The bell tolls for the infectious diseases clinician

Infectious diseases training in Canada: one size does not fit all

PURPOSE

To evaluate training in infectious diseases, determining which components of the training program best prepare residents for their career choices and where improvements are needed.

METHOD

A cross-sectional survey was mailed to all 14 physicians who had graduated from both the Adult and Paediatric Infectious Diseases Training Program at the University of Calgary from 1985 to 1998. Responses about the adequacy of training were measured using a Likert-type scale and a qualitative questionnaire.

RESULTS

Of 14 mailed questionnaires, nine responses were received (64%). Two-thirds of respondents were in an academic setting, and seven (78%) graduates obtained postfellowship training. The specialists in academic settings were all engaged in multiple nonclinical activities. The clinical and diagnostic microbiological components of training received the highest scores in terms of adequacy of training.

CONCLUSION

Graduates of the University of Calgary training program indicated an overall satisfaction with their training. However, improvements are needed in career counselling, health administration, antibiotic utilization, infection prevention and specialized outpatient clinics. Potential strategies for addressing these issues include didactic lectures, enhanced exposure to clinical outpatient settings and provision of designated faculty mentors.

Evolution of the Infectious Diseases Practitioner

In 1986, I wrote of the imminent decline in professional opportunities for the infectious diseases clinician because of unique problems with clinical practice in this specialty.' Although others have disagreed with my prophecy, none were able to refute my basic contention that it soon will be almost impossible for most new physicians with specialty training in infectious diseases to become self-supporting from a purely clinical practice. If a clinician is “an expert clinical [pertaining to or founded on actual observation and treatment of patients] physician and teacher,” then many of us are no longer only clinicians in the strictest sense of the word. The bell does toll for the pure clinician in this field of medicine, and the time of the easy establishment of a clinical practice is coming to a close. Future viability depends on developing beyond the role of clinician and becoming an “infectious diseases practitioner.”

Evolution of the infectious diseases practitioner

In 1986, I wrote of the imminent decline in professional opportunities for the infectious diseases clinician because of unique problems with clinical practice in this specialty.' Although others have disagreed with my prophecy, none were able to refute my basic contention that it soon will be almost impossible for most new physicians with specialty training in infectious diseases to become self-supporting from a purely clinical practice. If a clinician is “an expert clinical [pertaining to or founded on actual observation and treatment of patients] physician and teacher,” then many of us are no longer only clinicians in the strictest sense of the word. The bell does toll for the pure clinician in this field of medicine, and the time of the easy establishment of a clinical practice is coming to a close. Future viability depends on developing beyond the role of clinician and becoming an “infectious diseases practitioner.”