The fellows will perform a mix of clinical work (primarily outpatient but also some inpatient), self and collaborative study, didactics, conferences, on-line tools, quality improvement activities, and teaching.
Each fellow will have a panel of approximately 50 HIV patients plus 500 non-HIV patients, or 550 total patients per fellow, commensurate with a 4 clinic per week schedule. Of the 50 HIV patients for whom each fellow will be responsible, 10-15 will be their primary care patient, and for the other 35-40 they will be the collaborative care consultant to another primary care provider. This includes time scheduled to see these patients together with the PCP, and will give the fellows not only direct care experience but also training in how to support other PCPs in HIV care. Fellows will also see HBV and HCV patients for consultation and management visits during their clinics. They will maintain their primary care skills by seeing non-HIV patients, and will have the option to provide prenatal care and be part of the FHCW obstetric call pool during the fellowship.
Fellows will be notified of HIV patient admissions by the UMass pharmacy whenever it receives an HIV medication order. The fellow will follow the patient with the admitting team, and (if consulted) the Infectious Disease team. Their added value will come in three forms:
- Review initial antiretroviral regimen (50% of admitted patients had at least one HIV medication error in separate studies presented at the ID Week 2012 Conference, one from the Cleveland Clinic and the other at the University of Chicago);
- Recommend ID consultation if this has not been done and the fellow identifies this need;
- Provide discharge continuity of care planning
- The latter will be of great value to the patient and outpatient provider, but also to UMass as it seeks to lower its hospital readmission rate. The fellow will benefit from following the presentation, workup, diagnosis and treatment of HIV patients with both HIV- and non-HIV-related admitting diagnoses. Even though this fellowship will not accredit its graduates to be inpatient consultants, this inpatient experience is critical to the overall knowledge base needed to be an HIV expert.
Self and Collaborative Study
Fellows will use the AAHIVM Fundamentals of HIV Medicine curriculum as their primary text, as well as the DHHS and IDSA HIV Treatment Guidelines as a resource and guide to self-study. AASLD (US) and EASL (European) guidelines on Hepatitis B and C management and other resources will also be used. Each week the fellows will share “fellow time” among themselves and review that week’s topics, as well as “preceptor time” to present and review both topics and clinical cases with Dr. Bolduc. Fellow time will also be used to work on QI projects (see below).
Clinical Case Conferences
Every other month the fellows, preceptor and Dr. Cheeseman (of UMass Infectious Diseases) will hold a Case Conference, wherein challenging cases will be reviewed, the fellows will make presentations, and the group will review news in the HIV and viral hepatitis literature.
Monthly HIV Grand Rounds and Weekly HIV Clinical Rounds
The fellows will be scheduled to attend these meetings, held at the Memorial and University Campuses, respectively. Options will also be explored to connect with the UMass GI department for routine didactics and conferences.
- Harvard Medical School Annual HIV Update Conference in Boston, MA, which includes a symposium on Hepatitis C
- Conference on Retroviruses and Opportunistic Infections: the leading clinical HIV conference, occurs each March.
Fellows may also use their allocation of CME time and funds to attend family medicine conferences such as STFM and to attend local and regional NEAETC HIV educational events.
Fellows will complete the 5-part on-line HealthHIV HIV Primary Care Training and Certificate Program, a coordinated series of on-line didactics and interactive learning tools with pre- and post-test evaluations for each of the five modules (www.healthhiv.org).
Fellows will participate in the FHCW HIV Continuous Quality Improvement Program, and will design and implement a QI project during their fellowship year, culminating in a poster presentation at the UMass Levine Quality Symposium.
Developing teaching skills and resources will be one of the main focuses of the fellowship. The fellows will participate in UMass’s Teachers of Tomorrow workshop series to strengthen their skills as educators. Throughout the fellowship they will be scheduled to teach on HIV/HBV/HCV topics in various settings, such as inpatient IM and FM resident/medical student teams, outpatient resident didactics, Family Health Center Learning Lunches, and in the community at such venues as AIDS Project Worcester.
Fellows will be evaluated according to the ACGME core competencies, namely patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice, in addition to the development of their teaching skills. Additionally, the fellows will complete the AAHIVM HIV Specialist credentialing process, which includes passing a credentialing exam, after completion of the fellowship. Fellows will also complete an on-line HIV skills assessment provided by the University of Washington at the beginning and end of the fellowship. Other on-line CME tools, oral preceptor exams, and faculty and