VA Interprofessional Fellowship in Palliative Care: 15 Years of Training Excellence.

Since 2002, the Department of Veterans Affairs (VA) has provided a unique training opportunity in palliative care at six VA medical centers. The VA Interprofessional Fellowship in Palliative Care has trained chaplains, nurses, pharmacists, physicians, psychologists, and social workers to provide clinical palliative care and to develop as leaders in the profession. This article describes the program's origin, mission, outcomes, and lessons learned.

Impact of clinical training on recruiting graduating health professionals.

OBJECTIVES: Recruiting professional staff is an important business reason for hospitals allowing health trainees to engage in supervised patient care. Whereas prior studies have focused on educational institutions, this study focuses on teaching hospitals and whether trainees' clinical experiences affect their willingness to work (ie, recruitability) for the type of healthcare center where they trained. STUDY DESIGN: A pre-post, observational study based on Learners' Perceptions Survey data in which respondents served as their own controls. METHODS: Convenience sample of 15,207 physician, 11,844 nursing, and 13,012 associated health trainees who rotated through 1 of 169 US Department of Veterans Affairs (VA) medical centers between July 1, 2014, and June 30, 2017. Generalized estimating equations computed how clinical, learning, working, and cultural experiences influenced pre-post differences in willingness to consider VA for future employment. RESULTS: VA recruitability increased dramatically from 55% pretraining to 75% post training (adjusted odds ratio [OR], 2.1; 95% CI, 2.0-2.1; P <.001) in all 3 cohorts: physician (from 39% to 59%; OR, 1.6; 95% CI, 1.5-1.6; P <.001), nursing (from 61% to 84%; OR, 2.5; 95% CI, 2.4-2.6; P <.001), and associated health trainees (from 68% to 87%; OR, 2.7; 95% CI, 2.6-2.9; P <.001). For all trainees, changes in recruitability (P <.001) were associated with how trainees rated their clinical learning environment, personal experiences, and culture of psychological safety. Satisfaction ratings with faculty and preceptors (P <.001) were associated with positive changes in recruitability among nursing and associated health students but not physician residents, whereas nursing students who gave higher ratings for interprofessional team culture became less recruitable. CONCLUSIONS: Academic medical centers can attract their health trainees for future employment if they provide positive clinical, working, learning, and cultural experiences.

Veterans Health Administration's Physician Assistant Primary Care Residency: An Evaluation of the First 3 Years.

PURPOSE: Results from an evaluation of a 12-month postgraduate Veterans Health Administration (VHA) residency in primary care for physician assistants (PAs). METHODS: Descriptive and open-ended data were collected to describe the experience of faculty and trainees participating in the first 3 years of this pilot residency. Quantitative data were summarized using descriptive statistics. Text data were transcribed and reviewed for common themes across residency sites and respondents. Data were collected at 2 time points-the end of the first year and the beginning of year 4. RESULTS: In the first 3 years of the program, 18 residents were enrolled at 6 sites, with 89% completing the residency. At the second time point, 8 more residents were enrolled. Residents were primarily female (69%). Of the residents completing the program, 56% obtained VHA employment, and 75% of the current residents planned to work for the VHA upon completing the program. Program infrastructure, such as written curriculum, a dedicated administrative staff, and written evaluations for trainees, was more common at the second time point. Recurring themes included the importance of establishing relationships with potential applicants, preceptors, medical center leadership, and trainees to support the program and the importance of securing resources such as space and protected time for faculty. CONCLUSIONS: Although postgraduate residency programs are less common for PAs than for some other health professions, our data suggest that a one-year residency can provide training for new graduates to help solidify their clinical experience and facilitate their transition to practice.

Has Interprofessional Education Changed Learning Preferences? A National Perspective.

OBJECTIVE: To assess how changes in curriculum, accreditation standards, and certification and licensure competencies impacted how medical students and physician residents value interprofessional team and patient-centered care. PRIMARY DATA SOURCE: The Department of Veterans Affairs Learners' Perceptions Survey (2003-2013). The nationally administered survey asked a representative sample of 56,569 U.S. medical students and physician residents, with a comparison group of 78,038 nonphysician trainees, to rate satisfaction with 28 elements, in two overall domains, describing their clinical learning experiences at VA medical centers. STUDY DESIGN: Value preferences were scored as independent adjusted associations between an element (interprofessional team, patient-centered preceptor) and the respective overall domain (clinical learning environment, faculty, and preceptors) relative to a referent element (quality of clinical care, quality of preceptor). PRINCIPAL FINDINGS: Physician trainees valued interprofessional (14 percent vs. 37 percent, p < .001) and patient-centered learning (21 percent vs. 36 percent, p < .001) less than their nonphysician counterparts. Physician preferences for interprofessional learning showed modest increases over time (2.5 percent/year, p < .001), driven mostly by internal medicine and surgery residents. Preferences did not increase with trainees' academic progress. CONCLUSIONS: Despite changes in medical education, physician trainees continue to lag behind their nonphysician counterparts in valuing experience with interprofessional team and patient-centered care.

The Impact of VA's geriatric research, education and clinical centers on academic affiliates.

The education mission of the Department of Veterans Affairs (VA) is to train health professionals to benefit VA and the United States. One approach for achieving that mission, along with VA's research and clinical missions, was the establishment of Geriatric Research, Education and Clinical Centers (GRECCs) in 1975. These were developed at VA hospital sites that had existing strong partnerships with schools of medicine already engaged in research on aging. GRECCs were funded to enhance those research enterprises, to expand health professions education in geriatrics, to expand interest in geriatrics among medical faculty and to support them to become more expert in geriatrics, to develop new approaches to care of the aging, and to disseminate the lessons learned within VA and beyond. Using 2001 and 2008 data from two surveys of U.S. medical schools' geriatrics programs, this article explores the impact of GRECCs on geriatric programs at their affiliated schools of medicine. It demonstrates how VA's academic mission through GRECCs has benefited VA and its affiliates and how it has benefited the nation through the growth of geriatric medicine as an academic enterprise and a legitimate clinical specialty.

A survey of recommendations on the care of ocular prostheses.

BACKGROUND: The purpose of this study was to determine if there is a consistent set of recommendations for patients who wear an ocular prosthesis or if each patient needs an individual plan. METHODS: A self-report questionnaire was distributed to members of the American Society of Ocularists. The survey consisted of 4 questions regarding frequency of removal and cleaning and preferred cleaning and lubrication agents. Respondents had 4 weeks to return the survey for results to be included. RESULTS: One hundred three surveys were sent; 8 were undeliverable, leaving a sample size of 95. Thirty-four percent (32 ocularists) responded. The reason with the most frequency for prosthesis removal was only when the prosthesis felt irritated (31%). Fifty-eight percent reported that the ocular prosthesis should be cleaned every time it is removed. Mild soap or baby shampoo was listed as the preferred cleaning agent with 24% each. A majority listed a silicone oil-based lubricant (29%), but responses varied based on the patient's needs. CONCLUSIONS: An individualized treatment plan is indicated for most patients who wear an ocular prosthesis. Despite this, some commonalities in responses were noted, specifically that the ocular prosthesis needs to be cleaned with every removal, and a silicone oil lubricant is recommended.