Tufts Medical Center is well known for its antimicrobial stewardship program (ASP). Established in 2003, it is one of the most comprehensive programs in the country with demonstrated success in reversal of resistance patterns, decreasing inappropriate antimicrobial usage, and lowering pharmacy costs.
The Tufts Medical Center ASP has a close working relationship with the Massachusetts Department of Public Health and its members, including ID fellows, regularly participate in statewide initiatives. These include a recent statewide educational program for hospitals interested in implementing antimicrobial stewardship, and an initiative to improve the management of asymptomatic bacteriuria in the elderly.
Led by Shira Doron, MD a graduate of the Tufts Infectious Diseases fellowship training program, and Kira Beaulac, PharmD, a pharmacist with advanced training in infectious diseases and antimicrobials, the program offers opportunities for fellows to gain hands-on learning experience with close supervision. Kira also rounds with fellows on the inpatient consult teams, providing the fellows with extra training in pharmacokinetics, pharmacodynamics, and pharmacology.
ALL fellows have the opportunity to participate in Antimicrobial Stewardship during their ID fellowship as a core competency of training. Every fellow will have a closely supervised experience in approving restricted antimicrobials with feedback from the antimicrobial stewardship staff on this activity.
Fellows choosing this as a concentration will have a more intensive experience, at the end of which will be able to implement and/or lead similar programs, making them highly desirable in the present infectious disease employment market. Many of our trainees have gone on to jobs in which this skill has been well-utilized.
- Developing educational materials for hospital staff and trainees on specific Antimicrobial Stewardship issues
- Internal and external speaking opportunities promoting prudent antimicrobial use
- Prospectively evaluating and authorizing restricted antimicrobials on a routine basis
- Contributing to the annual revision of the Tufts Medical Center “Antimicrobial Treatment and Dosing Guide” by developing clinical algorithms and treatment pathways
- Leadership roles on hospital quality improvement task forces, allowing fellows to have important input, and to experience working in a multidisciplinary hospital team.
- Integral involvement in the Tufts Antimicrobial Stewardship Team, where key processes and execution of policies and practices are developed and implemented
- Weekly journal club reviewing guidelines, articles, and news at the forefront of antimicrobial stewardship.
- Participating in the Antimicrobial subcommittee of the Pharmacy and Therapeutics Committee at Tufts Medical Center, a multidisciplinary group in which essential aspects of antimicrobial use are discussed.
- Participation in quarterly Infection Prevention meetings
- Participation in Microbiology rounds
For 2-year fellows, and for fellows who are interested and eligible for our 3 year Physician-Investigator track, many opportunities exist in Antimicrobial Stewardship-related research. Examples of recent projects include the effect of empiric therapy for neutropenic fever on C. difficile rates, implementation of an antimicrobial stewardship program in long term care facilities, effect of mini-BAL results on de-escalation of antimicrobials for ventilator-associated pneumonia.
Antimicrobial stewardship is an exceptionally fertile area for QI/QA projects, and our fellows often choose projects from this area, even if not specifically enrolled in this concentration.
Fellows in this track will have specific opportunity to develop their expertise as Clinician Educators. Teaching opportunities include leading small group discussions with pre-clinical medical students, as well as providing lectures to medical students on clinical rotations and housestaff.
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