Advertisement

Journal of General Internal Medicine

, Volume 6, Issue 1, pp 18–26 | Cite as

Program directors’ attitudes towards residents’ care of patients who have AIDS

  • Rodney A. Hayward
  • Richard L. Kravitz
  • Martin F. Shapiro
Original Articles

Abstract

Objective:To evaluate the educational strategies and experiences of residency programs regarding the training of primary care providers in the care of patients who have AIDS.

Design:Cross-sectional, self-administered questionnaire survey.

Setting:Survey conducted November 1988–April 1989.

Participants:All 771 non-military U.S. internal medicine and family medicine program directors were surveyed; 80% responded.

Interventions:None.

Measurements and main results:While 91% of the directors felt that primary care of AIDS patients was an important educational experience and 94% reported that their programs usually had AIDS inpatients, only 16% reported that the majority of trainees cared for AIDS patients in their continuity clinics. Even at programs that typically had six or more AIDS inpatients, only 26% of directors reported that most residents had cared for an AIDS patient in their continuity clinics. Among the 57% who did not believe or were unsure whether their residents were adequately trained in AIDS ambulatory care, only 38% reported improving resident education in this area to be a high priority. Among the 39% who did not encourage residents’ assumption of primary care, 60% had at least one of the following concerns: AIDS care too stressful for residents (24%), AIDS care too complicated for generalists (31%), or clinic faculty not qualified to supervise residents’ caring for AIDS patients (39%).

Conclusion:Although program directors view education in AIDS ambulatory care as important, most do not believe that residents are adequately trained, many do not encourage residents’ assumption of primary care of AIDS patients, and residents usually have not provided such care in their programs. Strategies to augment residents’ ambulatory experience in AIDS care are needed.

Key words

AIDS ambulatory care internship and residency attitudes of health professionals 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dondero TJ, St. Louis ME, Anderson JE, Petersen L, Pappaioanou M. Evaluation of the estimated numbers of HIV infections using a spreadsheet model and empirical data [abstract]. Montreal, Canada: Fifth International Conference on AIDS, 1989;45.Google Scholar
  2. 2.
    Health and Public Policy Committee, American College of Physicians, Infectious Diseases Society of America. The acquired immunodeficiency syndrome (AIDS) and infection with the human immunodeficiency virus (HIV). Ann Intern Med. 1988;108:460–9.Google Scholar
  3. 3.
    Coolfont report: A PHS plan for prevention and control of AIDS and the AIDS virus. Public Health Rep. 1986;101:341–8.Google Scholar
  4. 4.
    Cooney TG. The AIDS epidemic and the general internist [editorial]. J Gen Intern Med. 1986;1:339–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Northfelt D, Hayward RA, Shapiro MF. AIDS is a primary care disease: the need for ambulatory care education. Ann Intern Med. 1988;109:773–5.PubMedGoogle Scholar
  6. 6.
    Wachter RW. The impact of the acquired immunodeficiency syndrome on medical residency training. N Engl J Med. 1986;314:177–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Link RN, Feingold AR, Chorea MH, Freeman K, Sheley SP. Concerns of medical and pediatric house officers about acquiring AIDS from their patients. Am J Public Health. 1988;78(4):455–9.PubMedGoogle Scholar
  8. 8.
    Crowley AE, ed. 1988–1989 directory of graduate medical education programs. Chicago, IL: American Medical Association, 1988.Google Scholar
  9. 9.
    Kish L. Survey sampling. New York: John Wiley & Sons, 1965.Google Scholar
  10. 10.
    Emanuel EJ. Do physicians have an obligation to treat patients with AIDS? N Engl J Med. 1988;318:1688–90.CrossRefGoogle Scholar
  11. 11.
    Bender BS, Quinn TC. Medical responses to AIDS epidemics [letter]. N Engl J Med. 1984;310:389.PubMedGoogle Scholar
  12. 12.
    Ostrow DG, Gayle TC. Psychosocial and ethical issues of AIDS health care programs. QRB. 1986 (Aug):284–94.Google Scholar
  13. 13.
    McKusick L, Horstman W, Abrams D, Coates TJ. The psychological impact of AIDS on primary care physicians. West J Med. 1986;144:750–1.Google Scholar
  14. 14.
    Physicians increasingly worried about AIDS transmission, as residents fret about AIDS exposure. Med World News. 1987;28(16):12–3.Google Scholar
  15. 15.
    Lewis CE, Freeman HE, Kaplan SH, Corey CR. The impact of a program to enhance the competencies of primary care physicians in caring for patients with AIDS. J Gen Intern Med. 1986;1:287–94.PubMedCrossRefGoogle Scholar
  16. 16.
    Lewis CE, Freeman HE, Corey CR. AIDS-related competence of California’s primary care physicians. Am J Public Health. 1987;77:795–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Lewis CE, Freeman HE. The sexual history-taking and counseling practices of primary care physicians. West J Med. 1987;147:165–7.PubMedGoogle Scholar
  18. 18.
    Douglas CJ, Kalman CM, Kalman TP. Homophobia among physicians and nurses: an empirical study. Hosp Community Psychiatry. 1985;36:1309–11.PubMedGoogle Scholar
  19. 19.
    Mathews WC, Booth MW, Turner JD, Kessler L. Physicians’ attitudes toward homosexuality — survey of a California county medical society. West J Med. 1986;144:106–10.PubMedGoogle Scholar
  20. 20.
    Kelly JA, St. Lawrence JS, Smith S, Hood HV, Cook DJ. Medical students’ attitudes toward AIDS and homosexual patients. J Med Educ. 1987;62:549–56.PubMedGoogle Scholar
  21. 21.
    Cook M, Koenig B. House officers’ attitudes towards the acquired immunodeficiency syndrome [abstract]. In: Proceedings of the Third International Conference on AIDS. Washington, DC: Third International Conference on AIDS, 1987.Google Scholar
  22. 22.
    Rizzo JA, Marder WD, Willke RJ. Physician contact with attitudes toward HIV-seropositive patients. Med Care. 1990;28:251–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Hayward RA, Shapiro MF. A national study of AIDS and residency training: experiences, concerns, and consequences. Ann Intern Med. 1991;114. In press.Google Scholar

Copyright information

© Society of General Internal Medicine 1991

Authors and Affiliations

  • Rodney A. Hayward
    • 1
  • Richard L. Kravitz
    • 2
  • Martin F. Shapiro
    • 2
  1. 1.the Division of General Medicine, Departments of Medicine and Health Services Management and PolicyUniversity of MichiganAnn Arbor
  2. 2.the Division of General Internal Medicine and Health Services Research, Department of MedicineUniversity of California at Los AngelesLos Angeles

Personalised recommendations