HIV Training Track Informational Session

September 11, 2020

ID5578

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00:02Dear applicant, due to COVID-19
00:04pandemic we will not have the
00:07chance to meet you in person.
00:09So we are going to take this opportunity to.
00:14Introduce our amazing faculty
00:16and give you an information
00:18session and an overview of our
00:21HIV training track program.
00:22Here joining me our wonderful faculty,
00:25doctor Dinadan, Doctor,
00:26Green and Doctor Obagi.
00:31And Dana done in one of the
00:34infectious disease faculty members.
00:35I also serve as a clerkship
00:37director for Internal Medicine.
00:38I'm associate chair for educator
00:40development and academic affairs in
00:42the Department of Medicine, Angioni,
00:44director for educator development.
00:46Hello applicants, my name is Michael Green.
00:49I'm a professor in the Department of
00:51Medicine and director of student assessment
00:54in the teaching and Learning Center
00:56in the medical school and one of the
00:59core faculty in the HIV training track.
01:03Hi everyone, my name is Anya mub Wago.
01:05I'm an associate professor of
01:07Medicine in the section of infectious
01:08disease saying hi from one of
01:10our clinical trial locations.
01:11I'm also one of the core faculty
01:13of the HIV training track.
01:15Very nice to meet all of you.
01:19So we're going to spend around 10 minutes
01:21giving you an overview about our program.
01:24As you know, I'm the program director
01:27of the HIV training track and
01:30just a little bit of an overview.
01:33As you might know,
01:35that is 38 million individual living
01:37with HIV globally and around 1.7 million
01:41new infection every year with zero point,
01:447 million HIV related dash in the United
01:47States that is over 1.2 million person
01:50living with HIV in the United States.
01:53And these you know.
01:55Hot area are in dark purple in
01:58the South and in the North East.
02:01The reason there is an increased
02:03number of patient living with HIV is
02:06because the people are living longer
02:08due to effective until little viral
02:10treatment as well as the continuous
02:12of new infection every year.
02:15This makes us thinks about you know,
02:18how can we understand the evolution
02:20of HIV care?
02:21And if you look at the history of
02:24HIV in the beginning of the 80s,
02:27there was no effective treatment so
02:30that people were unfortunately dying
02:33and it was more of a palliative care
02:35and primary care as we had knew.
02:38Virus therapy and research.
02:39So it became more of a specialty
02:42care and focus on infectious disease.
02:44But now in 2010 and.
02:47Beyond it became more of a primary
02:50care because we have a wealth of
02:53treatment options for our patient
02:56that are safer and simpler.
02:58However,
02:59patient suffered from a significant
03:01amount of comorbidities,
03:03including diabetes, hyperlipidemia,
03:04cardiovascular disease,
03:05and they are all primary care issues,
03:08and because of this, here at yell in 2012,
03:13we were led the novel program,
03:16which is the HIV.
03:17Primary care track which is attract
03:19within the Yelp primary care residency
03:21program and it was a really a
03:24collaboration between our infectious disease,
03:27it's program and the end primary
03:29care program.
03:30Under the leadership of Doctor
03:32Moriarty and these are wonderful
03:34core faculty that you met and you
03:37will hear from throughout this talk.
03:39I would ambulatory sites are the
03:42Nathan Smith Clinic which is the yell
03:45infectious disease HIV clinic and
03:47the healing center at the SRC campus.
03:50In addition,
03:51we have the inpatient Donaldson firm
03:54rotation where we have infectious
03:57disease or HIV specialist.
03:59Doctors who will lead a team of
04:02residents and students and care for
04:05patients with HIV,
04:06needs an infectious disease.
04:07Need in a dedicated unit and yell
04:10behaving hospital.
04:11York Street campus.
04:12In addition,
04:13there is also the opportunity to do
04:16ID concept service and rotations.
04:18Little bit of background about our ambulatory
04:20clinic side the Nathan Smith Clinic.
04:23It was the first clinic and
04:25still the largest clinic of HIV
04:28in Connecticut where we provide.
04:30Primary care for our patient
04:32living with HIV in a patient center
04:35medical home model we have on site,
04:39psychiatry, neurology, HIV counseling,
04:41prep, hepatitis C treatment,
04:42pretransplant evaluation,
04:43social work, mental health,
04:45and substance abuse counseling and we
04:48have also on site a clinical pharmacists.
04:51We were the first to launch
04:54a rap program in
04:56Connecticut and we were
04:58the first in New England.
05:00You have the hope act HIV to HIV
05:04organ transplantation program.
05:05Our demographic is really a very
05:09good variety of demographic that
05:11is a reflection of what we see
05:14actually in the US as a whole,
05:17where we have 62% male, 38% female,
05:2045% of our patients are black, 32 White,
05:2324% Hispanic and as far as HIV risk factor,
05:27we have a variety from heterosexual.
05:30A risk of transmission to MSN
05:34and person who use drugs.
05:37I'm going to press the button to Doctor Dan,
05:40who will talk briefly about the
05:42HIV training track curriculum.
05:46Thank you Lydia.
05:47So we're going to talk about how
05:49we came up with the curriculum
05:52to support your development.
05:53Tordsson independent HIV primary
05:55care provider. So just to remind you,
05:57this track is fully embedded within
06:00the larger yell primary care program
06:02you are part of that large group.
06:04You just have a smaller home in
06:06addition to support this specific
06:08skill development towards HIV medicine.
06:10So the whole impetus was to allow
06:13you to take care of patients and
06:15do your primary care but with.
06:18A special emphasis on HIV and HIV risks.
06:22So to do this,
06:23what we did is we used a somewhat
06:26novel approach to come up with the
06:28curriculum based on asking the question
06:30what do you really need to do to be
06:33able to care for somebody with HIV
06:36and do primary care in that context.
06:38So we used a assessment model paradigm
06:40called in trustable professional activities,
06:42which just means how can we put
06:43you on a path towards trusting
06:46that without direct supervision.
06:47By the time you're done,
06:49you're able to do the activities of an HIV.
06:53Primary care provider.
06:54So once we were able to identify
06:56those activities,
06:57we then came up with the medical knowledge
06:59and activities that would support
07:01your ability to meet those activities.
07:04As a independent practitioner.
07:05By the time you're done and we came up
07:08with assessment tools to make sure you
07:10were making progress along that path.
07:15These are the 12 that we came up with.
07:18The embedded process that
07:19you could read about.
07:21If you're interested and these are
07:23all things that we thought were going
07:26to be key to you being able to go
07:29directly into a primary care practice.
07:31Treating people with HIV or at risk for HIV.
07:36So the way that we've been,
07:38once we establish those 12 topics that
07:41we that we filled in the ability to get
07:45you to an independent practice by the
07:48time you're done with your residency
07:51was to come up with activities,
07:54medical knowledge, activities,
07:55computer based reading, etc.
07:57And modules that would support each
07:59of these professional attributes like
08:01performing HIV testing and counseling,
08:04which is one of our core EPS.
08:07That we have international AIDS
08:09Society cases on the web.
08:11For example,
08:11we have standardized patient scripts
08:14that were written that we do with
08:16you in the beginning and then we
08:19have ways for you to evaluate your
08:21knowledge skills over the three years.
08:26So that the medical knowledge and
08:28some of the didactics and substance
08:31is given in a number of venues in
08:33addition to asynchronous learning
08:35that you can do on line you have.
08:40Scheduled didactics during the week,
08:42both in the Donaldson firm.
08:44When your inpatient or in the HIV
08:47clinic when your outpatient and
08:49there's a variety of other venues in
08:52which you would get exposed to that
08:55core training that you see listed,
08:58listed there.
09:01And where these things will
09:03happen will be as I mentioned.
09:05In the inpatient setting and
09:07during your immersion block,
09:09which you will be assigned in addition
09:11to all the other interns in your class,
09:14you'll see that there's going to be
09:17a variety of Lanja tude inal clinics
09:20where you'll get to be introduced
09:22to a panel of HIV patients as
09:25well as subspecialty clinics that
09:26are within our HIV clinic. Ann.
09:29Some that we rotate you through that
09:31give you the additional clinical
09:33exposure to meet those EPS like.
09:36Hepatitis C clinic. For example.
09:38Prep clinic, for example, and.
09:42You'll be assigned to one of the
09:45preceptors and you'll be monitored
09:47with workplace based assessments
09:49in other ways that we can make sure
09:52that you're making progress through
09:54those activities towards graduating
09:57as an independent practitioner.
10:00So now.
10:00I will turn it over to doctor
10:02Michael Green to talk about how
10:04we evaluate your progress.
10:05Thank
10:05you so doctor done told you how the HIV
10:08EPS informed our curriculum development.
10:11I'm going to tell you how we
10:14use the EPS for assessment.
10:16First we observe you performing an EPA with
10:20the patient in the Nathan Smith Clinic.
10:23For example, EPA 7 provide appropriate
10:25age based in HIV associated
10:27preventive services to patients.
10:29As you can see on the cell phone app,
10:33we determine how much supervision you
10:36require to safely perform the task.
10:38And then we give you feedback about what
10:41you need to do to become more independent.
10:46And then to track your development overtime,
10:50we meet as a team every six months to
10:53review all of your assessments for the
10:57EPA's take EPA to initiate an monitor ART,
11:01for example, the scale ranges in
11:04sophistication from critical deficiencies,
11:05as evidenced by the inability to initiate a
11:09party to the goal of unsupervised practice,
11:12evidenced by initiating a
11:14party based on guidelines.
11:16Literature resistance mutations,
11:19comorbidities, and shared decision making.
11:25An under scrap. You can see the
11:28different residents develop on different
11:30trajectories for different EPS overtime.
11:33Sometimes we discover that residents
11:35had insufficient opportunities for
11:37a particular EPA and we adjust
11:40the curriculum accordingly.
11:41Thus far, all of our residents have
11:44achieved the goal of entrustment
11:47for unsupervised practice.
11:53Oh, and all of our residents are
11:58eligible to take the exam from the.
12:02Ahi DM to become certified in HIV medicine.
12:11Thank you doctor Greene I'll go ahead
12:13to mention additional enrichment
12:15activities and extracurricular
12:16activities that have only added breadth
12:19and depth to our program starting
12:21with community engagement activities.
12:23Residents have teaching opportunities
12:24on the Donaldson and HIV ambulatory
12:26curriculum representing both inpatient
12:28and outpatient opportunities
12:30in medical education.
12:31Our residents also are involved in quality
12:34improvement projects within the clinic.
12:36But we also make effort to engage the
12:39community in different sites such as.
12:41Freeway, which is a long term
12:43care facility apps foundation.
12:45We deal with substance abuse and
12:47we also have started programs to
12:49visit our patients at home to
12:51provide that home visit experience.
12:53There also opportunities for
12:55international health electives
12:56and also time where we take set
12:58time apart to spend time to get us
13:01providers to discuss current issues.
13:03We don't always do serious events.
13:05We also have extracurricular activity is
13:07where we have relaxed events where we
13:10typically meet in a faculties home and.
13:12Do all kinds of events,
13:14including playing music dramatizing
13:16plays and also sharing our experience
13:19with participation in advocacy events.
13:21All these activities adds to the richness
13:24and Press of our training program.
13:28We also participate in community activities,
13:31which are very meaningful.
13:32We are hospital is within New Haven,
13:36which is a hotspot for HIV
13:38activity within the state.
13:40An example of programs.
13:42We've involved in our aids walk New Haven.
13:45We've also help programs
13:47around HIV and aging.
13:49We've also engaged in community events
13:51around HIV testing and Prevention activities
13:54as particularly targeted at the lesbian,
13:57gay, bisexual,
13:58transgender queer communities.
13:59Within our community,
14:00we've also engaged in advocacy around
14:04the issues around social justice.
14:06We also have a footprint globally.
14:09We have a couple of our faculty
14:11within the eighth program who are
14:13involved in international work.
14:14We currently have clinical and research
14:17opportunities in South Africa as well
14:20as Liberia and these opportunities
14:22are certainly open to residents
14:24within the HIV training track.
14:26Now moving on to research.
14:29Are we have a whole host of faculty?
14:32Who are engaged in various aspects of
14:35HIV care prevention and management.
14:37An example would be the intersection
14:39of substance use and HIV risk HIV
14:42prevention and HIV treatment.
14:43We also run large clinical trials
14:46program that's involved with HIV.
14:47Therapeutics research all the way
14:50from phase one to Phase 4 studies.
14:53This is just a an example of some
14:55of the research that were involved
14:57in I'll give 2 examples.
14:59One is the start study,
15:01which helped define the CD 4 count
15:03thresholds at which HIV treatment
15:05should be started and the Gilead prep.
15:07Discovery trial,
15:08which export 2 different modalities
15:10of HIV prevention Center for elephant
15:12on my dental professor proxy fume
15:14rates for Prevention of HIV among
15:16high risk cisgender and transgender
15:17men who had sex with transgender
15:19women who have sex with men since
15:22the COVID-19 outbreak.
15:23We've also been involved in.
15:24Pivotal COVID-19 trials such as
15:26their ambassador trials and the
15:28Pfizer vaccine trial.
15:31Our residents have also made good use
15:34of their experience with clinical trials
15:36and their quality improvement projects.
15:38We're very proud of the scholarly output
15:41and work that our residents have both
15:44presented at local, state meanings.
15:46National meanings and even international
15:49conferences as oral or poster presentations
15:51and many of these scholarly work have
15:54gone on to be to be published in peer
15:57reviewed manuscripts as is currently shown
15:59here we've had case reports case series.
16:02Research quality improvement projects.
16:06Published but also we've also
16:08published work on our work within
16:10the HIV training tribe program,
16:12which had also described
16:14unique HIV training track.
16:16That's house within primary care
16:18residency training program and I've
16:20also published on the novel competency
16:22based evaluation system for HIV primary
16:25care training that is done and Michael
16:27Green have mentioned previously.
16:31So thank you everyone for sharing
16:34your experience about the
16:35program and for our applicants.
16:37We look forward to hearing from
16:40you please navigate our website
16:43and if you have any questions
16:45don't do not hesitate to email
16:48me at Lydia Dot Barakat yet.
16:50Best wishes and looking
16:52forward to hearing from you.