Fellows are assigned to Tuesday afternoon or Friday morning clinic during their fellowship training. In their assigned clinics, fellows treat long term and newly diagnosed HIV patients, internal and external referrals, and patient follow-ups from in-house consultations. In the COVID and post COVID era, fellows are increasingly “seeing” new patients and follow ups as virtual visits with their attendings.

Fellows also attend the Employee Health and Wellness clinic approximately four to six times a year to become proficient at evaluation and management of employees with LTBI or exposure to blood-borne pathogens.

MSK Inpatient Consults

Inpatient consults for fellows are divided between two teams: the regular consult service, Blue Team, and the immunocompromised host service, Red Team, which consists of leukemia and transplant patients. Fellows alternate between Blue Team and Red Team over the course of their fellowship. To unload the consult burden from fellows, there is also an attending only service comprised of consults deemed of low educational value for fellows.

Outside Rotations

NYPH-Cornell and NYU-Bellevue Inpatient Consults

Fellows rotate for one month on the inpatient service at New York Presbyterian/Weill Cornell Medical Center as first-year fellows and for one month at NYU-Bellevue in either their first or second year of fellowship. There they encounter infectious problems occurring in a different hospital setting where patient populations include immunologically normal hosts, the elderly, patients with alcohol and/or drug abuse histories, returning travelers, and recent immigrants. Infectious disease fellows from these respective programs also function as full fellows and members of the Infectious Diseases Service during their time at MSKCC.

Ambulatory Care

To enhance the fellows’ ambulatory care experience, second-year fellows complete one month rotations at the STD clinic at SUNY Downstate Medical Center in Brooklyn and the ID Associates/Travel Medicine Clinic of NYP/Cornell.

Elective time is offered to second year fellows who wish to pursue clinical rotations at local New York hospitals if arranged beforehand with the program director and leadership at the hospital in question. Recent electives pursued by fellows include a solid organ transplantation elective at Mount Sinai and outpatient HIV clinic elective at NYP/Cornell.

Research

During one research block in the second year of fellowship, fellows spend eight half-day sessions at SUNY Downstate’s STD clinic. During another research block in the second year of fellowship, they spend six half-day sessions at the ID Associates/Travel Medicine Clinic affiliated with NYPH-Cornell.

Approximately fifty percent of MSK ID fellows seek additional research training that is not required for ID Boards certification. This is completed in an optional third year. See the Research section for additional information or visit the ID faculty members’ web pages to see the groundbreaking cancer research ID fellows are currently participating in.

Increased prevalence of infection and antibiotic resistance observed in intensive care units (ICUs), outbreaks of zoonotic infections and respiratory viruses such as SARS-CoV-2, and expanding and aging immune-suppressed host populations underscore the need for joint training in Critical Care Medicine (CCM)-Infectious Diseases. Multi-disciplinary ICU care is increasingly becoming the standard of care, reflecting the current complexity of patient care in the era of pandemics, such as those caused by the Ebola, H1N1, and SARS-CoV-2 viruses. Combining these two well-established, world-renowned training tracks into a joint track at Memorial Sloan Kettering Cancer Center (MSK) is therefore a natural next step for a world that requires a dynamic command of both ID and CCM.

Led by Anna Kaltsas, MD, (of ID) and Stephen Pastores, MD, (of CCM), the dual-track training program is one of the few combined ID-CCM programs in New York City. MSK trainees will have the opportunity to learn from the “sickest of the sick” highly immune-compromised patients with cancer while receiving an education in “bread and butter” ID-CCM principles in this fast-paced but educationally enriching environment.

Description

The three-year ID-CCM dual training track requires a minimum of 24 months of clinical training and 12 months of scholarly activity. Over the three-year period, the fellow will devote 12 months of clinical training to ID, and 12 months of clinical training to different medical, surgical, and specialized (organ system-based) ICUs.

ID Training Component

The first two years of training will primarily comprise clinical and research training in ID; this follows the current schedule for ID fellows at MSK. Inpatient consult time is mostly made up of inpatient time at MSK, with rotations at New York University and Weill-Cornell. The majority of these inpatient consult months take place during the first year of fellowship (8.5-9.0 months), with the remainder (up to 12 months total across the first two years of fellowship) to occur during the second year of the fellowship. For a full description of the ID portion of training, see the ID fellowship and clinical research training page.

The second year of the fellowship centers mainly on elective and research time. Fellows in the joint ID-CCM track will be encouraged to pick research projects with both an ID and CCM focus, and to work with research mentors from both fields. Electives may be pursued in either ID or CCM at any of our affiliated hospitals or rotation sites during this time.

Provided that the fellow has received satisfactory to outstanding evaluations by the ID Clinical Competency Committee (CCC) up until December of the second year of their fellowship, and after discussion with Critical Care leadership, they will proceed with the third year of CCM training on this track. The trainee will be “guaranteed” a spot in the incoming CCM class of fellows; trainees do not need to apply or go through the Match.

CCM Component

The CCM component of the training program is 10 months in duration. Trainees spend five months at MSK’s state-of-the-art 20-bed adult medical-surgical ICU and are required to complete four outside rotations at three institutions for experience in cardiothoracic surgery (one month), neurocritical care (one month), trauma surgical ICU (one month), and community-based medical ICU rotation. Trainees will also complete one month in MSK Anesthesiology Department to their optimize airway management skills. Additional ICU time may be arranged based on the interests of the trainee.

The CCM component also includes extensive ICU procedural training and experience including but not limited to: central venous and arterial catheter and chest tube insertions, ventilator management and waveform interpretation, and therapeutic and diagnostic bronchoscopy. Additional information the CCM portion of the track can be obtained here.

Upon completion of the two years of ID fellowship training, the fellow will be eligible for board certification in ID. After completion of CCM training, the fellow will be eligible for board certification in CCM. The ID-CCM fellow will share didactics, journal clubs, and other formalized learning opportunities with the fellows in both the ID and CCM fellowship programs.

How to Apply

Residents interested in the combined ID-CCM training track are invited to apply for fellowship training in ID first, and are asked to specifically state their interests in ID-CCM in their personal statements. Applications will be accepted through ERAS. Invites to interview will be extended via email.

On interview day, applicants will be interviewed by both ID and CCM Program Directors and faculty (via Zoom; approximately two faculty members from each department). That same week, applicants will also be invited to attend virtual presentations on both the ID and CCM programs and to meet with respective fellows in each program virtually.

Applicants will “match” into ID first. They will complete the two years of ID and joint ID-CCM research in their second year, as outlined above. Provided they have had at least satisfactory performance up until December of their second year, and with the joint approval of the ID CCC and the ID and CCM Program Directors, they will proceed to the third-year CCM fellowship portion after the second year of ID fellowship. No additional applications or match process is needed.

Please email [email protected] with any questions.

Specific responsibilities are distributed throughout the two to three years of the fellowship. In general, the first-year (junior) fellows provide the majority of inpatient care. Second-year (senior) fellows provide leadership and serve as role models for the junior fellows and other rotators to the ID service. The senior fellows are also responsible for organization and preparation of monthly call schedules, organization of monthly TransYork rounds; end-of-the-year presentation of their own research work at the “Advanced Topics in Infectious Disease” lecture series; supervision of the Blood Culture Quality Improvement (QI) Project and other QI projects; representation to the ID fellowship’s Program Evaluation Committee; and representation to the hospital’s Graduate Medical Education (GME) committee.

Microbiology Rounds

Plate rounds are held every Wednesday morning from 9:30 – 10 a.m., either in person or virtually. Clinical microbiology fellows or the ID fellow on microbiology rotation present an interesting clinical case and an analysis of the microbiologic work up, as well as review of relevant microbiology material. The educational programs for both the clinical microbiology fellowship and the infectious disease fellowship at MSK are closely intertwined, and fellows from both programs gain from joint faculty expertise and research opportunities. Director Esther Babady supervises the microbiology laboratory.

Antibiotic Approvals

The Antibiotic Management Program (AMP) handles antibiotic approvals seven days a week from 9:00 a.m. to 5:00 p.m. After hours the approval pager is rolled over to the ID fellow on call; no antibiotic approval is required between 10 p.m. and 9 a.m. The bulk of night approvals generally occur before 9:00 p.m. Ample research opportunities exist with the antibiotic management program as well as additional training in this very important area of infectious disease. Fellows also spend time during their microbiology month in first year becoming familiar with the AMP program and our ID pharmacists.

Needlesticks, Splashes, and Other Occupational Exposures

After hours and on weekends and holidays, the ID fellow may be contacted regarding an employee who has or was exposed to an infectious agent or who had an accidental needlestick or splash exposure (varicella, measles, mumps, rubella, pertussis, and various respiratory viruses including influenza). There is always an Employee Health attending on call that can guide and maximize ID fellow learning through these situations.

Conferences

Memorial Sloan Kettering has a long history of conducting research on the management of infectious diseases in immunocompromised patients. In the 1970s, our Infectious Diseases Service performed pioneering studies on the diagnosis of and therapy for infections in patients undergoing intensive chemotherapy for cancer, and in the 1980s we became a center for the study and treatment of AIDS. In recent years, the research focus of the Infectious Diseases Service has been extended to clinical and laboratory investigation of immune responses to bacterial, fungal, and viral infection.

Our laboratory and clinical investigators are studying adaptive and innate immune responses to infection in patients undergoing cancer chemotherapy and stem cell transplantation.

Broadly speaking, clinical investigation within the Infectious Diseases Service focuses on diagnosis and therapy of infections in the compromised host and hospital infection control. Collaborative clinical research projects between the Infectious Diseases Service and other services within Memorial Sloan Kettering focus on monitoring and augmenting antiviral immunity in transplant patients and people receiving other forms of cancer therapy.

Quantitative methods are being used to identify and characterize T lymphocyte populations that combat viral and fungal infections in immunocompromised patients. On a more basic research level, laboratories of the Infectious Diseases Service are studying infectious diseases in animal models to develop a deeper understanding of immune defenses against invasive microbes.

Laboratory Research

The research laboratories of the Infectious Diseases Service at Memorial Sloan Kettering are focused on the immune response to infection by bacterial, fungal, and viral pathogens. The pathogenesis of mycobacterial infections is also actively investigated. Interested fellows are encouraged to work in the laboratory on research projects that characterize the interface between the mammalian immune system and pathogens in the setting of infectious disease.

Fellows are provided with on-site training in laboratory investigation and also have opportunities to participate in basic science course work. Fellows with interest in microbiology, cell biology, and other fields have a variety research options at MSK along with opportunities at The Rockefeller University and Weill Cornell Medical College.

The Tobias Hohl Lab

Physician-scientist Tobias Hohl studies the molecular pathogenesis of human fungal pathogens and how the immune system responds to them.

Learn more

The Michael Glickman Lab

Physician-scientist Michael Glickman investigates the physiology and pathogenic mechanisms of mycobacteria, including the use of mycobacteria as bacterial cancer therapies.

Learn more

Clinical Research

Infectious Diseases fellows can become involved with, and may initiate, a broad range of clinical studies. Research projects may include clinical reports, case series, and epidemiologic investigations. Faculty members within MSK or from The Rockefeller University or Weill Cornell Medical College who are associated with the MSK Infectious Diseases Service will supervise all research projects.

Though most clinical studies typically occur within the Infectious Diseases Service, they often cross borders into other disciplines. Thus, collaborative studies with other clinical services (including lymphoma, leukemia, and transplant) are commonplace and encouraged. The close relationship between the Clinical Microbiology Service and the Infectious Diseases Service also provides many opportunities for fellow-initiated research projects.

Lucille Castori Center for Microbes, Inflammation & Cancer

In January 2010, Memorial Sloan Kettering created a multidisciplinary research center to shed light on the role that microbes and the body’s inflammatory and immunological responses to them play in the development of cancer. The Lucille Castori Center for Microbes, Inflammation, and Cancer unites researchers in the areas of molecular biology, immunology, computational biology, and microbiology and members of the Infectious Diseases and Clinical Microbiology Services in Memorial Hospital.

In addition to facilitating research among MSK’s investigators and clinicians, the Castori Center provides grants for clinical and laboratory-based fellows to extend their research and training.

The fellowship director, service chief, and other faculty speak with each fellow individually regarding potential projects in the first months of fellowship. By fall of the first year of fellowship, fellows generally have identified a few areas of potential interest and a specific mentor for each area.