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.

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 Veterans Access, Choice, and Accountability Act of 2014: Examining Graduate Medical Education Enhancement in the Department of Veterans Affairs.

From 2006 to 2011, the Department of Veterans Affairs (VA) introduced the Graduate Medical Education (GME) Enhancement initiative to increase residency positions at VA training sites. VA once again has an opportunity to fund new residency positions through the Veterans Access, Choice, and Accountability Act of 2014 (VACAA). Congressional requirements under VACAA give priority to positions in primary care, mental health, and other specialties that the Secretary of Veterans Affairs deems appropriate. Moreover, facilities meeting the following criteria will be awarded priority for expansion: no prior GME activities, a shortage of physicians, rural locations, areas with a "high concentration of veterans," or located in Health Professional Shortage Areas as defined by the Health Resources and Services Administration. The authors of this Commentary discuss the implications of the new legislation, reviewing the past VA GME Enhancement efforts to examine the potential impact of further expansion of VA GME positions. Understanding the intent of the legislation and its provisions will allow qualified existing and potentially new affiliates to successfully pursue new residency positions during the five-year period of VA GME expansion under VACAA.