AIDS patients and primary care: A new outpatient rotation for residency training

The effective management of HIV-infected individuals in the outpatient clinic is not easily learned through the traditional hospital ward rotations. Furthermore, residents have few opportunities to develop these outpatient skills and may therefore be reluctant to provide primary care for AIDS patients. To investigate this issue, we designed an experience for primary care PG-3 residents to rotate through the AIDS/ID clinic one-half day per week for a 6-week period of time. There, they participated as part of a multi-disciplinary team of physicians, nurses, social workers, and therapists managing non-hospitalized HIV-infected patients. To date, 14 residents have participated. Evaluation was through a 10-item retrospective pre- and post-rotation questionnaire using a 5-point Likert scale and designed to assess the resident's perceived mastery on various management topics. Five outpatient items (OUT) included HIV history taking, screening examinations, legal and ethical issues, prophylactic treatment strategies, and the use of community resources for AIDS patients. Five general HIV/AIDS items (GEN) not specific to the outpatient setting included virology, epidemiology, treatment of opportunistic infections, laboratory diagnoses, and the writing of advanced directives. A two-tailed T-test was used to assess statistical significance between pre- and post- scores. The residents demonstrated significant improvement (p< 0.05) for all OUT items after completing the rotation; the GEN scores were uniformly high and insignificantly different. Through this new rotation, our residents improved their primary care outpatient skills in the management of AIDS patients.