Assessing Training Needs Related to the Care of Sexually Transmitted Diseases (STDs) Perspectives of Medical Providers Working Among American Indian and Alaska Native Populations (AI/ANs) Cheryl Mason, MPH, Laura Shelby, BA, Rachel Pacheco, RN Indian Health Service, National Epidemiology Program, Albuquerque, NM ■ Sharon Adler, MD, MPH, Jolie Pearl, RN, MPH California STD/HIV Prevention Training Center, Berkeley, CA ■ Teri Anderson, MT Denver STD/HIV Prevention Training Center, Denver Public Health, Denver, CO ■ Candace Nelson, MA Kaiser Permanente, Denver, CO

Background From 1996 to 2002, Chlamydia rates among AI/AN were consistently 3 times that for non-AI/ANs From 1989 to 2002, rates for gonorrhea, primary & secondary syphilis declined among AI/ANs but at markedly lower rates than that for non-AI/ANs

Background (cont.) Assess STD training needs among medical care providers working with AI/ANs Content areas evaluated: Skills needed or challenges in STD care Training logistics Learning modalities

Methods Sampling Convenience sample 14 healthcare facilities 63 in-person structured interviews Data analysis Transcripts analyzed using ATLAS*ti Data coded by major content areas and common themes Common themes reported

Common needs or challenges in STD Care Prevention Diagnosis Treatment Partner management

Common needs or challenges in prevention Patient education is a challenge Need effective patient education tools good pamphlets or educational material pass onto patients addresses risks

Common needs or challenges in diagnosis Training on “less prevalent” or “rare(r) diseases” syphilis chancroid Training on diagnosis updates Training on HIV/AIDS

Common needs or challenges in treatment Training on HIV/AIDS Difficulty in locating patients is a challenge getting people in for follow-up/testing finding them after a positive test Training on treatment updates

Common needs or challenges in partner management Getting partners into clinics is a challenge Prescribing medications for partners is a challenge tempting to just give a prescription for the partner...but dangerous legally and medically how do you cover and protect your patient and that partner? Locating partners is a challenge

Training logistics Previous training & duration of training Factors influencing training attendance

Previous training & duration of training Previous training General medical training, 71% (n=45) STD-specific training, 18% (11) Duration of training Previous trainings attended lasted 1-5 days Ideally, general medical training should last 2-3 days Ideally, STD-specific training should last days

Factors influencing training attendance Funding and time allocated Funding varies by facility and provider type Average physicians’ annual training funds, $1500 Average non-physicians’ annual training funds, $500 Allotted 1 week of ‘educational’ leave Onsite v. offsite 65.1% (n=46) preferred ‘onsite’ training Definition of ‘onsite’ varies by location of facility CME/CEU credits and advance notice are essential

Learning modalities Best available learning modalities Desired learning modalities Computer-based learning

Best available & desired modalities Best available modalities by rank 1Lecture/update/conference 2Reading 3Slides/visual aids 4Hands-on training 5Facilitated discussion 6Handouts/notes/workbook 7Internet/computer CME 8Small group learning 9Peer team learning 10Roleplaying Desired modalities by rank 1Lecture/update/conference 2Hands-on training Slides/visual aids 3Facilitated discussion 4Handouts/workbook 5Peer team learning 6Case studies 7Internet/computer CME 8Reading; videos 9Roleplaying

Computer comfort level Most providers & administrators are comfortable using computers What they like about computers: Quick, easy access to information Onsite, does not require travel Offers variety of resource material What they don’t like about computers: Too complicated Crash/too slow Work solo/don’t benefit from group discussion No time

Computer/Internet access at work Availability of computers/Internet 88.9% (n=56) have access to computers 38.1% (n=24) have access to the Internet Actual utilization of computers 23.8% (n=15) actually utilize 15.9% (n=10) actually utilize, but too busy to do when want 57.1% (n=36) don’t utilize, too busy 7.9% (n=5) don’t utilize, lack computer skills

Summary What training is needed? Updates on diagnosis & treatment (changes/latest techniques) Emphasis on “rare(r)” diseases (i.e. syphilis and chancroid) & HIV/AIDS Training logistics General medical trainings widely attended Trainings that are onsite, offer CME/CEU, and advance notice are preferred Training modalities Lecture/updates/conference is a common way to learn Although computers are available at work, utilization is difficult

Next Steps Provide training that addresses needs assessment findings Updates Rare(r) diseases (i.e. syphilis and chancroid) & HIV/AIDS When developing training, one should consider: Incorporating training into existing, widely attended medical conferences Combine lecture/updates/conference & hands-on training with other desired ways of learning Computer-based learning has potential, but implementation and acceptance may prove challenging Further exploration Provider survey Determine consistency & strength of these findings in other settings

Acknowledgements Project participants IHS: James Cheek PTCs: Kitty Corbett, Mabel Davis, Tom Davis, John Fitch, Alice Gandelman, Maxine Haytin, Terry Lee, Anne Meegan, Kees Reitmeijer, Dodie Rother, Terry Stewart, Debbie Tripp, Stacy Vogan