Enhanced Skills Program: OHTN HIV Care - Inpatient HIV Unit Rotation Goals and Objectives

DEPARTMENT OF FAMILY & COMMUNITY MEDICINE

ENHANCED HIV SKILLS PROGRAM

OBJECTIVES FOR THE ROTATION ST. MICHAEL’S HOSITAL INPATIENT/POSITIVE CARE CLINIC

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 fellowship 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 members of the LGBT population
   • 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
   • 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, and mental health

Communicator

At the end of the fellowship 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

Collaborator

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

• Demonstrate an understanding of the roles and specific expertise of infectious disease and other specialists 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

Leader

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

• Advocate effectively for the biopsychosocial needs of patients living with HIV and their families within the health care system and community
• Support health of patients/families by appropriate referrals, support and information on health maintenance, lifestyle, community/home resources
  • Intervene on behalf of patients or the community with respect to the social, economic and biologic factors that may impact on their health.

• 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 fellowship 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 fellowship the resident will be able to:

• Demonstrate a commitment to patients and their families, as well as to their profession and to society, through ethical practice
• Demonstrate a commitment to excellence in clinical care and personal ethical conduct.
• Exhibit proper professional behavior, including adhering to legal and ethical codes of practice.
• 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