Infectious Disease Fellowship

Creighton’s infectious diseases fellowship trains internists seeking careers as clinical consultants in infectious diseases. In addition, some trainees have embarked on careers in internal medicine with an emphasis on infectious diseases, careers in state and federal public health agencies, careers with significant commitments to medical education, and careers in basic research.

In the fellowship can be seen Creighton’s Jesuit commitment to individuals in particular need of help–such as recent immigrants and economically disadvantaged individuals—in our clinical service to such individuals. The fellowship embodies the value of cura personalis that is inherent in excellent medical care for the individual and also in its opportunities to tailor the fellowship to the needs and interests of individual learners. The fellowship seeks to maintain an environment that promotes learning, an environment that goes beyond its setting in a community with affordable housing and manageable traffic.

Our fellows’ experiences include clinics (continuity, HIV, travel), inpatient rotations (including transplant ID and oncology ID), research, quality improvement, and telemedicine. We also provide educational experiences including antimicrobial stewardship, hospital epidemiology, and teaching.

Ultimately, the program aims to prepare physicians for the practice of infectious diseases. The program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). It seeks to prepare trainees for certification in infectious diseases by the American Board of Internal Medicine (ABIM).

1. To promote a positive learning atmosphere as we aim for collegiality, kindness, and respect amongst all members of the ID Division within Creighton University.
2. To foster a collaborative environment in a diverse culture of teachers and learners. Our division is grounded in efforts to improve upon current Diversity, Equity, Inclusion, and Belonging (DEIB) initiatives and remains dedicated to serving LGBTQIA2S+ patients and underserved communities. Over the years, individuals with various positions in our division have come from six continents, and a variety of belief systems, - including Buddhism, Hinduism, Judaism, Christianity, and Islam.
3. To provide an effective and efficient education by balancing patient care and educational training. We have protected didactic time combined with a diverse patient population, including Veterans, people living with HIV, and people living with transplants, providing broad clinical exposure.
4. To be innovative. Infectious Disease Fellows have the opportunity to improve clinical care through scholarly activity via publications, presentations, quality improvement projects, and multi-disciplinary initiatives.
5. To foster individual development, tailoring training to areas of interest, including opportunities to seek additional training in: antimicrobial stewardship, travel medicine, HIV, telemedicine, and infection prevention and epidemiology. The division maintains strong ties with the Creighton Heider College of Business and supports ongoing professional development programs, including those within Creighton’s Chapter of Women in Medicine (WIMs).

• Opportunity for ID/critical care training as a result of large number of critical care beds and faculty, with Creighton’s standalone 1-year critical care fellowship
• Collegial learning environment with great faculty mentoring
• Good work/life balance
• High quality of living in the Midwest (little traffic; affordable housing)
• Creighton University Medical Center - Bergan Mercy ranked among the nation's 250 best hospitals in 2022

• One of our 2023 graduating fellows is staying at Creighton for a critical care fellowship
• Our 2022 graduating fellow stayed at Creighton for a critical care fellowship
• One of our 2021 graduating fellows also stayed at Creighton for a critical care fellowship
• The other 2021 graduate went to Mayo Clinic Rochester for a critical care fellowship
• Our academic medical center has 3 pods (52 beds) of critical care
• Two of our previous graduates have gone on to ID/critical care careers
• ACGME accredited Creighton for a one-year stand-alone fellowship in critical care. This opens an attractive pathway at Creighton for training for a career in ID critical care:
  • Join Creighton for our two-year ID fellowship. See how you like training at Creighton and living in Omaha. Some of your ID consults will involve seeing our critical care patients. See how you like working with these patients in our critical care setting. Get to know our critical care specialists—and let them get to know you.
  • Submit your ERAS application for Creighton’s one-year stand-alone critical care fellowship. It will be evaluated (see material below on "Standards to be met during ID fellowship"), and you will be appropriately ranked in the Match. If your application does result in being accepted into Creighton’s critical care fellowship, then … complete Creighton’s critical care fellowship.
  • Pass the ABIM exam in ID and become certified in ID
  • Pass the ABIM exam in critical care and become certified in critical care as well.
  • In contrast to integrated pulmonary critical care fellowships, the list of ACGME-accredited fellowships does not include integrated ID critical care fellowships. (http://www.acgme.org/Specialties/Overview/pfcatid/2). ABIM does allow for a physician who has completed an ID fellowship to train for a year in critical care and (after passing exams in both fields) become certified in ID and critical care
• Details of the process to apply for ID and critical care medicine (CCM) training at Creighton
  • ID fellowship seeks and invites applicants for ID fellowship interview. Highly qualified candidates who are also interested in CCM will be interviewed by the CCM fellowship program director (PD)
  • The ID and CCM fellowship leadership both agree on the quality of the applicant and the likelihood of successful completion of ID fellowship while maintaining agreed upon standards (below)
  • ID PD determines and submits ID rank list.
• Standards to be met during ID fellowship to maintain candidacy for guaranteed entry into 1 year CCM fellowship immediately after completion of 2 year ID fellowship:
  • Passing score on ABIM internal medicine boards
  • Successful completion of a 2-week ICU rotation during each year of the ID fellowship, with no red flags identified on ICU course evaluations from faculty and feedback from current critical care medicine/pulmonary critical care fellows
  • Combined faculty and fellow participation in quarterly ID-CCM fellowship case conference, with the ID/CCM fellow presenting at least two conferences per year
  • ID/CCM fellow identifies a quality improvement project and mentor in first year of ID fellowship, preferably overlapping between ID and CCM subspecialties
  • ID/CCM fellow identifies a research project and mentor in first year of ID fellowship, preferably overlapping between ID and CCM subspecialties
  • Successful completion of 24-month ID fellowship in 2 year timeframe

• Friday morning VA continuity clinic throughout fellowship (including longitudinal care of HIV patients)
• Monday afternoon Travel Clinic (4 months a year)
• Thursday afternoon Bergan clinic (many hepatitis B and C; some HIV; some general ID) 4 months a year

• 1 month a year of inpatient solid organ transplant and oncology ID
• Subacute and long term transplant patients seen at CUMC-Bergan Mercy and at VA from time to time; recent example: sepsis in a renal transplant patient
• Subacute and long term transplant patients part of VA continuity clinic; recent example: long term itraconazole for histoplasmosis in a transplant patient

• Substantial portion of VA continuity clinic (every Friday morning)
• Increasing part of Thursday afternoon Bergan ID clinic (four months a year)
• Challenging patients often admitted to CUMC-Bergan Mercy

• 4 months of inpatient at Creighton University Medical Center-Bergan Mercy
• 4 months of inpatient at VA Medical Center in Omaha
• 1 month of solid organ transplant and oncology ID
• 3 months research/scholarly, including quality improvement

View schedule of monthly rotations

VA inpatient

• Interprofessional experience with pharmacy faculty and students (J Osteopath Med; 116(9): 588-593 https://doi.org/10.7556/jaoa.2016.116)
• Routine part of rounds
• Includes discussion of patients and interventions with primary teams
• Emphasize motivational interviewing

CUMC-Bergan Mercy program

• Grew out of program developed by division chief that saved system hundreds of thousands of dollars
• Remote stewardship an interest of faculty

• Monday: board review 3 weeks a month, guideline review 1 week a month
• Tuesday: HIV roundtable 2 weeks a month, journal club 1 week a month
• Thursday: citywide ID case conference weekly
• Friday: ID grand rounds weekly, including in-depth journal club 1 week a month

View Didactic Schedule

• CUMC-Bergan Mercy
  • Academic service is generally capped at 15 patients so service doesn’t overwhelm education
  • Service generally includes a fellow and one or two residents
• VA inpatient
  • Experience includes eConsults—focus on evaluating and answering a question
  • Service is small enough to facilitate didactics and study in relation to the patients

Research:

1. COVID-19 Mortality and Therapeutics in Nebraska and Southwest Iowa during Early Pandemic. Pharmacy (Basel). 2022
2. Readmissions among People Living with HIV Admitted for Hypertensive Emergency. South Med J. 2022
3. Role of procalcitonin as a predictor of clinical outcomes in patients with COVID-19. International Journal of Infectious Diseases (2022).
4. Outbreak of central-line–associated bloodstream infections (CLABSIs) amid the coronavirus disease 2019 (COVID-19) pandemic associated with changes in central-line dressing care accompanying changes in nursing education, nursing documentation, and dressing supply kits. Infection Control & Hospital Epidemiology 2022
5. Getting Through COVID-19: Keeping Clinicians in the Workforce. Ann Intern Med. 2022
6. Racial and Ethnic Differences in Zoster Vaccine Uptake: A Cross-Sectional Study in a Veterans Health Administration Primary Care Clinic. WMJ. 2021

QI projects:

1. Appropriate use of urinary legionella antigen in patients admitted with CAP
2. Prevalence and Optimization of Statins to Reduce Cardiovascular Disease in people with HIV
3. Improve Utilization of sputum culture in patients admitted to ICU with Pneumonia

Dr. Tierney and Dr. Vivekanandan worked with the Nebraska Department of Health and Human Services during the COVID-19 pandemic.

Dr. Tierney’s recent public health awards:

• National: Inaugural Awardee of the McKnight Prize for Healthcare Outbreak Heroes 2020
• Nebraska Infection Control Network Distinguished Service Award 2020
• Council of State and Territorial Epidemiologists: Selected HAI Mentor for Peer to Peer Mentorship Program 2018

Dr. Vivekanandan’s award for her work on COVID-19:

• Creighton University Distinguished Faculty Service Award 

Other faculty played active role in promoting mask mandate laws, writing infection prevention protocols and treatment protocols during the pandemic, promoting vaccine confidence, and participating in vaccine trials