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The Changing Face of HIV Care: Expanding HIV Training in an Internal Medicine Residency Program
Lydia Aoun Barakat1, Dana W Dunne, Jeanette M Tetrault
1L. Aoun Barakat is associate professor of medicine, Department of Internal Medicine, Section of Infectious Disease, Yale School of Medicine, New Haven, Connecticut. D.W. Dunne is associate professor of medicine, Department of Internal Medicine, Section of Infectious Disease, Yale School of Medicine, New Haven, Connecticut. J.M. Tetrault is associate professor of medicine, Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut. S. Soares is assistant professor of medicine, Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut. D. Chia is assistant clinical professor of medicine, Department of Internal Medicine, Zuckerberg San Francisco General, and University of California, San Francisco, School of Medicine, San Francisco, California. O.E. Ogbuagu is assistant professor of medicine, Department of Internal Medicine, Section of Infectious Disease, Yale School of Medicine, New Haven, Connecticut. J.P. Moriarty is associate professor of medicine, Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut. S.J. Huot is professor of medicine, Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut. M.L. Green is professor of medicine, Department of Internal Medicine, and director of student assessment, Teaching and Learning Center, Yale School of Medicine, New Haven, Connecticut.
Problem:
People with HIV/AIDS are living longer and are at an increased risk of comorbidities. A qualified physician workforce is needed to care for this growing population.
Approach:
In 2012, a novel three-year HIV training track (HIV TT) was implemented as part of the Yale Primary Care Residency Program. To prepare for the implementation of this program, a needs assessment was performed, a web-based curriculum and 12 HIV-specific entrustable professional activities (EPAs) were created, and adequate clinical training opportunities in HIV and primary care were established. Program evaluation included process, learner, and outcome evaluations from 2012 to 2017.
Outcomes:
Since its inception, the HIV TT has enrolled a total of 11 residents (6-7 at a time), with 5 graduating to date. Residents delivered high-quality HIV and primary care for a diverse panel of patients; improved their knowledge and performance in HIV care, including according to the HIV-specific EPAs; and were highly satisfied with the program. All faculty remained with the program, and patients indicated satisfaction.
Next Steps:
Next steps include enhanced coordination of residents' schedules, improved EPA documentation, evaluation of residents' HIV and non-HIV competence beyond residency, and monitoring graduates' career trajectories. Expanding HIV training within internal medicine residency programs is feasible and effective and has the potential to alleviate the shortage of physicians trained to provide HIV care and primary care in a single setting.
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