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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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4131 — Influences on VA Retention and Recruitment Efforts by VA Health Professions Education Programs: Trainee, Service Chief, and Site Leader Perspectives

Lead/Presenter: Linda Kawentel,  COIN - Ann Arbor
All Authors: Kawentel LM (QUERI Center for Evaluation and Implementation Resources (CEIR)), Yahya GM (QUERI Center for Evaluation and Implementation Resources; CEIR) Nelson SM (QUERI Center for Evaluation and Implementation Resources; CEIR) Doredla JS (QUERI Center for Evaluation and Implementation Resources; CEIR) Bowersox NW (QUERI Center for Evaluation and Implementation Resources; CEIR)

Objectives:
The VA Quality Enhancement Research Initiative (QUERI) has identified workforce development, retention, and wellbeing of VA employees and trainees as a formally stated priority area. At the request of QUERI leadership, the Center for Evaluation and Implementation Resources (CEIR) conducted a qualitative evaluation of VA’s Graduate Medical Education (GME) training programs for the VA Office of Academic Affiliations (OAA) to assess the impact of these programs on areas of VA priority, including retention and recruitment efforts. This presentation describes findings related to the following evaluation questions: 1) How do VA GME training programs promote VA as a place for a post-training career? 2) How do VA training programs impact recruitment and retention efforts of VA staff? 3) What contextual factors influence relationships between VA GME training programs and staff recruitment efforts? 4) What best practices support the recruitment of VA GME health professions trainees (HPTs) into VA staff roles?

Methods:
Established qualitative methods were used to address the evaluation questions. Stratified sampling by VA facility complexity level (1a, 1b, 1c, 2, 3) was used to select sites, with two sites randomly selected from each complexity level (N = 10 sites total). At each site, three semi-structured group interviews were conducted with the following populations: 1) GME HPTs at different levels of education (medical student, first-year resident, third-year resident), 2) service chiefs from Medicine, Surgery, and Psychiatry, and 3) site educational leadership (Designated Education Officers and Chiefs of Staff). Interviewees were asked about steps that sites took to present VA as a place for a post-training career, perceived trainee impacts related to retention and recruitment of VA GME HPTs, and barriers and facilitators of HPT impacts on recruitment and retention efforts. Interviews were transcribed, coded, and reduced into meaningful domains and themes.

Results:
GME HPT recruitment strategies were catalogued and characterized as formal vs. informal, with most sites taking informal approaches to the recruitment of HPTs into VA staff roles. Interviewees highlighted six factors which supported the view of VA as a attractive place for post-training employment: engaged mentors, learning opportunities, attractive benefits, VA’s unique population and mission, healthy work-life balance, and affiliate connections. Across all groups, three factors were identified which made VA seem like a less attractive place for post-training employment: limited employment opportunities, limited clinical specialty opportunities, and non-competitive salary. For staff not recruited through VA’s training programs, factors that made VA an attractive place to work and stay included VA’s learning and teaching culture, affiliate connections, and mentorship opportunities.

Implications:
VA’s training mission and learning culture play important roles in both the recruitment of VA trainees into VA employment and the recruitment and retention of staff not recruited through VA’s training programs. Sites should emphasize VA’s academic culture, affiliate relationships, and mentorship opportunities in recruitment efforts.

Impacts:
Findings will be used to develop recommendations to inform national strategic planning related to VA retention and recruitment. Findings will also complement planned future QUERI work to assess HPT impact.