Boise VA Physician Training Programs August 10 th, 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

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

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 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. Coombs Rural 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 years UNIVERSITY UNDERGRADUATE 4 years MEDICAL SCHOOL 3 years RESIDENCY POST-MD training 2+ years FELLOWSHIP 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-SEATTLE PSH- SPOKANE PSV- PORTLAND BILLINGS UW/VA BOISE NONE UW = University of Washington, VM = Virginia Mason, PSH = Providence Sacred Heart, OHSU = Oregon Health Science University, LE = Legacy Emmanuel, PSV = Providence St. Vincent PROV = Providence Medical Center, UU = University of Utah Pacific NW Internal Medicine Residencies

2 nd 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/or Outpatient (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 Education Update for WWAMI Legislative Assistants August 10, 2015 C. Scott Smith, MD, MACP National Physician Consultant Centers of Excellence in Primary Care Education V.A. Office of Academic Affiliations -and- Professor of Medicine and Medical Education University of Washington

LEVELNUMBERDURATION Nurse Practitioner DNP students NP Residents Gonzaga University, ISU years Nursing BSN & Valor students NNU, BSU months Pharmacy PHARM D PGY-2 PGY-1 VA + ISU years Physician PGY-1 PGY-2 PGY-3 U. of Washington years Psychology Intern Post Doctoral Boise VA 5 universities trainees 1-2 years Trainees in the Boise Program

OUTCOMES: Access

37 p =.01 p =.008 p =.002 OUTCOMES: Patient Centeredness

<.001 N = 22 OUTCOMES: Graduates’ career plans

Thank You ?