(PO-089) Complexity, Intersectionality, and CBME: A Needs Assessment for an HIV Psychiatry Educational Experience

Background: As postgraduate education transitions to Competency-Based Medical Education (CBME), there is growing recognition that traditionally siloed competency domains inadequately capture an approach to complexity. HIV illness and its interface with psychiatry form syndemics with other comorbidities and can serve as an excellent model to develop educational competencies that capture complexity. We aim to develop a competency-based framework that integrates an approach to medically and psychiatrically complex populations, exemplified by the care needs of patients affected by HIV, mental illness, and substance use disorders.

Methods: We conducted a focus group interview that involved multiple stakeholders including clinical providers, community agencies, and persons living with HIV to identify current learning needs and gaps. Using content analysis methodology, we used an inductive then deductive approach to analyze the transcript, generated a list of codes that we used to develop a competency-based framework to guide training experiences that reflect the needs of this population.

Results:
Competency domains with supporting specific competencies were developed from thematic analysis of the manuscript of the focus group. Domains encompassed themes including: “Comprehensive understanding of complexity for individuals with triple diagnosis”; “Integrated medical and neuropsychiatric assessment and management of patients with triple diagnosis”; “Navigation of systems of care across community and hospital systems, including interdisciplinary models of care for individuals with triple diagnosis”; “Psychotherapeutic skills as a means for engagement and traversing barriers to health for this complex population”. “Triple diagnosis” here describes those afflicted by HIV, mental illness, and substance use disorder.

Discussion:
The needs assessment process brought key stakeholders together and illustrated the importance of interdisciplinary collaboration in caring for complex populations; recognizing that much of the care for patients with complex health needs occurs in teams or collaborative systems or through collaboration between community and hospital resources. Other HIV psychiatry related curriculum has also highlighted the potential to positively influence treatment adherence and medical care outcomes by incorporating mental health and trauma-informed approaches into care (Tavakkoli, 2014).



Conclusion:
The transition to CBME is an opportune moment to ensure that educational frameworks for learners foster an approach, to medical and psychiatric complexity, that is informed by stakeholders from a variety of perspectives, including patients and community AIDS Service Organizations. Consultation-liaison psychiatrists are well poised to lead development of these CBME learning objectives that prepare our future physicians, in psychiatry and other specialties, to care for those with multifaceted needs. Future evaluations of learner experiences can assess the effectiveness of this framework in preparing trainees for practice in supporting this patient population.



References:
Tavakkoli, M., Cohen, M.A., Alfonso, C.A. et al. Caring for Persons with Early Childhood Trauma, PTSD, and HIV: a Curriculum for Clinicians. Acad Psychiatry 38, 696–700 (2014).