Infection prevention training in ID fellowship is limited, survey shows
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Key takeaways:
- Of programs surveyed, 90% reported some IPC/HE training, whereas 33.3% reported a dedicated IPC/HE training track.
- Common barriers to IPC/HE training were funding, lack of curriculum and time constraints.
A national survey of ID fellowship program directors revealed that only about a third of programs have a dedicated infection prevention and control and health care epidemiology training track.
“During my second year of infectious disease fellowship in the Mass General Brigham program, I subspecialized under the mentorship of Erica Shenoy, MD, PhD, and Alyssa Letourneau, MD, MPH, in infection prevention and control and health care epidemiology (IPC/HE) and antimicrobial stewardship,” Marisa L. Winkler MD, PhD, assistant professor at Emory Healthcare, told Healio.
“This subspecialized track was one of the factors that led me to choose the Mass General Brigham program for my fellowship training and provided timely education during the COVID pandemic and mpox global outbreak that occurred during my fellowship,” she said.
Winkler said that spending this time focused on IPC/HE highlighted how unique this opportunity was and made her want to better understand the landscape of training available to fellows.
“The last study describing IPC/HE training in infectious disease fellowships was published more than 20 years ago, and when surveyed, half of infectious disease physicians reported job responsibilities in IPC/HE,” she said.
To evaluate availability of specialized IPC/HE training in ID fellowship programs, Winkler and colleagues conducted a national survey of all ID fellowship program directors in the U.S. and Puerto Rico. According to the study, the surveys — which assessed current IPC/HE training components in programs and barriers to implementation — were distributed using to program directors in March 2023, followed by two reminder emails, with 4 weeks for respondents to participate.
In total, 54 of 166 program directors contacted (32.5%) responded to the survey. Responses to the survey revealed that 49 (90.7%) of the programs reported didactic training in IPC/HE, averaging 4.4 hours over the course of the fellowship, whereas 18 (33.3%) reported a dedicated IPC/HE training track.
The survey also showed that nearly half of the programs (42.6%) reported barriers to expanding training. These barriers to implementation included lack of funding as the largest barrier to implementation (65.2%), lack of curriculum (65.2%) and time constraints (60.9%). Another notable barrier mentioned in the comments of the survey included lack of fellow interest because of perceived burnout, although no specific data on this as a barrier were available.
“There continue to be opportunities to increase IPC/HE training in ID fellowship programs in the U.S. and to better prepare ID fellows for the responsibilities they are likely to have during their career,” Winkler said. “Offering dedicated training in IPC/HE may also be a mechanism to recruit trainees into this exciting and practical ID subspecialty.”
Perspective
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In this study, Winkler and colleagues conducted a national survey of ID fellowship program directors (PDs) to assess current practices and curricula focused on IPC/HE. They also evaluated PDs’ preferences for training standardization across programs and barriers to expanding and implementing education and training in this area.
The authors found that while most programs have some education around IPC/HE, fewer programs had more in-depth training such as a dedicated training track, formal coursework in epidemiology and biostatistics, and scholarly, project-based education. There was also strong support by PDs to have a formal and standardized curriculum in IPC/HE that could lead to nationally recognized certification of a specialized skillset foundational for a career in this field. One caveat, however, was that this certification should be achievable within the confines of standard ID fellowship training and should not require additional years of training. Barriers to implementing and expanding IPC/HE training included lack of resources, time constraints and a lack of a national curriculum. Of fellows and prospective fellows surveyed, approximately a quarter were either highly or very highly interested in a standardized IPC/HE curriculum.
This study is an incredibly valuable needs assessment to help understand opportunities to fill gaps in educational training on IPC/HE during ID fellowship. Education leaders should develop standardized learning objectives for all ID fellows, as well as additional learning objectives for fellows pursuing an IPC/HE career. From the learning objectives, educational strategies and tools can be developed for fellows, faculty and programs to use during fellowship training.
Similar to the national curriculum created by Infectious Diseases Society of America for antimicrobial stewardship, the tools should make use of evidence-based teaching methods and should be customizable so that teaching can be individualized to local health systems and learning environments. An equitable assessment should simultaneously be developed that aligns with the learning objectives and can serve as a standardized metric to ensure competency in IPC/HE. This type of curriculum not only will better prepare ID fellows for a career in this area but will potentially attract more trainees to this critically important field.
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