Department of Family & Community Medicine

Enhanced Skills Program: Objectives for the Rotation in HIV Primary Care 410 Sherbourne

In addition to maintaining and fostering all key and enabling competencies in family medicine, as set out by the College of Family Physicians of Canada, the completion of the rotation in Outpatient HIV Care will enable acquisition of the following competencies in each of the following domains.

Medical Expert

At the end of the rotation the resident will be able to:

1. Apply knowledge of the clinical, socio-behavioral, and fundamental biomedical sciences relevant to HIV Medicine.

  • Cite the unique epidemiological, physiological, and social factors that impact HIV incidence and prevalence in at risk populations
  • Demonstrate understanding of the laboratory tests used in the diagnosis of HIV and their respective sensitivities and window periods
  • Perform a focused history and physical exam relevant to a patient presenting with initial HIV infection or for a follow-up
  • Accurately interpret results of laboratory investigations, including lymphocyte markers, HIV viral load, and resistance testing
  • Evaluate indications for the initiation of ARV therapy
  • Identify common adverse effects of ARV therapy and demonstrate knowledge of their management
  • Select appropriate ARV medications for the initiation of therapy and for modification of existing therapy
  • Demonstrate knowledge of the current recommendations for health promotion, disease prevention, and preventative care for HIV positive patients (i.e. vaccinations, cancer screening, cardiovascular risk)
  • Identify opportunistic infections and demonstrate knowledge of their prevention/prophylaxis and management
  • Identify malignancies and other chronic complications related to HIV/AIDS including bone disease, cardiovascular disease, metabolic disorders and sexually transmitted infections
  • Identify and counsel patients appropriately for pre- and post-exposure prophylaxis
  • Demonstrate knowledge of unique concerns in the management of HIV patients co-infected with Hepatitis B or Hepatitis C
  • Describe the complex relationships between HIV, stigma, psychosocial factors, mental health and addiction
  • Demonstrate familiarity with issues related to contraception and fertility planning

Communicator

At the end of the rotation the resident will be able to:

  • Exhibit effective communication skills, including verbal and written presentation of patient consultations with the respectful and culturally sensitive use of language
  • Demonstrate sensitivity in determining the constitution of the patient’s family and/or other main social supports, communicate well with the patient’s supports and encourage their involvement in shared decision making when appropriate
  • Sensitively manage the communication of patient information regarding HIV status, and demonstrate understanding of the consent requirements for communication with third party agents
  • Obtain informed consent, providing sufficient information regarding risks and benefits of HIV treatment alternatives
  • Exhibit effective and timely documentation of pertinent aspects of the clinical encounter

Collaborator

At the end of the rotation the resident will be able to:

  • Demonstrate an understanding of the roles and specific expertise of the HIV Primary Care Provider and other providers in the care of the HIV positive patient
  • Consult with other professionals and inpatient teams in a timely manner, when needed for optimal care of the HIV positive patient
  • Actively involve appropriate members of a patient’s health care team, including allied health workers, in the assessment, planning, and provision of care
  • Identify and implement strategies for safe handovers and transfer of accountability for ongoing patient care issues

Manager

At the end of the rotation the resident will be able to:

  • Assist a patient in accessing funding for anti-retroviral medications
  • Demonstrate fiscally responsible allocation of government resources in support of HIV positive patients needs

Health Advocate

At the end of the rotation the resident will be able to:

  • Recognize special needs, impairments, disabilities, and resource limitations of patients
  • Identify and, when appropriate, inform patients of available specialized resources and community supports
  • Advocate for optimal provision of care to the HIV positive patient
  • Advocate for unbiased and sensitive care of HIV positive patients by all healthcare professionals

Scholar

At the end of the rotation the resident will be able to:

  • Apply lifelong self-directed learning skills to keep up-to-date on advancements in HIV care
  • Appropriately apply evidence-based approaches and knowledge of the current HIV literature to inform clinical decision-making
  • Critically appraise medical information and successfully integrate information from a variety of sources

Professional

At the end of the rotation the resident will be able to:

  • Identify and appropriately respond to unique ethical issues arising in the care of the HIV positive patient
  • Respect personal/professional boundaries with patients, residents, and faculty
  • Demonstrate insight into his/her limitations and respond appropriately to constructive feedback