The Infectious Diseases Training Program at Tulane University Health Sciences Center (TUHSC) utilizes three hospitals:
Tulane Medical Center (TMC) comprises the main hospital downtown and Tulane-Lakeside Hospital in Metairie. TMC is the major tertiary hospital in the medical center with programs in cardiac surgery, solid organ and bone marrow transplantation and similar advanced disciplines.
University Medical Center New Orleans (UMCNO) is the main hospital providing indigent care and is shared by Tulane and Louisiana State University Health Sciences Centers (LSU).
Southeast Louisiana Veterans Health Care System (VA) closed its inpatient facility due to Hurricane Katrina but continues to have an active outpatient department and is now admitting VA patients to TMC.
Pediatric Infectious Diseases cases are taken care of by the Tulane Pediatric Infectious Disease Service, which has several full-time professional faculty members. First- or second-year fellows may elect to do a month of Pediatric ID. Together, the three hospitals provide a full range of Infectious Diseases patients, and by rotation through them, an Infectious Diseases Fellow experiences a balanced range of clinical problems.
Trainees act as consultants at both teaching hospitals and in each instance under the direct, close supervision of faculty. At each of these sites, trainees actively follow between 5 and 15 in-patients. Note that trainees are assigned to only one hospital during any one time.
During the clinical portion of the Fellowship experience, Fellows can expect to consult on or manage approximately 300-400 in-patients.
Trainees develop a broad experience with recognizing and treating infectious diseases in this program because of the rich diversity of clinical material accumulated in three referral centers. TMC and UMCNO have very active Emergency Rooms including a Level I trauma center at UMCNO.
Tulane Medical Center has a diverse mix of patients, drawing from both the indigent population and its contractual health care plans, which include Tulane University students and faculty members, tourists staying at many New Orleans hotels, etc. In addition, active programs in renal and liver transplantation, bone marrow transplantation, cardiac surgery, neurosurgery, obstetrics and gynecology, orthopedic surgery, ENT, and ophthalmology, generate their own infectious diseases consultations. Tulane Medical Center also acts as a regional tertiary referral hospital for Hospital Corporation of America (HCA), which own 80% of the hospital (the Tulane School of Medicine owns the other 20%) and operates numerous health care facilities in Alabama, Mississippi and Louisiana.
The University Medical Center New Orleans (formerly "Charity Hospital") receives many of the difficult and puzzling cases among the indigent population in Louisiana and provides extensive experience for trainees with tuberculosis, sexually transmitted diseases, complications of injection drug use, and unusual infections such as Mycobacterium kansasii and other mycobacteria-other-than-TB (MOTT), Vibrio species, fresh water gram-negative pathogens, and the endemic mycoses, blastomycosis and histoplasmosis. As the trauma center for metropolitan New Orleans, extensive experience is gained with intensive care and surgical complications of head injuries, chest and abdominal trauma and the orthopedic complications of blunt trauma.
The VA is the regional VA hospital for Southern Mississippi and all of Louisiana. At present, only the outpatient clinics are open and most VA patients requiring inpatient care are now admitted to the VA Service at TMC.
Fellows share with faculty in the responsibility of teaching and supervising medical residents during their infectious disease clinical rotations. Fellows are responsible for being familiar with all patients being followed by residents and students on the service. To facilitate continuity of care despite monthly turnover of residents during the clinical year, fellows are often assigned to specific hospitals for longer terms, which also assures their opportunity for prolonged surveillance of hospitalized patients.
Ambulatory Care Facilities
Infectious Diseases outpatient clinics meet weekly at UMCNO, TMC and VA.
Throughout their two years, trainees do their continuity clinic at the UMCNO HIV Outpatient Program (HOP), which serves both HIV patients as well as patients with general infectious diseases.
Fellows interested in learning to practice outpatient ID in a private setting may attend faculty clinics at TMC.
Trainees first evaluate the patient's complaints and perform a physical examination independently before presentation of findings to faculty. Findings are then reviewed, confirmed or extended. Decisions on diagnostic and therapeutic steps are taken after joint discussion between trainee and faculty. Fellows are expected to see 4-8 patients per clinic, and are required to follow a panel of HIV patients over at least 12 months in order to gain longitudinal experience in the management of HIV infection.
First- and second-year fellows rotate through the metropolitan New Orleans Office of Public Health Region I Wetmore TB Clinic, where they gain experience in the prophylaxis, treatment, and diagnosis of tuberculosis.
First- or second-year fellows are also expected to attend at least 3 sessions at the City of New Orleans Delgado Sexually Transmitted Diseases Clinic. Trainees may also participate in the Travel Clinic at Tulane School of Medicine.
Each trainee will see approximately 160-175 outpatients during the first year of the program. Trainees are responsible for patient evaluation, design of diagnostic and treatment programs, decisions about entry into studies, record keeping, and data assembly on groups, as well as assisting in supervision of residents and students who are rotating through the ID service for shorter periods of time.
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