Purpose: The U.S. Department of Veterans Affairs (VA) supports 8,700 resident positions nationally to enhance quality of care for veterans and to educate physicians. This study sought to establish a yearly quality indicator to identify and follow strengths and opportunities for improvement in VA clinical training programs.
Method: In March 2001, the VA Learners' Perceptions Survey, a validated 57-item questionnaire, was mailed to 3,338 residents registered at 130 VA facilities. They were asked to rate their overall satisfaction with the VA clinical training experience and their satisfaction in four domains: faculty/preceptor, learning, working, and physical environments using a five-point Likert scale. Questionnaires were received from 1,775 residents (53.2%). A full analysis was conducted using 1,436 of these questionnaires, whose respondents were categorized in four training programs: medicine (n = 706), surgery (n = 291), subspecialty (n = 266), and psychiatry (n = 173).
Results: On a scale of 0 to 100, residents gave their clinical training experience an average score of 79. Eighty-four percent would have recommended VA training to peers, and 81% would have chosen VA training again. Overall, 87% were satisfied with their faculty/preceptors, 78% with the learning environment, and 67% with the working and physical environments. The survey was sensitive to differences in satisfaction among the trainee groups, with residents in internal medicine (IM) the least satisfied.
Conclusion: The VA Learners' Perceptions Survey is the first validated survey to address comprehensive satisfaction issues in clinical training. The survey highlights strengths and opportunities for improvement in VA clinical training and is the first step toward improving education.
Providing care for U.S. veterans while at the same time educating tomorrow's health care providers are fundamental commitments of the U.S. Department of Veterans Affairs (VA). The VA's Veterans Health Administration (VHA) has over 6 million veterans enrolled in its health care delivery system. Presently 4.5 million of these veterans are cared for through a nationwide network that includes 163 hospitals, more than 1,000 outpatient clinics, nursing homes, domiciliaries, and home care programs. The VA's medical care appropriation for fiscal year 2002 was over $21 billion.1 Since 1946, when President Harry Truman signed the law that established the Department of Medicine and Surgery (now VHA), affiliations between the VA and academic institutions have become an invaluable national training resource for medical students and resident physicians. The affiliations also serve as a vital component to recruiting and maintaining excellent VA staff and ensuring quality of care provided directly by the VA.
The VA's graduate medical education (GME) is conducted through affiliations with university schools of medicine. Currently 130 VHA medical facilities are affiliated with 107 of the nation's 125 medical schools. Through these partnerships, almost 29,000 residents receive some of their training in the VA every year.2 Accounting for approximately 9% of U.S. GME,3 the VA pays for 8,700 resident-physician positions in almost 2,000 residency programs.4 In the VA fiscal year 2001, appropriations in support of physician education totaled $706 million.5
Despite the VA's significant commitment to GME through allocation of faculty resources, resident salary dollars, and clinical learning environments, there has been no systemwide attempt to measure learners' perceptions of the clinical training experience in VA settings. The Government Performance and Results Act (GPRA) of 19936 required agencies to establish measurable performance goals and to report on the results annually to the Office of Management and Budget. In support of the GPRA, VHA's Office of Academic Affiliations (OAA) was charged with developing a tool to measure performance for the VA's academic mission. This tool could be used as a yearly quality indicator to highlight strengths and opportunities for improvement in VA clinical training programs.
In this report, we outline the development, validation, and implementation of a nationwide VA Learners' Perceptions Survey for all clinical health trainees. We focus on results for residents and report differences in learner perceptions among residents in IM, surgery, subspecialty training, and psychiatry.