CLINICAL INFECTIOUS DISEASES - … infectious... · Infectious diseases curriculum Rotation map Year Of training Rotation 1 (6 ... Recognize the concept of normal and non-normal distribution

THE EGYPTIAN FELLOWSHIP

CLINICAL

INFECTIOUS DISEASES CURRICULUM

The structure and Regulation of Infectious disease Training

Clinical Infectious Diseases Egyptian Fellowship

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Egyptian Fellowship Board

Infectious Disease Fellowship Training Curriculum

الوظيفة اإلسم هيئة المجلس

القاهرةبطب األمراض الباطنة.أ أميمة مصطفى الحناوى/ د.أ رئيس المجلس

األمراض الباطنة بطب القاهرة.أ هناء الدجوى/ د.أ مقرر التدريب

األمراض الباطنة بطب القاهرة.أ مرفت مطر/ د.أ مقرر اإلمتحانات

األمراض المتوطنة بطب القاهرة.أ جمال عصمت/د.أ عضو

الباطنة بطب القاهرةاألمراض .أ منى أمين/ د.أ عضو

بطب المنيا الصحة العامة. أ ايمان محفوظ/ د.أ عضو

بنى سويفبطب الميكروبيولوجى.أ عزة. د.أ عضو

استشارى الحميات مستشفى حميات امبابة فتحى شبانة. د عضو

استشارى التحاليل بالمعامل المركزية فاطمة. د عضو

سيةمدير مستشفى حميات العبا ماجدة.د عضو

عضو

عضو

عضو

عضو

عضو

عضو

عضو

عضو

عضو


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5

Acknowledgement


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TABLE OF CONTENTS

Page

Programme content and objectives

10

First Training Rotation 11

Community acquired infections 13

Long Term infections 17

The principles of pulmonology as related to clinical infectious diseases -18 18

Hospital acquired infection (HAI), including intensive care (ICU) related illness – 20 20

Infection in immunocompromised host – 21 21

List of required lectures and seminar titles – 23 23

Methods of assessment – 27 27

The structure of the examination – 28 28

The structure and regulation of infectious diseases training – 29 29

Trainees duties and obligations – 30 30

Specific requirements and obligations – 30 30

General rules and regulations - 31 31

vEgyptian Fellowship for infectious diseases – Medical Microbiology – 32 32


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Infectious diseases curriculum Rotation map

Year

Of

training

Rotation 1

(6 month)

Rotation 2

(6 month)

Rotation 3

(6 month)

First

18 month

Basic sciences

General fever hospital

General

fever

hospital

2&1/2 month

Bacteriology

1/2 month

parasitology

2 month

Epidemiol

ogy

1 month

Infection

control

Second

18 month

Rotation 1

(6 month)

Rotation 2

(6 month)

Rotation 3

(6 month)

2

month

2

month

2 month 2 month 2 month 2

m

o

n

t

h

General

fever

hospital

1

month

1 month 1

month

1

month

1

month

1

month

Liver

institut

e

Chest

hospit

al

Pediatr

ic out

patient

clinic

ICU Post

operativ

e

Skin&

Venerea

l

Out

patient

clinic

BM

transpla

nt unit

Renal

transp

lant

Unit

H

I

V

U

N

I

T


9


01

Programme content and objectives

The Training Programme in Infectious Diseases aims to Qualifies practitioners who:

1. Exhibit appropriate attitudes and communication skills in dealing with colleagues and

patients.

2. Have effective team working and leadership skills

3. By appropriate use of history, clinical examination and investigation can perform the core

assessment required for all physicians practicing in Infectious Diseases

4. Are able to establish a differential diagnosis of patients presenting with clinical features of

Infectious Diseases

5. Are able to apply sufficient knowledge and skill in diagnosis and management to ensure safe

independent practice in Infectious Diseases

6. Can apply knowledge of the appropriate basic sciences relevant to Infectious Diseases

7. Can develop management plans for the “whole patient” and have a sound knowledge of

appropriate treatments including health promotion, disease prevention and long term

management

8. Fully appreciate and know how to use the multi-disciplinary team approach for management

of infection within the hospital and community, including a recognition and understanding of

application of public health management

9. Have achieved a firm grasp of basic research methodology and are able to participate in and

initiate research activity

10. Can use skills of lifelong learning to keep up to date with developments in Infectious

Diseases

11. Can be an effective teacher

12. Are able to manage time and resources to the benefit of their patients and colleagues.

Specialty specific objectives are:

1. To obtain clinical competence at consultant level in the assessment, Investigation, diagnosis

and management of community acquired infection

2. To obtain clinical competence at consultant level in the management of

Immunocompromised patients including those suffering from HIV/AIDS

3. To acquire the skills necessary at consultant level to recognize and manage

4. Hospital acquired infection, and institute control systems, including

5. Postoperative and Intensive Care related illness

6. To achieve competence at consultant level in the diagnosis, investigation and

7. Management of imported infection and in the provision of advice in relation to

8. Travel medicine

9. To obtain an understanding of the role of the microbiologist and virologist and

10. The importance of microbiological techniques and their interpretation in

11. Infectious Diseases and to understand the process and constraints around

12. The microbiological report

13. To become competent in all aspects of the management of antibiotic use.

14. To obtain an understanding of research methodology and the practical Implementation of

research projects

15. To have the opportunity for additional enhanced training in specific areas Related to

Infectious Diseases including Medical Virology, Clinical Pharmacology, Public Health and

Epidemiology, GU Medicine, Vaccinology, Overseas practice (this part of the curriculum is

optional but will be important To some trainees dependent on their intended career pathway)


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16. To have the opportunity, if desired and appropriate, to participate in clinical or Laboratory

based research related to infectious diseases by taking time out of Programme if

prospectively agreed by training authorities.

17. To obtain an understanding of prevention of spread of infection in both

18. Community and healthcare settings.

First Training Rotation

Epidemiology rotation

The purpose of this rotation is to train fellows in the field of Infectious Disease Epidemiology. The

trainees will learn the principles of epidemiology and will be introduced to a spectrum of

biostatistical techniques. These skills will be applied and fully developed by completing a research

project of appropriate content, scope, and depth. The course is composed of the following modules:

Principles of outbreak investigation:

Trainees by the end of the module will be able to:

a) Evaluate disease outbreak to determine likely source, cause, mode of acquisition and

resulting recommendations

b) Calculate an incidence (attack rate). Prevalence rate, secondary attack rate, and case

fatality rate in an outbreak

c) Recognize the epidemiologic characteristics indicative of a common source outbreak

(e.g. contaminated vehicle).

d) Differentiate infection, disease, colonization, and carrier rate.

Modes of transmission:


a) Discuss the major routes of transmission/acquisition of microorganisms (e.g. Type of

contact, common vehicle, airborne, vector-borne.)

b) Describe major sources and reservoirs of different microorganisms, including sites of

colonization

c) Explain the seasonal effects on infectious diseases

Infection control in hospitalized patients


a) Differentiate between sterilization, disinfection, cleaning and decontamination in

hospital infection control procedures.

b) Recognize the predisposing factors for hospital –acquired infection by organ system,

including lung, urinary tract, skin, blood, CNS & GI tract.

c) Develop immunization plan for health-care professionals

d) Make recommendations for control of epidemic/outbreak of hospital-acquired

Infection


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Surveillance

a) Recognize diseases that should be reported to the relevant public health, and the procedures

to be used

Principles of Epidemiologic research and biostatistics

a) Recognize the design and application of different types of observational and experimental

studies

b) Identify the major types of bias in epidemiologic studies (selection bias, misclassification, or

ascertainment bias)

c) Recognize outcome and risk factors

d) Calculate prevalence, incidence, relative risk, attributable risk, case fatality rate, and odds

ratio

e) Evaluate and appraise epidemiologic studieDescriptive statistics

Differentiate an arithmetic mean from a geometric mean

Recognize the concept of normal and non-normal distribution of data

Use appropriate methods of describing dispersion (range, standard error, standard

deviation)

Calculate vaccine efficacy

Perform sample size estimation

Recognize methods for hypothesis testing and application of statistical tests

Calculate the sensitivity and specificity of diagnostic tests


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Community acquired infections

Module Intended Learning Outcomes

A. KNOWLEDGE:

By the end of the training program, trainee must have adequate knowledge and deep

understanding of:

The Clinical presentation of infectious diseases including unusual infections and rare

infectious diseases.

Common conditions& syndromes in infectious diseases including:

PUO

Sepsis syndrome

Community acquired pneumonia

IE

Infective hepatitis

Food born infections

CNS infections

Urosepsis

Bone& joint infections

severe skin& soft tissue infections

exanthemata

fever in the returning traveler

The Pathophysiology of clinical physical signs relevant to infectious diseases

The Pathophysiological basis& relevance of investigations

The cost& safety of investigation

The principles of evidence based management of infections

How to access up & evaluate guidelines produced by agencies e.g. NICE

The indications, contraindications, side effects, drug interaction and dose of commonly used

drugs in the management of infectious diseases

The epidemiological consequences of infectious diseases and when& how to access other

relevant health care teams and services

The diseases that are notifiable& systems for notifications

The availability and purpose of relative screening& immunization programmes

The components of safe working practice in the personal, clinical& organizational settings

B. INTELLECTUAL AND PROFESSIONAL SKILLS

To have the ability to:

Take relevant, succinct& logical histories even when the patient is confused, aggressive and

non compliant

Perform a valid clinical examination even in distracting environment or with unconscious

patient.

Elicit appropriate physical signs, assess cognitive functions& mental state including

recognition of possible deliberate harm

Select appropriate investigation& interpret results.

Perform specific diagnostic techniques including lumbar puncture, chest and ascetic

aspiration, joint aspiration, LN aspiration


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Assimilate clinical, laboratory and epidemiological information’s and use it to differentiate

between infections and other conditions

Construct a problem list in scenarios where there are a number of issues to be considered

Competent perform core& therapeutic procedures including ABG, CV cannulation, urinary

catheterization, basic air way management& advanced life support

Recognize when a patient is not responding to treatment& reassess the situation

Communicate effectively& respectively with other relevant professionals

Module Contents

A. THEORETICAL TOPICS

Topics

Temperature regulation

Antipyretics& anti inflammatory drugs

Definition& approach to a patient with PUO

Immune response to infection, cytokines& sepsis syndrome

Antibacterials, Mode of action,

Mechanism of resistance

Streptococcal infections

Staphylococcal infections

Including MRSA

Anti mrsa & anti vre Drugs

Pneumococcal infections

Atypical pneumonias

Nosocomial& ventilator associated pneumonia

Pertussis, diphtheria

Meningeal infections

Osteomyelitis

Clostridial infections

Tetanus

Salmonella infections

Shigellosis, Cholera Campylobacter, E coli

Diarrhea of travelers

Yersinia infections

Anthrax

Pseudomonas infections

Listeriosis, Erysipeloid

Actinomycosis, Nocardiosis

Brucella infections

Bartonella infections

Leprosy

Uti

Sexually transmitted diseases

Relapsing fever

Leptospirosis

Chlamydia infections

Rickettsiosis

Zoonosis

Antiviral drugs


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Common cold, Influenza, RSV

Adenovirus diseases

Exanthemata

Mumps

HSV infections

Hzv

Ebv, cmv

Hemorrhagic fevers

Coxsackievirus diseases

Encephalitis

Rabies

Antiprotozoal drugs

Malaria

Babesiosis

Giardiasis

Endameba

Toxoplasma infection

Leishmaniasis

Antifungal drugs

Superficial mycosis

Endemic mycosis

Histoplasmosis

Coccidioidomycosis

Paracoccidioidomycosis

Blastomycosis

Sporotrichosis

Opportunistic, mycosis, Aspergillosis, Candidiasis, Cryptococcal , Zygomycosis

Anthelminthic drugs

Trematode infestation

Nematode infestation

Cytode infestation

Schistosomiasis

Fasciola infestation

B. CLINICAL CASES (All cases are expected to be seen in the fever hospital wards, OP clinic or

ER)

Central nervous system

Meningitis

Encephalitis

Brain abscess

Subdural, epidural abscess

Venous sinus septic thrombosis

Mucormycosis

Tetanus

Rabies

Respiratory system

Upper respiratory tract infections

pharyngitis, epiglottitis

Otitis media, otitis externa

pertussis

http://emedicine.medscape.com/article/220298-overview


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lower respiratory tract infections

Bronchitis

Pneumonia (Community acquired & Hospital acquired)

Pleural effusion

Empyema

Conjunctivitis

CVS infections

Endocarditis

Myocarditis

Pericarditis

Fever of unknown origin

Gastrointestinal infections

Oral & Esophageal candidiasis

Biliary tract infections

Gastroenteritis

Infectious diarrhea

Enteric fever

Brucellosis

Peritonitis

Infective hepatitis

liver abscess

pseudo membranous colitis

Diverticulitis

Whipple disease

Skin infections

Cellulites

Erysipelas

Diabetic foot

necrotizing fasciitis

cutaneous leishmaniasis

Sepsis, septic shock syndrome

Viral infections

Influenza

CMV

EBV

HS VIR

HZ

Viral Exanthemata

Mumps

Hemorrhagic fevers

Genitourinary infections

Cervicitis, vaginitis

Sexually transmitted infections

Gonorrhea, Chlamydia, trichomonas, herpes simplex, syphilis

Pelvic inflammatory disease

Septic abortion, puerperal sepsis

Cystitis

pyelonephritis

Perinephric abscess


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Systemic candidiasis

Aspergillosis

Mucormycosis

Musculoskeletal

Osteomyelitis

septic arthritis

Pot’s disease

Tropical myositis

Malaria

Giardia

Endameba

Toxoplasmosis

Heat emergency

Heat stroke

Malignant neuroleptic hyperthermia

Malignant hyperthermia

Long Term infections (TB, HCV, HBV)


A. KNOWLEDGE


understanding of

The epidemiology and natural history of HCV& HBV

Extra hepatic presentations of chronic HCV& HBV

Complications of chronic HCV& HBV infection

Indications for treatment

The importance of multi-disciplinary working.

Drugs in HBV& HCV treatment


Appropriately Diagnose illness including atypical presentations using clinical and

epidemiological skills

Select suitable hepatitis patients for treatment

Monitoring therapy and ensuring compliance with treatment

Counseling patients on matters of infection risk, transmission and control

Develop and agree with your patients and care givers on holistic management plan ensuring

awareness of alternative therapies and means of patient support

Prescribe anti HCV &anti HBV drugs

Follow up patients regarding responders & non responders

Follow up patients for adverse side effects of drugs

Diagnose & treat extra hepatic presentations of HCV& HBV


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Module Contents


Acute viral hepatitis

Chronic active hepatitis

extra hepatic manifestations of HCV&HBV infection

Indications For antiviral treatment

Antiviral drugs in HCV&HBV infection

Regimens of treatment

Management of extra hepatic manifestations

Prophylactic measures

Economic impact of HCV&HBV infection& treatment

B. CLINICAL CASES (All cases are expected to be seen in the NATIONAL LIVER INSTITUTE)

Acute viral hepatitis

Acute HCV infection

Chronic active HCV

Chronic active HBV

Chronic active HCV with essential mixed cryoglobulinemia

Chronic active HCV with renal disease

Chronic active HCV with lichen planus

Chronic active HCV with arthritis

Chronic active HBV with renal disease

Chronic active HBV with polyarteritis nodosa

The principles of pulmonology as related to

clinical infectious diseases


A. KNOWLEDGE:


understanding of

Pathogenesis& immune response to TB infection

Patterns of tuberculous infection

Pathology of TB granuloma

Epidemiology of TB

Clinical presentations of TB

Investigations for diagnosing active& latent TB

Anti TB drugs: dose, side effects, contraindications

Different regimens for treatment

MDR-TB

Isolation& precautions to protect other patients& hospital staffs

DOT& DOT plus programme


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To have the ability to:

Take relevant, succinct& logical histories even when the patient is confused, aggressive and

non compliant.

Perform a valid clinical examination

Select appropriate investigation& interpret results.

Perform specific diagnostic techniques including lumbar puncture, chest and ascetic

aspiration, joint aspiration, LN aspiration

Assimilate clinical, laboratory and epidemiological information and use it to suspect those

with e.g. hepatic or renal impairment who need dose adjustment or those suspected to have

MDRTB

Construct a problem list in scenarios where there are a number of issues to be considered

Be competent in different therapeutic regimens

Expert in mandatory measures against spread of infection e.g. negative pressure isolation

rooms, safety masks

Follow up patients in outpatient clinics through DOT programme & pick up patients with

drug toxicity or treatment failure

Be competent in treating patients with MDRTB

Discuss treatment plan with patient& family stressing the importance of adherence to

treatment& explaining means of infection control

Be competent in interpreting tests for latent TB& identify those who need prophylactic

treatment

Module Contents


Pulmonary TB

Extrapulmonary TB

Diagnosis of TB

Non tuberculous mycobacterial infections

Management of patients with TB

Anti TB drugs

Selection of anti TB drugs

MDR, EDR TB

DOT& DOT PLUS

Latent TB

Prophylactic anti TB treatment

B. CLINICAL CASES ( All cases are expected to be seen in ABBASIA CHEST HOSPITAL

Pulmonary TB

Extra pulmonary TB

TB serositis Lymphadenitis

Pot’s disease TB arthritis

Genitor urinary TB TB meningitis

Miliary TB TB enteritis


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Hospital acquired infection (HAI), including intensive care

(ICU) related illness (2 weeks in pediatric ER, 3 Weeks in ICU and 2weeks in surgical wards)


A. KNOWLEDGE


understanding of:

Presentation, pathophysiology and management strategies for

Common problems in HAI and ICU.

Confidentiality and consent issues in the unconscious patient

Outcomes of HAI and ICU-related infection

Common infections associated with particular surgical procedures

Local/ national/ international antibiotic resistance patterns, clinical standards, guidelines and

protocols.

Evidence base for effectiveness of infection control policies

Local/ national/ international clinical standards, guidelines and

Protocols of infection control

Specific categories of personal protective equipment


Be able to acquire relevant information pertinent to the specific clinical scenario.

Be able to determine origin of infection and develop a strategy for its containment.

Be able to Differentiation between colonization and infection

Be able to identify t situations giving rise to antibiotic resistance

Be Aware of the therapeutic options available for the treatment of multi-resistant organisms

Recognize & implement appropriate Interventions to prevent the spread of multi-resistant

organisms

Formulate appropriate local advice for HAI reduction and

containment

Ability to instruct concerning the usefulness of personal protective

equipment and their appropriate use for a given infective scenarios

Module Contents


Topics

Septic shock

Infection in ICU

Antimicrobial resistance

Isolation rooms

Post-operative infections

Fluid replacement therapy in infants& adults

Guidelines and

Protocols of infection control

Hospital Protocols for limiting spread& emergence of new resistant strains


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B. CLINICAL CASES (All cases are expected to be seen in the ICU units and surgery

departments)

Wound infection

Urinary catheter related infection

Central line related infection

Ventilator associated pneumonia

Septic shock

Infection with multi –drug resistant organisms e.g. MRSA, EBL, Acinetobacter…

Infection in immunocompromised host

6 Weeks in HIV department in fever hospital

2 Weeks in BM transplantation unit 2 Weeks in Renal transplantation unit


A. KNOWLEDGE By the end of the training program, trainee must have adequate knowledge and deep

understanding of

the normal immune response to infection

Biological and iatrogenic etiology of immune deficiency

Types of immunocompromised patients and types of infections related.

Relevance of specific aspects of history and specific physical signs (and their absence).

the utility of laboratory investigations

General epidemiology and therapeutic options.

Prognostic assessment

Risk/benefit analysis of therapies

the current diagnostic techniques

the indications and uses of anti-retroviral therapy in HIV

infection including:

Pharmacokinetics, modes of action, interactions, mechanisms of resistance and cross

resistance

Current guidelines for management.

Post-exposure prophylaxis

therapies and other interventions in non-HIV

Immunocompromised individuals including prophylactic antimicrobials and vaccinations.

Spectrum of professional and complementary therapies available,

e.g. palliative medicine, nutritional support, pain relief, psychology of dying


Provide appropriate advice regarding risk reduction for opportunistic infections relevant to

the underlying condition

Recognize clinical and laboratory manifestations of immune deficiency.

Interpret test results and explain their relevance to patient

Identify hiv patients who are candidate for antiretroviral drugs

Apply practice guidelines and recommend appropriate drug regimens.


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Monitor and recognize the side effects and possible drug interactions

Identify patients who need prophylactic medications against opportunistic infections

Detect symptoms& signs pointing to opportunistic infections

Appropriately use current diagnostic techniques to detect opportunistic infections

Diagnose patients with possible malignant complications

Provide appropriate information regarding hiv transmission and strategies for its reduction

Engage with patients in the responsibility of their treatment to support adherence and

facilitate treatment decisions.

Module Contents


Immune response to infection

Classifications of immune deficiency states

Type of Infections in relation to type of immune deficiency

Immunosuppressive drugs in renal& hepatic transplantation

Different Prophylactic measures in dealing with different immunosuppressed patients

Fever in neutropenic patient

OPSI

HIV

Opportunistic infections

Anti HIV drugs

HAART

B. CLINICAL CASES ( All cases are expected to be seen in the renal transplant units, BM

transplant unit and HIV departments)

Infections in Renal transplant patient

Liver transplant patients

Infections in Bone marrow transplant patient

Patient with neutropenia

Patient with neutrophil dysfunction

Patient under immunosuppressive drugs for rheumatologic diseases

AIDS

AIDS with pulmonary infection

AIDS with CNS infection

AIDS with mycobacterial infections

AIDS with complicated malignancy

All with fever


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LIST OF REQUIRED LECTURES AND

SEMINAR TITLES


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First year lectures

Lectures Titles number

1. Temperature regulation 1

2. Immune response to infection 1

3. FUO 2

4. Antipyretics& anti-inflammatory drugs 2

5. Antibacterial drugs 5

6. Sepsis 1

7. Streptococcal infections 1

8. Staphylococcal infections 1

9. Pneumonias 2

10. Radiological diagnosis of chest infections

11. Meningitis 1

12. Encephalitis 1

13. Radiological diagnosis of CNS infections 1

14. IE 1

15. Salmonellosis 2

16. Diarrhea 1

17. Brucellosis 1

18. Infection in travelers 1

19. Pseudomonas infections 1

20. Urosepsis 1

21. Antiviral drugs 3

22. Herpes Simplex infections 1

23. HZV infections 2

24. CMV infections 2

25. EBV infections 1

26. Influenza 1

27. Hemorrhagic fevers 1

28. Infections in DM 1

29. Heat emergencies 1

Second year(Hepatic institute)

30. Acute virus hepatitis 2

31. Chronic viral hepatitis 3

32. Hepatic emergencies 1

33. Anti viral drugs in HCV& HBV infection 2

Second year(Chest hospital)

34. Tuberculosis 2

35. Anti TB drugs 2

36. Drug resistant TB 1

37. Radiological diagnosis 1

Second year( Pediatric ER)

38. Fluid replacement therapy in infants& children 1

39. Exanthemata 1

40. RSV 1

Second year(ICU)

41. Septic shock 1


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Lectures Titles number

42. ICU infections 1

43. Ventilator related pneumonia 1

44. Infectious diseases emergencies 1

Second year(surgical wards)

45. Postoperative infection 1

46. Multi-drug resistant micro-organisms `1

Second year

47. Superficial mycosis 1

48. Skin manifestations of infectious diseases 2

49. Cutaneous leishmaniasis 1

50. Leprosy 1

51. Sexually transmitted diseases 3

52. Skin manifestations of adverse drug reactions 1

Second year(BM & renal transplant units)

53. Immunosuppressive drugs 2

54. Prophylactic measures during iatrogenic immunosuppression 2

55. Fever in neutropenic patient 1

56. Opportunistic infections 1

57. Fever in patients with solid organ transplantation 1

Second year( HIV unit)

58. HIV 1

59. Management of HIV patient 1

60. Antiretroviral drugs 2

61. Radiological diagnosis of fever in immunocompromised patient

Second year(Fever hospital)

62. Antifungal drugs 2

63. Invasive mycosis 2

64. Antiprotozoal drugs 1

65. Malaria 1

66. Toxoplasmosis 1

67. Kala azar 1

68. Anti helminthic drugs 1

List of Topics and titles covered in seminars

Seminar Titles Number

First year

1. Interpretation of laboratory data of patient with FUO 1

2. Acute respiratory failure, Inhalation therapy 1

3. . Infectious and non infectious diarrhea

4. Clostridial infections 1

5. Tetanus 1

6. Bioterrorism 1

7. Actinomycosis, Nocardiosis 1

8. Selection of prophylactic antimicrobials in patient with cardiac

lesion which? And for whom?

9. DD of Fever in a cardiac patient 1


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Seminar Titles Number

10. DD of Fever with jaundice 1

11. Listeriosis ,Erysipeloid 1

12. Prophylactic measures for travelers 1

13. DD of fever in travelers 1

14. Infectious diseases, lines of management other than

antimicrobials 1

15. Fever with disturbed consciousness 1

16. Rheumatologic diseases presented with fever 1

17.Ricketssiosis 1

18.Chalamedia 1

19. Zoonosis 1

20. Immunological diseases related to infectious agent

Second year( National liver institute)

21.Fulminant hepatitis

22. Extrahepatic manifestations of virus hepatitis.

23. Responders& non responders to drugs

24, Economic impact of disease& therapy

25.Hepatitis……other causes

26.Fever in patient with chronic liver disease

Second year(Chest hospital)

27 .Latent TB: Prophylactic anti TB drugs indications& regimens

28. Patient related consideration in prescribing anti TB drugs

29. Isolation rooms

30. Non tuberculous mycobacteria

Second year(ICU)

31. Electrolyte disturbances: Diagnosis and management

32. ICU procedures related infections

33. Biofilms

34. Septic shock: debates in management

35. DIC

Second year(surgical wards)

36. DM management& targets during infections

37. Preoperative prophylaxis

Second year(BM & renal transplant units)

41. Different infections in different post transplant times

42.Latent viruses

43. pre-emptive therapy

44. OPSI

45 . Graft versus host reaction

46 . Oncogenic viruses

Second year( HIV unit)

47. Infections in drug abusers

48.Schedules of prophylactic therapy in HIV +ve patient

Second year(Fever hospital)

49. Periodic fevers

50. Hemophagocytic syndrome


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Methods of assessment

REGULATIONS

The general rules and regulations of assessment approved by the Egyptian fellowship board and

published at the training handbook and also the board web site applies for the pediatric specialty. In

addition to the successful completion of the training program, all candidates must successfully pass

three exams in order to get the fellowship certificate.

FIRST PART EXAM The first part exam is a written exam. Trainees are allowed to sit for the first part exam after six

months of training. Each candidate has three chances to pass the exam and one more additional

chance may be granted in some special circumstances approved by the secretary general of the

higher committee of medical specialties. It is to be noted that after one year of training each time

the candidate will choose not to enter the exam will be calculated as one of his three attempts.

SECOND PART EXAM The second part exam is a written exam. Trainees are allowed to sit for the second part exam after

passing successfully the first part and after completion of the training period (two years). In addition,

each candidate must submit his log book for final assessment. The log book requirements must all be

completed and signed by the trainer and educational supervisor.

Each candidate has three chances to pass the exam and one more additional chance may be granted

in special approved circumstances.

CLINICAL EXAM (THIRD PART)

The third part exam is a clinical and oral exam. Candidates who pass successfully the second part are

allowed to sit for the third part. Again each candidate has three chances to pass the clinical exam and

an additional fourth chance may be granted in special approved circumstances.

Pre-requisites for entering the first part exam

Trainees should pass the following courses in order to be eligible

for the first part exam

1. Local TOEFEL with a score of at least 500

2. Computer courses in word processing, spread sheets and

internet


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THE STRUCTURE OF THE EXAMINATION

THE FIRST PART EXAM

The first part exam aims to test trainee's knowledge in basic science as it applies to the infectious

diseases discipline.

The structure of the first part exam: PART I examination consists of two papers:

1. Paper I (2 hours): Multiple choice questions with a single best answer format. This paper

will cover applied basic sciences mentioned in the curriculum.

THE SECOND PART EXAM

The second part exam aims to test trainees' knowledge and skills in infectious diseases. In this exam

all the infectious diseases curriculum will be covered.

The structure of the second part exam: Part II examination consists of four papers:

1. Two MCQ papers each two hours in duration. They are covering all infectious diseases

specialties. In both papers, facts, problem solving and management skills are going to be

assessed. You will choose one best answer in each question

2. Two short assay papers each two hours in duration. They cover all infectious diseases

subspecialties. Questions will assess Trainees' knowledge about various infectious

diseases and their management. In addition, it will test students' problem solving skills.

THE THIRD PART EXAM

The structure of the third part exam: part III exam is a clinical and oral exam and is composed of

the following components:

CLINICAL EXAM

The clinical exam remains the most important part of the examination as the long case evaluate the

potential performance of the candidate in clinical practice while short cases assess clinical

examination skills in various system. Passing this component of the exam independently is essential

for certification.

1. Long Clinical Case : the candidate is observed in silence for the first part of the examination by

two examiners where he/she is taking the history from the patient and performing a physical

examination and then The examiner asks them to present their findings in the history and

examination and discuss their management of the case . Marks are given according to a

predetermined weighting of the components of the exam.

2. Clinical OSCE (Objective Structured Clinical Examination) this has replaced the traditional short

cases. Each candidate examines four or five patients. The examiners evaluate his abilities to

correctly elicit and interpret physical signs. An agreed marking system is used to ensure

objectivity and fairness of the exam.

3. OSPE is a multiple station examination including ECG/ X-ray / CT Scans/ laboratory data results

/ skin photographs etc set as 10-20 OSCE stations. The candidate rotates from station to station

where he / she are tested on a specific element that measures his data interpretation skills.

4. VIVA: The oral exam which tests the candidates’ ability to manage patients and explores his/her

knowledge of making an accurate diagnosis and whether he/she understands the essentials of

therapeutics. It also assesses his attitudes and interpersonal communication skills. It is based on a

set of topics with opening and supplementary questions. The questions cards are prepared in

advance together with the expected ideal answer and allocated marks. This allows a good

objective basis for marking.

Comment [E1 :]No applied basic science in the curriculum what are the

components of first part exam and what is

the timing Epidemiology , microbiology and

parasitology and infection control


29

THE STRUCTURE AND REGULATION OF INFECTIOUS

DISEASES TRAINING

The Egyptian Fellowship Board requires two years of supervised training program that must be

conducted in accredited hospitals before sitting for the final examination. A list of accredited

hospitals will be announced yearly by the Board. Entry to the clinical infectious diseases training

program has the following requirements for Trainees who are affiliated to MOHP:

1. Graduates from a medical school and successful completion of the pre-registration

house officers' year, which spend two years in internal medicine fellowship programme and

passes IM fellowship examination at the end of the first 2 years before attending infectious

disease programme.

2- Trainees, who finished their internal medicine fellowship-training program (within 5

years).

3. Trainees, who finished their master degree in internal medicine or tropical medicine

(within 5 years).

4. Trainees, who finished their internal medicine or tropical medicine diploma (within 5

years).

5- Trainees, who finished their master degree bacteriology or epidemiology will be

exempted from the first 6 month of program.

The infectious diseases fellowship training program consists of two years of training. During the

entire training program, the candidate must be dedicated full time and must be fully responsible for

patient care.

FIRST FOUR MONTHS OF TRAINING

1. The trainee should spend the first four months of training in general fever hospital

a. The first two months of training must be spent in bacteriology laboratory

b. two weeks in of training must be spent in bacteriology laboratory

With special focus on parasitology (pathogenesis, diagnosis etc…)

c. one month in fever hospital with lectures and seminars focused on epidemiology &

surveillance studies

d. two weeks in fever hospital with special focus on infection control

The sequencing of rotations is flexible.

It is to be noted that all previously mentioned rotations should be finished by the end of the

first 6 months of training.

Important notice

before being Trainees must pass successfully all the seven foundation courses

Full information about foundation omoted to the second year of training.pr

courses is available at The EF website and administration office

Comment [E2 :]What is their situation

regarding internal medicine training

They will finish internal medicine two years

and then get exempted from the six initial

months of CID fellowship


31

FOLLOWING 20 MONTHS OF TRAINING

During The Following 20 months of training, trainees must get experience in different infectious

diseases subspecialties mentioned in the curriculum.

Trainees will have rotations in different clinics and subspecialty departments during the second half

of the first year and the whole second year of training, like the following guide

1. Twelve months in general fever hospital

2. Six weeks in national hepatic institute

3. One month in chest hospital

4. Four weeks in dermatology hospital

5. Two weeks in surgical wards

6. Six weeks in ICU& pediatric ER

7. Four weeks in transplantation units

8. Six weeks in HIV units

TRAINEES DUTIES AND OBLIGATIONS

1. Trainees must attend at least 75% of lectures in infectious disease subjects. They should pass

successfully through the first part Fellowship Exam before being promoted to the second year of

training.

2. They should be actively involved and fully responsible for patient care including sharing in

making decisions about diagnosis and management under supervision of the consultants.

3. They must attend 75% of weekly meetings including clinical rounds, tutorials and journal clubs

4. Their performance will be monitored and evaluated by trainers and a report made of their

performance on monthly basis to The Egyptian Fellowship Board.

5. All trainees will work as residents in The training specialty and they must fulfill all residents jobs

defined by supervisors and trainers

6. They should be responsible under supervision for outpatient & in patients' routine work.

7. They must take supervised shifts according to the hospitals requirements and regulation.

SPECIFIC REQUIREMENTS AND OBLIGATIONS

1- Obligations towards the Admitted Patients:

A. The trainees will be responsible for supervised admission of patients from the outpatient

department or emergency.

B. They will share in the completion of the following documents under supervision

a. Complete history and physical examination form.

b. Investigation requests, (laboratory, radiology, pathology, etc.).

c. Reporting results of the investigations.

d. The plan of management after consultation & approval from supervisors.

e. Daily progress notes.

f. Order and medication sheets

g. Order the necessary diagnostic procedures

h. Discussion of The case with the trainer and consultants

i. Discharge summaries.

j. Sick leaves and medical reports.

C. The Trainee should inform the senior staff of any high risk patient admission.

Comment [E3 :]Where are the ILOs relevant to dermatology

Comment [E4 :],kThey will be waste

Comment [E5 :]Fever hospitals ICUs and pediatric department to focus on

matters relevant to infectious diseases

Comment [E6 :]Suggest adding the two

surgical weeks here

Comment [E7 :]What is the timing and contents of first part


30

2- Obligations in The outpatient Clinics:

The trainees should attend the general fever hospital outpatient clinics & clinics related to the

rotation in different subspecialties as requested by trainers & supervisory staff. They should

participate in different patients' interviews & share in management under supervision.

3- Mandatory Clinical and Academic Activities:

The trainees shall be required to attend and participate in the mandatory academic and clinical

activities of the department. Attendance and participation should not be less than 75% of the total

number of activities within any training rotation / period including.

Daily morning patients' rounds and meetings.

Clinical round presentation, at least once weekly to cover various topics, problems, research,

etc.

Journal club meeting.

Interdepartmental Meetings

Grand staff rounds

4. The Log Book:

The trainees must keep and update The Log Book where they record all activities and skills

performed and learned during the training program. The activities should be dated and categorized to

whether been performed by the trainee him/herself or as an assistant or participant. Each activity

registered in the Log book should be counter signed by the trainer and finally the educational

supervisor. The Trainer and educational supervisor shall sign the completed Log Book.

5. The Research project:

The trainees shall undertake at least one research project or audit during the training program under

the guidance & supervision of their trainers. Such project or mini thesis should be written before the

trainee is accepted for admission to the final certifying examination. The candidates will get their

their project proposals after the epmiology course & submit it for evaluation before the second part

exam

Before the completion of the training program, The trainee should have completed satisfactorily

the Rotations described in the structure of the program and performed him/herself & assisted in the

various requested procedures.

GENERAL RULES & REGULATION

1. Holidays & on call duties:

According to Ministry of Health & Population regulation

2. Evaluation Procedures:

a. Performance of the trainee shall be evaluated on regular & continuous basis the

evaluation process should involve all aspects of the training including theoretical,

clinical & investigative procedures skills as well as the attendance & participation.

b. The trainers who are required to write confidential reports of the performance of each

trainee should evaluate the trainee periodically. The trainee should not be allowed to

proceed in the training program & move to the next rotation unless he/she attains a

satisfactory level of performance acceptable to the responsible trainer & educational

supervisor.

c. There is annual assessment (theoretical & clinical) for the trainees before each pass

from one level to the next (year 1 to year2) etc.

d. The trainee shall not be allowed to proceed to level 2 before successfully passing the

first part Exam

Comment [E8 :]What is the timing and theme for research project


32

Interruption of Training

It is not permissible to interrupt such a structural training program except in major unavoidable

circumstances. Such circumstances should be convincing & approved by the Secretary General. The

Interruption once approved should not be for more than one year. Interruption of the training

program for more than one year shall result in dismissal from the program & cancellation of the

preceding training period.

EGYPTIAN FELLOWSHIP FOR INFECTIOUS DISEASES

MEDICAL MICROBIOLOGY

COURSE GOALS, ILOS & CURRICULUM

1- EDUCATIONAL PURPOSE & GOALS OF COURSE:

Supplemental knowledge of properties of microbial pathogens is an important adjuvant to properly

identifying and treating infectious diseases problems. Additionally, close interface between the

fellow and the microbiology laboratory contributes to improved patient care.

The purpose of this rotation is:

1. To provide students with knowledge concerning with microbial causes of diseases (bacteria,

viruses, fungi).

2. To enable students to reach laboratory diagnosis of infectious diseases (at all levels).

3. Correlate diagnostic laboratory testing with clinical exam, history, and other laboratory

findings

4. To enable students understand the basic immunology &immunological disorders.

5. To provide students with adequate knowledge about applied microbiology and applied

immunology.

2- INTENDED LEARNING OUTCOMES OF THE COURSE (ILOS):

KNOWLEDGE AND UNDERSTANDING

By the end of this course, trainees will be able to

Describe the different microbial causes of infections that may be (bacteria, viruses, fungi),

explain how do they cause diseases (pathogenesis) , clinical signs, symptoms and

complications of microbial infections.

Describe the different laboratory methods needed for the diagnosis of microbial infections.

Describe the structure and function of immune system and the diseases that may result from

disturbed immunological functions as in autoimmunity and hypersensitivity reactions.

Outline the treatment for various microbial infections and the methods of prevention and

control of infection on individual and community levels.

Discuss the different types of vaccination that are required to prevent infections.

Outline of fundamental immunology and molecular biology applicable in microbiology to

achieve better and accurate diagnosis .

INTELLECTUAL SKILLS (HIGHER COGNITIVE SKILLS)


33

Interpret the most important signs and symptoms of important microbial infections of endemic

character (using case study).

Choose the best suited laboratory investigations for each microbe and interpret the clinical and

laboratory findings to reach a proper diagnosis.

Protect themselves and the patients from infections by applying & following different

infection control polices

PROFESSIONAL SKILLS (PSYCHOMOTOR OR PRACTICAL SKILLS):

Identify microscopically different microbes as well as their different culture media and the

most important biochemical reaction that are important for their identification

Identify different methods of sterilization &disinfections.

Identify nosocomial infections &different infection control methods for protections of patients

& staff.

Be perfect in the selection of appropriate antibiotics depending on the provisional results of

antibiotics sensitivity tests.

Be aware of different laboratory methods of autoimmunity and hypersensitivity reactions

GENERAL AND TRANSFERABLE SKILLS: React positively with any microbial problem on a national level e.g. influenza and hepatitis

diseases.

Be aware of national schedules of vaccinations and the different methods of administrations.

Work in a multi disciplinary health care team to solve nosocomial infections and introduce

effective infection control programs.

3- CURRICULUM OF CLINICAL MICROBIOLOGY:

Content:

Lectures

Cleaning , sterilization and disinfection

Antibacterial chemotherapy

Host parasite relationship & normal flora

Basic immunology I (structure & function of the immune system), innate immunity

Basic immunology II ( cellular & Humoral immune responses )

Protective immunity to microbial infections

HLA and HLA associated diseases

Autoimmune diseases

Hypersensitivity reactions

Immuno-deficiency and immuno-suppression ,

Assessment of immune Functions

Mycobacterial infections ( TB & Leprosy )

Diphtheria , Haemophillus and Bordettella

Spirochetes, Chlamydiae & Rickettsiae &vector born infections

General Virology , antiviral therapy

Vaccines

Viral hepatitis

Human immuno- deficiency virus ( HIV viruses )

Orthomyxo & paramyxo viruses

Oncogenic viruses


34

Mycology ( Mycotic infections ), antifungal therapy

Fever of unknown origin (enteric fever, shigellosis, brucellosis in details )

Bacterial respiratory and CNS infections ,

Viral respiratory and CNS infections

Diarrheal infections and food poisoning

Infections of pregnancy and peurperium

Diseases transmitted from mother to foetus & neonatal sepsis

Reproductive Immunology

Hazards of blood transfusion

Sexually- transmitted diseases (Bacterial , Viral & fungal )

Urinary tract infections

Skin infections ( Bacterial & Viral )

Pyogenic infections

Anaerobic infections (tetanus, gas gangrene, botulism)

Bacteraemia , toxaemia and toxic shock

Nosocomial infections & laboratory methods used in epidemiology

Infection Control

Documents

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