boise va physician training programs august 10 th, 2015
TRANSCRIPT
Boise VA Physician Training Programs
August 10th, 2015
10-11:15-Overview of programs with Q&A 11:15-noon-Facility tour, including Simulation
and Training Clinic
Introduction
Overview of VA Physician Training Programs Andrew Wilper, MD
Boise VAMC UW Medical Student Program James Branahl, MD
Boise Internal Medicine Residency Lisa Inouye, MD
Boise Center of Excellence in Primary Care Education C. Scott Smith, MD
Research at the Boise VA Dennis Stevens, PhD, MD
Agenda
Title 38 U.S.C. mandates that VA assist in the training of health professionals for its own needs and those of the nation.
For almost sixty years, VA has worked in partnership with this country's medical and associated health professions schools to provide high quality health care to America's veterans and to train new health professionals to meet the patient care needs within VA and the nation.
This partnership has grown into the most comprehensive academic health system partnership in history.
Overview of VA Physician Training
In 2013, 124 hospitals of 152 VA medical centers offered graduate medical education or undergraduate medical education
Affiliations with 130 of the nation's 141 allopathic medical schools and 22 of the 29 osteopathic medical schools
The VA Advanced Fellowships Program offers post-residency fellowships to physicians and dentists in emerging health professions of particular importance to VA and the nation
Overview of VA Physician Training
In 2013, 40,420 medical residents, 21,540 medical students, and 253 Advanced Fellows received some or all of their clinical training in VA.
Overview of VA Physician Training
Boise VA Medical Center
Medical Student Programs
UWSOM Required Clerkships
• Chronic Care (4 weeks)• Internal Medicine (12 weeks)• Psychiatry (6 weeks)• Surgery (6 weeks)
30 students took one or more in 2014-15
Electives
• Anesthesiology• Geriatrics• Infectious Diseases• Internal Medicine Sub-internship• Psychiatry in Primary Care• Respiratory Diseases/Critical Care Medicine• Urology
22 students took one or more in 2014-15
Internal Medicine Clerkship
• Onset 1977• Approaching 800 students• All WWAMI states (and beyond)• 24 per year (nearly 10% of UWSOM class)• Full 12 weeks• Great reputation
Retention of Students
Former BVAMC Med Students
• Anesthesiology• Cardiology (including invasive, non-invasive
and electrophysiology)• Dermatology• Emergency Medicine• Family Practice• Gastroenterology• General Internal Medicine
Former BVAMC Med Students
• General Surgery• Geriatrics• Medical Oncology• Nephrology • Neurology• Obstetrics and Gynecology• Orthopedic Surgery (adult and pediatric)• Otolaryngology (adult and pediatric)
Former BVAMC Med Students
• Pediatrics (including NICU)• Physical Medicine and Rehabilitation• Psychiatry• Pulmonary Medicine (including Critical Care
and Sleep Medicine)• Radiation Oncology• Radiology• Sports Medicine
Increasing Demand
• UWSOM class increased 26 (12%)/5 yr.• Idaho added 5 slots this year• 2017- BVAMC Internal Med clerkship will add
2 slots (33%) per quarter (8/yr.)
“The Boise VA is the jewel in the crown of WWAMI.”
Dr. John B. CoombsRural Health Advocate
Former Vice Dean for Regional Affairs
Other Students BVAMC
• Audiology• CRNA• Dietetics• Health Care Administr.• LPN• Nurse Practitioner• Occupational Therapy• Pharmacy Tech
• Phlebotomy • Physical Therapy• Physician Assistant• Radiology Technology• Recreation Therapy• Registered Nurse• Respiratory Therapy• Speech Pathology
• Internal Medicine Residency training is 3 years
• Preliminary Resident training is 1 year
4 yearsUNIVERSITY
UNDERGRADUATE
4 yearsMEDICAL
SCHOOL
3 yearsRESIDENCY
POST-MD training
2+ yearsFELLOWSHIP
Subspecialty training
Bachelor’s Degree
MD/DO
Board Certified
Subspecialty
Board Certified
License
Primary care: check ups, birth control, evaluate symptoms and concerns (cough, back pain, headache, erectile dysfunction)
Complex care in the clinic, hospital or ICU: heart attacks/failure, stroke, asthma, emphysema, stomach ulcers, severe infections, cancer, diabetes, kidney failure, dementia
Consult care: pre/post operative medical issues, medical issues in pregnancy
Not kids, not surgery, not routine pregnancy/delivery
Internal Medicine: “Doctors for Adults”
UW-SEATTLE
OHSU- PORTLAND
LE-PORTLAND
PROV- PORTLAND
UU-SLC
VM-SEATTLEPSH-SPOKANE
PSV- PORTLAND
BILLINGS
UW/VABOISE NONE
UW = University of Washington, VM = Virginia Mason, PSH = Providence Sacred Heart, OHSU = Oregon Health Science University, LE = Legacy Emmanuel, PSV = Providence St. VincentPROV = Providence Medical Center, UU = University of Utah
Pacific NW Internal Medicine Residencies
2nd Internal Medicine Residency of the University of Washington Department of Medicine 8 internal medicine PGY-1* residents “interns”4 preliminary PGY-1 residents “interns”
8 internal medicine PGY-2 8 internal medicine PGY-3 2 Chief Residents (PGY-4)
General Internal Medicine = Inpatient (Hospitalist) and/orOutpatient (Primary Care)
Fellowship (Allergy, Cardiology, Endocrinology, Gastroenterology, Geriatrics, Infectious Diseases, Nephrology, Pulmonary/Critical Care, Rheumatology, Sleep)
*PGY = post-graduate year
Other residency training (Anesthesiology, Dermatology, Neurology, Physical Medicine, Ophthalmology, Radiology, Radiation Oncology)
Where do the residents work?
Inpatient wards/ICU (~2800 admissions/year, 24/7/365)
Silver Team: primary care for over 4000 veterans VA specialty & subspecialty clinics St. Luke’s & Saint Alphonsus-hospital wards , ICU,
Emergency Dept & subspecialty consult services 1-2 months in Seattle at VA, Harborview, UWMC 1-2 months Community-Based Training – remote
rural sites in Idaho
Work and Supervision
5-6 months/year on inpatient services (at VA, SL, SA) (70-80 hours/week, 1day off/week)
4 weeks/year of night float (7pm – 9am) All patient care done under a
supervising attending physician 1 attending for every 4 residents in clinic,
usually 2 attendings per each half-day 1 attending for every 2-3 residents on the
inpatient service = 4 attendings at all times (on Boise VAMC wards) plus ICU resident and attending
Rules and Oversight
University of Washington Office of Academic Affairs, VHA American Board of Internal Medicine (rules to
graduate and sit for the boards) Accreditation Council of Graduate Medical
Education (accrediting body) National Board of Medical Examiners: US
Medical Licensing Examination State Boards of Medicine
Funding
Graduates’ Destinations
Class of 2014 5 hospitalists:
Saint Alphonsus Salem, OR Sheridan, WY Dallas, TX St. Luke’s Boise
2 ”hybrid” (hospitalist/primary care) Sheridan, WY St. Luke’s Boise
Class of 2015 2 Chief Residents 4 hospitalists
2 at Saint Alphonsus Denver, CO Provo, UT
2 Primary Care Boise
VAMC/Integrated Spine Team
Boise VAMC Telehealth 1 Nephrology fellowship
Thank You!
V.A. Centers of Excellence in Primary Care EducationUpdate for WWAMI Legislative Assistants
August 10, 2015
C. Scott Smith, MD, MACP
National Physician ConsultantCenters of Excellence in Primary Care Education
V.A. Office of Academic Affiliations
-and-
Professor of Medicine and Medical EducationUniversity of Washington
Faculty and Trainees Discover TogetherTransformative Potential
Common, Extensive Experiential/Curricular Components
Shared Decision Making
Sustained Relationships
InterprofessionalCollaboration
Practice Improvement
Center of Excellence inPrimary Care Education
LEVEL NUMBER DURATION
Nurse Practitioner
DNP students
NP Residents
Gonzaga University, ISU
2
2
1-2 years
Nursing BSN & Valor studentsNNU, BSU
3 3-12 months
Pharmacy PHARM DPGY-2PGY-1VA + ISU
35
1-2 years
Physician PGY-1PGY-2PGY-3U. of Washington
888
3 years
Psychology InternPost DoctoralBoise VA5 universities
43
46 trainees
1-2 years
Trainees in the Boise Program 2015-2016
OUTCOMES: Access
37
p = .01 p = .008
p = .002
OUTCOMES: Patient Centeredness
38
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
PRE POST
Primary Care
Rural
Idaho
VA
.01 .009 .02 <.001
N = 22
OUTCOMES: Graduates’ career plans
Thank You
?