To gain experience with diagnosis and management of patients with pulmonary tuberculosis. This involves:
- Development of therapeutic longitudinal relationships with patients
- Development of a body of knowledge concerning the ambulatory care of adults with tuberculosis
- Developing efficiency and facility in handling acute, urgent and chronic problems in the care of patients with Pulmonary Tuberculosis in the out-patient setting
Each fellow attends a half-day clinic every week. The fellows see, evaluate, diagnose and treat patients with all stages of pulmonary and extra-pulmonary tuberculosis under the direct supervision of attending physicians, Drs. William Clapp and the Clinic Directors, Dr. Mamie Long at Englewood, Dr. Victoria Gomez at Uptown, and Dr. Carmen Tibayan at West Town. Fellows are oriented to the Tuberculosis Clinic on July 1 by Dr. Clapp. For their first eight weeks Dr. Clapp works with the new fellows in the clinic. Thereafter, the clinical directors provide on site attending coverage. All treatment is driven by protocols that are recommended by the American Thoracic Society, Center for Disease Control and Infectious Disease Society of America. Chicago tuberculosis experts (including Drs Schraufnagel, McAuley, Cook, and others) have been involved with the formulation of these guidelines. Deviations from these protocols, although encouraged in special situations, need to be discussed with Drs. Clapp or Schraufnagel.
The radiographs of interesting or difficult cases are reviewed by Dr. Clapp or Schraufnagel. Dr. Schraufnagel also provides additional supervision and education though several lectures on tuberculosis and environmental mycobacteria. City-wide, multi-institutional conferences are held at the West Center for Disease Control near the University and attended by Pulmonary and Infectious Disease specialists from around Chicago. The Chicago Department of Health also discuss public health aspect of tuberculosis. There is opportunity to participate in research projects.
Mix of Diseases, Patient Characteristics, and Types of Clinical Services
Patients have all stages and sites of active tuberculosis and latent tuberculosis. The patients extend all age ranges including infants. Patients also have other mycobacterial disease and other lung disease thought to be tuberculosis, including lung cancer. A large percentage of patients do not speak English; many have drug problems; many are homeless. The patients are put on directly observed therapy and the challenge is to make sure all the medication is taken to avoid the development of drug resistance.
Fellow Evaluation Method
Dr. Clapp fills out the standard ACGME competency-based evaluation for each fellow semiannually. In addition, he reviews all active cases each week and speaks with the fellow and Program Director if any deviation in care is found.
The fellows evaluate the experience quarterly in their meetings with the Program Director and semiannually in the individual meetings with the Program Director. Informal verbal feedback is welcome and given at any time.