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Local Implementation of the LEAP Program
Significant portions of the LEAP fellowship were designed to be adaptable by ID training programs and health departments wishing to create an experiential program that teaches an ID fellow how to build a career that bridges academic clinical medicine and public health. Below you will find detailed information on the major components of the LEAP fellowship as well as specific implementation tips for both the academic program and the health department.
The LEAP program
General program details
• Duration: The LEAP program was designed to span the course of one calendar year. This was considered a length of time sufficient for the fellow to immerse themselves in the health department, health care epidemiology and antimicrobial stewardship programs, as well as complete at least one longer-term project.
• Locations of performance: LEAP program activities are intended to be performed in two locations, an academic hospital and the headquarters of a public health department. The current LEAP fellowship intentionally requires these facilities to be geographically proximate to each other and to the fellow’s current location to prevent the need for fellow relocation and the hardship that would represent. The primary academic health care facility site for the LEAP program should have strong hospital epidemiology/infection prevention and antimicrobial stewardship programs as well as training opportunities in medical leadership, and the public health program should have a wide breadth of activities. Specific criteria are listed below.
○ Implementation comment: While there is no intrinsic reason why a longer or shorter duration program is not possible, longer durations were noted by previous applicants and fellows to likely be prohibitive from a career momentum and family standpoint. Shorter durations were considered unlikely to provide sufficient exposure to the often relatively rare events needed to establish competence in the experiential fields and would not provide enough time for a long-term project.
○ Academic health care facility criteria:
■ The facility/institution should be able to provide educational opportunities such as leadership training, quality improvement training (such as adverse outcomes case reviews, rapid improvement events, process redesign events, K-T analysis, change management sessions and emergency command center events), relevant educational coursework (such as biostatistics, epidemiology, public health policy and experimental design) and tutorials on antimicrobial stewardship and infection prevention.
■ The facility’s hospital epidemiology/infection prevention program should be led by an ID physician, have hospital leadership support, have board-certified infection prevention staff, perform infection surveillance, perform cluster and outbreak investigation, be engaged in hospital emergency management, be engaged in medical equipment reprocessing and environment of care monitoring, and conduct isolation policy management and monitoring. The program should be able to provide experiences such as infection preventionist shadowing, surgical site infection prevention and surveillance, health care epidemiology educational lectures, health care-associated infection cluster evaluation, outbreak/emerging infectious diseases response and investigation, and infrastructure design/construction meetings.
■ The facility’s antimicrobial stewardship program should be led by an ID physician medical director, have commitment from hospital leadership, have at least one dedicated stewardship pharmacist with advanced training in stewardship (such as MAD-ID training), perform internal and external monitoring and reporting of antimicrobial use and resistance patterns, be involved in the education of staff on appropriate antimicrobial use, and be involved in multiple interventions aimed at reducing antimicrobial over-/mis-prescription. The program should be able to provide experiences such as antimicrobial usage case reviews and interventions, drug use evaluations, interdisciplinary antimicrobial improvement efforts, hospital network stewardship meetings and improvement efforts, sepsis management interventions, outpatient and long-term care stewardship efforts, and antimicrobial use lectures.
○ Regarding the public health department, while no specific type of health department is required (e.g., capability at state, county or city health departments may vary greatly), it is recommended that the public health department be able to provide the following expertise and experiences: training in the basic infrastructure, scope and functions of health department; access to department-specific database resources; access to meetings where current initiatives and priorities are discussed; outbreak investigations; multidrug-resistant organism reduction efforts; health care-associated infection prevention efforts; antimicrobial stewardship efforts; influenza response efforts; tracking of surgical site infections; and other relevant public health activities.
○ Implementation comment: A mix of in-person and virtual/teleconferencing activities is expected for the fellow’s activities. However, it is strongly recommended that the fellow have regularly scheduled in-person protected time at the health department, such as one day a week where the fellow can physically attend relevant public health meetings, meet with their health department mentor and work on their LEAP project with relevant public health partners. This allows the fellow to be naturally drawn into public health activities that are unplanned or occur unpredictably. As a result, it is desirable for the partner health department to be in relatively close geographic proximity to where the fellow’s home medical facility lies.