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The American Journal of Managed Care April 2019
Time to Fecal Immunochemical Test Completion for Colorectal Cancer
Cameron B. Haas, MPH; Amanda I. Phipps, PhD; Anjum Hajat, PhD; Jessica Chubak, PhD; and Karen J. Wernli, PhD
From the Editorial Board: Kavita K. Patel, MD, MS
Kavita K. Patel, MD, MS
Comment on Generalizability of GLP-1 RA CVOTs in US T2D Population
Maureen J. Lage, PhD
Authors’ Reply to “Comment on Generalizability of GLP-1 RA CVOTs in US T2D Population”
Eric T. Wittbrodt, PharmD, MPH; James M. Eudicone, MS, MBA; Kelly F. Bell, PharmD, MSPhr; Devin M. Enhoffer, PharmD; Keith Latham, PharmD; and Jennifer B. Green, MD
Deprescribing in the Context of Multiple Providers: Understanding Patient Preferences
Amy Linsky, MD, MSc; Mark Meterko, PhD; Barbara G. Bokhour, PhD; Kelly Stolzmann, MS; and Steven R. Simon, MD, MPH
The Health and Well-being of an ACO Population
Thomas E. Kottke, MD, MSPH; Jason M. Gallagher, MBA; Marcia Lowry, MS; Sachin Rauri, MS; Juliana O. Tillema, MPA; Jeanette Y. Ziegenfuss, PhD; Nicolaas P. Pronk, PhD, MA; and Susan M. Knudson, MA
Effect of Changing COPD Triple-Therapy Inhaler Combinations on COPD Symptoms
Nick Ladziak, PharmD, BCACP, CDE; and Nicole Paolini Albanese, PharmD, BCACP, CDE
Deaths Among Opioid Users: Impact of Potential Inappropriate Prescribing Practices
Jayani Jayawardhana, PhD; Amanda J. Abraham, PhD; and Matthew Perri, PhD
Do Health Systems Respond to the Quality of Their Competitors?
Daniel J. Crespin, PhD; Jon B. Christianson, PhD; Jeffrey S. McCullough, PhD; and Michael D. Finch, PhD
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Impact of Clinical Training on Recruiting Graduating Health Professionals
Sheri A. Keitz, MD, PhD; David C. Aron, MD; Judy L. Brannen, MD; John M. Byrne, DO; Grant W. Cannon, MD; Christopher T. Clarke, PhD; Stuart C. Gilman, MD; Debbie L. Hettler, OD, MPH; Catherine P. Kaminetzky, MD, MPH; Robert A. Zeiss, PhD; David S. Bernett, BA; Annie B. Wicker, BS; and T. Michael Kashner, PhD, JD
Continuity of Outpatient Care and Avoidable Hospitalization: A Systematic Review
Yu-Hsiang Kao, PhD; Wei-Ting Lin, PhD; Wan-Hsuan Chen, MPH; Shiao-Chi Wu, PhD; and Tung-Sung Tseng, DrPH

Impact of Clinical Training on Recruiting Graduating Health Professionals

Sheri A. Keitz, MD, PhD; David C. Aron, MD; Judy L. Brannen, MD; John M. Byrne, DO; Grant W. Cannon, MD; Christopher T. Clarke, PhD; Stuart C. Gilman, MD; Debbie L. Hettler, OD, MPH; Catherine P. Kaminetzky, MD, MPH; Robert A. Zeiss, PhD; David S. Bernett, BA; Annie B. Wicker, BS; and T. Michael Kashner, PhD, JD
A business case is made for medical centers to offer high-quality clinical training experiences to recruit graduating health professionals.
Overall Pre–Post Training Effect on Recruitability by Discipline

As shown in Table 2, VA trainees were 2.1 times more likely to consider VA employment after VA experiences, with recruitability increasing from 1.6-fold for physicians to 2.5-fold for nursing and 2.7-fold for AH trainees. The largest before–after differences were reported for blind and other rehabilitation therapy (4.5), speech pathology (4.3), and occupational (4.2) and physical (4.1) therapy. Podiatry residents were the only profession reporting no net increase in recruitability following VA training.

Impact of Clinical Experience and Program Factors on Recruitability

Table 3 reports how satisfaction and assessment ratings of the clinical experiences and program factors were associated with pre–post changes in recruitability for physician, nursing, and AH profession trainees. For all 3 groups, higher ratings for learning environment, personal experiences, and psychological safety were associated with larger changes in recruitability. Physician trainees were also influenced by how they rated their clinical environment, whereas nursing students and AH trainees were influenced by how they rated faculty/preceptors. In contrast, the presence of interprofessional team experiences and patient-centered care were unrelated to changes in recruitability. In fact, clinical environments emphasizing interprofessional team care were associated with smaller changes in recruitability for nursing students. Ratings of satisfaction with physical environment did not influence the impact of training on recruitability for any group. Among training program characteristics, training in more complex facilities had a slight advantage in increasing recruitability. Gender mattered only for AH, where female trainees were observed to be 1.2 times more likely to change perceptions about VA employment than were their male counterparts.

Prior to training, trainees at rural VA medical centers were only 59.6% (95% CI, 52.2%-67.9%; P <.001) as likely to consider VA employment as their urban counterparts. VA training narrowed this gap, but only for AH trainees. That is, AH trainees at rural VA medical centers were initially only 41.9% (95% CI, 33.8%-51.9%; P <.001) as likely to consider VA employment as their urban counterparts. After VA training, this increased by an adjusted factor of 1.77 (95% CI, 1.44-2.17; P <.001) to 74.1% (95% CI, 58.0%-94.6%; P <.001).

DISCUSSION

VA medical centers face many of the same challenges of staff recruitment and retention as academic medical centers in the private sector that engage in patient care, health profession education, and research. This study found that clinical trainees from all disciplines, except podiatry, were substantially more likely to consider VA for future professional employment after clinical training at a VA facility than before. This pre–post increase in recruitability was associated not only with structural factors, but also with their clinical training experiences. This is consistent with the theory that mere exposure to a teaching facility is not sufficient to induce trainees to change their perceptions about whether they will want to work there in the future. These data suggest that across disciplines, urban/rural settings, and facility complexities, trainees must give high ratings to their learning environment, personal experiences, and sense of psychological safety before their VA training experiences are expected to be associated with improved willingness to consider VA for future employment.

Our findings provide a business case to support VA’s long-standing affiliations with the nation’s academic institutions.26,27 VA Policy Memorandum Number 2, published January 30, 1946, codified relationships between VA facilities and medical schools that gave veterans the highest quality medical care and opportunities to further their education, raise the standard of medical practice in the United States, and mitigate the shortage of physicians after World War II.28,29 These data provide evidence that the network of academic partnerships increased healthcare trainee willingness to work in VA14 and are consistent with the policy behind the Veterans Access, Choice, and Accountability Act of 2014 [PL 113-146; 38 USC 7302(e) (1)-(2)], which expands the number of funded VA physician resident and fellow positions in primary care, mental health, and other specialties by 1500 over 10 years.30,31

Psychological safety is defined as a sense of safety in taking personal risks to discuss problems without fear of retribution. Our data suggest that psychological safety is associated with future employment choices across all trainee disciplines. Our finding is consistent with earlier reported positive associations between psychological safety and trainee satisfaction with the clinical learning environment,8 error reporting, team performance, personal work engagement and systems improvement,32-34 and mental health employees’ job satisfaction and turnover intentions.35 Collectively, these studies underscore the role that psychological safety plays in the quality of clinical training programs.

Personal experiences include job stress, fatigue, and capacity to balance personal and professional life. Our data showing that personal experience is important to future employment preferences of physician, nursing, and AH profession trainees are consistent with prior findings that controllable lifestyles influence specialty choices.36,37 While lifestyle factors have also been shown to be important to dental students,38 the literature does not offer insight into the effect of lifestyle or personal experiences on employment choice of other AH trainees.


 
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