Assessing HIV Preexposure Prophylaxis Education in a Family Medicine Residency.

BACKGROUND AND OBJECTIVES: HIV preexposure prophylaxis (PrEP) has been purposefully incorporated into our family medicine resident training within existing didactic lectures, readings, and routine office visit precepting. This mixed-methods evaluation assesses training strategies for PrEP use via survey and drug use evaluation (DUE). METHODS: We surveyed 80 current and former family medicine residents (2014-2018) about their exposure to training components, self-reported confidence and competency in PrEP use, and practice behaviors reflecting CDC guidelines for patient eligibility and testing. In addition, we conducted a DUE of patients receiving PrEP from 2012-2018 for adherence to CDC guidelines. We report results with descriptive statistics, with χ2 analysis for group comparisons. RESULTS: Survey response rate was 56.3%. Among respondents, 46.7% have prescribed PrEP and 55.5% self-assessed as competent to prescribe PrEP, with the majority (84%) rating precepting as most effective for building competence. Those self-assessed as competent were more likely to endorse practice behaviors reflecting CDC guidelines for monitoring PrEP (P<.05). DUE identified 68 patients; 98.5% men who have sex with men. No women with recent sexually transmitted infections, nor persons who inject drugs (PWID) received PrEP. Initial testing completion ranged from 79.4% (HIV) to 54.4% (hepatitis B). Follow-up testing completion ranged from 41.5% (HIV) to 26.4% (syphilis). CONCLUSIONS: Residents rated precepting as the most effective training. However, DUE demonstrated that PrEP underuse, as well as suboptimal testing, limited experiential training on CDC guidelines. Curricular updates should further emphasize appropriate patient selection for PrEP, including women, minorities, and PWID, as well as robust testing, to continue expanding PrEP access.

Text messaging to improve resident knowledge: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Advances in technology present opportunities to develop and test innovative teaching methods. We sought to evaluate whether text messaging could improve medical resident knowledge in musculoskeletal medicine. METHODS: Eleven U.S. family medicine residency programs with a total of 269 residents participated in this randomized, controlled trial. Residents were invited to complete a pretest to assess musculoskeletal medicine knowledge. The residents randomized to the intervention group were then offered to receive text messages termed electronically Generated Educational Messages (eGEMs) three times per week during a 12-week period. The primary outcome was change in pretest and posttest scores among residents in an intervention group (those who received text messages) as compared to a control group (those who did not receive the text messages). Focus groups were conducted to assess resident acceptability and usefulness of text messaging as a teaching tool. RESULTS: Sixty-three residents completed the pretests and posttests. The intervention group's score improved from 55% of questions answered correctly to 64%; the control group improved from 56% to 61%. While these pretest/posttest changes each were statistically significant, the difference in improvement between the two groups was not. Focus groups revealed that participants liked the intervention, but suggestions for improvement included ability to tailor the eGEMs. CONCLUSIONS: The use of eGEMs as initially developed did not increase resident knowledge based on exam scores. Further study is needed to determine if a more tailored intervention is effective.