Outpatient Clinics

Outpatient experience will be gained by assignment to one clinic or another according to the following schedule of one-half day per week assignments. Board eligibility and program accreditation requirements dictate that all trainees must have 24 consecutive months of outpatient clinic experience.

 

Location	Year 1	Year 2	Year 3
Duke ID Clinic	*	**	**
VA ID Clinic	***	**	**
Durham Health Dept STD Clinic	***
Fellow’s Clinic for inpatient follow up

 

* Optional

** Selection of one of these for 24 months is required

*** Required while on the VA clinical service

 

The outpatient clinics provide consultations for ambulatory patients with acute infectious diseases problems and ongoing care of patients with chronic infectious diseases requiring specialized management and/or treatment. The ID clinics provide outpatient services to over 1500 patients with HIV infection, and more than 100 patients visit the clinics each week. Almost one third are enrolled in clinical studies involving anti-retroviral drugs or drugs to treat opportunistic infections and neoplasms. The active clinical research program in the clinic includes both federally funded and privately sponsored research. The clinics provide treatment rooms for the administration of medications, fluids, and transfusions, and they provide social work and counseling support for patients. The Duke AIDS clinic advocates outpatient management of HIV and its complications whenever possible and offers an outstanding opportunity to develop skills in an HIV practice as well as clinical research.

 

The Durham VA ID Clinic is managed by ID attendings, fellows, a full-time nurse ID coordinator and other support services. The majority of the 35 to 50 patients per week have HIV-related problems, but an array of other chronic infectious diseases such as chronic osteomyelitis, chronic fungal diseases, and pulmonary and extrapulmonary mycobacterial diseases are also seen. Beginning at noon, an HIV support group consisting of a psychologist and social worker meet with interested patients. Between 1 p.m. and 4 p.m., patients are seen by the medical staff, and assessments and decisions are made. At 4:00 p.m., all staff meet in conference for about 1 hour to discuss in brief each patient seen in the clinic that day, with emphasis on special problems that require further attention, or one of the staff presents a discussion of a predetermined subject of interest. Clinical trials supported by the VA are in progress, and some patients are referred to the Duke ID clinic for enrollment into NIH-sponsored trials.

 

Fellows working in the ID Clinics learn to deliver outpatient care to HIV-infected patients, to participate in clinical trials, and to pursue individual research interests. Fellows are welcomed as members of the clinic team, and past fellows have presented and published their research results in appropriate settings.

 

STD Clinic. The major focus of the STD clinic experience is the acquisition of skills in the diagnosis and management of sexually transmitted diseases. In addition, there may be opportunities for clinical research in the field. A developing program in STD research is evolving via collaboration between Duke, the University of North Carolina and the Durham County Health Department's STD clinic. This clinic sees a large number of patients with a wide variety of sexually transmitted diseases. All fellows gain experience in the diagnosis and management of STDs by spending a half day per week at the STD clinic during the VA consult rotation. Chris Woods serves as the Duke attending for this clinic.

Fellows Clinic. Clinical fellows are encouraged to follow up on inpatients who are discharged from the hospital but would benefit from a subsequent evaluation. This is accomplished in the “Fellows Clinic” that meets each Friday morning. Fellows are responsible for scheduling their own patients as needed.