July 7th, 2019

In Praise of Experienced ID Fellows — and a Dozen On-Service ID Learning Units

A few weeks ago, I cautioned ID fellows about underestimating their hospital’s interns and residents.

My message — you were like them not so long ago; they didn’t suddenly all lose their brainpower when you graduated. This ungenerous opinion of house staff may be especially held by experienced fellows, as the accumulating workload of the year can lead to impatience.

OK, grouchiness.

The post might have felt a bit tough on current fellows, but that was not my intention. As I noted at the start (citing my own experience), it’s nearly a universal illusion, one we all have to get through.

So here’s the flip side of working with those experienced ID fellows — for us attendings, it’s wonderful.

I frequently attend on the inpatient ID service during the transition period between fellowship years, and once again it’s been an absolute joy to witness the expertise and confidence of these seasoned pros as they finish their fellowship year.

Their clinical instincts. Their remarkable growth in fund of knowledge. Their ability to assess, rapidly, not just “sick” vs. “not sick” — that starts with residency — but even more importantly, “sick from an ID problem” vs. “sick from something else entirely; the ID issue is secondary.”

The skills go on. The experienced ID fellows focus their diagnostic and therapeutic suggestions in ways that would have been impossible for them just months ago. They handle serious, difficult ID problems — Staph aureus bacteremia, a new HIV diagnosis, epidural abscess — with confidence and aplomb. They communicate with patients, family members, and consulting teams accurately and clearly, without excessive jargon.

As they present cases on rounds, I await their assessments with deep interest — as more often than not they have insights about diagnosis and treatment that are spot-on.

Plus — and this is a tough one — they recognize that the late afternoon or weekend consult may be highly appropriate, and not just an annoyance, no matter how busy the day.

So thank you, ID fellows who have just finished their first year — it’s been a blast.

And here’s a list of some of what we discussed on rounds — a dozen “Learning Units” for each day on service:

And finally…

4 Responses to “In Praise of Experienced ID Fellows — and a Dozen On-Service ID Learning Units”

  1. Loretta S says:

    Thanks, as always, Paul. And please give the ID fellows a big “Thank you!” from this primary care provider.

    I now know what “dropped gallstones” are, thanks to that article. 🙂

    As for HZ, is there an advantage to acyclovir over valacyclovir? Or were you referring to the use of acyclovir inpatient, because it is available for IV administration? In the outpatient setting, I tend to avoid acyclovir in favor of valacyclovir because of the need for patients to take acyclovir 5 times a day. That’s a tough regimen for them to keep straight, and taking it can become haphazard.

    • Paul Sax says:

      Hi Loretta,
      Completely agree with you about avoiding acyclovir in outpt treatment of zoster — 5x/day is impossible, except for those with OCD!
      On the inpatient side, we have to use IV acyclovir.

  2. Elpida Cyprus says:

    Such a article. I want to talk. Please contact me by email divingcyprus[at]gmail.com.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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