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Li LX, Lin JS, Tackett S, Bertram A, Sisson SD, Rastegar D, Berkenblit G. Knowledge of Pre- and Postexposure Prophylaxis for HIV Prevention Among Internal Medicine Residents in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:48-59. [PMID: 38349354 DOI: 10.1521/aeap.2024.36.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prescription rates of pre-exposure prophylaxis (PrEP) have remained low among noninfectious disease providers in the United States despite almost a decade since their introduction. For future primary care doctors, residency is the optimal time to build practice patterns around HIV prevention. We assessed baseline knowledge of PrEP in specific pre- and post-exposure prophylaxis content areas among internal medicine trainees who completed the Physician Education and Assessment Center HIV learning module between 2013 to 2020 (N = 12,060). Resident baseline PrEP knowledge was universally low; despite rising awareness of antiretroviral therapy for PrEP in successive years following the nadir of 41% in 2014, still only 56% of residents affirmed this means of HIV prevention by 2020. Knowledge remained limited regardless of academic year, local HIV prevalence, or training program type. Online module completion increased competence across all content areas. There is still a deficit in HIV prevention knowledge across U.S. internal medicine residents, suggesting insufficient education and exposure to HIV-related care.
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Affiliation(s)
- Lucy X Li
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica S Lin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, and Department of Medicine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda Bertram
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen D Sisson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darius Rastegar
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gail Berkenblit
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ahmad T, Robinson L, Uleryk E, Yu C. Trans health training objectives: A scoping review. CLINICAL TEACHER 2024; 21:e13673. [PMID: 37806669 DOI: 10.1111/tct.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Transgender individuals are discriminated against in health care environments and consistently experience poorer health outcomes than their cisgender counterparts. Enhancing physician training in transgender-specific health is critical to closing the transgender health gap. METHODS We conducted a scoping review to identify transgender health training objectives in Internal Medicine and Internal Medicine Subspecialty residency programmes in Canada and the United States. A systematic search was conducted from 1946 to 15 February 2022. Studies were eligible for inclusion if they were written in English, included transgender training objectives, and were aimed at resident physicians in Internal Medicine or Internal Medicine Subspecialty training programmes in Canada or the United States. FINDINGS We found 4048 papers, of which 11 were included for analysis. Transgender health training objectives were synthesised into five themes, including (1) terminology, physiology, and gender presentation, (2) gender-affirming care and communication, (3) hormonal and surgical management, (4) routine health management and maintenance, and (5) equity, diversity, and inclusion in clinical care. The majority of objectives pertained to equity, diversity, and inclusion in clinical care, namely, respectful communication and non-judgemental care of transgender patients. DISCUSSION Our findings provide a comprehensive overview of published transgender health objectives in Canada and the United States and highlight existing gaps in postgraduate medical education for Internal Medicine and Subspecialty programmes. CONCLUSIONS We argue a need for standardisation of transgender-related residency training and suggest that postgraduate Internal Medicine programmes can utilise this review as a framework to begin enhancing transgender health education for their residents.
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Affiliation(s)
- Tehmina Ahmad
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Lilian Robinson
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Uleryk
- Medical Information Sciences, E.M. Consulting, Mississauga, Ontario, Canada
| | - Catherine Yu
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Dubin S, Kutscher E, Nolan I, Levitt N, Cook TE, Greene RE. Assessment of Medical Education on Transgender Health: A Scoping Literature Review. Eval Health Prof 2023:1632787231214531. [PMID: 37966355 DOI: 10.1177/01632787231214531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Little is known about how physician learners are assessed following educational interventions about providing gender-affirming care to transgender and gender diverse (TGD) people. The inclusion of learner assessments with educational interventions is essential to understand and measure health professionals' knowledge and skills. We seek to describe how the medical literature has approached the assessment of learners following educational interventions about TGD health. A scoping literature review was done. The guiding research question was "What are the current learner-assessment practices in medical education pedagogy about TGD health?" A total of 270 manuscripts were reviewed. 17 manuscripts were included for data extraction. Miller's pyramid was used to categorize results. 15 used pre- and post-intervention knowledge questionaries to assess learners. Six used simulated patient encounters to assess learners. Most assessments of TGD knowledge and skills among physician learners are pre- and post-surveys. There is sparse literature on higher level assessment following educational interventions that demonstrate learner skills, behaviors, or impact on patient outcomes. Discrete, one-time interventions that are lecture or workshop-based have yet to rigorously assess learners' ability to provide clinical care to TGD patients that is both culturally humble and clinically astute.
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Affiliation(s)
- Samuel Dubin
- Department of Medicine, NYU Grossman School of Medicine, New York, USA
| | - Eric Kutscher
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ian Nolan
- Plastic and Reconstructive Surgery, RUSH University Medical Center, Illinois, USA
| | | | - Tiffany E Cook
- Diversity and Inclusion Office, UMass Chan Medical School, Worcester, USA
| | - Richard E Greene
- Department of Medicine, NYU Grossman School of Medicine, New York, USA
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Mains-Mason JB, Ufomata E, Peebles JK, Dhar CP, Sequeira G, Miller R, Folb B, Eckstrand KL. Knowledge Retention and Clinical Skills Acquisition in Sexual and Gender Minority Health Curricula: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1847-1853. [PMID: 35703197 PMCID: PMC9837881 DOI: 10.1097/acm.0000000000004768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for sexual and gender minoritized (SGM) individuals and individuals born with a difference in sex development (DSD). METHOD The authors conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in PubMed/MEDLINE, The Cochrane Library, Web of Science, ERIC, Embase, PsycINFO, and the gray literature to identify studies that (1) pertained to undergraduate and/or graduate medical education, (2) addressed education on health care of SGM/DSD individuals, and (3) assessed knowledge retention and/or clinical skills acquisition in medical trainees. The final searches were run in March 2019 and rerun before final analyses in June and October 2020. RESULTS Of 670 full-text articles reviewed, 7 met the inclusion criteria. Five of the 7 studies assessed trainee knowledge retention alone, 1 evaluated clinical skills acquisition alone, and 1 evaluated both outcomes. Studies covered education relevant to transgender health, endocrinology for patients born with DSDs, and HIV primary care. Only 1 study fully mapped to the Association of American Medical Colleges (AAMC) SGM/DSD competency recommendations. Six studies reported institutional funding and development support. No studies described teaching SGM/DSD health care for individuals with multiply minoritized identities or engaging the broader SGM/DSD community in medical education curriculum development and implementation. CONCLUSIONS Curriculum development in SGM/DSD health care should target knowledge retention and clinical skills acquisition in line with AAMC competency recommendations. Knowledge and skill sets for responsible and equitable care are those that account for structures of power and oppression and cocreate curricula with people who are SGM and/or born with DSDs.
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Affiliation(s)
- Janke B Mains-Mason
- J.B. Mains-Mason is a senior research associate, Department of Pathology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Eloho Ufomata
- E. Ufomata is assistant professor, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0002-2175-806X
| | - J Klint Peebles
- J.K. Peebles is a dermatologist, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Washington, DC
| | - Cherie P Dhar
- C.P. Dhar is assistant professor, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-1994-3722
| | - Gina Sequeira
- G. Sequeira is assistant professor, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; ORCID: http://orcid.org/0000-0001-5906-869X
| | - Rebekah Miller
- R. Miller is a research and instruction librarian, Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0002-9783-8234
| | - Barbara Folb
- B. Folb is a public health informationist, Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0001-5531-980X
| | - Kristen L Eckstrand
- K.L. Eckstrand is assistant professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0002-6506-3649
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Suarez S, Lupez E, Demers L, Streed CG, Siegel J. Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents. LGBT Health 2022; 9:589-594. [PMID: 35905057 DOI: 10.1089/lgbt.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.
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Affiliation(s)
- Sebastian Suarez
- Internal Medicine Residency Program, Boston University Medical Center, Boston, Massachusetts, USA
| | - Emily Lupez
- Internal Medicine Residency Program, Boston University Medical Center, Boston, Massachusetts, USA
| | - Lindsay Demers
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Education Evaluation Core, Boston University School of Medicine, Boston, Massachusetts, USA.,Health Sciences Education MS Program, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carl G Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Jennifer Siegel
- Internal Medicine Residency Program, Boston University Medical Center, Boston, Massachusetts, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston University Medical Center, Boston, Massachusetts, USA
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Catalanotti JS, Popiel DK, Barbour A. Retaining interest in caring for underserved patients among future medicine subspecialists: Underserved Medicine and Public Health (UMPH) program. BMC MEDICAL EDUCATION 2021; 21:589. [PMID: 34801016 PMCID: PMC8606069 DOI: 10.1186/s12909-021-03006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Accessing subspecialty care is hard for underserved patients in the U.S. Published curricula in underserved medicine for Internal Medicine residents target future-primary care physicians, with unknown impact on future medicine subspecialists. METHODS The aim was to retain interest in caring for underserved patients among Internal Medicine residents who plan for subspecialist careers at an urban university hospital. The two-year Underserved Medicine and Public Health (UMPH) program features community-based clinics, evening seminars, reflection assignments and practicum projects for 3-7 Internal Medicine residents per year. All may apply regardless of anticipated career plans after residency. Seven years of graduates were surveyed. Data were analyzed using descriptive statistics. RESULTS According to respondents, UMPH provided a meaningful forum to discuss important issues in underserved medicine, fostered interest in treating underserved populations and provided a sense of belonging to a community of providers committed to underserved medicine. After residency, 48% of UMPH graduates pursued subspecialty training and 34% practiced hospitalist medicine. 65% of respondents disagreed that "UMPH made me more likely to practice primary care" and 59% agreed "UMPH should target residents pursuing subpecialty careers." CONCLUSIONS A curriculum in underserved medicine can retain interest in caring for underserved patients among future-medicine subspecialists. Lessons learned include [1] building relationships with local community health centers and community-practicing physicians was important for success and [2] thoughtful scheduling promoted high resident attendance at program events and avoided detracting from other activities required during residency for subspecialist career paths. We hope Internal Medicine residency programs consider training in underserved medicine for all trainees. Future work should investigate sustainability, whether training results in improved subspecialty access, and whether subspecialists face unique barriers caring for underserved patients. Future curricula should include advocacy skills to target systemic barriers.
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Affiliation(s)
| | - David K Popiel
- Department of Emergency Medicine, The George Washington University, Washington, DC, USA
| | - April Barbour
- Department of Medicine, The George Washington University, Washington, DC, USA
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Pregnall AM, Churchwell AL, Ehrenfeld JM. A Call for LGBTQ Content in Graduate Medical Education Program Requirements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:828-835. [PMID: 34031304 DOI: 10.1097/acm.0000000000003581] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements.
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Affiliation(s)
- Andrew M Pregnall
- A.M. Pregnall is LGBTQ health intern, Vanderbilt Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9629-0636
| | - André L Churchwell
- A.L. Churchwell is professor of medicine (cardiology), professor of radiology and radiological sciences, professor of biomedical engineering, and senior associate dean, Diversity Affairs, Vanderbilt University School of Medicine, and chief diversity officer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jesse M Ehrenfeld
- J.M. Ehrenfeld is senior associate dean and director, Advancing a Healthier Wisconsin Endowment, the Medical College of Wisconsin, Milwaukee, Wisconsin
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Budak JZ, Sears DA, Wood BR, Spach DH, Armstrong WS, Dhanireddy S, Teherani A, Schwartz BS. Human Immunodeficiency Virus Training Pathways in Residency: A National Survey of Curricula and Outcomes. Clin Infect Dis 2021; 72:1623-1626. [PMID: 32211781 DOI: 10.1093/cid/ciaa301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Ending the HIV Epidemic initiative, which aims to decrease the annual incidence of HIV infections in the United States (US) by 90% over the next decade, will require growth of a limited HIV provider workforce. Existing HIV training pathways within Family Medicine (FM) and Internal Medicine (IM) residency programs may address the shortage of HIV medical providers, but their curricula and outcomes have not previously been assessed. METHODS We identified HIV residency pathways via literature review, Internet search, and snowball sampling and designed a cross-sectional study of existing HIV pathways in the US. This survey of pathway directors included 33 quantitative items regarding pathway organization, curricular content, graduate outcomes, and challenges. We used descriptive statistics to summarize responses. RESULTS Twenty-five residency programs with dedicated HIV pathways in the US were identified (14 FM and 11 IM), with most located in the West and Northeast. All 25 (100%) pathway directors completed the survey. Since 2006, a total of 228 residents (77 FM and 151 IM) have graduated from these HIV pathways. Ninety (39%) of 228 pathway graduates provide primary care to persons with HIV (PWH). CONCLUSIONS HIV pathways are effective in graduating providers who can care for PWH, but generally are not located in nor do graduates practice in the geographic areas of highest need. Our findings can inform quality improvement for existing programs, development of new pathways, and workforce development strategies. Specifically, expanding pathways in regions of greatest need and incentivizing pathway graduates to work in these regions could augment the HIV workforce.
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Affiliation(s)
- Jehan Z Budak
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - David A Sears
- Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.,Mountain West AIDS Education and Training Center, Seattle, Washington, USA
| | - David H Spach
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Wendy S Armstrong
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Arianne Teherani
- Department of Medicine, University of California, San Francisco, California, USA
| | - Brian S Schwartz
- Division of Infectious Diseases, University of California, San Francisco, California, USA
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Ufomata E, Eckstrand KL, Spagnoletti C, Veet C, Walk TJ, Webb C, Gutiérrez EJ, Imming C, Guhl E, Jeong K, Rubio D, Hasley P. Comprehensive Curriculum for Internal Medicine Residents on Primary Care of Patients Identifying as Lesbian, Gay, Bisexual, or Transgender. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10875. [PMID: 32051853 PMCID: PMC7012308 DOI: 10.15766/mep_2374-8265.10875] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Significant gaps remain in the training of health professionals regarding the care of individuals who identify as lesbian, gay, bisexual, and transgender (LGBT). Although curricula have been developed at the undergraduate medical education level, few materials address the education of graduate medical trainees. The purpose of this curriculum was to develop case-based modules targeting internal medicine residents to address LGBT primary health care. METHODS We designed and implemented a four-module, case-based, interactive curriculum at one university's internal medicine residency program. The modules contained facilitator and learner guides and addressed four main content areas: understanding gender and sexuality; performing a sensitive history and physical examination; health promotion and disease prevention; and mental health, violence, and reproductive health. Knowledge, perceived importance, and confidence were assessed before and after each module to assess curricular effectiveness and acceptability. General medicine faculty delivered these modules. RESULTS Perceived importance of LGBT topics was high at baseline and remained high after the curricular intervention. Confidence significantly increased in many areas, including being able to provide resources to patients and to institute gender-affirming practices (p < .05). Knowledge improved significantly on almost all topics (p < .0001). Faculty felt the materials gave enough preparation to teach, and residents perceived that the faculty were knowledgeable. DISCUSSION This resource provides an effective curriculum for training internal medicine residents to better understand and feel confident addressing LGBT primary health care needs. Despite limitations, this is an easily transferable curriculum that can be adapted in a variety of curricular settings.
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Affiliation(s)
- Eloho Ufomata
- Assistant Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
- Corresponding author:
| | - Kristen L. Eckstrand
- Psychiatry Fellow, Department of Psychiatry, UPMC Western Psychiatric Institute and Clinic
| | - Carla Spagnoletti
- Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Clark Veet
- General Internal Medicine Fellow, Division of General Internal Medicine, University of Pittsburgh School of Medicine
- Clinical Instructor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Thomas J. Walk
- Clinical Instructor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
- Clinical Instructor of Medicine, Division of General Internal Medicine, VA Pittsburgh Healthcare System
| | - Camille Webb
- Clinical Instructor of Medicine, Division of Infectious Diseases, University of Texas Medical Branch School of Medicine
| | - Elena Jiménez Gutiérrez
- Assistant Professor, Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio School of Medicine
| | - Christina Imming
- Pediatric Hospitalist, UPMC Children's Hospital of Pittsburgh
- Primary Care Provider, Complex Care Center, UPMC Children's Hospital of Pittsburgh
| | - Emily Guhl
- Cardiology Fellow, University of Pittsburgh Medical Center
| | - Kwonho Jeong
- Statistician, Data Center, Center for Research on Health Care, University of Pittsburgh School of Medicine
| | - Doris Rubio
- Professor of Medicine, Biostatistics, Nursing, and Clinical and Translational Science, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Peggy Hasley
- Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
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Dunne D, Green M, Tetrault J, Barakat LA. Development of a Novel Competency-Based Evaluation System for HIV Primary Care Training: the HIV Entrustable Professional Activities. J Gen Intern Med 2020; 35:331-335. [PMID: 31667752 PMCID: PMC6957645 DOI: 10.1007/s11606-019-04956-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is an anticipated shortage of primary care providers trained to care for patients with HIV. The Yale School of Medicine developed and implemented a novel HIV training track within our Primary Care Internal Medicine Residency Program. A set of 12 Entrustable Professional Activities (EPAs) were developed to guide curriculum development and resident assessment. AIM To describe the process of implementing a novel EPA-based curriculum for the HIV Primary Care Training Track including EPA-based trainee evaluation tools. PARTICIPANTS/SETTINGS Two to three residents were enrolled annually from 2012 to 2017 (total n = 11). Training sites included the outpatient academic center HIV clinic and inpatient HIV ward. PROGRAM DESCRIPTION An expert panel developed 12 HIV-specific EPAs. These were mapped to curricular and reporting internal medicine milestones. Curricular activities and evaluation tools were developed to guide EPA progress. PROGRAM EVALUATION Graduating residents were ready for unsupervised practice in 91% of EPAs at the end of the 3-year program. DISCUSSION Development of HIV-specific training EPAs was effective for driving curricular development and resident evaluation, and served as an effective method to communicate expectations to resident participants. These HIV-specific EPAs could serve as a useful template to enhance HIV education in academic settings.
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Affiliation(s)
- Dana Dunne
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
| | - Michael Green
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeanette Tetrault
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lydia Aoun Barakat
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
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Hale AJ, Ricotta DN, Freed J, Smith CC, Huang GC. Adapting Maslow's Hierarchy of Needs as a Framework for Resident Wellness. TEACHING AND LEARNING IN MEDICINE 2019; 31:109-118. [PMID: 29708437 DOI: 10.1080/10401334.2018.1456928] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
ISSUE Burnout in graduate medical education is pervasive and has a deleterious impact on career satisfaction, personal well-being, and patient outcomes. Interventions in residency programs have often addressed isolated contributors to burnout; however, a more comprehensive framework for conceptualizing wellness is needed. EVIDENCE In this article the authors propose Maslow's hierarchy of human needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a potential framework for addressing wellness initiatives. There are numerous contributors to burnout among physician-trainees, and programs to combat burnout must be equally multifaceted. A holistic approach, considering both the trainees personal and professional needs, is recommended. Maslow's Needs can be adapted to create such a framework in graduate medical education. The authors review current evidence to support this model. IMPLICATIONS This work surveys current interventions to mitigate burnout and organizes them into a scaffold that can be used by residency programs interested in a complete framework to supporting wellness.
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Affiliation(s)
- Andrew J Hale
- a Infectious Diseases, University of Vermont Medical Center , Burlington , Vermont , USA
| | - Daniel N Ricotta
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Jason Freed
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - C Christopher Smith
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Grace C Huang
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
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12
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Two Novel Urban Health Primary Care Residency Tracks That Focus On Community-Level Structural Vulnerabilities. J Gen Intern Med 2018; 33:2250-2255. [PMID: 29299817 PMCID: PMC6258596 DOI: 10.1007/s11606-017-4272-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/30/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although residency programs are well situated for developing a physician workforce with knowledge, skills, and attitudes that incorporate the strengths and reflect the priorities of community organizations, few curricula explicitly do so. AIM To develop urban health primary care tracks for internal medicine and combined internal medicine-pediatrics residents. SETTING Academic hospital, community health center, and community-based organizations. PARTICIPANTS Internal medicine and combined internal medicine-pediatrics residents. PROGRAM DESCRIPTION The program integrates community-based experiences with a focus on stakeholder engagement into its curriculum. A significant portion of the training (28 weeks out of 3 years for internal medicine and 34 weeks out of 4 years for medicine-pediatrics) occurs outside the hospital and continuity clinic to support residents' understanding of structural vulnerabilities. PROGRAM EVALUATION Sixteen internal medicine and 14 medicine-pediatrics residents have graduated from our programs. Fifty-six percent of internal medicine graduates and 79% of medicine-pediatrics graduates are seeking primary care careers, and eight overall (27%) have been placed in community organizations. Seven (23%) hold leadership positions. DISCUSSION We implemented two novel residency tracks that successfully placed graduates in community-based primary care settings. Integrating primary care training with experiences in community organizations can create primary care leaders and may foster collective efficacy among medical centers and community organizations.
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Budak JZ, Volkman K, Wood BR, Dhanireddy S. Building HIV Workforce Capacity Through a Residency Pathway: Outcomes and Challenges. Open Forum Infect Dis 2018; 5:ofy317. [PMID: 30591922 PMCID: PMC6301186 DOI: 10.1093/ofid/ofy317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/19/2018] [Indexed: 12/03/2022] Open
Abstract
To help address the impending HIV physician shortage, we launched an HIV Medicine Pathway within our Internal Medicine Residency in 2008. Between 2015 and 2017, surveys showed a decrease in the number of graduates providing primary care for people living with HIV. We suggest evaluation of long-term outcomes from similar training programs and stronger support for HIV primary care career development.
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Affiliation(s)
- Jehan Z Budak
- Division of Infectious Diseases, University of California, San Francisco, California
| | - Kathleen Volkman
- Department of Medicine, University of Washington, Seattle, Washington
| | - Brian R Wood
- Department of Medicine, University of Washington, Seattle, Washington.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington.,Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Shireesha Dhanireddy
- Department of Medicine, University of Washington, Seattle, Washington.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
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Barakat LA, Dunne DW, Tetrault JM, Soares S, Chia D, Ogbuagu OE, Moriarty JP, Huot SJ, Green ML. The Changing Face of HIV Care: Expanding HIV Training in an Internal Medicine Residency Program. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1673-1678. [PMID: 29901657 DOI: 10.1097/acm.0000000000002317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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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Affiliation(s)
- Lydia Aoun Barakat
- L. 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
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15
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Fessler DA, Huang GC, Potter J, Baker JJ, Libman H. Development and Implementation of a Novel HIV Primary Care Track for Internal Medicine Residents. J Gen Intern Med 2017; 32:350-354. [PMID: 27704368 PMCID: PMC5330998 DOI: 10.1007/s11606-016-3878-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/01/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Declining mortality has led to a rising number of persons living with HIV (PLWH) and concerns about a future shortage of HIV practitioners. AIM To develop an HIV Primary Care Track for internal medicine residents. SETTING Academic hospital and community health center with a history of caring for PLWH and lesbian, gay, bisexual, and transgender (LGBT) patients. PARTICIPANTS Internal medicine residents. PROGRAM DESCRIPTION We enrolled four residents annually in a 3-year track with the goal of having each provide continuity care to at least 20 PLWH. The curriculum included small group learning sessions, outpatient electives, a global health opportunity, and the development of a scholarly project. PROGRAM EVALUATION All residents successfully accrued 20 or more PLWH as continuity patients. Senior residents passed the American Academy of HIV Medicine certification exam, and 75 % of graduates took positions in primary care involving PLWH. Clinical performance of residents in HIV care quality measures was comparable to those reported in published cohorts. DISCUSSION We developed and implemented a novel track to train medical residents in the care of PLWH and LGBT patients. Our results suggest that a designated residency track can serve as a model for training the next generation of HIV practitioners.
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Affiliation(s)
- David A Fessler
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Grace C Huang
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jennifer Potter
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Fenway Health, Boston, MA, USA
| | | | - Howard Libman
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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