Infectious Disease Program Description


University of Alabama at Birmingham and Children’s of Alabama Pediatric Infectious Diseases Program
1600 6th Avenue South, CHB 308 | Birmingham, AL |  35233
P: 205.934.2441
F: 205.975.6549
Residency:  Pediatrics, UAB
Fellowship: Pediatric Infectious Diseases

Program Director
Scott James, MD
Assistant Professor of Pediatrics
sjames@peds.uab.edu

Program Coordinator
Tracy Downey


About Us
 | Introduction | Teaching Staff | Research Interests | Cirriculum | Competencies


About Us:

The pediatric infectious diseases fellowship is a three-year training program approved by the Accreditation Council for Graduate Medical Education (ACGME) and affiliated with Pediatric Residency Program at the University of Alabama School of Medicine. The fellowship program provides trainees with a broad clinical experience and strong foundation in scholarly pursuits, including basic or clinical research, antimicrobial stewardship, infection control, and infectious diseases in the immunocompromised host. The program is flexible and is tailored to suit each individual's interests, previous experience, and future career goals. Our overall objective is to prepare fellows for a career in academic pediatric infectious diseases. Stated plainly, our fellows’ success is our success. Our track record over many years of placing fellows in top clinical, research, and public health programs throughout the country is a testiment to the success of this approach.  All of our former fellows over the past decade have easily passed their pediatric infectious diseases boards.

Introduction: 

The University of Alabama at Birmingham is an excellent academic medical center where all clinical and research activities are based at a single contiguous campus.  Children’s of Alabama is located in the middle of this large medical complex, and is the only free-standing children’s hospital in the state.  The University of Alabama Hospital is adjacent and physically connected to Children’s of Alabama. The research facilities for Pediatric Infectious Diseases occupy an entire floor of the Children’s Harbor Center inside Children’s of Alabama, with our clinical offices on an entire other floor in that building; both are connected by short enclosed walkways to Children’s of Alabama clinical facilities.

Our program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and was approved October 26, 1998. As of 2015, we have had 20 graduates since 1993. The duration of our Fellowship training program is three years, with an emphasis on extensive clinical and scholarly experiences. Our goal is to train and nurture academically oriented pediatric infectious diseases physicians to be proficient in diagnosis and management of simple and complex infectious diseases problems, and to initiate and develop scholarly activities to further their knowledge in the field of Pediatric Infectious Diseases. We have robust antimicrobial stewardship and infection control programs that provide foundational training on these important areas of growth for our field, as well as a developing immunocompromised host service.

From the research perspective, the Fellow will learn basic research principles in which to develop a project, follow it through completion, and prepare the project for publication and presentation. This not only allows the Fellow to determine is research is a direction in which they would like for their career to develop, but also ensures that they emerge from fellowship training fully qualified to sit for their pediatric infectious disease boards. The Fellow will have the opportunity to be both a student and teacher, as they will be involved in teaching residents and 
students. They will have supervised instruction in providing consultative services and communication with other physicians and other members of the healthcare team.

Teaching Staff

Scott James, MD, Assistant Professor, Fellowship Program Director 
Richard Whitley, MD, Professor, Co-Division Director
David Kimberlin, MD, Professor, Co-Division Director William Britt, MD, Professor
Suresh Boppana, MD, Professor Cecelia Hutto, MD, Professor
Shannon Ross, MD, Associate Professor

Division Faculty Research Interests: 

Richard Whitley, MD – Neonatal herpesvirus infections, HSV gene therapy, antiviral therapy for pediatric viral infections, and drug discovery

David Kimberlin, MD – Antiviral therapy for congenital and neonatal herpesvirus infections, national vaccine policy

William Britt, MD – Congenital CMV, CMV virion assembly and animal models for CMV neuropathogenesis and hearing loss

Mary Ballestas, PhD – Viral Expression Core, Kaposi’s sarcoma herpesvirus (HHV-8)

Suresh Boppana, MD – Congenital CMV infections and hearing loss, molecular diagnostics, correlats of protective immunity against congenital CMV infection, maternal CMV infections

Maaike Everts, PhD – Alabama Drug Discovery Alliance

Karen Fowler, MD – Epidemiologic studies of maternal and congenital CMV infections and the role of congenital CMV infection in sensorineural hearing loss in children

Cecelia Hutto, MD – Epidemiology and diagnosis of perinatal and congenital infections of perinatal and congenital infections and natural history of HIV infections in children

Scott James, MD – Emerging antiviral resistance in congenital CMV infection and translational molecular virology with an emphasis on studying mechanism and frequency of antiviral resistance in herpes viruses

Mark Prichard, PhD – Antiviral drug development and mechanisms of herpes virus drug resistance, molecular diagnostics 

Debra Quenelle, PhD – Animal models for viral diseases and antiviral drug testing

Shannon Ross, MD – Pathogenesis of congenital cytomegalovirus related to hearing loss and maternal cytomegalovirus infections, correlats of protective immunity against congenital CMV infection

Veronica Sanchez, PhD – Effects of CMV infection of cytoskeletal dynamics and lipid metabolism and how these cellular processes contribute to viral pathogenesis

Division Fellows Research Interest

James Aaron Grubbs, MD – Studying the pathogenesis and host immune response to pneumococcal disease

Catherine Hough-Telford, MD –Breastmilk transmission of CMV and perceptions of vaccine hesitancy by AAP pediatricians

Claudette Poole, MD – Pilot study to evaluate the presence of viruses in neonates undergoing a sepsis evaluation in the NICU and prevalence of Neisseria gonorrhea and chlamydia trachomatis in prepubertal children being evaluated for sexual abuse with routine screening using NAAT on pharyngeal and recta swabs and urine

Program Curriculum

Research Training:
Fellows spend at least two thirds of their time, primarily during their second and third years, in a protected research environment during which they have no clinical responsibilities and no call. During the first few months of the fellowship, each Fellow is given time to explore research opportunities within the University of Alabama Medical Center and to identify a research mentor.

A variety of research projects are underway in the Division of Pediatric Infectious Diseases and fellows are encouraged to consider a research mentor from within the Division. However, research mentors can be chosen from any of the departments at UAB where work related to infectious diseases is being carried out. While all the members of pediatric infectious diseases division have strong research interests appropriate for the young investigator, previous or current fellows have undertaken their research training in other basic sciences departments. A variety of opportunities exist within the medical center, and all are in very close proximity to  the pediatric infectious diseases offices. Fellows can consider mentors in the Department of Microbiology and Immunology, the Department of Medicine (e.g. Adult Infectious Diseases), the Department of Pathology, the Department of Cell Biology, the Department of Epidemiology and International Health and in other divisions within the Department of Pediatrics. During the research phase of training, fellows are expected to develop an independent project, with close involvement of and supervision by their research mentor(s), and to present results periodically at the weekly Division and monthly Departmental research conferences. In addition, fellows are encouraged to present their experimental data at a minimum of one national meeting. By completion of training the fellow will be subspecialty board eligible, meeting all requirements for completion of Scholarly Activities. For  those fellows seeking to develop a research career post-fellowship, this also will include either publication of first authored manuscripts in peer-reviewed journals and/or preparation of an application  for  extramural  support  by  a  national  funding  agency.  Opportunities  are also available for Fellows to enroll in graduate level courses in microbiology and immunology, and in courses offered by the School of Public Health in epidemiology, biostatistics, and international health. Support to develop grant-writing skills is available and extended support to continue training beyond the third year is available in select instances.

Clinical Training:

Fellows are required to spend a minimum of 10 months of inpatient clinical training during the 3-year period. This clinical schedule is flexible and typically, the first year of training involves an intensive clinical experience, with five to six months on the inpatient consultation service, time in the Pediatric Infectious Disease Clinic and the Maternal-Child HIV Clinic (family clinic), 2 to 4 weeks in the clinical microbiology laboratories, and exposure to activities of the Infection Control, Antimicrobial Stewardship, and Pharmacy & Therapeutics committees of The Children's Hospital of Alabama. Rotations on the Adult Infectious Disease service at the University of Alabama Hospital (Department of Medicine), on the Pediatric Pulmonary Medicine, Immunology and Rheumatology service, the Stem Cell Transplant Center at the Children’s Hospital, the Travel Medicine Clinic staffed by the members of the Geographic Medicine Department, and the Sexually Transmitted Clinic at the Jefferson County Department of Public Health and staffed by the Adult Infectious Disease Faculty are available for those who are interested.

Clinical training consists of monthly rotations with a supervising infectious diseases faculty member. The fellow fields phone calls from referring physicians and rounds with the attending physician daily. At the Children’s Hospital, the fellow supervises medical students and pediatric and medicine/pediatric residents serving on the infectious diseases team. Fellows are never required to take in-house night call and are given 1 day off per week (averaged monthly) during their clinical rotations. Fellows typically take calls by pager at night during their months on service excluding their days off; however, in accord with ACGME guidelines, fellows are not required to be responsible for calls more than every third night averaged monthly. In addition, clinical training includes outpatient care of children with infectious diseases including those with HIV infection.

The second and third years of the fellowship are devoted almost entirely to scholarly activities, with fellows spending one to two months per year on the inpatient consultation service. The Division of Pediatric Infectious Diseases convenes a weekly clinical conference, which serves as a forum for discussion of recent inpatient and outpatient consultations and journal clubs. Clinical conference occurs once per week and the fellow on the consultation service is responsible for preparing and presenting selected cases at this conference. Several additional conferences are shared with the Division of Adult Infectious Diseases in the Department of Medicine, including a weekly lecture series on topics in clinical infectious diseases, and a weekly case conference featuring pediatric and adult patients. Fellows are encouraged to attend these conferences throughout their training. In addition, the Department Microbiology and Immunology coordinates a weekly seminar series on mechanisms of infection and microbial pathogenesis. Fellows are encouraged to attend these sessions during their second and third years of training.

Scope of Clinical Services

Clinical rotations at The Children’s Hospital of Alabama afford the fellow the opportunity to manage a variety of immunocompetent and immunocompromised pediatric patients. The children’s Hospital is a licensed, JCAHO-accredited 325-bed pediatric hospital (www.childrensal.org). In addition, the University of Alabama Women and Infant Facility Center contains a 120-bed Regional Neonatal intensive Care Unit. All congenital and acquired heart defect surgeries and solid organ transplants (liver, kidney, heart) are performed at Children’s of Alabama. Approximately 450 consultations for infectious disease issues are performed yearly. The full spectrum of pathology is seen including infections in neonates, immunocompromised patients, and infections in immunocompetent patients, children with cystic fibrosis, hemoglobinopathies, post-surgical patients, children with a variety of malignancies, bone marrow transplant recipients, solid organ transplant recipients, and those with HIV infection.

Approximately 80 to 100 children born to HIV-infected women are followed in a specialized clinic (Family Clinic) at The Children’s Hospital. This clinic follows both children and their mothers. In addition to the clinic for HIV-exposed and infected infants, a separate pediatric infectious disease clinic is in operation weekly at the Children’s Hospital. Approximately 250 patients are seen yearly in this clinic for a variety of infectious diseases related problems. Approximately 70% are new patients referred from regional healthcare providers and 30% are followed-up patients from the Children’s Hospital inpatient service. A Pediatric AIDS Clinical Trial Unit (ACTU) is located at Children’s Hospital and the HIV-infected children participating in the PACTU protocols are also followed in the Family Clinic.

Our curriculum is designed to:

• Present a wide variety of acute and chronic infectious diseases, including disorders of host defense;
• Prepare the subspecialty resident to understand and deal with the principles of disease control, prevention of nosocomial infections, and immunization programs;
• Teach basic epidemiologic and biostatistical methods and their application to clinical research and patient care;
• Teach the subspecialty resident the functions and appropriate utilization of diagnostic microbiology, immunology, virology, mycology, and parasitology laboratories;
• Prepare the subspecialty residents to conduct research in the broad area of pediatric infectious diseases;
• Ensure acquisition of appropriate teaching skills that can be used in the area of pediatric infectious diseases.

An example of the 3 year fellowship curriculum:
• 1st year Clinical-consult rotation, outpatient clinical responsibility and development of research project
• 2nd and 3rd years for development of research project leading to publication in a peer- reviewed journal, ongoing outpatient continuity clinical responsibilities, and a rotation as attending in 3rd year.
1st   year
1st month is ID introduction course/micro 6 months clinical/ consults
4 months research
1 month vacation or meetings
2nd   year
3 months clinical/consults
8 months research
1 month vacation or meetings
3rd   year
1 month clinical/consults
2 months for clinical elective 8 months research
1 month vacation or meetings

Competencies

Competency 1:  Patient Care.  Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Competency 2: Medical Knowledge. Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
Competency 3: Practice-based Learning and Improvement. Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life- long learning.
Competency 4: Interpersonal and Communication Skills. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
Competency 5: Professionalism.  Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
Competency 6: Systems-based Practice. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Promotion of Sub-Specialty Residents

1. The program director will have a written record of all faculty evaluations which are formally reviewed with the fellow.
2. Fellows will be advanced to the next level of responsibility based on evidence of their satisfactory progressive scholarship and professional growth. The Clinical Competency Committee will meet twice yearly to evaluate the Fellow’s readiness for promotion.
3. At the conclusion of the final year, the program director will provide a final written evaluation for each subspecialty resident who completes the program. This evaluation will include:
a. Verification of demonstrated professional ability and acquisition of appropriate clinical skills to practice competently and independently.
b.   The final evaluation will be a part of the Fellow’s permanent record which is maintained by UAB.