a. Before fellowship

No additional training beyond residency in pediatrics is necessary to train successfully in pediatric infectious diseases. However, some residency electives may offer learning more relevant to infectious diseases than others. here is a list of electives that residents with an interest in infectious diseases can consider.

  • Infectious Diseases (either at your residency institution, your future fellowship institution if known, or both)
  • Immunology (specifically focused on immunodeficiency and an opportunity to learn antibiotic allergies)
  • Hematology/Oncology and other specialty services that manage solid organ transplants (e.g. Gastoenterology, renal)
  • Dermatology (specifically dermatologic manifestations of infectious diseases and/or adverse drug reactions)
  • Radiology
  • Pulmonary (to gain exposure to cystic fibrosis)
  • Rheumatology
  • Specific research training (e.g. statistics, epidemiology)
  • Public/global health (consider doing an internship at your local or state health department, the Centers for Disease Control and Prevention, or an international organization such as WHO)

Identify a mentor in infectious diseases at your program or elsewhere that you can talk to during residency and learn more about the field. They can also help you decide which programs might be a good fit for you and introduce you to others within the field.

We recommend joining PIDS as a resident. Membership is free for residents and fellows and is a great way to learn more about pediatric infectious diseases. The Infectious Diseases Society of America offers membership at a nominal fee ($30 as of 2020) for residents and a discounted fee ($120 as of 2019) for fellows.

If able, attend a national PIDS meeting (yearly, in March) or IDWeek (yearly, in October). These meetings are a great way to learn more about the field of ID. expose yourself to interesting research. and meet potential mentors. Fellows are highly encouraged to attend these meetings and can provide insight into which programs might suit your interests. 

b. Application Process

Most pediatric infectious diseases fellowship programs receive applications through the Electronic Residency Application Service (ERAS) and offer positions through the National Resident Matching Program (NRMP) Pediatric Specialties Fall Match. Through this process, applicants may begin ERAS applications on July 5th, approximately a year prior to the intended fellowship start date. Interviews typically occur in August through October, and rank lists are due in late October. Match Day is in mid-December.

Visit the ERAS fellowship applicant page for information about the ERAS fellowship application process. Visit the NRMP Pediatric Specialties Fall Match page for information about the NRMP match process.

Not all pediatric infectious diseases fellowship programs participate in ERAS. Click here to find out which programs participate. A comprehensive list of all pediatric infectious diseases fellowships is available on the PIDS website, and application information for positions are available on the PIDS Fellowship Positions page. You may also contact programs directly for application information.

To get an idea of what is expected for an ID fellow to graduate and become an ID physician, you can access the American Board of Pediatrics (ABP) list of Entrustable Professional Activities (EPAs) for Pediatric subspecialties here

c. Clinical Service

Inpatient Service: Each hospital is unique regarding having an inpatient service, having a consulting service, or both. As a fellow, you should expect to be the primary provider for your service's patients and to coordinate the patient care activities of the team (rounds, returning pages, consulting with other teams, etc.). Your clinical time will be your opportunity to focus on learning infectious disease processes and treatments – take advantage of it! Also, become familiar with the microbiology lab and find out about how your lab functions. Keep in mind that some institutions have one year of clinical service followed by two years of research, while others divide clinical time over the three years. Take this into account when considering your goals in fellowship to make sure you are able to pursue your desired research, additional degrees, or specific clinical training.

Clinic: Most outpatient clinics see a mix of hospital follow-ups, new outpatient consults, and HIV infected or exposed children. Some clinics also have a focus on international adoption and/or travel medicine. Get a sense of the make up of your division's clinic. If there is a disease process you are particularly interested in but is seen in another clinic (i.e, a city-run tuberculosis clinic, or a separate HIV clinic), discuss with your fellowship program director about incorporating these experiences into your training so you feel trained appropriately by the end of fellowship.

Calling your Attending with Questions: You should never feel badly about calling your attending, even late at night. Especially at the beginning of the year, it is much better to talk through a case when you are uncertain about next steps. Besides making good decisions for patients, talking through your thought process is a  important part of your education. Your attendings fully expect to be called often, if not always, with questions in the beginning of the year.

Phone Calls and Curbside Consults: You will receive many questions from both inpatient and outpatient providers who do not request a formal consult. Managing these questions is challenging and requires a different skill set than being a front-line clinician. Rely on your attendings to help develop this skill. Do not hesitate to tell providers that you will discuss their question with your attending and call them back. Most providers are happy to hear that you are taking their question seriously and will not mind waiting. Additionally, it is important to realize the limitations of telephone medicine. It is not uncommon to receive incomplete or inaccurate information, as there is likely more complexity to the patient than can be conveyed by phone. This can make providing a recommendation difficult and even unsafe. It is usually okay to answer general questions, but when the questions become patient-specific or very involved, it is often better to do a formal consult. Check with your attendings to see how much information they are comfortable giving over the phone. If the question is too complex, suggest that you do a formal consult. For patients outside of your institution, this may require referral to your clinic or the emergency room, or having them transferred to your hospital.

Residents and Medical Students: Most hospitals have several learners involved in service – residents, medical students, and observers, to name a few. Learn early what role these members should take on (and can take on, by legal standards at your institution.) Can medical students write notes? Can observers examine patients? Finding out early will save you confusion down the line. Even if you assign patients to the other learners, make sure you know everything going on with your patients. Don't just rely on other learners during rounds.

Billing: Frequently, trainees are removed from the billing process. However, many of our actions do affect how divisions can bill for services. Ask your attendings or co-fellows what practices need to be followed so that your hard work also keeps your division in business! It's not a bad idea to learn the billing process during fellowship either. You will be in charge as soon as you graduate, so learning early could be of great benefit.

Health Records: Become proficient in your institution's health record system early on. Many other trainees likely have tips and tricks for the system – don't be shy about asking to spend a few minutes with someone to maximize your efficiency so that paperwork doesn't distract you too much from taking care of patients.

Duty Hour Restrictions: Fellows must abide by ACGME duty hour restrictions just like residents. Your schedule should be designed to make sure you have the proper days off per month – if it's not, work with your program to prevent duty hour violations. Duty hour requirements are included in the ACGME revised common program requirements.

Electives: Each institution offers elective time in different ways, both to complement your training and also to fulfill certain ACGME requirements. Some elective rotation may include Infection Prevention & Control, Antimicrobial Stewardship, and/or a Microbiology Laboratory experience. Find out early on what your responsibilities are so that you can make sure your electives are scheduled accordingly to balance clinical service and research responsibilities.

Education: Any teaching hospital will have an array of educational talks for you to choose from. Prioritize any ID specific talks – case management, journal club, microbiology rounds, and learning directed towards fellows. Also seek out the other talks that interest you – grand rounds, immunology conferences, conferences with adult ID physicians, or research talks that will keep you connected to your research interests during clinical time. You can't attend everything, but ensuring you prioritize those that fit with your training goals is important.

Feedback: Giving and receiving feedback is an important component of your training. Be sure to set aside time for feedback with your service attending, as this will be your main opportunity to get feedback on your clinical skills. We all are so focused on taking care of the patients that it is easy to forget about this! Your attendings are also required to provide an evaluation of your progression through clinical and professional milestones, similar to residency. All programs should use the ACGME "Milestones" as part of your evaluation, which follow development over time. You should review these with your program director at during your semi-annual review throughout fellowship. Keep in mind that milestones track growth. You should not really excel at anything as a first year fellow, but rather should improve over the three-year program. Additionally, when you have residents and medical students rotating with you learn how to give them feedback on their performance during that rotation.

d. Useful clinical references

A large part of training as a fellow is gaining a fund of knowledge, and also knowing the references to rely on to increase your fund of knowledge. Many obscure questions will come your way and knowing how to quickly access specialized references will also help you succeed clinically.

  • The Red Book: The Red Book is a good starting point for looking things up. If you are a member of the AAP, you will receive access to the online version as well as the mobile versions as a member benefit. If you want the hard copy version, you can order it through the AAP website.
  • Antibiotic Guides: Sanford Guide (app available), Nelson's Pediatric Antimicrobial Therapy, and NeoFax are all worth looking through and deciding which is best for your workflow.
  • Nelson's Pediatric Antimicrobial Therapy: The Nelson's Pediatric Antimicrobial Therapy Book provides instant access to reliable, up-to-the-minute recommendations for treatment of all infectious diseases in children. Access is available through the AAP website.

Textbooks: Many people like to own a copy of the major texts, and many provide online access depending on the publisher so that you can review topics if you are by a computer. Find out what you have access to, and consider purchasing the others.

  • Principles and Practice of Pediatric Infectious Diseases
  • Feigin and Cherry's Textbook of Pediatric Infectious Diseases
  • Nelson Textbook of Pediatrics
  • Vaccines 
  • Remington & Klein's Infectious Diseases of the Fetus and Newborn Infant
  • Tropical Infectious Diseases 
  • Hurwitz Clinical Pediatric Dermatology

These references are available online:

  • Antimicrobe.org: A comprehensive database of infectious diseases and antimicrobial agents, frequently updated.
  • The Pink Book: Comprehensive information on vaccines and vaccine-preventable diseases. You can order a copy, or download from cdc.gov
  • The Yellow Book: Excellent reference for travel medicine, published every two years by the CDC.
  • The Purple Book: The Vaccine Handbook: A Practical Guide for Clinicians is one of your one-stop shop for all things vaccine, from understanding basic vaccine immunology to overcoming vaccine hesitancy. Details about infrastructure, logistics, delivery, and special circumstances are laid out, and information about every licensed vaccine (and its corresponding preventable disease) are given. The book is available as a free app for iOS devices                   (https://itunes.apple/com/us/app/the-vaccine-handbook-app/id1043246009?mt=8

This list is just a start – if there is a specific area of infectious diseases you love, there is sure to be a reference book that can help you master it!

Online Resources:

Institution Specific Resources: Many institutions have internal documents that will make your clinical job easier - find out early about clinical pathways, order sets, easily available resources, journal article repositories, your university library, and any additional access to books that are a shared resources. If you find your institution is lacking in shared resources, start accumulating any electronic resources that can easily be passe fellow to fellow. 

Journals:
These journals are frequently read by most Infectious Diseases fellows and attendings, some of which come free with society memberships.

  • Journal of the Pediatric Infectious Diseases Society (JPIDS) (included with PIDS membership)
  • Clinical Infectious Diseases (CID) (included with IDSA membership)
  • Journal of infectious Diseases (JID) (included with IDSA membership)
  • Open Forum Infectious Diseases (OFID) (Included with IDSA membership)
  • Pediatric Infectious Diseases Journal (PIDJ)
  • emerging Infectious Diseases (EID) open access publication from CDC

Journals also accompany your membership to the AAP, including Pediatrics.

Of course, depending on your interests and your library's access, many individuals choose additional journals to subscribe to – check in with mentors early on regarding what they have found most useful. Also consider establishing your own RSS feed that will pull topics of interest from numerous journals and deliver them to your mailbox through your institution's library. Alternatively, you can flag topics you are interested through Pubmed's "saved searches" feature which can automatically send you search results for topics on a recurring basis.

Podcasts and listservs:
There are many modern ways to find out about ID including podcasts, list-servs, and even Twitter!

  • Emerging Infectious Diseases podcast
  • Puscast: weekly podcast that summarizes the ID literature
  • CIDRAP list-serv: provides a summary of hot topics in Infectious Diseases
  • Morbidity and Mortality Weekly: publication from CDC on public health topics
  • COCA webinars: webinars from CDC on public health topics
  • Register for health alert networks (HAN) from your state and local health departments to keep up to date on outbreaks
  • Antimicrobial Stewardship Program (ASP) list-serve: poses questions and answers for antimicrobial stewards around the country by sharing resources and ideas