Boise VA Physician Training
Programs
August 10th, 2015
Introduction
 10-11:15-Overview of programs with Q&A
 11:15-noon-Facility tour, including Simulation and
Training Clinic
Agenda
 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
Overview of VA Physician Training
 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 postresidency 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.
Boise VA Medical Center
Medical Student Programs
UWSOM Required Clerkships
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Chronic Care (4 weeks)
Internal Medicine (12 weeks)
Psychiatry (6 weeks)
Surgery (6 weeks)
30 students took one or more in 2014-15
Electives
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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
•
•
•
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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
•
•
•
•
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General Surgery
Geriatrics
Medical Oncology
Nephrology
Neurology
Obstetrics and Gynecology
Orthopedic Surgery (adult and pediatric)
Otolaryngology (adult and pediatric)
Former BVAMC Med Students
•
•
•
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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. Coombs
Rural Health Advocate
Former Vice Dean for Regional Affairs
Other Students BVAMC
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Audiology
CRNA
Dietetics
Health Care Administr.
LPN
Nurse Practitioner
Occupational Therapy
Pharmacy Tech
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Phlebotomy
Physical Therapy
Physician Assistant
Radiology Technology
Recreation Therapy
Registered Nurse
Respiratory Therapy
Speech Pathology
4 years
UNIVERSITY
UNDERGRADUATE
4 years
MEDICAL
3 years
RESIDENCY
SCHOOL
POST-MD training
2+ years
FELLOWSHIP
Subspecialty
training
• Internal Medicine Residency training is 3 years
• Preliminary Resident training is 1 year
Internal Medicine: “Doctors for Adults”
 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
UW-SEATTLE
VM-SEATTLE
Pacific NW
Internal
Medicine
Residencies
PSHSPOKANE
OHSU- PORTLAND
BILLINGS
LE-PORTLAND
PSV- PORTLAND
PROV- PORTLAND
UW/VA
BOISE
NONE
UU-SLC
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
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”
Other residency training
(Anesthesiology, Dermatology,
Neurology, Physical Medicine,
Ophthalmology, Radiology,
Radiation Oncology)
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)
*PGY = post-graduate year
Fellowship (Allergy, Cardiology,
Endocrinology, Gastroenterology,
Geriatrics, Infectious Diseases,
Nephrology, Pulmonary/Critical
Care, Rheumatology, Sleep)
Where do the residents
work?
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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
-andProfessor of Medicine and Medical Education
University of Washington
Center of Excellence in
Primary Care Education
Shared Decision
Making
Sustained
Relationships
Interprofessional
Collaboration
Practice
Improvement
Transformative Potential
Faculty and Trainees Discover Together
Common, Extensive Experiential/Curricular Components
Trainees in the Boise Program 2015-2016
LEVEL
Nurse
Practitioner
NUMBER
DURATION
DNP students
2
1-2 years
NP Residents
2
Gonzaga University, ISU
Nursing
BSN & Valor students
NNU, BSU
Pharmacy
PHARM D
PGY-2
PGY-1
VA + ISU
3
3-12 months
1-2 years
3
5
Physician
PGY-1
PGY-2
PGY-3
U. of Washington
8
8
8
3 years
Psychology
Intern
Post Doctoral
Boise VA
5 universities
4
3
1-2 years
46 trainees
OUTCOMES: Access
OUTCOMES: Patient Centeredness
p = .002
p = .01
p = .008
37
OUTCOMES: Graduates’ career plans
5
4.5
N = 22
.01 .009
.02 <.001
4
3.5
3
Primary Care
2.5
Rural
2
Idaho
VA
1.5
1
0.5
0
PRE
POST
38
Thank You
?