Outpatient Continuity Clinics
All first year I.D. fellows are expected to attend the I.D. Outpatient Clinic for one half day session per week at the UCSD MC Hillcrest, Thornton, VAMC and Owen Clinic facilities when assigned to rotations on these services. The specific purpose of these outpatient activities is to provide continuity care and followup for those patients seen as consultations on the inpatient I.D. service, and who are discharged but require ongoing I.D. followup. These outpatient experiences do not meet all of the outpatient and ambulatory care requirements of the ACGME. As such all second year fellows are assigned a one-half day per week outpatient HIV continuity clinic for the duration of their second year, with the option to continue this experience in the third year. The outpatient continuity clinic experience can be fulfilled at either the Owen Clinic in the Ambulatory Care Center on the Hillcrest campus or at the VAMC Special I.D. Clinic on the La Jolla campus as described below.
The Owen Clinic Outpatient Practice: The Owen Clinic is an extremely active Ryan White Care Act-funded comprehensive care program that provides primary and specialty medical care to over 2,000 HIV-infected persons. The clinic is fully staffed with internists, infectious disease specialists, psychiatrists and other mental health workers, a hepatologist, an oncologist, an obstetrician-gynecologist, pharmacists, nurse practitioners, social workers, and other staff critical to the multidisciplinary care required of HIV-infected individuals. When assigned to the Owen Clinic in their second year, fellows function as primary care physicians for their panel of HIV-infected patients. There are 1-2 I.D. specialists available to fellows during their assigned one-half day per week clinic for supervision and consultation. Fellows participate in weekly staff meetings to address special needs of Owen Clinic patients.
VAMC Special I.D. Clinic: The VAMC Special I.D. Clinic follows nearly 500 HIV-infected patients, including those with HCV and HBV co-infection. This clinic includes all of the resources of the VA as well as two I.D. pharmacists, a social worker, nurses, nurse practitioners, and I.D. faculty attending physicians. When assigned to the Special I.D. Clinic in their second year, fellows function as primary care physicians for their panel of HIV-infected patients (the VA Access program). There are 1-3 faculty available to staff the clinic during each fellow session. The staff has monthly meetings to discuss HIV practice and available clinical trials.
Educational Objectives of Outpatient Continuity Clinics: At the end of these rotations, fellows are expected to master the ability to recognize, diagnose, treat and manage complications associated with HIV infection, to master the principles of the longitudinal care of HIV-infected patients and to demonstrate an understanding of the following specific topics:
- Initiation and management of chronic antiretroviral chemotherapy
- The use of viral load and CD4 cell count monitoring in HIV therapy
- The pharmacology of HIV medications including toxicities and their management
- The treatment of HCV and HBV co-infection
- Sexually transmitted diseases
- Prevention and treatment of opportunistic infections and HIV-related malignancies
- HIV-related pleuropulmonary and bronchial infections
- Central nervous system infections
- Skin and soft tissue infections
- Gastrointestinal infections
- Pathogenesis of HIV and AIDS
- Other organ system complications of HIV and AIDS
- Infections in drug users
- Mechanisms of action of and adverse reactions associated with antimicrobial agents
- Management of antiretroviral drug resistance and HIV drug resistance assays
- Principles of prevention of HIV transmission and prevention principles for chronically HIV-infected individuals
- Diagnosis and management of acute HIV infection