1328. Medical Education in an Epidemic: Historical Lessons From the Early Days of HIV in America (1982–1986)

BACKGROUND: Much historical work has investigated the impact of HIV on patient rights, American culture, and medical research; however, there is little scholarship on the impact of HIV on medical education. This study asks how the process of training at the epicenter of an epidemic disease that was poorly understood, incurable, and contagious shaped a cohort of physicians’ experience of residency, beliefs about the role of the doctor in society, and their approach to practicing medicine. METHODS: Members of the University of California San Francisco (UCSF) intern classes of 1982 and 1983 were interviewed, as well as individuals who were young faculty at San Francisco hospitals in the 1980s. Other sources included academic publications from the 1980s on HIV and medical education, archival documents, nursing and volunteer communications books from the SF General Hospital AIDS Ward, and patient ephemera such as thank you notes and obituaries. RESULTS: These interviews and documents highlight themes of commitment to care for HIV patients regardless of risk, lack of formal institutional support for residents engaged in HIV care, and differences in professional norms that allowed nurses and volunteers access to modes of reflection that were unavailable to trainee physicians. For residents, the day to day experience of the HIV epidemic became an important locus for a narrative of medical professionalism and resilience that continues to animate medical education today. Provider narratives about the encounter with HIV served a parallel function to the creation of HIV clinics and public health programs—both were interventions that made HIV into an intelligible cultural and biological entity that could be managed by the medical profession. CONCLUSION: Using the HIV epidemic in San Francisco as a historical example, this project argues that formalizing narrative practices by setting aside time for journaling and verbal reflection in residency and fellowship training can build resilience and prevent burnout. Historical narratives of provider experience, like the oral histories collected in this project, may also be valuable in undergraduate medical education to generate discussion about professional ethics and the responsibilities of providers in an epidemic. DISCLOSURES: All authors: No reported disclosures.