A First Look at the VA MISSION Act Veteran Health Administration Medical School Scholarship and Loan Repayment Programs.

Background: The US Department of Veterans Affairs (VA) is challenged by physician staffing shortages. The 2018 VA MISSION ACT authorized 2 scholarship and loan repayment programs. The Health Professions Scholarship Program (HPSP) created scholarships for physicians and dentists. The Education Debt Reduction Program (EDRP) increased the maximum debt reduction. The Specialty Education Loan Repayment Program (SELRP) authorized the repayment of educational loans for physicians in specialties deemed necessary for VA. The Veterans Healing Veterans (VHV) program was a 1-year pilot program specifically for veteran medical students. Observations: For academic years 2020/2021 and 2021/2022, HPSP offered 54 scholarships with 51 accepted. In 2020, the VHV program offered 22 scholarships with 12 accepted by recipients at all 5 Teague-Cranston medical schools and 4 Historically Black Colleges and Universities. For SELRP, 14 applicants have been approved in family medicine, internal medicine, emergency medicine, and geriatrics. The average loan repayment is anticipated to be $110,000, which equates to 38.5 VA service years for the 14 applicants. Since 2018, 1546 physicians received EDRP awards with amounts increased from an average of $96,090 in 2018 to $148,302 in 2020. Conclusions: The VA MISSION Act's scholarship and loan repayment programs provide VA with several ways to address physician workforce shortages. Ultimately, the success of the program will be determined by the recruitment of scholarship recipients to VA careers.

The use of simulation in teaching the basic sciences.

PURPOSE OF REVIEW: To assess the current use of simulation in medical education, specifically, the teaching of the basic sciences to accomplish the goal of improved integration. RECENT FINDINGS: Simulation is increasingly being used by the institutions to teach the basic sciences. Preliminary data suggest that it is an effective tool with increased retention and learner satisfaction. SUMMARY: Medical education is undergoing tremendous change. One of the directions of that change is increasing integration of the basic and clinical sciences to improve the efficiency and quality of medical education, and ultimately to improve the patient care. Integration is thought to improve the understanding of basic science conceptual knowledge and to better prepare the learners for clinical practice. Simulation because of its unique effects on learning is currently being successfully used by many institutions as a means to produce that integration through its use in the teaching of the basic sciences. Preliminary data indicate that simulation is an effective tool for basic science education and garners high learner satisfaction.

Sarin exposure: a simulation case scenario.

Given the current geopolitical tensions, the risk of a terrorist attack on the United States is constant and increasing. Chemical terrorism, specifically the use of nerve agents, has occurred in other nations. Because of the ease of manufacture, the ability to conceal them, and the lethality of these agents, they pose a potential threat as a weapon of terror. Nerve agent exposure requires prompt recognition, a series of actions to mitigate further exposure to others, and management of the physiological sequelae of exposure. Many civilian healthcare providers are unprepared to manage injuries from nerve exposure. Failure to recognize the signs of nerve agent exposure will increase mortality and morbidity in victims and place healthcare providers at risk. Simulation is an effective methodology to train healthcare personnel in disaster preparedness. This article presents a simulation scenario that reviews the presentation of nerve agent exposure, its management, and a recipe for performing this simulation in a training exercise.

Comparing the standardized live trauma patient and the mechanical simulator models in the ATLS initial assessment station.

BACKGROUND: Mechanical simulators may be an acceptable substitute for the live patient model in trauma skills teaching and assessment. We compare these models in the initial assessment station of the Advanced Trauma Life Support (ATLS) course. METHODS: After a pilot project utilizing both models in a provider ATLS course it appeared that the mechanical model would be satisfactory for ATLS teaching and assessment. Instructors (n = 32) and ATLS Students (n = 64) were randomly selected from our database and completed a questionnaire evaluating the patient model and the simulator after viewing a video in which the simulator replaced the patient model. The evaluators indicated whether the patient and simulator models were satisfactory and then compared them by indicating whether there was any difference between the models, indicating which was more challenging, interesting, dynamic, enjoyable, realistic, and better overall. Comments were also written in the evaluation form. RESULTS: All 32 instructors and 64 students indicated that both the patient and simulator models were satisfactory for teaching and testing ATLS resuscitation skills. At least 62 of the 64 students rated the simulator higher in all categories. Two students rated the patient model as more realistic and two noted no difference in terms of being more interesting. All 32 instructors indicated that the simulator was more challenging, interesting, dynamic, and better overall. Two of the 32 instructors indicated that the patient model was more enjoyable and two indicated that there was no difference as far as the models being realistic. Comments included inability to hear breath sounds that were changing in the patient model as opposed to the simulator model, and the simulator was more interesting and dynamic because the hemodynamic and physiologic parameters could be witnessed without being prompted by the instructor. One main concern expressed by the participants was the more costly simulator, and two instructors indicated that the scenarios could be improved to fit the superior capabilities of the simulator. CONCLUSIONS: There was strong support from both students and instructors for the use of the simulator as a satisfactory substitute for the live patient model. The cost of the simulator is considered a significant issue. However, in centers where simulators are readily available, it appears from our data that it is a very satisfactory substitute for the patient model in teaching and assessing trauma resuscitation skills in the ATLS program.

Simulation devices in cardiothoracic and vascular anesthesia.

The subspecialty of cardiothoracic and vascular anesthesia is becoming increasingly complex. Trainees must learn to manage difficult cases and be skilled in performing a variety of procedures. With work hour limitations and societal pressures working to reduce learning and practice opportunities for trainees, new training modalities must be utilized. Simulation is currently being used to increase training efficiency. It allows trainees to experience uncommon clinical situations and complications, repetitive practice opportunities, and can be done on a flexible schedule-all without risk to the patient. Additionally, feedback after a simulation can provide trainees with an assessment of their training progress. Many of the procedures and cases in cardiothoracic and vascular anesthesia can be simulated. Current devices can simulate bronchoscopy, vessel cannulation, complex case management, and cardiopulmonary bypass. They vary from the simple to the complex and from inexpensive homemade wooden devices to high-end computer-controlled virtual reality simulators. Although not all these simulators have been validated as to their educational efficacy, they offer a new avenue to improve training efficacy and efficiency. More research needs to be done to validate these devices and assess their role in anesthesia training.