Training & Education

Fellows gain rigrous, front-line, hands-on experience in the administration and daily operation of a nationally recognized Antimicrobial Stewardship Program at the Los Angeles General Medical Center. With support from the Chief Medical Officer, Dr. Brad Spellberg, an internationally recognized Stewardship expert, active biostatisticians, and highly integrated Microbiology and ID Pharmacy staff, the Antimicrobial Stewardship Progam at Los Angeles General Medical Center is a model of clinical success and academic productivity within the field. Trainees reap the benefit of this support, with resident and fellow direct involvement in numerous recent peer-reviewed publications in the field on Antimicrobial Stewardship including: difficile diagnostic stewardship (ICHE 2018), short course antibiotic therapy Expected Practice (OFID 2019), CAUTI reduction via diagnostic stewardship (OFID 2021), oral antibiotic stepdown therapy (Am J Med 2021), and oral fosfomycin for complicated UTIs (OFID 2021)

Fellows are exposed to an unparalleled tripartite clinical experience in three very different settings. First, the Los Angeles General Medical Center – serving a primarily underserved minority population (60-70% Latino, 12-15% Black) — offers three core rotations including a General Infectious Disease Consult Service where fellows serve as team leaders guiding medical students, interns, and residents on a bustling inpatient ID Consult Service. Fellows will also rotate on a Surgical & Orthopedic Infection Service at Los Angeles General Medical Center in which they work one on one with an ID faculty attending in surgical consultation for a host of inpatient surgical primary teams including: Acute Care and Trauma, Burn, Cardiothoracic, Gynecology (including Gyn-Onc), Hepatobiliary, Obstetric, Oral & Maxillofacial, Orthopedic, Otolaryngology, Plastic, Urology, and Vascular. Second, fellows will gain inpatient experience in Transplant Infectious Disease and General Infectious Disease at the nationally ranked USC Keck Medical Center and the USC Norris Comprehensive Cancer Center serving patients requiring highly specialized medical and surgical care. And third, fellows receive unrivaled experience in outpatient HIV, Infectious Disease, and Hepatitis C care (mono-infected and HIV-coinfected) at the Los Angeles General Medical Center Rand Schrader Clinic, one of the nation’s oldest and LA County’s largest HIV Clinic. The clinical and racial/ethnic diversity made ID fellowship training at USC one of the truly unique programs in the U.S.

Fellows will gain experience (with the option to select a Transplant ID Track) in the diagnosis and management of infections in highly immunocompromised hosts on the Keck Transplant ID Service. The USC Transplant Institute is a high-volume, nationally recognized transplant center performing heart, lung, kidney, and liver (including living-donor liver) solid organ transplantats. The Transplant ID Service also provides consultation for the management of complex ventricular assist device (i.e., LVAD) infections in patients with advanced heart failure and mechanical device therapy either as destination or bridge to transplantation.

In addition to their general ID experience, USC ID fellows will provide direct patient care to one of the nation’s largest volume HIV centers with a breadth of AIDS complications unrivaled in the U.S. In addition, Los Angeles General Medical Center provides direct care to more tuberculosis patients than any other hospital in California, with nearly 2-5% of all tuberculosis cases in the country receiving care in our facilities.

Los Angeles General Medical Center offers the unique experience of Hepatitis C care delivery managed solely through its Infectious Disease Division. This model increases the volume of clinical experience in treating both HepC mono-infected and HIV-coinfected patients in both ambulatory and Correctional Health settings.

With Los Angeles General Medical Center having provided care to one of California’s highest volumes of Covid-19 patients, including the development of novel care delivery models, opportunities for formal ID fellow training experience in Hospital Epidemiology abound. Beyond didactic lectures, formal educational curricula in the field of Infection Control & Prevention include: formal hospital Environment of Care rounds with Infection Preventionists, direct consultation for employee Bloodborne Pathogen Exposure (needlestick) evaluations and Post-Exposure Prophylaxis, attendance at standing Infection Control Committee Meetings, weekly Hospital Acquired Infection Review, as well as participation in CLABSI and CAUTI Committee Meetings. Scholarship and QI projects in Hospital Epidemiology and encouraged and mentored for interested fellows.

The Infectious Disease Core Lecture Series is a vital component of the didactic portion of the ID fellowship curriculum and provides a comprehensive overview of all key Infectious Disease topics over a two-year cycle. Annually updated lectures are given primarily by faculty in the Division of Infectious Disease, but also by expert guest lecturers from departments such as Allergy & Immunonology, Microbiology, and Pharmacy. ID fellows are also expected to deliver one to two lectures annually.

The weekly Infectious Disease Case Conference features two 30-minute case presentations of patients from the various inpatient consult services or outpatient clinics at Los Angeles General Medical Center and Keck, with periodic cases presented by the Pediatric Infectious Disease service at Los Angeles General Medical Center. Faculty and fellows unfamiliar with the case discuss the diagnostic and therapeutic approach to each case, providing an ample opportunity for case-based discussion and teaching. Clinical, pharmacy, and laboratory faculty members provide insight into the case, followed by a five-minute didactic session by the presenting fellow that highlights important or unique aspects of the cases presented. This lively conference is the centerpiece of our didactic set and is usually attended by 20-30 participants including faculty, fellows, residents, students, Rand Schrader Clinic providers, and community Infectious Disease practitioners.

Infectious Disease Grand Rounds are hosted monthly and feature outside guest speakers selected and invited by the USC Infectious Disease faculty members, including visiting faculty of local and national stature in their respective areas of expertise.

Clinicopathology Conference is a monthly, hour-long, multidisciplinary conference that includes faculty from other specialties and departments who discuss diagnostic and management issues for a single, complex or unique case. Most often this involves in-depth review and discussion of histopathology, microbiology slides, imaging, and other diagnostics by expert faculty. In recent years, faculty and experts from divisions as varied as Public Health, Neurology, Hepatology, Pathology, Cardiology, Surgery, and Radiology have all attended this engaging and highly educational conference.

During montly ID Journal Club, two articles are selected by an ID faculty facilitator. One fellow is assigned as the primary presenter and discussant for each article and presents a critical analysis of the study’s hypothesis, design, methods, results, and appropriateness of the authors’ conclusions leading to group discussion of the applicability of the study results to our daily patient care.

A montly Combined Pulmonary-Infectious Disease Conference is held on second Tuesdays and consists of case presentations of two unknowns, one each by the USC ID Division and the USC Pulmonary Division. Faculty, fellows, residents, and students from both divisions attend the conference and participate in the interpretation of relevant chest imaging and discussion of instructive cases. A short review of the relevant literature follows each case presentation.

Intercity Infectious Disease Case Conference is a long-standing, two-hour, monthly meeting among academic ID specialists, trainees and allied health professionals across Southern California. Hosting institutions rotate between the participating medical centers: Los Angeles General Medical Center, Harbor-UCLA, Kaiser-Harbor City, Providence St. Mary’s Medical Center, UC Irvine/Long Beach VA, and Torrance Memorial. Three to four cases are presented to visiting faculty and trainees as unknowns by the host institution facilitator. At the end of each presentation, fellows from the sponsoring institution give a brief didactic overview of the salient features of the case.

HIV Resistance Conference is a monthly workshop held jointly by the USC Department of Medicine’s Division of Infectious Disease, HIV-trained faculty members and HIV clinicians and trainees from the Department of Family Medicine, and invited HIV experts from across the country. Patients with complex HIV resistance profiles and multiclass drug resistance are presented. Using ART treatment histories along with HIV phenotypes and genotypes, conference attendees work with expert faculty facilitators to arrive at treatment recommendations. This unique, case-based approach to HIV resistance provides a core component of fellows’ training in HIV Medicine.