CLINICAL INFECTIOUS DISEASES - … infectious... · Infectious diseases curriculum Rotation map...
Transcript of CLINICAL INFECTIOUS DISEASES - … infectious... · Infectious diseases curriculum Rotation map...
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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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
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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:
Trainees by the end of the module will be able to:
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
Trainees by the end of the module will be able to:
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
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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)
Module Intended Learning Outcomes
A. KNOWLEDGE
By the end of the training program, trainee must have adequate knowledge and deep
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
B. INTELLECTUAL AND PROFESSIONAL SKILLS
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
A. THEORETICAL TOPICS
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
Module Intended Learning Outcomes
A. KNOWLEDGE:
By the end of the training program, trainee must have adequate knowledge and deep
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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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
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
A. THEORETICAL TOPICS
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)
Module Intended Learning Outcomes
A. KNOWLEDGE
By the end of the training program, trainee must have adequate knowledge and deep
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
B. INTELLECTUAL AND PROFESSIONAL SKILLS
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
A. THEORETICAL TOPICS
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
Module Intended Learning Outcomes
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
B. INTELLECTUAL AND PROFESSIONAL SKILLS
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
A. THEORETICAL TOPICS
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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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
Clinical Infectious Diseases Egyptian Fellowship
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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
Clinical Infectious Diseases Egyptian Fellowship
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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
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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
Clinical Infectious Diseases Egyptian Fellowship
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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
Clinical Infectious Diseases Egyptian Fellowship
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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)
Clinical Infectious Diseases Egyptian Fellowship
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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
Clinical Infectious Diseases Egyptian Fellowship
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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