• Rotation Director: Shannon Kasperbauer M.D..
• Rotation Location: National Jewish Hospital and Research Center, Denver, CO
• Rotation Duration: One 4-week block
• Trainees/month: One

Education Purpose and Rotation Description:

This rotation provides an opportunity for the fellow to develop expertise in the diagnosis and management of refractory mycobacterial infections – both multidrug resistant tuberculosis and nontuberculous disease – at a national referral center.  Patients include both males and females of various ethnic and socioeconomic groups.  This experience emphasizes searching for predisposing conditions, recognizing, and dealing with drug toxicity utilizing pharmacokinetic studies to optimize treatment, and preparing patients for surgery and post-operative care.  As a member of a multidisciplinary team consisting of an attending infectious disease or pulmonary physician specialist, nurse practitioner, pharmacist, and respiratory therapist, the fellow will have primary responsibility for patients admitted to either the inpatient or day treatment units.   Rotation Objectives:

1. Acquire knowledge and clinical experience in the following areas:
   • Multidrug resistant tuberculosis
   • Nontuberculous mycobacterial disease
   • Bronchiectasis
   • Medical treatment of mycobacterial disease including pharmacokinetic principles to guide treatment and drug interactions
   • Surgical management of severe mycobacterial disease
   • Adjunctive treatments for mycobacterial disease including mucous clearance therapies
   • Underlying conditions that predispose to chronic, refractory mycobacterial disease
   • Public health issues regarding mycobacterial disease
2. Establish competence in pulmonary techniques and procedures
   • Bronchcoscopy and other techniques to obtain samples from the lower respiratory tract
   • Mucociliary clearance techniques
   • Radiographic interpretation of chronic lung infections
3. Gain experience in:
   • Diagnosis and treatment of chronic lung infections caused by mycobacteria
   • Interpretation of radiographs for chronic mycobacterial infections
   • Management of complex antituberculous medication regimens that includes use of pharmacokinetic principles to optimize treatment and recognition of drug side effects and interactions. 
   • Working with a multidisciplinary team    

Learning Venues and Teaching Methods:

Conferences:

• Please refer to the schedule.

Direct Patient Care:

• Inpatient and day treatment unit: Goodman Building, 2nd floor, South Wings
• Pulmonary clinic: May Building, 1st floor
• Radiology department/conference room: May Building, Basement
• PFT Laboratory: May Building, 3rd floor
• Procedure suite: May Building, Basement

Suggested Reading:

1. NJMRC TB Course Binder (compendium of lectures from quarterly course)
2. Nontuberculous Mycobacteria, Clinics in Chest Medicine, Sept 2002
3. ATS Position Statements on Tuberculosis and Nontuberculous Mycobacterial Disease

Evaluation:

Trainees will receive a written evaluation upon completion of their rotation. This evaluation will assess their cognitive, patient management, procedural, and humanistic skills. The evaluation, including suggested areas for improvement, will be discussed personally with the trainee at the end of the rotation and then shared with the Fellowship Director to be included in the trainee’s permanent file.