Training Residents in Outpatient HIV Care

Excerpt

To the Editor:—The recent JGIM article entitled, "Training Internal Medicine Residents in Outpatient HIV Care: A Survey of Program Directors" by Adams et al. found that fewer than half of the program directors surveyed agreed that it was important to train residents to be PCPs for patients with HIV and provide residents with an outpatient-based HIV curricula 1. One of the most common reasons cited was the belief by program directors that most graduates will not provide HIV ambulatory care as a generalist. The authors go on to say that it is not known if surveying residents would yield the same result. In fact, these findings are in stark contrast to internal medicine residents’ perceptions of training, competence, and performance in outpatient HIV care as reported in our recent multicenter study 2. In our study managing HIV patients was rated an excellent educational opportunity by 89% of residents and 77% planned to care for HIV patients in the future. Adams et al. also found that very few program directors believed their graduates had the skills to care for HIV outpatients, which is consistent with our findings with residents, 39% of whom stated that they did not feel competent to provide HIV outpatient care. Furthermore, we found that higher rates of residents reported deficiency in outpatient HIV training compared to outpatient non-HIV training (p < 0.05) or inpatient HIV training (p < 0.05). Residents reported substandard HIV risk assessment, testing, counseling, and initial management performance. Self-reported proficiency correlated with the number of HIV outpatients cared for and perceived training adequacy. …