Mission

Our primary mission is to provide an educational environment conducive to preparation for a lifetime of study, problem solving, and critical decision making in the practice of Infectious Diseases and provide care and consultation for our military beneficiary population.

Vision

Support fellows as they develop into infectious disease subject-matter experts providing expert care to our military beneficiaries and advancing military medicine through their professionalism, proficiency, and scholarship.

Aims

• Train a diverse group of ID expert physicians who are committed to exceptional care of our military beneficiaries.
• Prepare trainees who are poised to become leaders in patient care, education, research, and scholarship.

The curriculum is based upon the ID core knowledge content as outlined by the RRC-IM. Presentations are saved in electronic format upon a share-drive which all fellows and staff have access for review. Core didactic sessions include both fellows and faculty members, include fellow-fellow and faculty-fellow interactions, emphasize the importance of interaction, occur weekly, and include:

Thursday afternoons (3:30 p.m. - 4:30 p.m.)

Case Conference

During case conference, a fellow presents a clinical case followed by a review of medical literature pertinent to questions raised by the case (these are 30 minutes long and two sessions are paired on Thursday afternoons; fellows will typically present two cases/four week block of inpatient consults). The ordering of these conferences may be spaced or changed based on speaker availability.

HIV Case Conference

Occurs once each block (30 minutes), typically on the fourth Thursday, the fellow on urgent care or a faculty will present an HIV-relevant case conference and review the pertinent literature.

Pediatrics Case Conference

Occurs once each block (30 minutes), typically on the fourth Thursday with an HIV case conference, the pediatric ID fellow on service (or covering faculty), will present an pediatric ID case.

First Thursday Guest Speakers and Wellness

Occurs each first Thursday of the block rotates between guest speakers (who are experts in various ID relevant topics) who will deliver an ID grand rounds talk on their area of expertise or a wellness activity. The wellness activities rotate between including only fellows together and the faculty and fellows and are arranged and organized by the chief fellows and program leadership. Further details below in “Well-Being” section.

Friday morning academics (7:30 - 8:30 a.m.) 

Academics

Rotates through journal club, research/QI conferences, and core academics

Journal Club

This conference occurs approximately once per month, and is co-led by a faculty and one fellow who jointly choose an article to examine with the other fellows and faculty. This article is selected based on recent practice changing publications or a recent challenging clinical question of the fellow.

Research/Quality Improvement (QI) Conference

Each fellow will present at least annually. These conferences are designed to provide exposure to the program’s ongoing projects as well as to provide valuable feedback to the investigator. Content includes research or QI projects at any stage of development from conceptualization through presentation of mature data.

Core Academics

Approximately 20-30 core academics are presented during the first months of each academic year in order to maximize new fellow exposure to common infectious disease problems seen early in training (e.g. “Intro to Travel”, “Intro to Antimicrobials”, “Intro to HIV”). Core academics then continue throughout the year. When appropriate, the core academics will focus on topics unique and/or relevant to a military Infectious Disease provider (i.e. infection prevention and control in the deployed setting; Updates in HIV and the military; Emerging Viruses, IPAC, and the Military). Core academics are also assigned to various additional formats including guideline reviews, reviews (by attendees) of recent national or international meetings’ content, and “hot topics” literature reviews, and faculty development.

Friday afternoon academics (12 or 12:15 - 1 p.m.)

Academics

Rotates through challenging cases discussion, Friday fellow Round-Up, DC Tropical Medicine, and USU/WRNMMC Department of Medicine Grand Rounds

Challenging Cases Discussions

These occur at 12:15 on Fridays throughout the academic year and are designed to discuss ongoing challenging inpatient and outpatient cases of fellows and faculty in a less formal setting.

Friday Fellow Round-up

Occurs once during each 4-week block, a faculty will review high yield teaching points from that block’s prior academics using interactive discussion with only fellows in a less formal setting. This capitalizes on time-spaced learning to consolidate the information taught and increase fellow learning and retention.

D.C. Tropical Medicine

Occurs once monthly on Fridays at noon, a D.C.-wide virtual academic session taught by national leaders in tropical medicine.

USUHS/WRNMMC Department of Medicine Grand Rounds

Occurs approximately once monthly grand rounds on Fridays at noon nationally renowned speakers with a wide-range of expertise will present grand rounds.

Microbiology Plate Rounds (Mondays and Thursdays at 11 a.m.)

Plate Rounds

Led by the department of microbiology and includes a review on ongoing relevant cultures for the ID inpatient and outpatient team as requested by the fellows. Additionally, a compendium of microbiology core topics has been compiled, and is reviewed throughout the year, including high yield microbiology resources.

Additional WRNMMC ID Fellowship Academic Opportunities

Greater Washington Infectious Diseases Society Meetings

Occur monthly in the evenings, off-site, throughout the non-summer months. All the fellowships throughout the DC area will gather to share their most interesting cases. Each fellow presents at least one case during their fellowship in this forum. Presentations are based upon clinical questions and include an expansive review of the literature. This is a formal grand rounds presentation for 20-30 minutes. Programs presenting at GWIDS are the National Institutes of Health, WRNMMC, Inova Fairfax Hospital, The George Washington University/Washington VA Medical Center, USUHS Pediatrics, Children’s National Hospital, Georgetown University Hospital, and Howard University Hospital. There is additionally the yearly Franklin A. Neva Clinical Parasitology Symposium that occurs each spring organized through GWIDS.

WRNMMC and USUHS Faculty Development

In addition to the faculty and professional development included in ID Fellowship academics, fellows and faculty are encouraged to attend faculty development offerings through the institution and USUHS.

The ACGME requires a minimum of 12 months of supervised clinical rotations completed during year 1 and year 2.

• Clinical Educator Elective
• Additional clinical time available as requested at Washington Hospital Center

Fellows take call every other day while on inpatient consults. It is rare that an overnight consult results in the fellow having to come into the hospital and typically a fellow may receive approximately 4-5 calls overnight throughout the course of a 4-week block of inpatient consults.

The military-unique knowledge and skills required in this specialty include understanding of and ability to manage deployment and travel related infections, emerging infections, diseases of pandemic potential and bioterrorism agents, management of outbreaks, infectious complications of combat trauma and infection prevention and stewardship in the deployed setting.

• As a primary site for medical evacuations through Landstuhl Regional Medical Center, fellows have ongoing clinical exposure to a variety of combat, conflict, and deployment-related infectious complications.
• Academic time is dedicated to infections with a focus on combat trauma, burns, travel and tropical medicine, military requirements in HIV care, latent tuberculosis with a focus on military-specific risk factors and systems, infections in military trainees, deployment-specific infection control, among numerous others.
• Fellows and faculty participate in a formal faculty/leadership development course administered by the program including topics such as professional development, conflict resolution, and communication.
• Fellows participate in simulation exercises designed to advance competence in outbreak management, infection prevention and control, and antibiotic stewardship.
• Fellows are required to attend the USUHS military tropical medicine (MTM) course, which includes either a 4-week (short tropical medicine course for those doing 2-year clinical fellowships) or 3-month (for those who elect to complete a third year of fellowship) session with academics and hands-on lab experiences. Following the MTM course a 2-3 week overseas mission is available to multiple sites throughout the world based on fellow-interest.
• All fellows attend the Principles of Biocontainment Course (PBC) at Center for Sustainment of Trauma and Readiness Skills-Omaha (C-STARS Omaha). PBC is located at The University of Nebraska Medical Center / Nebraska Medicine (UNMC / NM) in Omaha, Nebraska. UNMC / NM is a public center of health sciences research, patient care, and education. They are a premier U.S. institution for highly hazardous communicable diseases and a go-to resource for the U.S. Dept of Health and Human Services. They are also recognized internationally for their expertise in the field of bio-preparedness and high-consequence special pathogens. The PBC course at C-STARS Omaha is a five-day course designed to prepare DOD medical personnel to respond to high consequence infectious diseases – infectious diseases that are capable of causing serious illness and spreading from person-to-person – to ensure operational readiness and maintain clinical currency.

In-Person

1. USUHS Military Tropical Medicine Didactics and Field Courses (either one of two courses): 
• Tropical Medicine Course, ASTMH (CTROPMED) Certification Course (Feb-May)
• Military Tropical Medicine Course (4 weeks)
2. National Jewish Tuberculosis Course
3. CSTARS Omaha Nebraska Principles of Biocontainment Course
4. National Institutes of Health Microbiology Course - All fellows will attend a weeklong course taught by nationally renowned microbiologists at the NIH during their first year of fellowship.

Virtual

1. SHEA Annual Fellows Course in Healthcare Epidemiology
2. Stanford Antimicrobial Stewardship Course
3. Stanford University Faculty Development Course for Health Professions Educators on the provision of healthcare to LGBTQ+ patients
4. Cultural Competency Training, “community engagement and culture competency" 

The fellows participate in two individual simulation exercises which are built from real-world deployment consults during their second year of fellowship.

Fellows have the opportunity to be nominated for the Junior Leadership Course if an Army fellow, the Female Physician Leadership Course, participate in longitudinal leadership training from USUHS, and have mentorship and coaching by a diverse group of military leaders while in ID Fellowship at WRNMMC and in the D.C. area.

Involvement in research is considered a crucial part of Infectious Diseases training. The ACGME requires that all fellows must engage in at least one of the following scholarly activities: participation in grand rounds; posters; workshops; quality improvement presentations; podium presentations; grant leadership; non-peer-reviewed print/electronic resources; articles or publications; book chapters; textbooks; webinars; service on professional committees; or serving as a journal reviewer, journal editorial board member, or editor.

All fellows are expected to participate in projects of their own design, or, more commonly, in collaboration with ongoing projects at WRNMMC, the Infectious Disease Clinical Research Program, Naval Medical Research Center, U.S. Army Medical Research Institute of Infectious Diseases, Walter Reed Army Institute of Research, the Multidrug-Resistance Organism and Surveillance Network, National Institutes of Health, local universities including the Uniformed Services University, and others. At the end of each year, each fellow presents their work for that year at during a Friday AM conference (in both their QI as well as research projects—which satisfies ACGME requirements for scholarly activity). All fellows are expected to choose a mentor(s) who will oversee their research experience.

Fellows are expected to present their research progress at the ID Fellowship Annual Research Reviews at the end of each academic year.
Additional opportunities to disseminate their research include:

• Regional conferences: Tri-service ACP Meeting, 2024 IDCRP Science Symposium Fellows Day, MHSRS Annual Meeting
• National conferences: ID Week and the ASTMH Annual Meeting

Each year the fellowship is required to develop and execute a quality improvement project. Recent projects have included addressing Lyme disease diagnostics, pneumococcal vaccination in transplant patients, C diff diagnostic stewardship, and anal pap screening.

In addition to the opportunities detailed within the Leadership Curriculum and military unique curriculum sections above, the ID Fellowship hosts a Transition to Practice Course prior to fellows graduation specifically designed to prepare them for leadership within areas specific to ID: Infection Prevention and Control, Antimicrobial Stewardship, and ID clinic leadership.

• Washington Hospital Center: 900+ bed hospital, level 1 trauma center, burn center, and patient population who have significant health disparities
• National Institutes of Health: National referral center with stem-cell transplant, rare immunodeficiencies, and regional didactics
• Children’s National Hospital: a top-ranked pediatric hospital seeing high acuity and complex pediatric cases

Medical students rotating on the Infectious Disease Service at WRNMMC will have the opportunity to see a broad variety of Infectious Disease syndromes at the largest training platform in the DOD. Students will spend the majority of their time on the inpatient consult service where they will have the opportunity to work closely with the ID Fellow and Faculty while evaluating patients with a wide variety of Infectious Disease complaints including but not limited to: bone and joint infections, trauma-related infections, infectious endocarditis, HIV/AIDS, device related infections (including cardiac devices), rickettsial infections, Tropical Medicine infections (including malaria, dengue fever), mycobacterial infections (including tuberculosis), Fever of Unknown origin/ID mimickers, and Fever in returning travelers.

WRNMMC is unique in the DOD due to its solid-organ transplant service, which ultimately provide unique opportunities to evaluate infections in immunocompromised hosts. While this is primarily an inpatient consult service rotation, there are opportunities to spend 1-2 half-days in the outpatient ID clinic seeing patients presenting for travel medicine consultation, latent tuberculosis, sexually transmitted infections, HIV, Pre-exposure prophylaxis for HIV, Non-tuberculous mycobacterial or fungal infections, tick-borne or arboviral infections, bone and joint infections, and/or suspected/unknown infectious syndromes. The student will be expected to attend ID conference academics on Thursday afternoons and Friday mornings and microbiology plate rounds twice weekly. They may also have the opportunity to attend the Greater Washington Infectious Disease Society Monthly meeting (typically September-May).

Since the pandemic, DOD Infectious Disease Fellowship programs have agreed that interviews should be primarily virtual so as to avoid over burdening trainees with the cost of traveling for interviews; however, this is not mandatory and should an applicant wish to travel to visit a program they are more than welcome to do so. Interviewees should plan to interview at both WRNMMC and SAUSHEC if they are Army applicants and both WRNMMC and NMCSD if Navy. Interested applicants may email the program to set up an interview, dha.ncr.walter-reed-med-ctr.list.ncc-id@health.mil. 

Program graduates take the ABIM Infectious Diseases Board exam. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABIM by 10/31. Those who elect to complete a third year of fellowship with the long tropical medicine course at USUHS, and have requisite international travel experience, are also eligible to sit for the Certificate of Knowledge in Clinical Tropical Medicine and Travelers' Health (CTropMed® Examination) which is offered every two years.

There are numerous teaching opportunities during ID fellowship including the opportunity to hone your teaching craft while completing a clinical educator elective, participating in a wide variety of didactics with varied learners through the year, as well as participating in the USU Faculty Development Teaching certificates. Additionally, as WRNMMC is co-located on NSA-Bethesda with USUHS, opportunities for teaching and mentoring USUHS students abound.

WRNMMC is the first MHS facility to have both an outpatient and inpatient stewardship pharmacist embedded within our team. Additional certifications carried by our inpatient ASP pharmacist include BCIDP and AAHIVP.

Well-being is about program culture, and at WRNMMC we emphasize fellow-centric training with open dialogue between leadership and our fellows—including creation of a chief fellow to increase communication and twice yearly program evaluation meetings to continually improve our program systematically. We have wellness regularly built into dedicated academic time to avoid this being an additional item for fellows. Recent wellness activities are fellow and faculty driven and have included dinners, volunteerism events (a faculty and fellow favorite is park clean-ups of our nearby beloved Rock Creek Park), and hikes.