A National Study of AIDS and Residency Training: Experiences, Concerns, and Consequences

Abstract

To examine residents' experiences in the care of patients with the acquired immunodeficiency syndrome (AIDS), and to examine factors that may influence their attitudes about such care. Cross-sectional, self-administered questionnaire survey conducted in 1989. All senior internal medicine and family medicine residents in ten geographically representative states who were identified through the 1986 National Residency Matching Program. Seventy-four percent of residents reported that patients with AIDS accounted for 5% or more of general medicine admissions, and 50% of residents reported that they were currently following one or more human immunodeficiency virus (HIV)-infected patients in their continuity clinics. Among residents who had provided ambulatory care to patients with AIDS, 77% felt that it was an excellent educational experience, and among those who planned to do general primary care in their future practices, 74% planned on providing primary care to patients with AIDS. However, 61% expressed concerns about the adequacy of their training in AIDS ambulatory care. A greater amount of contact with outpatients who had AIDS, but not with inpatients who had AIDS, was associated with residents' intending to provide AIDS primary care in their future practices. Among all residents, 23% reported that, if given a choice, they would not provide care to any patients with AIDS, and 23% reported that they would not work in an area with a high prevalence of AIDS because of concern about contracting the syndrome. Nine percent of residents reported that they had been exposed to a blood-contaminated needlestick from an HIV-seropositive patient. Although most residents have substantial contact with inpatients and outpatients with AIDS, most still find their education in AIDS ambulatory care to be deficient. A minority of residents would prefer not to care for patients with AIDS. Residency curricula should include training and experience in ambulatory AIDS care, explicitly address negative attitudes toward caring for patients with AIDS, and include programs to reduce needlestick exposures.