care practitioners in rural areas or areas where specialized training in STDs in not available may be able to access training modules or courses sponsored by the CDC, professional societies, or other organizations through distance learning programs. Staff in academic infectious disease clinics, dedicated STD clinics, federal, state, and local health departments, and primary care providers can develop shared information networks to exchange new information and epidemiologic data regarding STDs in order to improve clinical and public health practice. In addition, through telemedicine, infectious disease specialists may be able to assist in diagnosis and treatment of patients with STDs.

Therefore, the committee makes the following recommendation:

  • The training of primary care providers in STD prevention should be improved by:
  1. training based on a core set of clinical competencies, including population-based health promotion and disease prevention techniques, evidence-based clinical decision-making skills, and patient communication skills. The training experience should include experience in both dedicated STD clinics and primary care settings and instruction regarding techniques to promote individual behavior change and improve disease reporting;
  2. improving medical student training in STDs by encouraging medical schools to provide clinical instruction in STD clinics to ensure that students see a sufficient variety of STDs;
  3. conducting an annual survey of medical schools through the Liaison Committee on Medical Education of the Association of American Medical Colleges and the American Medical Association to determine the extent to which medical schools are providing appropriate instruction in STD diagnosis and treatment;
  4. expanding collaborations among federal, state, and local STD programs; health professional organizations; graduate medical education; and other health professional training programs to include STD diagnosis and treatment as part of continuing medical education for all primary care providers;
  5. providing additional federal support to academic health centers to establish clinical expertise and clinic-based training opportunities for STDs; and
  6. encouraging state and local public health departments to identify primary care clinicians and clinics serving populations with high rates of STDs and provide STD-related education materials, training modules, and other technical assistance to them. The CDC should work with STD clinical training centers to develop training programs specifically designed for primary care providers.

Improving Clinical Management of STDs

The major components of effective clinical management for STDs include appropriate screening, diagnosis and treatment, risk reduction counseling and



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