The cornerstone of the fellowship program is exposure to the full array of infectious diseases in both the inpatient and outpatient clinical settings (see descriptions of ambulatory clinical programs). Fellows participate in inpatient consultation services at Rhode Island Hospital (RIH), The Miriam Hospital (TMH), Women & Infants Hospital and the Providence Veterans Administration Medical Center (PVAMC) where they evaluate patients admitted to the medical and surgical services, including patients admitted to all of the specialty intensive care units.

At RIH, fellows spend most of their clinical time on the general ID consult service. Fellows spend additional time on the Transplant/Immunocompromised Host service which evaluates patients who have undergone renal transplantation at RIH, persons who are being treated for hematological malignancies, undergoing CAR T-cell therapy, and patients admitted to our institutions who have received solid organ transplantation or bone marrow transplantation at other institutions. Ambulatory training takes place at The Miriam Hospital Infectious Diseases and Immunology Center and consists of a longitudinal weekly clinic focused on HIV medicine, viral hepatitis, new outpatient ID consults, and infections that require outpatient parenteral antibiotic therapy (OPAT). Additionally, fellows participate in other specialty clinics for Lyme Disease and other tick-borne infections, tuberculosis and non-tuberculous mycobacterial infections, sexually transmitted infections, and travel medicine. The fellowship provides one-on-one teaching and mentoring provided by world-class faculty who are leaders in the field of infectious diseases and committed to the education of fellows, residents and medical students.

Inpatient ID Consultation Rotations: The Brown ID Division has created multiple ID consultation services at RIH and TMH to maximize the learning experience of the fellows. The “1st Service” at RIH and TMH is the primary ID teaching consultation service and the team consists of a fellow, supervising attending, and internal medicine residents and/or medical students who are taking an ID elective. The “2nd” and “3rd” Services are capped and are typically staffed by a faculty member only although Fellows will rotate on the RIH 2nd service in Year 1 or for an elective in Year 2. These services were created to offload consult volume from the “1st service” to optimize the learning experience for the fellow. Consults are distributed to the RIH and TMH services Monday-Friday through a central consult system utilizing our EMR managed by an administrator within the Division which decreases the number of calls to fellows who are assigned to the consult rotations. Consult orders are requested in the EMR to minimize non-urgent overnight calls to the fellows. Fellows have a cap of new consults each day to ensure that workload remains manageable and that education is the priority. Fellows are not required to work weekends unless they are specifically on call.

Transplant ID and Immunocompromised Host Rotation at RIH: Fellows rotate on the Transplant ID/Immunocompromised Host service during Years 1 and 2. The service provides ID consultation to patients who have received kidney transplants at RIH, and patients who have received other solid organ transplants (pancreas, liver, lung, heart) or hematopoietic stem cell transplants at other institutions, patients undergoing CAR T-cell therapy, and patients receiving chemotherapy for hematologic malignancies. This rotation provides comprehensive training related to opportunistic infections (viral, fungal, bacterial, and parasitic) among non-HIV immunocompromised hosts. Away rotations in transplant / immunocompromised host training are available with advanced planning.

Antimicrobial Stewardship & Infection Control/Hospital Epidemiology at RIH: This four-week combined rotation provides 1st-year fellows with an introduction to Antimicrobial Stewardship and Infection Control/Hospital Epidemiology to enable more focused and intensive training during Year 2 for fellows who wish to pursue careers in these important areas of infectious diseases. The Antimicrobial Stewardship (ASP) section is led by Dr. Chet Cunha and the Infection Control/Hospital Epidemiology section is led by Dr. Leonard Mermel.

Clinical Microbiology rotation at RIH: 1st Year fellows spend three weeks in the Clinical Microbiology Laboratories of the Brown University Health Academic Medical Center to become familiar with the functioning of a large high-volume lab. The rotation focuses on the basic principles of processing specimens, performing cultures and other diagnostic assays, and performing drug susceptibility testing. Fellows work directly with laboratory technicians in various sections of the lab, participate in daily rounds with the Director and Associate Director of the lab, and learn how the lab interacts with other parts of the ID Division including the Antimicrobial Stewardship and Infection Control/Hospital Epidemiology programs. The rotation is supervised by Dr. Tao Hong and Dr. Sara Geffert (graduate of the Brown ID fellowship Program)

Outpatient Longitudinal Clinic: Each fellow is assigned to one half day of clinic per week (Tuesday or Thursday morning) at The Miriam Hospital Immunology and Infectious Diseases Center. Education focuses on HIV medicine, treatment of hepatitis C infection, and treating patients who are receiving OPAT. Each fellow works with two faculty members who are assigned as clinic preceptors for the Tuesday and Thursday sessions.

The Providence VA Medical Center ID Rotation: Fellows rotate through the Providence VA Medical Center as 2nd year fellows. The VA ID rotation includes rounding on the inpatient consult service, participating in outpatient specialty clinics (HIV, wound clinic), and participating in other activities of the ID Division including antibiotic stewardship and infection control/hospital epidemiology. The rotation is supervised by Dr. Melissa Gaitanis, Section Head of Infectious Diseases.

Women & Infants Hospital: During the 1st year, fellows will complete a “Reproductive Infectious Disease Rotation”. The curriculum includes a series of lectures on infectious disease issues in pregnancy, including HIV, Influenza in Pregnancy, STI, Fever in the Pregnant Patient, COVID-19 in Pregnancy, Tuberculosis in Pregnancy, Antimicrobial Stewardship, “Bugs and Drugs” antibiotic lecture jointly with Women & Infants infectious disease pharmacist, and Mpox in Pregnancy. In addition to time at Women & Infants Hospital, fellows will spend additional time at the Immunology center with exposure to colposcopy and PAP testing and in the STI clinic.

The outpatient fellowship experience at Brown is centered around the Infectious Diseases and Immunology Center, a brand-new 16,600-square foot facility custom designed in 2019 to house the ID clinics. The Center offers care to a large and diverse patient population from across the state, with over 11,000 patient visits per year. The Ryan White HIV Care program is the largest program of the Center, offering comprehensive HIV primary care to over 2000 people living with HIV. Also, within the ID & Immunology Center is the nationally-recognized Center for Lyme and Tick-Borne Diseases, the state STI Clinic, and many other outpatient ID services including a robust OPAT program, Hepatitis C treatment program, and a general ID consult service.

ID fellows care for patients at the Center in a multidisciplinary environment, working alongside a highly effective support team that includes ID specialist pharmacists, social workers, medical case management and hepatitis C specialty nurses, a clinical ID nursing team, a psychologist, and a psychiatrist. Specialist Advance Practice Practitioners (NP’s and PA’s) also support the fellows in the clinical care of PLWH, OPAT patients, PrEP, women’s health, and substance use disorder. The Center has an onsite laboratory and pharmacy.

The Center is an active HIV research and training site, housing the Providence/Boston Center for AIDS Research (CFAR) and the AIDS Clinical Trials Group (ACTG) research unit, and serving as an active site for HIV-focused studies. ID Division faculty who work at the Center are active at the state, regional, and national levels with respect to HIV treatment and care including: 1) the Rhode Island 90-90-90 Campaign and the HIV Care and Prevention Planning Group (Drs. Chan, Garland, and Sanchez); 2) the Rhode Island peri- and postpartum HIV-positive women’s committee (Drs. Cu-Uvin, Hardy, and Sanchez); 3) the New England Steering Committee of the American Academy of HIV Medicine (Drs. Cu-Uvin, Garland, and Kantor); and 4) the DHHS Adult and Adolescent HIV Treatment Guidelines Panel (Drs. Beckwith, Cu-Uvin, and Kantor). This is just a sampling of physician leadership out of the Center. The Center and the Ryan White program are overseen by Dr. Joseph Garland.

• The Outpatient Parenteral Antimicrobial Therapy (OPAT) Program follows all patients discharged from the hospital system on IV therapy. The program is large and is coordinated by a physician and physician assistant, working with nursing and ID trained pharmacists. The program follows over 750 patients per year. An OPAT Database tracks diagnoses and outcomes, and is a rich source for QI and research projects for fellows and residents. The program is overseen by Dr. Jennie Johnson and Brian Resnick PA-C.
• The Hepatitis C Virus (HCV) Treatment Program focuses on treating both persons with HIV/HCV co-infection and those with HCV mono-infection. The team is run by Dr. Karen Tashima and has dedicated nursing and pharmacy staff members. The ID fellows have dedicated HCV clinics scheduled once-monthly during their usual weekly clinic time, which offers a focused HCV treatment experience and built-in HCV didactics.
• The Center for Tick-Borne Diseases provides care for patients struggling with symptoms of Lyme disease and other tick-borne diseases, and evaluates patients with other suspected tick-borne pathogens (e.g. babesiosis, anaplasmosis, ehrlichiosis). The clinic is run by Drs. Flanigan and Johnson.

Additional clinical sites for fellows include:

• The RISE (TB) Clinic treats both active tuberculosis cases and persons with latent tuberculosis infection, regardless of insurance status or ability to pay. The Clinic sees over 4000 patient visits annually, and works in close collaboration with the RI Department of Health. The clinic is run by Dr. Natasha Rybak. In 2018, Dr. Rybak started the Non-Tuberculous Mycobacteria (NTM) infection clinic which is held once weekly to treat a variety of NTM infections with the support of drug monitoring from the on-site ID pharmacist.
• The Brown Medicine Travel Clinic operates at the Brown Medicine Patient Center in East Providence, RI and offers pre-travel consultation for patients going abroad. It offers destination- and activity-specific counseling to travelers, and a wide range of vaccinations. It is currently the only site in the state to offer yellow fever vaccination. The clinic sees over 2000 patients annually. The clinic is staffed by infectious diseases clinicians, including Dr. Maria Mileno, who is the faculty expert in travel medicine.
• The Transplant Infectious Diseases Clinic, housed within the Brown University Health Cancer Center, follows all patients in Rhode Island who have undergone organ transplantation or who are undergoing treatment for hematologic malignancies. The clinic coordinates with the inpatient Transplant ID service for seamless care of these medically complex patients.

Brown has a robust and supportive clinical, translational, and basic science research environment to support ID fellow research and other scholarly activities. The Brown ID Division has approximately $15 million of external research funding annually, the highest among Divisions within the Brown Department of Medicine. Fellows have approximately six months of protected time during the two-year fellowship to pursue research based upon their individual interests. Drs. Cunha, Sanchez and D’Agata meet with 1st year fellows to explore research interests and to match fellows with faculty mentors. The Division has an NIH T32 clinical research training program, HIV and Other Infectious Consequences of Substance Abuse, funded by the National Institute on Drug Abuse (5T32DA013911). Eligible ID fellows can apply to this program to obtain up to two additional years of clinical research training in the areas of prevention, diagnosis and treatment of HIV and other infectious consequences of substance abuse. This training program brings together the multiple clinical research strengths from an institution that has a robust track record of training junior faculty members to become independent clinical investigators in the area of HIV and substance abuse. The T32 program is led by Principal Investigators Drs. Timothy Flanigan and Jody Rich and additional information is available from the T32 Senior Project Director, Lauri Bazerman (LBazerman@Lifespan.org).

The clinical research expertise is complemented by a diverse group of basic science researchers. These researchers investigate antibiotic discovery, mechanism of action, drug resistance including HIV, and pathogenesis of microbial infections.

ID Fellows have access to multiple research centers and resources housed within the Brown ID Division including the following:

• Providence/Boston Center for AIDS Research (2P30AI042853)
• COBRE Center on Opioids and Overdose (1P20GM125507)
• COBRE Center for Antimicrobial Resistance and Therapeutic Discovery (1P20GM121344)
• The Lifespan/Brown Criminal Justice Research Program on Substance Use and HIV (5R25DA037190)
• The Miriam Hospital Clinical Research Site of the AIDS Clinical Trials Group
• Center for Prisoner Health and Human Rights
• Brown Global Health Initiative

Fellows have the option to take elective rotations during their 2nd Year based upon their career interests. Examples of electives include but are not limited to the following:

• Infection Control/Hospital Epidemiology at RIH
• Antimicrobial Stewardship at RIH / TMH
• Pediatric ID at Hasbro Children’s Hospital
• Transplant ID/Immunocompromised Host Service at RIH
• Ambulatory ID at TMH
• TB Clinic Rotation
• Women’s Health / Reproductive Infectious Disease Rotation
• Rhode Island Department of Health (RIDOH) Public Health Scholars Program: Program Director and RIDOH approval required
• Global Health rotations (clinical or research): advance scheduling and Program Director approval required
  • Global health rotations are typically coordinated with the Brown Global Health Initiative. Former fellows have participated in clinical and research global health rotations in Ghana, Kenya, Ukraine, Haiti, Kurdistan, Myanmar, Cambodia, and Vietnam.

The fellowship has two training tracks, research and clinical, and fellows have the option of choosing their track at the beginning of their second year. Fellows can also opt to remain “undifferentiated” if he/she is still exploring different career paths. The Brown ID Fellowship program provides a flexible training platform and our goal is to help you identify your career path and prepare you for life after fellowship. All fellows, regardless of track, will develop a solid clinical foundation in the field of infectious diseases.

Each year of training consists of 13 four-week rotations and fellows have four weeks of vacation annually. Below are sample schedules for the clinical and research tracks (note: schedules may have slight variance year-to-year).

Sample block schedules:

Med/Peds Combined ID Fellowship: The Brown Adult and Pediatric ID Divisions collaboratively offer a combined Med/Peds ID fellowship that is four years in length. Combined ID fellows spend two years training in adult ID and two years in pediatric ID with integrated training activities. Applicants match through the Adult ID Fellowship or through the Pediatric ID Fellowship through the ERAS match system. Residents interested in the combined program should contact Dr. Chet Cunha or Dr. Tanya Rogo (Pediatric ID Division) to discuss the application process.

Call schedule: Fellows share weeknight, weekend, and holiday call evenly which roughly equates to one night of at-home weekday call per week, one weekend of call every five weekends, and covering 1-2 holidays per year. The call schedule is managed by the fellows, typically with a 2nd year fellow assuming responsibility for organizing the call schedule. On weekends, the on-call fellow sees new consultations at RIH only. New consults at TMH and the PVAMC are seen by attendings.

The fellowship program has a robust conference series that is a major component of the educational curriculum. Conferences held weekly include:

Monday: Fellows conference at the ID clinic allows one on one sessions with the fellows and faculty experts. Topics for this conference vary but typically include fellow meetings with Drs. Cunha and Sanchez, antimicrobial stewardship teaching sessions, HCV teaching sessions, TB / NTM curriculum, Infection Control curriculum, and other topics.

Tuesday: Department of Medicine Grand Rounds is held remotely via Zoom.

Wednesday: ID Division Conference via zoom. This conference includes a variety of ID topics presented by faculty (internal and external) and fellows. Basic ID topics are covered during the summer/fall months of each academic year.

Thursday: ID Board Review with Dr. Cunha.

Friday: The Friday ID Case conference at RIH. The ID teams from RIH and the TMH bring active cases for discussion. This is a great opportunity for teams to seek advice on the management of complex cases from their colleagues. ID faculty from around the state (and sometimes even globally if some faculty are outside the country) participate. Microbiology rounds occur immediately after the case conference in the Micro lab.

Additional Conferences:

• 1st-year fellows will complete the Society for Healthcare Epidemiology of America (SHEA) online course in Antimicrobial Stewardship and Infection Control (paid for by program).
• 1st-year fellows will also complete the IDSA Antimicrobial Stewardship Curriculum (paid for by program).
• 2nd-Year fellows attend the Advanced STD Intensive Course for ID Fellows in Boston.
• Fellows typically attend one ID Week conference during the two-year fellowship. The cost of the conference admission for one year will be covered by the program.
• Fellows may attend one CROI / HIV related conference during the two-year fellowship. The cost of the conference admission for one year will be covered by the program.
• Fellows have attended the IDSA Clinical Fellows’ Meeting and the Infectious Diseases Research Careers Meeting sponsored by IDSA and NIH.
• Other conference attendance is encouraged based on fellow interest.