A Mission for Graduate Medical Education at VA
We embraced the principles of cognitive learning theory by priming learners with preconference “teasers” that previewed conference topics to be discussed. Every Friday, we played a medical version of Jeopardy!, which used spaced learning to consolidate the week’s teaching points in a fun, collaborative, and collegial atmosphere. Our dedicated patient safety conference gave residents the chance to use QI tools to dissect and tackle real problems in the hospital, and our monthly Morbidity and Mortality conference served as inspiration for many of the resident-driven QI projects.
Our third goal was to challenge physicians to provide the best possible care to veterans, including learning about issues unique to this often-marginalized population. We emphasized that training at a VA hospital is a privilege and that the best way to honor our veterans is to take advantage of the unique learning opportunities available at VA. To that end, we exposed residents to veteran-specific educational content, ranging from the structure and payment model of VHA to service-related medical conditions, such as posttraumatic stress disorder, other mental health issues, traumatic brain injury, Agent Orange exposure, and Gulf War Syndrome.
Discussion
Findings from the recently published Accreditation Council for Graduate Medical Education’s (ACGME) 2016 Clinical Learning Environment Review (CLER) Report support the need for mission statements like ours to guide the delivery of graduate medical education.3 A major finding of this report was that the development and implementation of graduate medical education largely occurs separately from other areas of organizational and strategic focus within clinical learning environments. Our mission statement has served as a road map for aligning the delivery of graduate medical education at VABHS with the specific strengths of the clinical learning environment that VA affords.
Additionally, the 2016 CLER report identified a lack of specificity in training on health care disparities and cultural competency for the specific populations served by the surveyed residency programs. The emphasis we placed on learning about issues specific to the care of the veteran population highlights the potential for other mission statements like ours to bridge the gap between articulation and execution of educational priorities. Finally, through the academic partnerships it holds with more than 90% of medical schools in the U.S., VA already has an integral role in both undergraduate and graduate medical education that positions its hospitals as ideal training environments in which to address shortcomings in medical training like those identified by the ACGME.4
Conclusion
We propose this mission statement as a model for the delivery of graduate medical education throughout all VA hospitals with academic affiliations and especially those where trainees from multiple institutions work together. As embodied in our mission statement, our goal was to provide a clinical training experience at VA that complements that of our residents’ home institutions and fosters a respect for and interest in the special care provided at VA. The development of a shared mission statement provides an invaluable tool in accomplishing that goal. We encourage chief medical residents and other leaders in medical education in all specialties at VAMCs to develop their own mission statements that reflect and embody the values of each affiliated training program. For our residents, rotating at VA is an opportunity to learn the practice of medicine for veterans, rather than practicing medicine on veterans. It is our sincere hope that shaping our residents’ educational experience in this fashion will foster a greater appreciation for the care of our nation’s veterans.
