INFECTIOUS DISEASES UNIT

Royal Adelaide Hospital

University of Adelaide
Medical and Scientific
Attachment 2019

Years 4-6.
 Infectious Diseases Unit
Royal Adelaide Hospital
University of Adelaide
Medical and Scientific Attachment 2019
Years 4-6.

Introduction:
Welcome to the Infectious Diseases Unit (IDU) of the Royal Adelaide Hospital and
Infectious diseases laboratory of South Australia Pathology. We hope you will find this
rotation both academically challenging and professionally rewarding.

Clinical Infectious Diseases:

During your MSA, the following Infectious Diseases Physicians will assist with your
learning objectives and goals.

Associate Professor Dr David Shaw, Director of Infectious Diseases Unit

Dr Brett Ritchie, Infectious Diseases Physician
Dr Jennifer Catford, Infectious Diseases Physician
Dr Narin Bak, Infectious Diseases Physician
Dr Renjy Nelson, Infectious Diseases Physician
Dr Emily Rowe, Infectious Diseases Physician
Dr Anushia Ashokan Infectious Diseases Physician
Dr Lito Papanicolas Infectious Diseases Physician and clinical microbiologist
Dr Brendan Kennedy Infectious Diseases Physician and Communicable Diseases
Physician

It is important to liaise closely with both the Infectious Diseases Registrars (2) and
Infectious Diseases Residents (3) during your MSA.

Clinical Microbiology:
The laboratory component of this rotation is supervised by:-
Dr Ivan Bastian, Clinical Microbiologist and Head Microbiology Frome Rd
Dr Gerhard Weldhagen, Clinical Microbiologist
Dr Morgyn Warner, Clinical Microbiologist and Head Microbiology QEH

In addition 2 Microbiology Registrars will assist with laboratory tutorials.

2
Contacts:
The Infectious Diseases Unit secretary, Polina Mihnev, can be contacted by phone on
70742793.
All clinical Infectious Diseases staff can be contacted via the Royal Adelaide
switchboard on 70746000 and Clinical Microbiology staff via IMVS switchboard on
82223000.

Orientation:
Please report to 6G ward of the new Royal Adelaide Hospital at 0900 hrs. The
Infectious diseases registrar office is located in 6G ward. Please introduce yourself and
they will assist with orientation.
You will receive a formal orientation at the commencement of your rotation by one of the
senior Infectious diseases medical staff.

Student participation:
This unit is flexible in responding to your teaching needs. We do expect however active
participation from all students in all of the teaching activities including: in-patient
ward rounds, student tutorials, bedside teaching, infectious diseases consultations,
outpatient sessions, laboratory rounds and attendance at appropriate IDU/Microbiology
meetings scheduled during the rotation. You will be expected to be punctual at all
activities.

Learning activities for this rotation include:

1. Supervised direct patient care: in-patients on 6G ward, consultations from other units
and outpatient clinics.
2. Attending ward rounds and consult rounds
3. Weekly ID tutorial and bedside sessions
4. Laboratory tutorials and plate rounds
5. Regular formal clinical meetings within the ID unit

Student responsibilities:
1. Confirm times with tutors of all teaching activities within the ID and Microbiology
staff.
2. Discuss with ID consultant/registrar your problem based question and answer
activity before commencing this task during the ID rotation.
3. A log book is provided for your keeping. This is to record your learning activities
during the attachment. This will need to be signed off before your assessment is
completed.
4. We expect you to undertake your own reading of microbiology and infectious
diseases during the attachment. Pre-reading prior to joining the unit would make the
rotation more enjoyable and is highly recommended. Please refer to the reading
references below. Please make sure you are on time for all teaching and training
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 activities. Pre-reading prior to individual tutorials is recommended to make the
tutorials more valuable and interactive.
5. Roster your group fairly so you can all attend both outpatient and consultation
sessions over the 3 week period.

6. Contact Mr Neville White ext 41088/42792 to arrange Antibiotic Treatment Centre

visit (approx 30 minutes) during your attachment.
7. Contact Cheryl baker from STD clinic 275 on 82225075 to organise your scheduled
day in the clinic, one student per week.
8. Present your Problem base case to the group at the end of the rotation
9. Have your assessment sheet signed off at the end of your rotation.

Assessment:
All medical students attending the ID rotation will be assessed in accordance with
university requirements. Failure to attend ID activities without notification may
compromise your assessment. The university must also be informed of any days that
you are unable to attend due to sickness etc.

Resources:
The following resources are recommended as reference during the infectious diseases
rotation:
1. Yung A et al. Infectious Diseases A Clinical approach. Second Edition.
Melbourne: IP Communications, 2005.
2. J Keith Struthers, Roger Westran. Clinical bacteriology
3. Therapeutic Guidelines. Antibiotic. Version 14. Melbourne: Therapeutic
Guidelines Limited, 2010.
4. ASHM, Jennifer Hoy and Sharon Lewin. HIV Management in Australasia – a
guide for clinical care
5. Hepatitis B Virus Infection – Natural History and Clinical Consequences N Engl
J Med 2004;350:1118-29.
6. Chronic hepatitis C infection: a review and update on treatment strategies ADF
Health 2003; 4: 27-33
7. Mandel L, Bennet J, Dolin R. Principles and Practice of Infectious Diseases. 7th
edition. Philadelphia: 2010.

Feedback:
Students will be asked to offer suggestions for improving this rotation after they have
completed their assessments. This feedback will help enhance the infectious diseases
teaching for future medical students so your comments are valued. Students are
welcome to make suggestions during the rotation

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 Infectious Diseases Schedule 4th and 5th year Schedule
Weeks 1-3, 2019
MON TUES WED THURS FRI
0830 HIV Medical ID Journal/Club
Management ID
st
meeting 1 Mon Meeting
st RD
of the month 3F 1 &3
(495,496 & 497) Thursday of
(staff Hub area) Month 9F (312,
RAH & 313) and 3F
(496 & 497)
(staff Hub area)
RAH resp.
0900 Outpatients ID Ward Round Outpatients Outpatients ID Inpatient ward
3E 2.1, nRAH Q8 Conference 3E 2.1, nRAH 3E 2.1, nRAH Round Q8
Room RAH Conference
Room RAH
Outpatients
3E 2.1, nRAH

1100

1200 Microbiology
Journal Club/
Presentations
/Virology talk
st rd th
1 , 3 &4 Friday
of Month
Large Meeting
Room, Level 1
IMVS
1230 Grand Round
lecture theatre
8D
1300
1315 Outpatients Ward consults Outpatients Ward Consults
3E 2.1, nRAH RAH 3E 2.1, nRAH RAH
OR OR
Ward Consults Ward Consults
RAH RAH
1400 IDU Microbiology
Ward patients & Tutorial
Consults review TBA
5F (421 & 422)
Ward consults
RAH
1600

5
 Infectious Diseases Core Curriculum
4th and 5th Year

Factual Knowledge:
At the completion of this MSA, 4th and 5th year students should be familiar with the
broad principles of the topics listed below:

1. The biology and pathogenesis of infectious processes, including:

Basic knowledge of the organisms responsible; including viral, bacterial, fungal

and parasitic pathogens - the components of host defence; innate and adaptive
mechanisms. - the age related changes in host responses and host vulnerability
to infection.

2. The principles of anti-microbial pharmacology, therapeutics, monitoring,

resistance and prophylaxis.

3. Knowledge of the principles of routine diagnostic microbiology.

4. The principles and practice of infection control.

5. The importance of public health measures in disease control (including hygiene,

infection control, STD control, vaccination, disease notification, outbreak
investigation, surveillance contact tracking, case finding and education).

6. Needle stick injury awareness and procedures.

6
Problem Solving:
4th and 5th year medical students at the completion of the MSA in infectious diseases
should be able to:-
a) Solve more common infectious diseases problems using history, examination,
relevant investigations and where necessary evidence based published literature.
and
b) Understand the principles of managing these common infectious diseases.

The following topics are expected to be covered:

1. Adult patients with the following syndromes:

a) the sepsis syndrome
b) fever in the hospitalised patient
c) fever in the community setting
d) fever and headache and/or altered sensorium
e) fever with rash
f) fever and upper respiratory tract syndromes (acute otitis media, pharyngitis,
sinusitis)
g) diarrhoea and vomiting

2. The patient with the following organ based presentations:

a) pneumonia in its various clinical settings (includes tuberculosis)
b) osteomyelitis/septic arthritis
c) urinary/renal tract infection
d) soft tissue infections
e) intra abdominal infections
f) focal intracranial lesions
g) endocarditis including endovascular infections

3. Specific Infectious Diseases:

a) HIV
b) viral hepatitis
c) influenza

7
4. Infectious diseases emergencies:
a) bacterial meningitis
b) adult septicaemia (including meningococcal)
c) infections in immunocompromised persons (including neutropenia, post
splenectomy)
d) infections of deep structures to head and neck
e) necrotising soft tissue infections
f) Falciparum malaria

5. Problems of public health significance:

a) hepatitis A
b) food poisoning
c) tuberculosis

6. Surgical practice:
a) understanding of the principles and practice of sterile procedures
b) knowledge of the principles of anti-microbial surgical prophylaxis
c) evaluation of post operative fever including specific infections (eg. gas
gangrene, necrotising fasciitis)
d) surgical site infections

7. Antimicrobials:
a) antibiotics
b) antifungals
c) antivirals
d) antiparasitic agents
e) principles of antimicrobial stewardship (appropriate prescribing)

8. Healthcare associated infections and their prevention:

a) Hand hygiene principles (WHO ‘5 Moments’) and promotion strategies in
Australia (Hand Hygiene Australia)
b) Standard and Transmission based precautions – what these are and when they
are appropriate
c) IV catheter associated bacteraemia and prevention
d) Urinary catheter associated UTI and prevention
e) Hospital/ ventilator associated pneumonia and treatment

8
Practical Skills:
4th and 5th year students should be able to perform the following:-

1. Demonstrate appropriate history taking skills and conduct systematic examination

relevant to infectious diseases.
2. Interpret temperature charts and laboratory reports integral to the management of
infectious diseases (including microbiological, haematological, pathology and
radiological).
3. Know how to request and transport samples to the microbiology laboratory.
4. Understand the process of prescribing common antimicrobials safely and
appropriately.
5. Interpret a Gram stain.
6. Know how to collect common specimens for microbiological examination, including
skin or other surface swabs, needle aspirates from superficial abscesses,
uncontaminated midstream urine, nasopharyngeal aspirates, throat swabs and
uncontaminated blood cultures.
7. Understand how specimens are processed and pathogens are identified.
8. Perform systematic searches of published medical literature using evidence based
methodology to answer clinical questions
9. Demonstrate appropriate hand hygiene and complete the online medical learning
package provided by HHA available at
http://www.hha.org.au/LearningPackage/medicallearningpackage.aspx
Print off the certificate and present to Dr Ritchie/ Shaw/Bak as part of assessment
procedure
10 Demonstrate correct donning and doffing of gloves, gown and mask (including both
surgical and N95 mask)

Attitudes related to Infectious Diseases:

4th and 5th year students should be able to:-

1. Treat with compassion and discretion the major infectious problems outlined above.
2. Appreciate how to involve the patient in decision making with infectious diseases.
3. Understand the relationship between lifestyle and living conditions on disease
acquisition and manifestations of infectious diseases.
4. Communicate clinical information with patients and peers and understand the
important role of cross-consultation in patient management.
5. Appreciate the relationship between over-prescription of antimicrobials and
development of resistance.
9
6. Appreciate the importance to the community of certain infectious conditions and the
responsibility involved in disease notification.
7. Appreciate the stigma associated with certain infective conditions and observe the
appropriate discretion and confidentiality.

During your 3 week MSA, staff will aim to support your learning through focused
tutorials covering some of the following:
• Antimicrobial therapy concepts
• Viral hepatitis
• HIV
• Bacteraemia and Sepsis
• Gastrointestinal infections/UTI
• Bone and joint infection
• Meningitis and encephalitis
• Endocarditis
• Lower respiratory tract infection

10
 Infectious Diseases Core Curriculum
6th Year

Factual Knowledge
At the completion of 6th year, a newly qualified graduate should be familiar with broad
principles of the topics listed below:

1 The biology and pathogenesis of infectious processes, including:

basic knowledge of the organisms responsible; including viral, bacterial, fungal and
parasitic pathogens - the components of host defence; innate and adaptive
mechanisms. - the age related changes in host responses and host vulnerability to
infection.

2 The principles of anti-microbial pharmacology, therapeutics, monitoring, resistance

and prophylaxis.

3 The principles of immunisation consistent with national guidelines.

4 A sound knowledge of the principles of routine diagnostic microbiology.

5 The principles and practice of infection control.

6 The importance of public health measures in disease control (including hygiene,

infection control, STD control, vaccination, disease notification, outbreak
investigation, surveillance contact tracking, case finding and education).

7 Needle stick injury awareness and procedures.

11
Problem Solving:
The newly qualified medical graduate should be able to:-

a) Solve infectious diseases problems using history, examination, relevant

investigations and/or evidence based published literature
and
b) Manage patients with infectious diseases at an appropriate level of training and
experience.

The following topics are expected to be covered:

1. Patients with the following syndromes:

a) the Sepsis syndrome
b) fever in the hospitalised patient
c) fever in the community setting
d) fever and headache and/or altered sensorium
e) fever with rash (including common childhood exanthemata and pregnancy)
f) fever in the returned traveller
g) fever in the surgical patient
h) the febrile infant
i) fever and upper respiratory tract syndromes (acute otitis media, pharyngitis,
sinusitis)
j) diarrhoea and vomiting

2. The patient with the following organ based presentations:

a) pneumonia in its various clinical settings (includes tuberculosis)
b) osteomyelitis/septic arthritis
c) urinary/renal tract infection
d) soft tissue infections
e) intra abdominal infections
f) focal intracranial lesions
g) endocarditis including endovascular infections

12
3. Specific Infectious Diseases:
a) HIV
b) viral hepatitis
c) influenza

4. Infectious diseases emergencies:

a) bacterial meningitis
b) adult Septicaemia (including meningococcal)
c) infant sepsis
d) infections in immunocompromised persons (including neutropenia, post
splenectomy)
e) infections of deep structures to head and neck
f) necrotising soft tissue infections
g) Falciparum malaria

5. Problems of public health significance:

a) hepatitis A
b) food poisoning
c) tuberculosis

6. Sexually transmitted diseases:

a) pelvic pain, pelvic inflammatory diseases
b) vaginal discharge
c) urethral discharge males/female
d) ulcerative lesions
e) skin manifestations of systemic STDs
f) scrotal and penile pain

7. Surgical practice:
a) Understanding of the principles and practice of sterile procedures
b) Knowledge of the principles of anti-microbial surgical prophylaxis
c) Evaluation of post operative fever including specific infections (eg gas
gangrene, necrotising fasciitis)
d) Surgical site infections

13
8. Travel Medicine:
a) Awareness of need for and provision of pre-travel advice
b) Evaluation of the returned traveller or recent immigrant for infectious disease

9. Antimicrobials:
a) antibiotics
b) antifungals
c) antivirals
d) antiparasitic agents
e) principles of antimicrobial stewardship (appropriate prescribing)

10. Healthcare associated infections and their prevention:

a) Hand hygiene principles (WHO ‘5 Moments’) and promotion strategies in
Australia (Hand Hygiene Australia)
b) Standard and Transmission based precautions – what these are and when
they are appropriate
c) IV catheter associated bacteraemia and prevention
d) Urinary catheter associated UTI and prevention
e) Hospital/ ventilator associated pneumonia and treatment

14
Practical Skills
A newly qualified graduate should be able to perform the following :-
1. Demonstrate history and conduct systematic examination relevant to infectious
diseases

2. Interpret temperature charts and laboratory reports integral to the management of

infectious diseases (including microbiological, haematological, pathology and
radiological).

3. Know how to request and transport samples to the microbiology laboratory.

4. Prescribe common antimicrobials safely and appropriately.

5. Manage allergic reactions secondary to the administration of antibiotics or

vaccinations

6. Interpret a Gram stain

7. Collection of common specimens for microbiological examination, including skin or

other surface swabs, needle aspirates from superficial abscesses, uncontaminated
midstream urine, nasopharyngeal aspirants, throat swabs and uncontaminated blood
cultures.

8. Collect specimens appropriate for the laboratory diagnosis of STDs including: skin
scrapings for parasitic or fungal studies, urine microscopy and microscopic
examination of common specimens such as pus swabs or aspirates, sputum, vaginal
smears.

9. Perform systematic searches of published medical literature using evidence based

methodology to specific patient directed questions.

10. Demonstrate appropriate hand hygiene and complete the online medical learning
package provided by HHA available at
http://www.hha.org.au/LearningPackage/medicallearningpackage.aspx
Print off the certificate and present to Dr Ritchie/ Shaw/Bak as part of assessment
procedure

11. Demonstrate correct donning and doffing of gloves, gown and mask (including both
surgical and N95 mask)

15
Attitudes related to Infectious Diseases
A recent medical graduate should:-

1. Be able to treat with compassion and discretion the major infectious problems
outlined above.

2. Be comfortable with involving the patient in decision making with infectious diseases.

3. Understand the relationship between lifestyle and living conditions on disease

acquisition and manifestations of infectious diseases.

4. Be able to communicate effectively with their patients and peers, understand the
important role of cross-consultation in patient management.

5. Appreciate the relationship between over-prescription of antimicrobials and

development of resistance.

6. Appreciate the impact on the economy of inappropriate investigations and antibiotic

prescribing.

7. Appreciate the importance to the community of certain infectious conditions and the
responsibility involved in disease notification.

8. Appreciate the stigma associated with certain infective conditions and observe the
appropriate discretion and confidentiality.

16
Problem based learning activity:
All students will be evaluated on:-

1. Essential summative assessment.

Completion of one infectious diseases case based write up and presentation (power-
point). This should be discussed with ID consultant or registrar.

It should be presented in a standardised format (times new roman size 12 font) with
maximum words of 750 or less or a 10 minute power point presentation:

Heading: eg back pain and lower leg weakness (A case of vertebral osteomyelitis)

Short and concise description: to include history of presentation, salient physical

findings on examination, confirmatory investigation findings and any relevant
negative results. Include picture condition/ or lab result finding (microscopy, culture
etc) and/or table or diagram (as figure). You must obtain verbal consent from the
patient if clinical photo required.

Pose a series of questions from the presentation and findings: eg Q1what is

the diagnosis and differential diagnosis? Q2 what are the key clinical features of the
condition? Q3 what are the complications of the condition? Q4 what are the risk
factors for this condition. Q 5 What are the management or treatment options?

Provide concise answers to the above questions: this can be done by

description but using tables or charts if possible (treatment options, investigations
etc)

Ensure that you include between 5-10 references for your answers.
The cases should be presented to the ID students and consultant before the end of
the attachment and electronic version sent to Dr Renjy Nelson.

The learning experience from this exercise will also be used to build up a teaching
program for future medical students and we may also submit your case for
publication.

2. Development of skills and abilities relevant to Infectious Diseases (including

formative tasks)

3. Participation in ID activities

4. Attendance (log book)

All Students must meet individually with a Staff specialist on the last Friday of
their Rotation to discuss assessment and to complete the MSA form.

17