Journal of General Internal Medicine

, Volume 27, Issue 7, pp 839–844

Factors Affecting Clinician Educator Encouragement of Routine HIV Testing Among Trainees

  • Gail V. Berkenblit
  • James M. Sosman
  • Michael Bass
  • Hirut T. Gebrekristos
  • Joseph CofrancescoJr
  • Lynn E. Sullivan
  • Robert L. Cook
  • Marcia Edison
  • Philip G. Bashook
  • P. Todd Korthuis
Original Research

DOI: 10.1007/s11606-012-1985-9

Cite this article as:
Berkenblit, G.V., Sosman, J.M., Bass, M. et al. J GEN INTERN MED (2012) 27: 839. doi:10.1007/s11606-012-1985-9

Abstract

BACKGROUND

Adoption of CDC recommendations for routine, voluntary HIV screening of all Americans age 13–64 years has been slow. One method to increase adherence to clinical practice guidelines is through medical school and residency training.

OBJECTIVE

To explore the attitudes, barriers, and behaviors of clinician educators (CEs) regarding advocating routine HIV testing to their trainees.

DESIGN/PARTICIPANTS

We analyzed CE responses to a 2009 survey of Society of General Internal Medicine members from community, VA, and university-affiliated clinics regarding HIV testing practices.

MAIN MEASURES

Clinician educators were asked about their outpatient practices, knowledge and attitudes regarding the revised CDC recommendations and whether they encouraged trainees to perform routine HIV testing. Associations between HIV testing knowledge and attitudes and encouraging trainees to perform routine HIV testing were estimated using bivariate and multivariable logistic regression.

RESULTS

Of 515 respondents, 367 (71.3%) indicated they supervised trainees in an outpatient general internal medicine clinic. These CEs demonstrated suboptimal knowledge of CDC guidelines and over a third reported continued risk-based testing. Among CEs, 196 (53.4%) reported that they encourage trainees to perform routine HIV testing. Higher knowledge scores (aOR 5.10 (2.16, 12.0)) and more positive attitudes toward testing (aOR 8.83 (4.21, 18.5)) were independently associated with encouraging trainees to screen for HIV. Reasons for not encouraging trainees to screen included perceived low local prevalence (37.2%), competing teaching priorities (34.6%), and a busy clinic environment (34.0%).

CONCLUSIONS

Clinician educators have a special role in the dissemination of the CDC recommendations as they impact the knowledge and attitudes of newly practicing physicians. Despite awareness of CDC recommendations, many CEs do not recommend universal HIV testing to trainees. Interventions that improve faculty knowledge of HIV testing recommendations and address barriers in resident clinics may enhance adoption of routine HIV testing.

KEY WORDS

HIVscreeningclinician educatorresidency training

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Gail V. Berkenblit
    • 1
  • James M. Sosman
    • 2
  • Michael Bass
    • 3
  • Hirut T. Gebrekristos
    • 4
  • Joseph CofrancescoJr
    • 1
  • Lynn E. Sullivan
    • 5
  • Robert L. Cook
    • 6
  • Marcia Edison
    • 3
  • Philip G. Bashook
    • 3
  • P. Todd Korthuis
    • 7
  1. 1.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of Medical EducationUniversity of Illinois College of MedicineChicagoUSA
  4. 4.Department of EpidemiologyTulane School of Public Health and Tropical MedicineNew OrleansUSA
  5. 5.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  6. 6.Departments of Epidemiology and MedicineUniversity of FloridaGainesvilleUSA
  7. 7.Departments of Medicine and Public Health & Preventive MedicineOregon Health and Science UniversityPortlandUSA