An Infectious Diseases Fellowship [Draft]
What would it be like if I designed an ID fellowship?
Some of you might know I’m finishing my fellowship in HIV medicine from Rajiv Gandhi University.
You can read the curriculum of FHM course here (.doc file)
I was talking to a prospective student last day and it took me a few minutes to make them understand that a fellowship in HIV medicine will never be about treating just people living with HIV. Doctors cannot choose their diseases. Your HIV positive patients can be suffering from the same infections as your HIV negative patients are. And vice versa. So, there is no fellowship in HIV medicine without learning about various infectious diseases in general.
What if, then, instead of fellowship in HIV medicine, you call it a fellowship in infectious diseases? Would it make better sense?
Maybe, may not be. Renaming would also change the focus. With a fellowship in HIV medicine, your focus is on HIV. But with a broader fellowship, your focus dithers.
But in my philosophy there is no point in “specializing” or “focusing” on any single point. Knowledge compounds. The more you learn, the easier it becomes to learn even more. The more you learn the better your understanding of the concepts. The more you learn, the more you retain.
Let me try to design an ideal such course.
What would the objective of the course be? India struggles with infectious diseases even today. So, it is definitely worthwhile to gain knolwedge about managing infections.
But India is becoming the diabetes capital of the world as well. And infections love diabetic people. That means, it would not just be enough to manage infections, even diabetes will have to be managed.
So what about vector borne diseases? Air borne diseases? Individual patients can be managed. But what good is a doctor who identifies a contagious disease and doesn’t take measures to stop the spread? Public health would have to be an important part of the course.
Research. How does someone learn about the unknown? Knowing to make sense of statistics, and designing one’s own study to figure out a thing or two about diseases should find a place.
From my experience, it takes many many lab tests to manage an infection - maybe simple microscopy of pus/urine, maybe culture, maybe blood counts, maybe a quick abdominal scan. So it might be excellent if the course prepares one to use (or even do) these tests like a master.
Communication and collaboration are extremely important in anything we do today. If you think it is not important, that it is okay to live in your hut and do what you are doing, you are being irresponsible on top of being lazy. It is one’s responsibility to make maximum use of what is available to them for the benefit of everyone. With internet and various new technologies around, people must be ready to use them.
With these objectives in mind, the curriculum can be designed.
6-12 months can be spent in learning the things that make the rest easy - communication & collaboration, research, diagnostics, public health.
Communication & Collaboration
- Effective communication
- Using social media, blogs, instant messaging platforms
- Using search engines
- Working in teams
- Outpatient skills
Public health & Research
- National health programmes
The next 6-12 months can be spent in learning how to practise these in real
- Infections of various organ systems
- HIV, Tuberculosis
General Medicine, Paediatrics, Obstetrics, Geriatrics
- Diabetes Mellitus
- Issues in the very young and very old
It might make sense to include a practical project in this year wherein the student can do anything they like that is relevant to their course. Building a web portal for preparedness against rainy season diseases? Works. Training 20 field workers how to do pap smears? Works. Anything works.
It goes without saying that self-directed, self-motivated learning works the best. It would be ideal if ready access to patients and other data is available like a hospital, clinic, lab, or research center. Special care must be taken to ensure that no student spends their entire time in one particular institution/location as being doctors they are vulnerable to getting distracted into doing regular patient care all the time.
There ideally needs to be a forum for multiple students to interact with each other. This can also be associated with a portal with resources like video lectures, textbooks, and other useful stuff.
Open book exams and continuous assessment of practical skills from various centers where the students work can be used as proxies in assessment of learning.
Is there such a course available?
None that I know of (yet).