HIV clinical rotation increases interest in ID, study finds
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Researchers found that a clinical rotation in an HIV primary care clinic, paired with a specially curated curriculum, increased medical students’ — and even internal medicine residents’ — interest in a career in infectious diseases.
It also improved their knowledge of HIV and STI management, according to the results of a study published in Open Forum Infectious Diseases.
“There are fewer trainees who are entering the field of infectious diseases. There are a variety of reasons for this,” Darcy Wooten MD, MS, an associate clinical professor of medicine at the University of California San Diego (UCSD) School of Medicine and associate program director of the UCSD ID fellowship training program, told Healio.
Wooten said previous research has shown that when trainees have positive clinical, research and mentoring experiences earlier in their careers, such as during medical school and residency, they are more likely to pursue ID than if they did not have these experiences.
“Additionally, the skills required to provide culturally competent, trauma-informed care with request to sensitive topics such as taking a sexual history, and history around mental health and substance use are critical for all care providers regardless of specialty,” Wooten said. “HIV primary care clinics offer a unique training environment to provide clinical opportunities for students and residents to practice these skills with experienced providers.”
Wooten and colleagues created a curriculum for trainees rotating in their HIV clinic to evaluate whether it affected trainees’ skills in managing HIV and STIs, their confidence and ability to take a culturally competent sexual history, and their interest in entering a career in ID or HIV.
“This will become increasingly important as there continues to be a shortage of HIV and ID providers in the United States, and we will need more providers if we are going to end the HIV epidemic,” she said.
As part of the curriculum, third-year medical students and second-year internal medicine students participated in an elective rotation for 2 to 4 weeks in UCSD's HIV primary care clinic, which provides HIV primary and subspecialty care to 3,014 patients, Wooten and colleagues explained.
Overall, 31 trainees participated in the rotation during the 6-month study, and 21 completed the pre- and postrotation survey. Residents and medical students comprised 57% (12) and 43% (9) of the cohort, respectively.
According to the study, knowledge regarding ART management, treatment as prevention and STI management all improved following the rotation, with the greatest improvements seen in recommending first-line ART regimens. Knowledge regarding the treatment of gonorrhea and syphilis also improved (85% to 90% and 43% to 48%, respectively), Wooten and colleagues reported,
According to the study, residents had higher baseline knowledge about first-line ARV regimens, STI screening and syphilis treatment, whereas students had higher baseline knowledge about treatment as prevention and gonorrhea treatment. Students’ scores improved more for STI screening and gonorrhea treatment, whereas residents’ scores improved more for first-line ART regimens, treatment as prevention, and syphilis treatment.
Overall, trainees reported improvement in their clinical skills to medically manage people living with HIV (24% to 90%) and obtain a culturally competent sexual history (57% to 100%), as well as an increased interest in an ID career (24% to 71%) after the rotation a change predominantly driven by medical students, Wooten and colleagues said.
“Robust educational training programs in HIV clinics have the potential to teach trainees core knowledge and skills important for all future physicians and also has the potential to increase interest in trainees pursuing a career in ID or HIV,” Wooten said.
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