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Connecting the Dots: Interprofessional Health Education and Delivery System Redesign at the Veterans Health Administration

Gilman, Stuart C. MD, MPH; Chokshi, Dave A. MD, MSc; Bowen, Judith L. MD; Rugen, Kathryn Wirtz PhD, FNP-BC; Cox, Malcolm MD

doi: 10.1097/ACM.0000000000000312
Perspectives

Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

Dr. Gilman is director, Advanced Fellowships and Professional Development, Office of Academic Affiliations, Veterans Health Administration, Washington, DC.

Dr. Chokshi is director of population health improvement, New York University (NYU) Langone Medical Center, and assistant professor of medicine and population health, NYU School of Medicine, New York, New York. At the time this article was written, he was White House Fellow, Office of the Secretary, Department of Veterans Affairs, Washington, DC.

Dr. Bowen is professor of medicine, Oregon Health and Science University School of Medicine, Portland, Oregon, and education consultant, Office of Academic Affiliations, Veterans Health Administration Centers of Excellence in Primary Care Education, Washington, DC.

Dr. Rugen is nurse practitioner consultant, Centers of Excellence in Primary Care Education, Office of Academic Affiliations, Veterans Health Administration, Washington, DC.

Dr. Cox is adjunct professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. At the time this article was written, he was chief academic affiliations officer, Office of Academic Affiliations, Veterans Health Administration, Washington, DC.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimers: The views expressed in this article are those of the authors and do not necessarily reflect the policies or views of the Department of Veterans Affairs, the New York University Langone Medical Center, or the Perelman School of Medicine.

Correspondence should be addressed to Dr. Chokshi, NYU Langone Medical Center, 227 E. 30th St., Room 647, New York, NY 10016; telephone: (646) 754-5441; e-mail: dave.chokshi@nyumc.org.

© 2014 by the Association of American Medical Colleges