Preparing future physicians for complexity: a post-graduate elective in HIV psychiatry

Area of Science:

• Psychiatry
• Medical Education
• Complex Care Management

Background:

• Patients with complex care needs present with multiple concurrent medical, psychiatric, and social challenges.
• Care coordination across diverse settings is often fragmented, complicating desired health outcomes.
• Physicians frequently lack adequate support and skills to manage the inherent uncertainty in complex patient care.

Purpose of the Study:

• To evaluate a novel HIV Psychiatry resident elective designed to build competencies for managing complex patient care.
• To explore resident and staff experiences with an educational intervention aimed at navigating healthcare system complexities.

Main Methods:

• Qualitative thematic analysis of pre- and post-elective interviews.
• Involved 12 participants, including residents and clinic staff.
• Data collected from December 2019 to September 2022.

Main Results:

• The elective improved trainees' understanding of patient complexity.
• Emphasis was placed on accepting "not knowing" and employing integrative competencies.
• Trainees demonstrated adaptive expertise, showing improved improvisation skills through collaboration.

Conclusions:

• Postgraduate training must equip residents with skills for complex patient care, including improvisation and adaptive expertise.
• Educational experiences should address practice gaps and system navigation challenges.
• Findings will inform the continued development of this specialized elective.