstetrical or gynecological, and pediatric services. The BWH and MGH have several intensive care units, bone marrow and organ transplantation, oncology, and AIDS treatment populations. The clinical activities of the Dana Farber Cancer Institute are now fully integrated with the BWH and the MGH. The MGH has a Pediatric Service and a large Burn Unit, and ophthalmology and otolaryngology services are provided at the nearby Massachusetts Eye and Ear Infirmary (MEEI). Both MGH and BWH have a full range of outstanding medical, surgical, neurological, obstetrical, gynecological, pathological, and radiological expertise. Infectious Disease consultations are important in the operations of all services at these hospitals.

A typical clinical training year includes inpatient consultations, outpatient consultations and primary care of patients with HIV infection, a rotation in the Clinical Microbiology Laboratory, an elective rotation, an ambulatory block rotation focused on sexually transmitted diseases (STDs), travel medicine, tropical medicine, mycobacterial diseases, hepatitis C, and teaching conferences. Specific experience is provided in Transplantation Infectious Disease, care of patients with HIV infection and malignancies, and hospital Infection Control and epidemiology. Inpatient consultations are rendered daily by a consult team consisting of an Attending Physician, one fellow, and frequently medical residents and medical students. Generally two to five new patients are seen by each fellow each day. Each patient's problems are an opportunity for exemplary consultative care and for the dissemination of information among the members of the consult team and to other services. Fellows have a continuity Outpatient Clinic with the same Attending Physician one half-day session per week at their home-base hospital for two years.

Clinical conferences are important learning and teaching experiences. Weekly lectures at the beginning of the year provide a core of Infectious Disease knowledge and approaches. Weekly management conferences at each institution are an opportunity to gain the views of the entire faculty about the previous week's cases. A joint weekly conference brings the entire group of Infectious Disease faculties from BWH, MGH, DFCI, and the other Harvard-affiliated hospitals together for case-oriented, in-depth discussions and for research presentations by senior fellows or faculty. A weekly conference on HIV includes management, literature updates, and relevant research. Each Fellow prepares a journal club at a monthly conference. MGH and BWH also have Medical Grand Rounds and Morbidity and Mortality Conferences, which are core activities of the Medical Services.

Training in the Second Year and Beyond

After the year of clinical training, fellows pursue additional training to meet Board requirements in Infectious Diseases, as well as to prepare for their desired career paths. The majority of the fellows training in the combined Massachusetts General Hospital and Brigham Women's Hospital ID Fellowship pursue additional investigative training in areas ranging from basic science through translational investigation to clinical research and epidemiology. Fellows select a mentor from the Infectious Diseases faculty at either the MGH or BWH for an in-depth research experience. Some fellows pursue basic research training with other faculty at Harvard Medical School, in the Microbiology and Immunobiology Department, or occasionally other departments. Many of the faculty of the MGH and BWH Infectious Diseases Divisions have joint appointments in these Departments and Programs and are also part of these training communities. Depending on past background and experience, this investigative training path generally takes 2-4 years of additional training under the mentorship of an individual faculty member, as described below. Other fellows pursue training as clinician-educators in the fields of HIV medicine or in transplantation Infectious Diseases, sometimes combined with additional investigative training as described below. Key to the success of each of these training paths is the establishment of a personal relationship with an individual mentor to help guide the fellow through his/her training years. We have international health variances to offer international training opportunities for qualified fellows in Durban, South Africa and Mbarara, Uganda in the second year; there are additional international training sites for fellows in the 3rd year and beyond.

  1. Investigative Training in Infectious Diseases (see also Research Fellowship Training in ID)

    Fellows wishing to prepare for a career as an independently funded investigator pursue additional training under the guidance of an individual faculty mentor, in fields such as basic laboratory science, translational investigation, clinical research, epidemiology, or other areas. The key to the success of such a training path depends on identification of a faculty mentor to help guide the fellow during the training period. Potential faculty mentors have research funding of their own to support training of postdoctoral fellows and also serve as mentors on institutional training grants that can support such training. After sufficient experience and expertise has been developed, postdoctoral fellows are encouraged to compete for one of the Career Development Award programs funded through the National Institutes of Health, including the K08 Award (Mentored Clinical Scientist Career Development Award), the K23 Award (Mentored Patient-Oriented Research Career Development Award), and K01 (Mentored Research Scientist Development Award), or the International Research Scientist Development Award from the Fogarty International Center. These awards allow a more extended period of investigative training and the transition from post-doctoral fellow to faculty status as increasing independence from the mentor develops.

    Several of the most commonly used training grants available to Infectious Disease fellows and mentors serving on these training grants, are listed below.

    1. Infectious Disease and Basic Microbiological Mechanisms Training Grant
      T32 AI 007061
      Marcia B. Goldberg, PI

      Description
      The Harvard Medical School-based research training program entitled "Infectious Diseases and Basic Microbiological Mechanisms" offers laboratory-based research training for physicians and postdoctoral PhD scientists. The aim is to provide a substantive research training experience with relevant supporting course work and thereby to enable the postdoctoral trainee to become an independent investigator in the fields of infectious diseases and microbiology. Training laboratories are available in eight major areas (1) virology, (2) bacteriology, (3) parasitology, (4) immunology, (5) molecular biology and genetics, (6) cell biology, (7) epidemiology, and (8) biochemistry and vaccine science.

      List of Current Mentors

    2. Multidisciplinary AIDS Training Grant
      T32 AI07387
      Daniel R. Kuritzkes, PI


      Description:

      The primary purpose of this training program is the development of scientific leaders for careers in HIV/AIDS research. The current expanding epidemic of HIV infection demands commitment of investigators to the training of a new generation of leaders in research. It is anticipated that graduates of this postdoctoral program will follow careers in laboratory research related to AIDS. This program will provide in depth laboratory experience in a specific research area of virology, immunology, molecular biology, oncology, molecular genetics, or molecular therapeutics to selected candidates. Trainees will be MDs after completion of their clinical fellowships or PhDs and ScDs from an appropriate basic science program. Criteria for selection will include prior training record, aptitude for research, and commitment to research careers.

      The basic elements of the program are: 1) in depth research training through laboratory investigation of a specific problem in a particular area related to HIV/AIDS under a senior investigator; 2) a didactic program consisting of appropriately chosen specific courses that will advance the trainee's knowledge; 3) frequent exposure to seminars, workshops, and colloquia related to HIV/AIDS; 4) regular review of progress by individual Progress Evaluation Committees and the Program Steering Committee.

      The primary training facilities consist of well-equipped research laboratories at Harvard Medical School, Harvard School of Public Health, Massachusetts General Hospital, Beth Israel-Deaconess Medical Center, Brigham and Women's Hospital, Boston Children's Hospital, Dana-Farber Cancer Institute, and the New England Regional Primate Research Center. Senior faculty members at each of these institutions are mentors on this grant, and they represent a variety of disciplines. The faculty members collaborate with one another on HIV/AIDS research and will collaborate in directing this training program.

      List of Current Mentors

    3. Program for AIDS Clinical Research Training (PACRT)
      T32 AI007433
      Kenneth A. Freedberg, PI

      Description

      The goal of the Program for AIDS Clinical Research Training (PACRT) is to provide broad training in quantitative research methodologies and closely supervised research experience to both infectious disease and other physicians at an early stage in their careers, as well as to pre-doctoral PhD students with a focus on HIV clinical research. This training will prepare both groups to conduct clinical research of direct relevance to the prevention and treatment of HIV infection, and it will prepare them for the next phase of development as independent investigators using the mechanism of the K01, K08, K23, and K25 awards. This training program has the following three specific aims:

      1) Acquisition of a sufficient body of knowledge of quantitative methods to permit trainees to conduct independent research in one or more of the following areas: clinical epidemiology, biostatistics, clinical trials, decision sciences and outcomes research, and clinical virology or clinical immunology. This aim will be accomplished through pursuit of a core of didactic coursework at the Harvard School of Public Health.

      2) Development of a primary area of research expertise and focus for the trainee. This aim will be accomplished by a minimum of two years of direct research experience under the close supervision of one or more PACRT faculty mentors. Progress will be monitored by both the faculty mentor and the PACRT Steering Committee.

      3) Acquisition of broad understanding of the various aspects of HIV infection in order to permit the trainee to engage in novel interdisciplinary research. This aim will be accomplished through attendance at regular seminars and meetings of direct relevance to HIV research. These meetings include: a weekly HIV Clinical Conference at Massachusetts General Hospital; a weekly journal club in the Infectious Disease Division at the Brigham & Women's Hospital; a weekly journal club in the Infectious Disease Division at the Beth Israel Deaconess Medical Center; a three times monthly HIV Clinical Research-In-Progress meeting based at the Massachusetts General and Brigham & Women's Hospitals, and monthly HIV research meetings at the Harvard School of Public Health.

      Trainees in past years represented the breadth of institutions that make up this training grant, including the Beth Israel Deaconess Medical Center, the Massachusetts General Hospital, Brigham and Women's Hospital, and the Harvard School of Public Health. They have carried out research on HIV disease both in the US and internationally. All trainees have had opportunities to present their work to fellow trainees, as well as to more senior faculty at one or more of the conferences described above.

      List of Current Mentors

    4. Other Training Grants on Which ID Division Faculty Serve as Mentors

      A. Training Grant in Transplantation Biology
      T32 AI07529
      David H. Sachs, M.D., PI

      Description

      This program supports pre- and post-doctoral trainees with the major goal of producing outstanding independent investigators capable of addressing fundamental questions in the fields of immunology and transplantation. This program offers a minimum of 2 years of laboratory-based research training for physicians and postdoctoral Ph.D. scientists. The program integrates substantive research training with relevant supporting course work and research seminars. Training is focused on the basic science program of the Transplantation Biology Research Center, including investigation of allotransplantation and xenotransplantation in hematopoietic stem cell and organ transplantation. There are particular interests in preclinical models of tolerance induction for clinical application. The postdoctoral trainee will benefit from interdisciplinary training in molecular virology, immunology, pathology, and transplantation. For Infectious Disease trainees, research in the laboratory of Dr. Jay Fishman is focused on the pathogenesis of infections in immunosuppressed hosts with an emphasis on molecular virology and xenotransplantation. The components of this program include: 1) research training through laboratory investigation of a specific problem related to immunology and transplantation infectious disease; 2) appropriately chosen courses which will advance the trainee's knowledge; 3) frequent exposure to seminars, workshops, and colloquia related to immunology and infectious diseases; 4) regular review of the progress by the individual mentors and the Program Steering Committee.

      Massachusetts General Hospital:
      Mentor: Jay A. Fishman, M.D., Professor of Medicine

  2. Training as Clinician-Scholars in HIV Medicine or Transplantation ID

    Some fellows pursue training as clinician-educators in the fields of HIV medicine or in transplantation Infectious Diseases, sometimes combined with additional investigative training as described above.

    1. HIV Clinician-Educator Tracks (One spot at the BWH and one at the MGH each year)

      The primary purpose of this track is to train outstanding clinical educators in the field of HIV medicine. The ideal candidate for this position is a fellow who wishes to focus on HIV clinical care and education beyond what is learned through the standard infectious diseases fellowship. This path may also be well-suited for a fellow interested in a career in global HIV who desires additional focused training in the clinical care of HIV-infected patients. Fellows spend one year in this track, generally during the second year of their infectious diseases training. Each year in this track, there is one position at the BWH and one at the MGH.

      The main components of the HIV Clinician Educator Track are 1) outpatient and inpatient clinical work with an emphasis on longitudinal HIV care; 2) developing expertise in the use of antiretroviral therapy, management of HIV-related complications, interpretation of resistance testing, and use of experimental agents; 3) organizing the respective hospital's (MGH or BWH) weekly HIV clinical conference; 4) providing consultation for occupational and non-occupational administration of post-exposure HIV prophylaxis; 5) educating other fellows, residents, and medical students on HIV-related topics; 6) recruitment of subjects for on-site HIV clinical trials. A key additional component of the HIV Clinician-Educator track is for the fellow to take the lead on an academic project that will lead to a conference abstract, a review paper, or a book chapter. This project will be done under the mentorship of one of the Senior Faculty at his or her respective institution.

      After completion of the second-year HIV Clinician-Educator track, fellows are eligible to take the certification examination of the ABIM in the subspecialty of Infectious Disease and may seek a staff position in a clinical educator role. Alternatively, some fellows have used this HIV Clinical year as a springboard to other research projects and training related to HIV clinical and translational research, both here and internationally. If this path is chosen, fellows will be expected to identify during their second year an appropriate research mentor to help them apply for funding in this area.

      Supervising faculty:

      BWH:
      Daniel R.  Kuritzkes, M.D., Chief of the Infectious Disease Division, Brigham and Women's Hospital
      Paul Sax, M.D., Clinical Director, Brigham and Women's Division of Infectious Diseases and HIV Program
      Sigal Yawetz, M.D., Associate Physician, Brigham and Women's Hospital
      Cameron D. Ashbaugh, M.D.

      MGH:
      Stephen B. Calderwood, M.D., Chief of the Infectious Disease Division, Massachusetts General Hospital
      Rajesh T. Gandhi, M.D., Director, HIV Clinical Services and HIV Education, MGH
      Nesli O. Basgoz, M.D., Associate Chief and Clinical Director, Infectious Diseases, MGH
      Benjamin T. Davis, M.D., Physician, MGH; ID Fellowship Program Director
      Marcia Goldberg, M.D., Director of Research, Infectious Diseases, MGH
      Kimon Zachary, M.D., Associate Physician, MGH

      More details regarding the HIV Clinician-Educator Track may be found at http://www2.massgeneral.org/id/education_and_training/fellowship_training/goals/

    2. Transplantation ID Tracks

      MGH Fellowship Program in Clinical Care and Investigation in the Immunocompromised Host

      Jay A. Fishman M.D., Director, MGH Transplant Infectious Disease and Compromised Host Program

      This program provides advanced training in the clinical care of immunocompromised patients and clinical investigation in Transplantation Infectious Diseases. Infectious Disease Fellows will enter this program after completion of one clinical year in Infectious Diseases. The MGH Transplantation Infectious Disease and Compromised Host Program was established to facilitate the evaluation, prevention, and treatment of infectious diseases in liver, heart, lung, kidney, pancreas and hematopoietic stem cell transplant recipients at the Massachusetts General Hospital. These patients are unique in the complexity of their immune deficits, in their predisposition to opportunistic infection, and in the need to understand the management of antimicrobial therapies and of drug interactions for optimal clinical care. The goal of the program is an individualized approach to acquiring knowledge about immunosuppressive therapies (exogenous immune suppression), immune defects (innate or acquired), modern diagnostics, and antimicrobial therapies (prophylaxis and treatment). The trainee also benefits from ongoing interactions with expert clinicians in Transplant Surgery and Hematology-Oncology and basic research scientists studying preclinical models of transplantation in the Infectious Disease Division, Transplant Unit and Transplantation Biology Research Center.

      The optimization of care requires experience in the management of these complex patients and an understanding of the relationships between immune deficiency and the prevention of infection. Each Fellow will spend 1-2 years in a combination of clinical training and clinical investigation.

      Individualized programs will be developed to include: 1) mentored experience caring for immunocompromised patients; 2) clinical and translational research training through participation in studies of a specific problem in clinical immunology and transplantation infectious disease; 3) appropriately chosen courses that will advance the trainee's knowledge; 4) frequent exposure to seminars, workshops, and colloquia related to immunology and infectious diseases; 4) regular review of the trainee's progress. The expectation is that candidates will become superior clinicians and will develop peer-reviewed publications as a part of their training program. Criteria for selection include prior training record, clinical expertise, aptitude for research, and commitment to the care of immunocompromised hosts.

      BWH/DFCI Transplant/Oncologic Infectious Diseases Training Pathway

      Mentors and supervising faculty:

      Lindsey R. Baden, M. D., Director, Dana-Farber Cancer Institute Division of Infectious Disease
      Francisco M. Marty, M. D., Associate Physician, Brigham and Women's Hospital

      Brigham & Women's Hospital and Dana-Farber Cancer Institute provide a rich environment for advanced Infectious Diseases training in the areas of oncologic and transplant infectious diseases. The ID Division provides consultation services for a high volume of patients with complex infectious disease issues resulting from transplantation (both hematopoietic stem cell and solid organ, with several hundred transplants performed each year) and oncologic care. Services are provided in both the inpatient and outpatient setting.

      We are engaged in diverse aspects of clinical research in this patient population:

      a. Defining and refining the clinical epidemiology of opportunistic and non-opportunistic infections in diverse cohorts (leukemia, HSCT and lung transplantation).
      b. Development and validation of new diagnostic tests and strategies to optimize the care of the immunocompromised host.
      c. Design and conduct of local and multicenter clinical trials of new antivirals, antibacterials, and antifungals.
      d. Collaborative research with basic scientists to understand different aspects of the immunology, pathology and pathophysiology of opportunistic infections in this population.

      There are opportunities for advanced training in clinical care and clinical research for interested ID fellows. Such training will be tailored to the fellow's specific interests

Application Process

Applications to the ACGME Fellowship beginning in July 2015 will be accepted via ERAS (Electronic Residency Application Service) from July 1, 2014 – August 15, 2014.

Applications to the ACGME Fellowship beginning in July 2014 will be accepted via ERAS (Electronic Residency Application Service) from July 1, 2013 - August 15, 2013.

We also have Research Training opportunities outside the ACGME-Certified Program. Applicants wishing to have additional research training may contact individual faculty members about potential positions in their basic or clinical research programs. If you wish information about our faculty and their research interests, you should contact the Fellowship Program Manager, Denise Saleem.

 

 
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