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The Veterans Health Administration (VHA) is entrusted with three key missions: clinical care, research, and education. Although clinical care and research receive much of the publicity, the role that the VHA plays in education remains critically important to both current and future healthcare providers.
As one of the statutory requirements of the Department of Veterans Affairs (VA), the VHA runs multiple training programs, encompassing many types of healthcare providers, under the aegis of the Office of Academic Affiliations (OAA). Started after World War II, OAA was founded on the premise of joining each VA hospital with a medical school. For more than 60 years, these agreements have grown and flourished, and VHA facilities currently have affiliation agreements with 130 of the 141 accredited allopathic and 22 of the 29 accredited osteopathic medical schools in the United States. In partnership with these academic institutions, VHA trained more than 40,000 graduate medical learners (residents and fellows) and more than 21,000 medical students in 2013 alone. This makes VHA the nation’s single largest provider of medical education. Currently, more than 65% of all U.S. physicians have completed some portion of their training in a VHA setting.
A core piece of the VHA, OAA continues to innovate as it grows. For example, as the country moves toward patient-centered medical homes, VHA has developed its own version: patient aligned care teams (PACTs). Accordingly, OAA has been overseeing the development of “Academic” PACTs to better understand how to incorporate trainees into these new systems of care.
Along the same lines, there are three post-graduate training programs of particular interest to hospitalists: the Chief Resident in Quality and Patient Safety (CRQS) program, the Patient Safety Fellowship Program, and the VA National Quality Scholars Fellowship Program (NQSFP). All of these have rigorous educational components that are coordinated through the National Center for Patient Safety.
The CRQS program was developed to support additional chief residents who would be dedicated to educating housestaff and students about quality improvement and patient safety. As of July 1, 2015, there will be 58 such chief residents at VAs across the country. These positions are open to any residency that has at least eight other VA-funded resident positions in the program. Currently, there are CRQSs from internal medicine, surgery, anesthesia, and psychiatry.
The Patient Safety Fellowship is a one-year interdisciplinary program that includes nurses, pharmacists, and psychologists, as well as the physician fellows. This program is offered at six VA Medical Centers across the county and focuses on patient safety improvement science and leadership development.
Since 1999, the NQSFP has produced fellows that are leaders in QI scholarship and implementation. It is a two-year fellowship for post-graduate nurses and physicians and occurs at eight sites across the U.S.
These programs offer graduating residents who are interested in safety and quality opportunities to develop skills in research, implementation, and education. These are especially beneficial for hospitalists who may wish to pursue leadership roles in quality and safety at the program, institution, or healthcare system level.
The VA’s commitment to medical education starts at the level of medical school and continues through its post-graduate programs, many of which may well produce hospitalist leaders of the future.
Dr. Fletcher is associate program director for the internal medicine residency program at the Clement J. Zablocki VA Medical Center and the Medical College of Wisconsin in Madison. Dr. Bates is graduate medical education site director for internal medicine at Baylor College of Medicine at the Michael E. DeBakey VA Medical Center in Houston.