Article

The original four HPEER Advanced Fellowship sites were established by the Department of Veterans Affairs (VA) Office of Academic Affiliation in 2014, and expanded in 2020 to include 8 sites and a national coordinating center with leadership shared between VA facilities in Houston and White River Junction. The VA invests heavily in training the nation’s healthcare professionals. The mission of HPEER is to develop leaders who can educate, evaluate, and innovate in Health Professions Education for the VA and the nation. All HPEER sites take part in a nationally coordinated curriculum covering topics in curriculum design, learner assessment, leadership, interprofessional education, as well as scholarship and educational research.

As part of the national HPEER curriculum covering scholarship and educational research, and in concert with Wednesday, May 14, 2025 VA Research Week 2025, HPEER organized a joint conference with the Center for Health Professions Education at the Uniformed Services University of the Health Sciences (USUHS). This interagency online event included poster sessions and oral presentations from HPEER fellows and students in USUHS certificate and graduate degree programs.

Education scholarship is broad, ranging from descriptions of curricular innovations and works in progress to advanced research using techniques drawn from psychology, sociology, anthropology, economics, and other scientific disciplines. The abstracts presented here summarize some of the work being done by HPEER fellows. Dougherty et al (Boston) described a project to create a primer outlining methodology for conducting and interpreting cost-effectiveness evaluations in the context of proposed HPE innovations. Cohen et al (Cleveland) found reduction in potentially problematic orders in the context of life-sustaining treatment following a multifaceted intervention program. Sorenson (Dublin, Georgia) reported an expanded Tai Chi program that included modifications allowing seated positions for veterans with mobility limitations. Young et al (Dublin) described an interprofessional curriculum to strengthen communication between nurses and social workers in their conversations with women veterans living in rural settings. Misedah-Robinson et al (Houston) showed that a new training program strengthened coordinators’ self-reports of preparedness and confidence in their ability to support veterans who have experienced human trafficking. Tovar et al (Salt Lake City) describe a methodology for using data from the VHA Corporate Data Warehouse to optimize schedules of HPE students assigned to VA clinical rotations. Yanez et al (San Francisco) presented initial observations of learner-centered outcomes following participation in a new multidisciplinary integrative health elective. Resto et al (West Haven) reported that implementation of self-serve kiosks increased distribution of substance use harm reduction resources beyond usual clinical care.

A second joint conference between VA HPEER and USUHS is planned for VA Research Week 2026; we look forward to the abstracts that will be produced by this new cohort of fellows, as well as to the future scholarship and contributions to the field that will be made by alumni of the HPEER Advanced Fellowship.

The original four HPEER Advanced Fellowship sites were established by the Department of Veterans Affairs (VA) Office of Academic Affiliation in 2014, and expanded in 2020 to include 8 sites and a national coordinating center with leadership shared between VA facilities in Houston and White River Junction. The VA invests heavily in training the nation’s healthcare professionals. The mission of HPEER is to develop leaders who can educate, evaluate, and innovate in Health Professions Education for the VA and the nation. All HPEER sites take part in a nationally coordinated curriculum covering topics in curriculum design, learner assessment, leadership, interprofessional education, as well as scholarship and educational research.

As part of the national HPEER curriculum covering scholarship and educational research, and in concert with Wednesday, May 14, 2025 VA Research Week 2025, HPEER organized a joint conference with the Center for Health Professions Education at the Uniformed Services University of the Health Sciences (USUHS). This interagency online event included poster sessions and oral presentations from HPEER fellows and students in USUHS certificate and graduate degree programs.

Education scholarship is broad, ranging from descriptions of curricular innovations and works in progress to advanced research using techniques drawn from psychology, sociology, anthropology, economics, and other scientific disciplines. The abstracts presented here summarize some of the work being done by HPEER fellows. Dougherty et al (Boston) described a project to create a primer outlining methodology for conducting and interpreting cost-effectiveness evaluations in the context of proposed HPE innovations. Cohen et al (Cleveland) found reduction in potentially problematic orders in the context of life-sustaining treatment following a multifaceted intervention program. Sorenson (Dublin, Georgia) reported an expanded Tai Chi program that included modifications allowing seated positions for veterans with mobility limitations. Young et al (Dublin) described an interprofessional curriculum to strengthen communication between nurses and social workers in their conversations with women veterans living in rural settings. Misedah-Robinson et al (Houston) showed that a new training program strengthened coordinators’ self-reports of preparedness and confidence in their ability to support veterans who have experienced human trafficking. Tovar et al (Salt Lake City) describe a methodology for using data from the VHA Corporate Data Warehouse to optimize schedules of HPE students assigned to VA clinical rotations. Yanez et al (San Francisco) presented initial observations of learner-centered outcomes following participation in a new multidisciplinary integrative health elective. Resto et al (West Haven) reported that implementation of self-serve kiosks increased distribution of substance use harm reduction resources beyond usual clinical care.

A second joint conference between VA HPEER and USUHS is planned for VA Research Week 2026; we look forward to the abstracts that will be produced by this new cohort of fellows, as well as to the future scholarship and contributions to the field that will be made by alumni of the HPEER Advanced Fellowship.

The original four HPEER Advanced Fellowship sites were established by the Department of Veterans Affairs (VA) Office of Academic Affiliation in 2014, and expanded in 2020 to include 8 sites and a national coordinating center with leadership shared between VA facilities in Houston and White River Junction. The VA invests heavily in training the nation’s healthcare professionals. The mission of HPEER is to develop leaders who can educate, evaluate, and innovate in Health Professions Education for the VA and the nation. All HPEER sites take part in a nationally coordinated curriculum covering topics in curriculum design, learner assessment, leadership, interprofessional education, as well as scholarship and educational research.

As part of the national HPEER curriculum covering scholarship and educational research, and in concert with Wednesday, May 14, 2025 VA Research Week 2025, HPEER organized a joint conference with the Center for Health Professions Education at the Uniformed Services University of the Health Sciences (USUHS). This interagency online event included poster sessions and oral presentations from HPEER fellows and students in USUHS certificate and graduate degree programs.

Education scholarship is broad, ranging from descriptions of curricular innovations and works in progress to advanced research using techniques drawn from psychology, sociology, anthropology, economics, and other scientific disciplines. The abstracts presented here summarize some of the work being done by HPEER fellows. Dougherty et al (Boston) described a project to create a primer outlining methodology for conducting and interpreting cost-effectiveness evaluations in the context of proposed HPE innovations. Cohen et al (Cleveland) found reduction in potentially problematic orders in the context of life-sustaining treatment following a multifaceted intervention program. Sorenson (Dublin, Georgia) reported an expanded Tai Chi program that included modifications allowing seated positions for veterans with mobility limitations. Young et al (Dublin) described an interprofessional curriculum to strengthen communication between nurses and social workers in their conversations with women veterans living in rural settings. Misedah-Robinson et al (Houston) showed that a new training program strengthened coordinators’ self-reports of preparedness and confidence in their ability to support veterans who have experienced human trafficking. Tovar et al (Salt Lake City) describe a methodology for using data from the VHA Corporate Data Warehouse to optimize schedules of HPE students assigned to VA clinical rotations. Yanez et al (San Francisco) presented initial observations of learner-centered outcomes following participation in a new multidisciplinary integrative health elective. Resto et al (West Haven) reported that implementation of self-serve kiosks increased distribution of substance use harm reduction resources beyond usual clinical care.

A second joint conference between VA HPEER and USUHS is planned for VA Research Week 2026; we look forward to the abstracts that will be produced by this new cohort of fellows, as well as to the future scholarship and contributions to the field that will be made by alumni of the HPEER Advanced Fellowship.

Background

Veterans may have a greater risk of experiencing human trafficking (HT) than the general population because of social aspects of health, including housing insecurity, justice involvement, food insecurity, and adverse childhood events.^1-4 Since 2023, the U.S. Department of Veterans Affairs (VA) has explored veterans’ experiences of HT through the Anti-Human Trafficking (AHT) Pilot Project.  This quality improvement project evaluated: 1) development of clinician AHT training materials to enhance identification and response to Veterans experiencing HT, and 2) educational resources aimed at raising awareness tailored to veterans and clinicians.

Methods

South Central Mental Illness Research, Education and Clinical Center (SCMIRECC) facilitated two focus group discussions with AHT coordinators implementing the pilot at six sites. Based on discussions and leadership input, SCMIRECC developed a training curriculum, with bi-weekly readings culminating in a two-hour workshop. Training evaluation followed Kirkpatrick’s model using questions adapted from the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) Survey.^5,6 Veteran-facing materials, including a brochure and whiteboard video, were reviewed by two Veteran Consumer Advisory Boards (CAB). The brochures, whiteboard video, and awareness modules were developed and revised based on feedback from focus group discussions. VA Central Office cleared all materials.

Results

Coordinators were satisfied with the training (mean, 4.20). After the training, none of the coordinators (n = 6) felt unprepared to assist Veterans (pre-training mean, 2.25; post-training mean, 1.40), and confidence in documentation improved (pre-training mean, 3.00; post-training mean, 3.40). Veteran CAB members recommended simplified language and veteran-centered messaging. The coordinators found the brochures and training useful. Recommendations included adding more representation to brochure covers, advanced training, a list of commonly asked questions, and a simplified screening tool. Barriers included delays in material development due to language guidance under recent executive orders.

Conclusions

The AHT training improved coordinators’ preparedness and confidence in supporting Veterans with trafficking experiences. Feedback emphasized the value of concise, Veteran-centered materials and a practical HT screening tool. These findings support the continued implementation of AHT education across VA settings to enhance identification and response for Veterans at risk of HT.

Background

Veterans may have a greater risk of experiencing human trafficking (HT) than the general population because of social aspects of health, including housing insecurity, justice involvement, food insecurity, and adverse childhood events.^1-4 Since 2023, the U.S. Department of Veterans Affairs (VA) has explored veterans’ experiences of HT through the Anti-Human Trafficking (AHT) Pilot Project.  This quality improvement project evaluated: 1) development of clinician AHT training materials to enhance identification and response to Veterans experiencing HT, and 2) educational resources aimed at raising awareness tailored to veterans and clinicians.

Methods

South Central Mental Illness Research, Education and Clinical Center (SCMIRECC) facilitated two focus group discussions with AHT coordinators implementing the pilot at six sites. Based on discussions and leadership input, SCMIRECC developed a training curriculum, with bi-weekly readings culminating in a two-hour workshop. Training evaluation followed Kirkpatrick’s model using questions adapted from the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) Survey.^5,6 Veteran-facing materials, including a brochure and whiteboard video, were reviewed by two Veteran Consumer Advisory Boards (CAB). The brochures, whiteboard video, and awareness modules were developed and revised based on feedback from focus group discussions. VA Central Office cleared all materials.

Results

Coordinators were satisfied with the training (mean, 4.20). After the training, none of the coordinators (n = 6) felt unprepared to assist Veterans (pre-training mean, 2.25; post-training mean, 1.40), and confidence in documentation improved (pre-training mean, 3.00; post-training mean, 3.40). Veteran CAB members recommended simplified language and veteran-centered messaging. The coordinators found the brochures and training useful. Recommendations included adding more representation to brochure covers, advanced training, a list of commonly asked questions, and a simplified screening tool. Barriers included delays in material development due to language guidance under recent executive orders.

Conclusions

The AHT training improved coordinators’ preparedness and confidence in supporting Veterans with trafficking experiences. Feedback emphasized the value of concise, Veteran-centered materials and a practical HT screening tool. These findings support the continued implementation of AHT education across VA settings to enhance identification and response for Veterans at risk of HT.

Background

Veterans may have a greater risk of experiencing human trafficking (HT) than the general population because of social aspects of health, including housing insecurity, justice involvement, food insecurity, and adverse childhood events.^1-4 Since 2023, the U.S. Department of Veterans Affairs (VA) has explored veterans’ experiences of HT through the Anti-Human Trafficking (AHT) Pilot Project.  This quality improvement project evaluated: 1) development of clinician AHT training materials to enhance identification and response to Veterans experiencing HT, and 2) educational resources aimed at raising awareness tailored to veterans and clinicians.

Methods

South Central Mental Illness Research, Education and Clinical Center (SCMIRECC) facilitated two focus group discussions with AHT coordinators implementing the pilot at six sites. Based on discussions and leadership input, SCMIRECC developed a training curriculum, with bi-weekly readings culminating in a two-hour workshop. Training evaluation followed Kirkpatrick’s model using questions adapted from the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) Survey.^5,6 Veteran-facing materials, including a brochure and whiteboard video, were reviewed by two Veteran Consumer Advisory Boards (CAB). The brochures, whiteboard video, and awareness modules were developed and revised based on feedback from focus group discussions. VA Central Office cleared all materials.

Results

Coordinators were satisfied with the training (mean, 4.20). After the training, none of the coordinators (n = 6) felt unprepared to assist Veterans (pre-training mean, 2.25; post-training mean, 1.40), and confidence in documentation improved (pre-training mean, 3.00; post-training mean, 3.40). Veteran CAB members recommended simplified language and veteran-centered messaging. The coordinators found the brochures and training useful. Recommendations included adding more representation to brochure covers, advanced training, a list of commonly asked questions, and a simplified screening tool. Barriers included delays in material development due to language guidance under recent executive orders.

Conclusions

The AHT training improved coordinators’ preparedness and confidence in supporting Veterans with trafficking experiences. Feedback emphasized the value of concise, Veteran-centered materials and a practical HT screening tool. These findings support the continued implementation of AHT education across VA settings to enhance identification and response for Veterans at risk of HT.

Background

The Accreditation Council for Graduate Medical Education (ACGME) mandates an 80-hour weekly work limit for residents.¹ In contrast, decisions regarding undergraduate medical education (UME) are strongly influenced locally, with individual institutions setting academic policy for students. These differences in oversight reflect fundamental differences in residents’ and students’ roles in patient care, power, and responsibility. Considering rotation schedules, internal medicine (IM) clerkship directors have discussed the relative value of weekend vs weekday duty during inpatient rotations, a scheduling topic of interest to students as well, though these conversations are limited by a lack of knowledge regarding admission patterns. Addressing this information gap would inform policy decisions.

The Veterans Health Administration (VHA) is uniquely positioned to address questions about UME clinical experiences nationwide: annually, over 118,000 students representing 97% of US medical schools train at VHA facilities.^2,3 We aim to compare the number and variety of patient encounter opportunities presenting during inpatient VHA IM rotations on weekdays versus weekends to inform policy decisions for UME rotation schedules.

Innovation

The VHA Corporate Data Warehouse will be queried for all admissions, diagnoses, and length of stay on inpatient IM services at the 420 VHA hospitals affiliated with US medical schools from 2016-2026. We will aggregate case data for day of week, floor, hospital, and Veteran Integrated Service Network (VISN), and determine number of admissions by weekday (Monday-Friday) and weekend (Saturday-Sunday). Weekday vs. weekend admission data will be compared using generalized mixed effects models for clustered longitudinal data. Heterogeneity across hospitals and VISNs will be explored to examine unique regional trends.

Results

We have drafted strategies to query and curate relevant datasets, developed a preliminary analysis plan, and await data deployment from VHA data stewards.

Conclusions

We believe this will be the first VHA-wide evaluation of patient encounter trends on IM services to examine potential training experiences for medical students. This will increase understanding of the critical role VHA has in developing the nations’ healthcare workforce, and how patterns of opportunities for clinical education may be distributed over time, informing decisions about rotation schedules to maximize students’ abilities to interact with, learn from, and serve our nation’s veterans

Background

The Accreditation Council for Graduate Medical Education (ACGME) mandates an 80-hour weekly work limit for residents.¹ In contrast, decisions regarding undergraduate medical education (UME) are strongly influenced locally, with individual institutions setting academic policy for students. These differences in oversight reflect fundamental differences in residents’ and students’ roles in patient care, power, and responsibility. Considering rotation schedules, internal medicine (IM) clerkship directors have discussed the relative value of weekend vs weekday duty during inpatient rotations, a scheduling topic of interest to students as well, though these conversations are limited by a lack of knowledge regarding admission patterns. Addressing this information gap would inform policy decisions.

The Veterans Health Administration (VHA) is uniquely positioned to address questions about UME clinical experiences nationwide: annually, over 118,000 students representing 97% of US medical schools train at VHA facilities.^2,3 We aim to compare the number and variety of patient encounter opportunities presenting during inpatient VHA IM rotations on weekdays versus weekends to inform policy decisions for UME rotation schedules.

Innovation

The VHA Corporate Data Warehouse will be queried for all admissions, diagnoses, and length of stay on inpatient IM services at the 420 VHA hospitals affiliated with US medical schools from 2016-2026. We will aggregate case data for day of week, floor, hospital, and Veteran Integrated Service Network (VISN), and determine number of admissions by weekday (Monday-Friday) and weekend (Saturday-Sunday). Weekday vs. weekend admission data will be compared using generalized mixed effects models for clustered longitudinal data. Heterogeneity across hospitals and VISNs will be explored to examine unique regional trends.

Results

We have drafted strategies to query and curate relevant datasets, developed a preliminary analysis plan, and await data deployment from VHA data stewards.

Conclusions

We believe this will be the first VHA-wide evaluation of patient encounter trends on IM services to examine potential training experiences for medical students. This will increase understanding of the critical role VHA has in developing the nations’ healthcare workforce, and how patterns of opportunities for clinical education may be distributed over time, informing decisions about rotation schedules to maximize students’ abilities to interact with, learn from, and serve our nation’s veterans

Background

The Accreditation Council for Graduate Medical Education (ACGME) mandates an 80-hour weekly work limit for residents.¹ In contrast, decisions regarding undergraduate medical education (UME) are strongly influenced locally, with individual institutions setting academic policy for students. These differences in oversight reflect fundamental differences in residents’ and students’ roles in patient care, power, and responsibility. Considering rotation schedules, internal medicine (IM) clerkship directors have discussed the relative value of weekend vs weekday duty during inpatient rotations, a scheduling topic of interest to students as well, though these conversations are limited by a lack of knowledge regarding admission patterns. Addressing this information gap would inform policy decisions.

The Veterans Health Administration (VHA) is uniquely positioned to address questions about UME clinical experiences nationwide: annually, over 118,000 students representing 97% of US medical schools train at VHA facilities.^2,3 We aim to compare the number and variety of patient encounter opportunities presenting during inpatient VHA IM rotations on weekdays versus weekends to inform policy decisions for UME rotation schedules.

Innovation

The VHA Corporate Data Warehouse will be queried for all admissions, diagnoses, and length of stay on inpatient IM services at the 420 VHA hospitals affiliated with US medical schools from 2016-2026. We will aggregate case data for day of week, floor, hospital, and Veteran Integrated Service Network (VISN), and determine number of admissions by weekday (Monday-Friday) and weekend (Saturday-Sunday). Weekday vs. weekend admission data will be compared using generalized mixed effects models for clustered longitudinal data. Heterogeneity across hospitals and VISNs will be explored to examine unique regional trends.

Results

We have drafted strategies to query and curate relevant datasets, developed a preliminary analysis plan, and await data deployment from VHA data stewards.

Conclusions

We believe this will be the first VHA-wide evaluation of patient encounter trends on IM services to examine potential training experiences for medical students. This will increase understanding of the critical role VHA has in developing the nations’ healthcare workforce, and how patterns of opportunities for clinical education may be distributed over time, informing decisions about rotation schedules to maximize students’ abilities to interact with, learn from, and serve our nation’s veterans

Background

Integrative health (IH) combines conventional and complementary medicine in a coordinated, evidence-based approach to treat the whole person. Nearly 40% of American adults have used complementary health approaches,¹ yet IH exposure in medical training is limited. In 2022, the San Francisco VA Health Care Center launched a multidisciplinary clinical IH elective for University of California San Francisco (UCSF) internal medicine and SFVA nurse practitioner residents. Based on findings from a general and targeted needs assessment, including faculty and learner feedback, we found that the elective was well-received, but relied on one-on-one patient-based teaching. This structure created variable learning experiences and high faculty burden. Our project aims to formalize and evaluate the IH elective curriculum to better address the needs of both faculty and learners.

Methods

We used Kern’s six-step framework for curriculum development. To reduce variability, we sought to formalize the core curricular content by: 1) reviewing existing elective components, comparing them to similar curricula nationwide, and outlining foundational knowledge based on the exam domains of the American Board of Integrative Medicine (ABOIM);² 2) creating eleven learning objectives across three themes: patient-centered care, systems-based practice, and IH-specific knowledge; 3) developing IH subspecialty experience guides to standardize clinical teaching with suggested takeaways, guided reflection, and curated resources. To reduce faculty burden, we consolidated elective resources into a centralized e-learning hub. Trainees complete a pre/post self-assessment and evaluation at the end of the elective.

Results

We identified key learning opportunities in each IH shadowing experience to enhance learners’ knowledge. We developed an IH e-Learning Hub to provide easy access to elective materials and IH clinical tools. Evaluations from the first two learners who completed the elective indicate that the learning objectives were met and that learners gained increased knowledge of lifestyle medicine, mind-body medicine, manual medicine, and botanicals/dietary supplements. Learners valued increased IH subspecialty familiarity and reported high likelihood of future practice change.

Discussion

The project is ongoing. Next steps include collecting faculty evaluations about their experience, continuing to create and refine experience guides, promoting clinical tools for learner’s future practice, and developing strategies to recruit more learners to the elective.

Background

Integrative health (IH) combines conventional and complementary medicine in a coordinated, evidence-based approach to treat the whole person. Nearly 40% of American adults have used complementary health approaches,¹ yet IH exposure in medical training is limited. In 2022, the San Francisco VA Health Care Center launched a multidisciplinary clinical IH elective for University of California San Francisco (UCSF) internal medicine and SFVA nurse practitioner residents. Based on findings from a general and targeted needs assessment, including faculty and learner feedback, we found that the elective was well-received, but relied on one-on-one patient-based teaching. This structure created variable learning experiences and high faculty burden. Our project aims to formalize and evaluate the IH elective curriculum to better address the needs of both faculty and learners.

Methods

We used Kern’s six-step framework for curriculum development. To reduce variability, we sought to formalize the core curricular content by: 1) reviewing existing elective components, comparing them to similar curricula nationwide, and outlining foundational knowledge based on the exam domains of the American Board of Integrative Medicine (ABOIM);² 2) creating eleven learning objectives across three themes: patient-centered care, systems-based practice, and IH-specific knowledge; 3) developing IH subspecialty experience guides to standardize clinical teaching with suggested takeaways, guided reflection, and curated resources. To reduce faculty burden, we consolidated elective resources into a centralized e-learning hub. Trainees complete a pre/post self-assessment and evaluation at the end of the elective.

Results

We identified key learning opportunities in each IH shadowing experience to enhance learners’ knowledge. We developed an IH e-Learning Hub to provide easy access to elective materials and IH clinical tools. Evaluations from the first two learners who completed the elective indicate that the learning objectives were met and that learners gained increased knowledge of lifestyle medicine, mind-body medicine, manual medicine, and botanicals/dietary supplements. Learners valued increased IH subspecialty familiarity and reported high likelihood of future practice change.

Discussion

The project is ongoing. Next steps include collecting faculty evaluations about their experience, continuing to create and refine experience guides, promoting clinical tools for learner’s future practice, and developing strategies to recruit more learners to the elective.

Background

Integrative health (IH) combines conventional and complementary medicine in a coordinated, evidence-based approach to treat the whole person. Nearly 40% of American adults have used complementary health approaches,¹ yet IH exposure in medical training is limited. In 2022, the San Francisco VA Health Care Center launched a multidisciplinary clinical IH elective for University of California San Francisco (UCSF) internal medicine and SFVA nurse practitioner residents. Based on findings from a general and targeted needs assessment, including faculty and learner feedback, we found that the elective was well-received, but relied on one-on-one patient-based teaching. This structure created variable learning experiences and high faculty burden. Our project aims to formalize and evaluate the IH elective curriculum to better address the needs of both faculty and learners.

Methods

We used Kern’s six-step framework for curriculum development. To reduce variability, we sought to formalize the core curricular content by: 1) reviewing existing elective components, comparing them to similar curricula nationwide, and outlining foundational knowledge based on the exam domains of the American Board of Integrative Medicine (ABOIM);² 2) creating eleven learning objectives across three themes: patient-centered care, systems-based practice, and IH-specific knowledge; 3) developing IH subspecialty experience guides to standardize clinical teaching with suggested takeaways, guided reflection, and curated resources. To reduce faculty burden, we consolidated elective resources into a centralized e-learning hub. Trainees complete a pre/post self-assessment and evaluation at the end of the elective.

Results

We identified key learning opportunities in each IH shadowing experience to enhance learners’ knowledge. We developed an IH e-Learning Hub to provide easy access to elective materials and IH clinical tools. Evaluations from the first two learners who completed the elective indicate that the learning objectives were met and that learners gained increased knowledge of lifestyle medicine, mind-body medicine, manual medicine, and botanicals/dietary supplements. Learners valued increased IH subspecialty familiarity and reported high likelihood of future practice change.

Discussion

The project is ongoing. Next steps include collecting faculty evaluations about their experience, continuing to create and refine experience guides, promoting clinical tools for learner’s future practice, and developing strategies to recruit more learners to the elective.

Background

Among people who use drugs (PWUD), harm reduction (HR) is an evidence-based low barrier approach to mitigating ongoing substance use risks and is considered a key pillar of the Department of Health and Human Service’s Overdose Prevention Strategy.¹ Given the accessibility and continuity, primary care (PC) clinics are optimal sites for education about and provision of HR services.^2,3

Aim

1. Determining the impact of active and passive methods for HR supply.
2. Recognizing the importance of clinician addiction education in the provision of HR services.

Methods

In January 2024, physician and nurse practitioner trainees in the West Haven Veterans Affairs (VA) Center of Education (CoE) in Interprofessional Primary Care received addiction care and HR strategy education. Initially, all patients presenting to the CoE completed a single-item substance use screening. Patients screening positive were offered HR supplies, including fentanyl and xylazine test strips (FTS, XTS), during the encounter (active distribution). Starting October 2024, HR kiosks were implemented in the clinic lobby, offering patients self-serve access to HR supplies (passive distribution). Test strip uptake was tracked through clinical encounter documentation and weekly kiosk inventory.

Results

Between January 2024 and June 2024, 92 FTS and 84 XTS were actively distributed. Upon implementation of the harm reduction kiosk, 253 FTS and 164 XTS were distributed between October 2024 and February 2025. In the CoE, FTS and XTS distribution increased by 275% and 195%, respectively, through passive kiosk distribution relative to active distribution during clinical encounters.

Conclusions

HR kiosk implementation resulted in significantly increased test strip uptake in the CoE, proving passive distribution to be an effective low barrier method of increasing access to HR and substance use disorder (SUD) resources. Although this model may reduce stigma and logistical barriers when presenting for a healthcare encounter, it limits the ability to track and engage patients for more intensive services. While each approach has unique advantages and disadvantages, test strip demand via both methods highlights the significant need for HR resources in PC settings. Continuing education for PC clinicians on low barrier SUD care and HR is critical to optimizing care for this population.

Background

Among people who use drugs (PWUD), harm reduction (HR) is an evidence-based low barrier approach to mitigating ongoing substance use risks and is considered a key pillar of the Department of Health and Human Service’s Overdose Prevention Strategy.¹ Given the accessibility and continuity, primary care (PC) clinics are optimal sites for education about and provision of HR services.^2,3

Aim

1. Determining the impact of active and passive methods for HR supply.
2. Recognizing the importance of clinician addiction education in the provision of HR services.

Methods

In January 2024, physician and nurse practitioner trainees in the West Haven Veterans Affairs (VA) Center of Education (CoE) in Interprofessional Primary Care received addiction care and HR strategy education. Initially, all patients presenting to the CoE completed a single-item substance use screening. Patients screening positive were offered HR supplies, including fentanyl and xylazine test strips (FTS, XTS), during the encounter (active distribution). Starting October 2024, HR kiosks were implemented in the clinic lobby, offering patients self-serve access to HR supplies (passive distribution). Test strip uptake was tracked through clinical encounter documentation and weekly kiosk inventory.

Results

Between January 2024 and June 2024, 92 FTS and 84 XTS were actively distributed. Upon implementation of the harm reduction kiosk, 253 FTS and 164 XTS were distributed between October 2024 and February 2025. In the CoE, FTS and XTS distribution increased by 275% and 195%, respectively, through passive kiosk distribution relative to active distribution during clinical encounters.

Conclusions

HR kiosk implementation resulted in significantly increased test strip uptake in the CoE, proving passive distribution to be an effective low barrier method of increasing access to HR and substance use disorder (SUD) resources. Although this model may reduce stigma and logistical barriers when presenting for a healthcare encounter, it limits the ability to track and engage patients for more intensive services. While each approach has unique advantages and disadvantages, test strip demand via both methods highlights the significant need for HR resources in PC settings. Continuing education for PC clinicians on low barrier SUD care and HR is critical to optimizing care for this population.

Background

Among people who use drugs (PWUD), harm reduction (HR) is an evidence-based low barrier approach to mitigating ongoing substance use risks and is considered a key pillar of the Department of Health and Human Service’s Overdose Prevention Strategy.¹ Given the accessibility and continuity, primary care (PC) clinics are optimal sites for education about and provision of HR services.^2,3

Aim

1. Determining the impact of active and passive methods for HR supply.
2. Recognizing the importance of clinician addiction education in the provision of HR services.

Methods

In January 2024, physician and nurse practitioner trainees in the West Haven Veterans Affairs (VA) Center of Education (CoE) in Interprofessional Primary Care received addiction care and HR strategy education. Initially, all patients presenting to the CoE completed a single-item substance use screening. Patients screening positive were offered HR supplies, including fentanyl and xylazine test strips (FTS, XTS), during the encounter (active distribution). Starting October 2024, HR kiosks were implemented in the clinic lobby, offering patients self-serve access to HR supplies (passive distribution). Test strip uptake was tracked through clinical encounter documentation and weekly kiosk inventory.

Results

Between January 2024 and June 2024, 92 FTS and 84 XTS were actively distributed. Upon implementation of the harm reduction kiosk, 253 FTS and 164 XTS were distributed between October 2024 and February 2025. In the CoE, FTS and XTS distribution increased by 275% and 195%, respectively, through passive kiosk distribution relative to active distribution during clinical encounters.

Conclusions

HR kiosk implementation resulted in significantly increased test strip uptake in the CoE, proving passive distribution to be an effective low barrier method of increasing access to HR and substance use disorder (SUD) resources. Although this model may reduce stigma and logistical barriers when presenting for a healthcare encounter, it limits the ability to track and engage patients for more intensive services. While each approach has unique advantages and disadvantages, test strip demand via both methods highlights the significant need for HR resources in PC settings. Continuing education for PC clinicians on low barrier SUD care and HR is critical to optimizing care for this population.

Background

Rural women veterans often confront unique healthcare barriers—geographic isolation, gender-related stigma, and limited provider cultural sensitivity that undermine trust and engagement. In response, we co-designed an interprofessional communication curriculum to promote relational, patient-centered care grounded in psychological need support.

Innovation

Anchored in Self Determination Theory (SDT), this curriculum equips nurses and social workers with need-supportive communication strategies that nurture autonomy, competence, and relatedness, integrating two transformative learning methods for enhancing respectful and inclusive listening:

• Cultural humility reflections for veteran-centered care—personal narratives, storytelling, and power-awareness discussions to build lifelong reflective practices.
• Medical improv simulations—adaptive improvisational role plays for healthcare environments fostering presence, adaptability, empathy, trust-building, and real-time responsiveness.

Delivered via a multiday health professions learning lab, the training combines asynchronous workshops with in-person facilitated interactions. Core modules cover SDT foundations, need supportive dialogue, veteran-centered cultural humility, and shared decision-making practices that uplift rural women veterans’ voices. Using Kirkpatrick’s Four Level Model, we assess impact at multiple tiers:

1. Reaction: Participant satisfaction and perceived training relevance.
2. Learning: Pre/post assessments track SDT knowledge and communication skills gains.
3. Behavior: Observe simulations and self-reported changes in communication practices.
4. Results: Qualitative satisfaction metrics and care engagement trends among rural women veterans.

Results

A pilot cohort (N = 20) across two rural sites is pending implementation. pre/post surveys will assess any improved confidence in applying need supportive communication and the most effective component in building empathetic presence. Feedback measures will also indicate the significance of combined uses of medical improv and cultural humility on deepened relational capacity and trust.

Discussion

This program operationalizes SDT within healthcare communications, integrating cultural humility and improvisation learning modalities to enhance care quality for rural women veterans, ultimately strengthening provider-patient connections. Using health professions learning lab environments can foster sustained behavioral impacts. Future iterations will expand to additional rural VA sites, co-designing with the voices of women veterans through focus groups.

Background

Rural women veterans often confront unique healthcare barriers—geographic isolation, gender-related stigma, and limited provider cultural sensitivity that undermine trust and engagement. In response, we co-designed an interprofessional communication curriculum to promote relational, patient-centered care grounded in psychological need support.

Innovation

Anchored in Self Determination Theory (SDT), this curriculum equips nurses and social workers with need-supportive communication strategies that nurture autonomy, competence, and relatedness, integrating two transformative learning methods for enhancing respectful and inclusive listening:

• Cultural humility reflections for veteran-centered care—personal narratives, storytelling, and power-awareness discussions to build lifelong reflective practices.
• Medical improv simulations—adaptive improvisational role plays for healthcare environments fostering presence, adaptability, empathy, trust-building, and real-time responsiveness.

Delivered via a multiday health professions learning lab, the training combines asynchronous workshops with in-person facilitated interactions. Core modules cover SDT foundations, need supportive dialogue, veteran-centered cultural humility, and shared decision-making practices that uplift rural women veterans’ voices. Using Kirkpatrick’s Four Level Model, we assess impact at multiple tiers:

1. Reaction: Participant satisfaction and perceived training relevance.
2. Learning: Pre/post assessments track SDT knowledge and communication skills gains.
3. Behavior: Observe simulations and self-reported changes in communication practices.
4. Results: Qualitative satisfaction metrics and care engagement trends among rural women veterans.

Results

A pilot cohort (N = 20) across two rural sites is pending implementation. pre/post surveys will assess any improved confidence in applying need supportive communication and the most effective component in building empathetic presence. Feedback measures will also indicate the significance of combined uses of medical improv and cultural humility on deepened relational capacity and trust.

Discussion

This program operationalizes SDT within healthcare communications, integrating cultural humility and improvisation learning modalities to enhance care quality for rural women veterans, ultimately strengthening provider-patient connections. Using health professions learning lab environments can foster sustained behavioral impacts. Future iterations will expand to additional rural VA sites, co-designing with the voices of women veterans through focus groups.

Background

Rural women veterans often confront unique healthcare barriers—geographic isolation, gender-related stigma, and limited provider cultural sensitivity that undermine trust and engagement. In response, we co-designed an interprofessional communication curriculum to promote relational, patient-centered care grounded in psychological need support.

Innovation

Anchored in Self Determination Theory (SDT), this curriculum equips nurses and social workers with need-supportive communication strategies that nurture autonomy, competence, and relatedness, integrating two transformative learning methods for enhancing respectful and inclusive listening:

• Cultural humility reflections for veteran-centered care—personal narratives, storytelling, and power-awareness discussions to build lifelong reflective practices.
• Medical improv simulations—adaptive improvisational role plays for healthcare environments fostering presence, adaptability, empathy, trust-building, and real-time responsiveness.

Delivered via a multiday health professions learning lab, the training combines asynchronous workshops with in-person facilitated interactions. Core modules cover SDT foundations, need supportive dialogue, veteran-centered cultural humility, and shared decision-making practices that uplift rural women veterans’ voices. Using Kirkpatrick’s Four Level Model, we assess impact at multiple tiers:

1. Reaction: Participant satisfaction and perceived training relevance.
2. Learning: Pre/post assessments track SDT knowledge and communication skills gains.
3. Behavior: Observe simulations and self-reported changes in communication practices.
4. Results: Qualitative satisfaction metrics and care engagement trends among rural women veterans.

Results

A pilot cohort (N = 20) across two rural sites is pending implementation. pre/post surveys will assess any improved confidence in applying need supportive communication and the most effective component in building empathetic presence. Feedback measures will also indicate the significance of combined uses of medical improv and cultural humility on deepened relational capacity and trust.

Discussion

This program operationalizes SDT within healthcare communications, integrating cultural humility and improvisation learning modalities to enhance care quality for rural women veterans, ultimately strengthening provider-patient connections. Using health professions learning lab environments can foster sustained behavioral impacts. Future iterations will expand to additional rural VA sites, co-designing with the voices of women veterans through focus groups.

Background

The original program consisted of 12 movements that were to be split up between 3 weeks teaching 4 movements each week. Range of mobility was the main consideration for developing this HPE quality improvement project. Veterans who wanted to participate in Tai Chi were not able to engage in the activity due to the range of movement traditional Tai Chi required.

Innovation

The HPE Quality Improvement program developed a 15-movement warm-up, 12 co-ordinational movements consistent with the original program, 18 supplemental Tai Chi movements that were not included in the original program all of which focus on movements remaining below the shoulders and can be done standing or sitting. Four advanced exercises including “hip over heel” were included to target participants balance if able and to improve their hip strength, knee tendon/ligament strength. Tai Chi loses its potential to increase balance when performed in a sitting position.¹ The movements drew upon Fu style Tai Chi and the program developer was given permission from Tommy Kirchoff to use his DVD Healing Exercises. The HPE program consisted of four 30–60-minute weekly sessions of learning the movements with another 4 weekly sessions of demonstrating the movements. Instructors were given written and visual documents to learn from and were evaluated by the developer during the last 4 weeks.
.

Results

Qualitative Data: Instructors notice a difference in how they feel, and appreciate having another option to offer veterans with mobility/standing issues. Patients expressed improvement in mobility relating to bending, arm extension, arm raising, muscle strengthening, hip strengthening and rotation.

Discussion

Future research will want to look at taking measurements before and after patient implementation to determine quantitative data related to balance, strength and range of movement including grip strength, stand up and go, and one-legged stands.

Background

The original program consisted of 12 movements that were to be split up between 3 weeks teaching 4 movements each week. Range of mobility was the main consideration for developing this HPE quality improvement project. Veterans who wanted to participate in Tai Chi were not able to engage in the activity due to the range of movement traditional Tai Chi required.

Innovation

The HPE Quality Improvement program developed a 15-movement warm-up, 12 co-ordinational movements consistent with the original program, 18 supplemental Tai Chi movements that were not included in the original program all of which focus on movements remaining below the shoulders and can be done standing or sitting. Four advanced exercises including “hip over heel” were included to target participants balance if able and to improve their hip strength, knee tendon/ligament strength. Tai Chi loses its potential to increase balance when performed in a sitting position.¹ The movements drew upon Fu style Tai Chi and the program developer was given permission from Tommy Kirchoff to use his DVD Healing Exercises. The HPE program consisted of four 30–60-minute weekly sessions of learning the movements with another 4 weekly sessions of demonstrating the movements. Instructors were given written and visual documents to learn from and were evaluated by the developer during the last 4 weeks.
.

Results

Qualitative Data: Instructors notice a difference in how they feel, and appreciate having another option to offer veterans with mobility/standing issues. Patients expressed improvement in mobility relating to bending, arm extension, arm raising, muscle strengthening, hip strengthening and rotation.

Discussion

Future research will want to look at taking measurements before and after patient implementation to determine quantitative data related to balance, strength and range of movement including grip strength, stand up and go, and one-legged stands.

Background

The original program consisted of 12 movements that were to be split up between 3 weeks teaching 4 movements each week. Range of mobility was the main consideration for developing this HPE quality improvement project. Veterans who wanted to participate in Tai Chi were not able to engage in the activity due to the range of movement traditional Tai Chi required.

Innovation

The HPE Quality Improvement program developed a 15-movement warm-up, 12 co-ordinational movements consistent with the original program, 18 supplemental Tai Chi movements that were not included in the original program all of which focus on movements remaining below the shoulders and can be done standing or sitting. Four advanced exercises including “hip over heel” were included to target participants balance if able and to improve their hip strength, knee tendon/ligament strength. Tai Chi loses its potential to increase balance when performed in a sitting position.¹ The movements drew upon Fu style Tai Chi and the program developer was given permission from Tommy Kirchoff to use his DVD Healing Exercises. The HPE program consisted of four 30–60-minute weekly sessions of learning the movements with another 4 weekly sessions of demonstrating the movements. Instructors were given written and visual documents to learn from and were evaluated by the developer during the last 4 weeks.
.

Results

Qualitative Data: Instructors notice a difference in how they feel, and appreciate having another option to offer veterans with mobility/standing issues. Patients expressed improvement in mobility relating to bending, arm extension, arm raising, muscle strengthening, hip strengthening and rotation.

Discussion

Future research will want to look at taking measurements before and after patient implementation to determine quantitative data related to balance, strength and range of movement including grip strength, stand up and go, and one-legged stands.

Background

Veterans Health Administration Directive 1004.03(1) (Advance Care Planning) aims to establish a “system-wide, patient-centered and evidence-based approach to Advance Care Planning.”¹ Life-sustaining treatment (LST) orders are documents of patient preference regarding interventions such as mechanical ventilation, CPR, dialysis, artificial nutrition and hydration; and are considered part of an Advance Care Plan. From a bioethics perspective, these orders promote patient autonomy by formalizing patient preferences around LSTs in the medical record, particularly for when a patient lacks capacity and/or cannot make decisions on their own.² Through consensus building, our team defined vague, inactionable, or incorrectly written LST orders as Potentially Problematic Orders (PPO). PPOs which cause confusion at the bedside or lack clarity around preferences can pose serious risks to patient safety and autonomy by exposing patients to inappropriate initiation or withholding of LSTs. Improving the quality of LST orders and reducing the number of PPOs is a crucial element for safe and effective implementation of Directive 1004.03(1).

Aim

The aim of this quality improvement project was to reduce the number of PPOs in a VA Community-Based Outpatient Clinic (CBOC) by 75% by the end of 2025.

Methods

The Model for Improvement was used for this quality improvement project.³ One year of LST orders were audited and thematic analysis identified 7 subtypes of PPO. Some PPO subtypes included clerical errors, potentially mismatched order sets (e.g., Comfort Care order with no associated DNR order) ill-defined or vague orders, and clinically impractical orders (eg, “consents to one shock during CPR”). We defined vague, ill-defined, and impractical orders as the most ethically and clinically challenging given the possibility of confusion or error at the bedside. Initial data were collected from October 2022 to October 2023, and post-intervention data were collected from February 2024 to September 2024. Interventions included process changes (clarifying role responsibility, documentation practices, patient education), regular auditing and feedback from a supervisor, and staff education.

Results

Post-intervention analysis demonstrated that the proportion of PPO remained the same, with 25% of patient charts containing at least one PPO. However, the distribution of PPO in the most ethically and clinically problematic categories (vague, ill-defined, and impractical orders) decreased from 14.7% to <1%.

Conclusions

We successfully reduced the most ethically and clinically challenging PPOs to <1% in our initial intervention. To reduce the overall proportion of PPO, we plan enhancements in process automations, additional physical educational resources, and minor changes in audit criteria. Future projects will aim to address the remaining PPO error types and prepare this project for implementation in other CBOCs.

Background

Veterans Health Administration Directive 1004.03(1) (Advance Care Planning) aims to establish a “system-wide, patient-centered and evidence-based approach to Advance Care Planning.”¹ Life-sustaining treatment (LST) orders are documents of patient preference regarding interventions such as mechanical ventilation, CPR, dialysis, artificial nutrition and hydration; and are considered part of an Advance Care Plan. From a bioethics perspective, these orders promote patient autonomy by formalizing patient preferences around LSTs in the medical record, particularly for when a patient lacks capacity and/or cannot make decisions on their own.² Through consensus building, our team defined vague, inactionable, or incorrectly written LST orders as Potentially Problematic Orders (PPO). PPOs which cause confusion at the bedside or lack clarity around preferences can pose serious risks to patient safety and autonomy by exposing patients to inappropriate initiation or withholding of LSTs. Improving the quality of LST orders and reducing the number of PPOs is a crucial element for safe and effective implementation of Directive 1004.03(1).

Aim

The aim of this quality improvement project was to reduce the number of PPOs in a VA Community-Based Outpatient Clinic (CBOC) by 75% by the end of 2025.

Methods

The Model for Improvement was used for this quality improvement project.³ One year of LST orders were audited and thematic analysis identified 7 subtypes of PPO. Some PPO subtypes included clerical errors, potentially mismatched order sets (e.g., Comfort Care order with no associated DNR order) ill-defined or vague orders, and clinically impractical orders (eg, “consents to one shock during CPR”). We defined vague, ill-defined, and impractical orders as the most ethically and clinically challenging given the possibility of confusion or error at the bedside. Initial data were collected from October 2022 to October 2023, and post-intervention data were collected from February 2024 to September 2024. Interventions included process changes (clarifying role responsibility, documentation practices, patient education), regular auditing and feedback from a supervisor, and staff education.

Results

Post-intervention analysis demonstrated that the proportion of PPO remained the same, with 25% of patient charts containing at least one PPO. However, the distribution of PPO in the most ethically and clinically problematic categories (vague, ill-defined, and impractical orders) decreased from 14.7% to <1%.

Conclusions

We successfully reduced the most ethically and clinically challenging PPOs to <1% in our initial intervention. To reduce the overall proportion of PPO, we plan enhancements in process automations, additional physical educational resources, and minor changes in audit criteria. Future projects will aim to address the remaining PPO error types and prepare this project for implementation in other CBOCs.

Background

Veterans Health Administration Directive 1004.03(1) (Advance Care Planning) aims to establish a “system-wide, patient-centered and evidence-based approach to Advance Care Planning.”¹ Life-sustaining treatment (LST) orders are documents of patient preference regarding interventions such as mechanical ventilation, CPR, dialysis, artificial nutrition and hydration; and are considered part of an Advance Care Plan. From a bioethics perspective, these orders promote patient autonomy by formalizing patient preferences around LSTs in the medical record, particularly for when a patient lacks capacity and/or cannot make decisions on their own.² Through consensus building, our team defined vague, inactionable, or incorrectly written LST orders as Potentially Problematic Orders (PPO). PPOs which cause confusion at the bedside or lack clarity around preferences can pose serious risks to patient safety and autonomy by exposing patients to inappropriate initiation or withholding of LSTs. Improving the quality of LST orders and reducing the number of PPOs is a crucial element for safe and effective implementation of Directive 1004.03(1).

Aim

The aim of this quality improvement project was to reduce the number of PPOs in a VA Community-Based Outpatient Clinic (CBOC) by 75% by the end of 2025.

Methods

The Model for Improvement was used for this quality improvement project.³ One year of LST orders were audited and thematic analysis identified 7 subtypes of PPO. Some PPO subtypes included clerical errors, potentially mismatched order sets (e.g., Comfort Care order with no associated DNR order) ill-defined or vague orders, and clinically impractical orders (eg, “consents to one shock during CPR”). We defined vague, ill-defined, and impractical orders as the most ethically and clinically challenging given the possibility of confusion or error at the bedside. Initial data were collected from October 2022 to October 2023, and post-intervention data were collected from February 2024 to September 2024. Interventions included process changes (clarifying role responsibility, documentation practices, patient education), regular auditing and feedback from a supervisor, and staff education.

Results

Post-intervention analysis demonstrated that the proportion of PPO remained the same, with 25% of patient charts containing at least one PPO. However, the distribution of PPO in the most ethically and clinically problematic categories (vague, ill-defined, and impractical orders) decreased from 14.7% to <1%.

Conclusions

We successfully reduced the most ethically and clinically challenging PPOs to <1% in our initial intervention. To reduce the overall proportion of PPO, we plan enhancements in process automations, additional physical educational resources, and minor changes in audit criteria. Future projects will aim to address the remaining PPO error types and prepare this project for implementation in other CBOCs.

Background

Cost-effectiveness (CE) evaluations, for existing and anticipated programs, are common in healthcare, but are rarely used in health professions education (HPE). A systematic review of HPE literature found not only few examples of CE evaluations, but also unclear and inconsistent methodology.¹ One proposed reason HPE has been slow to adopt CE evaluations is uncertainty over terminology and how to adapt this methodology to HPE.² CE evaluations present further challenges for HPE since educational outcomes are often not easily monetized. However, given the reality of constrained budgets and limited resources, CE evaluations can be a powerful tool for educators to strengthen arguments for proposed innovations, and for scholars seeking to conduct rigorous work that sustains critical review.

Innovation

This project aims to make CE evaluations more understandable to HPE educators, using a one-page infographic and glossary. This will provide a primer, operationalizing the steps involved in CE evaluations and addressing why and when CE evaluations might be considered in HPE. To improve comprehension, this is being developed collaboratively with health professions educators and an economist. This infographic will be submitted for publication, as a resource to facilitate educators’ scholarly work and conversations with fiscal administrators.

Results

The infographic includes 1) an overview of CE evaluations, 2) information about inputs required for CE evaluations, 3) guidance on interpreting results, 4) a glossary of key terminology, and 5) considerations for why educators might consider this type of analysis. A final draft will be pilot tested with a focus group to assess interdisciplinary accessibility.

Discussion

Discussions between health professions educators and an economist on this infographic uncovered concepts that were poorly understood or defined differently across disciplines, determining specific knowledge gaps and misunderstandings. For example, facilitating conversation between educators and economists highlighted key terms that were a source of misunderstanding. These were then added to the glossary, creating a shared vocabulary. This also helped clarify the steps and information necessary for conducting CE evaluations in HPE, particularly the issue of perspective choice for the analysis (educator, patient, learner, etc.). Overall, this collaboration aimed at making CE evaluations more approachable and understandable for HPE professionals through this infographic.

Background

Cost-effectiveness (CE) evaluations, for existing and anticipated programs, are common in healthcare, but are rarely used in health professions education (HPE). A systematic review of HPE literature found not only few examples of CE evaluations, but also unclear and inconsistent methodology.¹ One proposed reason HPE has been slow to adopt CE evaluations is uncertainty over terminology and how to adapt this methodology to HPE.² CE evaluations present further challenges for HPE since educational outcomes are often not easily monetized. However, given the reality of constrained budgets and limited resources, CE evaluations can be a powerful tool for educators to strengthen arguments for proposed innovations, and for scholars seeking to conduct rigorous work that sustains critical review.

Innovation

This project aims to make CE evaluations more understandable to HPE educators, using a one-page infographic and glossary. This will provide a primer, operationalizing the steps involved in CE evaluations and addressing why and when CE evaluations might be considered in HPE. To improve comprehension, this is being developed collaboratively with health professions educators and an economist. This infographic will be submitted for publication, as a resource to facilitate educators’ scholarly work and conversations with fiscal administrators.

Results

The infographic includes 1) an overview of CE evaluations, 2) information about inputs required for CE evaluations, 3) guidance on interpreting results, 4) a glossary of key terminology, and 5) considerations for why educators might consider this type of analysis. A final draft will be pilot tested with a focus group to assess interdisciplinary accessibility.

Discussion

Discussions between health professions educators and an economist on this infographic uncovered concepts that were poorly understood or defined differently across disciplines, determining specific knowledge gaps and misunderstandings. For example, facilitating conversation between educators and economists highlighted key terms that were a source of misunderstanding. These were then added to the glossary, creating a shared vocabulary. This also helped clarify the steps and information necessary for conducting CE evaluations in HPE, particularly the issue of perspective choice for the analysis (educator, patient, learner, etc.). Overall, this collaboration aimed at making CE evaluations more approachable and understandable for HPE professionals through this infographic.

Background

Cost-effectiveness (CE) evaluations, for existing and anticipated programs, are common in healthcare, but are rarely used in health professions education (HPE). A systematic review of HPE literature found not only few examples of CE evaluations, but also unclear and inconsistent methodology.¹ One proposed reason HPE has been slow to adopt CE evaluations is uncertainty over terminology and how to adapt this methodology to HPE.² CE evaluations present further challenges for HPE since educational outcomes are often not easily monetized. However, given the reality of constrained budgets and limited resources, CE evaluations can be a powerful tool for educators to strengthen arguments for proposed innovations, and for scholars seeking to conduct rigorous work that sustains critical review.

Innovation

This project aims to make CE evaluations more understandable to HPE educators, using a one-page infographic and glossary. This will provide a primer, operationalizing the steps involved in CE evaluations and addressing why and when CE evaluations might be considered in HPE. To improve comprehension, this is being developed collaboratively with health professions educators and an economist. This infographic will be submitted for publication, as a resource to facilitate educators’ scholarly work and conversations with fiscal administrators.

Results

The infographic includes 1) an overview of CE evaluations, 2) information about inputs required for CE evaluations, 3) guidance on interpreting results, 4) a glossary of key terminology, and 5) considerations for why educators might consider this type of analysis. A final draft will be pilot tested with a focus group to assess interdisciplinary accessibility.

Discussion

Discussions between health professions educators and an economist on this infographic uncovered concepts that were poorly understood or defined differently across disciplines, determining specific knowledge gaps and misunderstandings. For example, facilitating conversation between educators and economists highlighted key terms that were a source of misunderstanding. These were then added to the glossary, creating a shared vocabulary. This also helped clarify the steps and information necessary for conducting CE evaluations in HPE, particularly the issue of perspective choice for the analysis (educator, patient, learner, etc.). Overall, this collaboration aimed at making CE evaluations more approachable and understandable for HPE professionals through this infographic.

What qualities are dermatology programs looking for that may be different from 5 years ago? 

DR. WORSWICK: Every dermatology residency program is different, and as a result, each program is looking for different qualities in its applicants. Overall, I don’t think there has been a huge change in what programs are generally looking for, though. While each program may have a particular trait it values more than another, in general, programs are looking to find residents who will be competent and caring doctors, who work well in teams, and who could be future leaders in our field. 

What are common mistakes you see in dermatology residency interviews, and how can applicants avoid them? 

DR. WORSWICK: Most dermatology applicants are highly accomplished and empathic soon-to-be physicians, so I haven’t found a lot of “mistakes” from this incredible group of people that we have the privilege of interviewing. From time to time, an applicant will lie in an interview, usually out of a desire to appear to be a certain way, and occasionally, they may be nervous and stumble over their words. The former is a really big problem when it happens, and I would recommend that applicants be honest in all their encounters. The latter is not a major problem, and in some cases, might be avoided by lots of practice in advance. 

What types of questions do you recommend applicants ask their interviewers to demonstrate genuine interest in the program? 

DR. WORSWICK: Because of the signaling system, I think that programs assume interest at baseline once an applicant has sent the signal. So, “demonstrating interest” is generally not something I would recommend to applicants during the interview day. It is important for applicants to determine on interview day if a program is a fit for them, so applicants should showcase their unique strengths and skills and find out about what makes any given program different from another. The match generally works well and gets applicants into a program that closely aligns with their strengths and interests. So, think of interview day as your time to figure out how good a fit a program is for you, and not the other way around. 

How can applicants who feel they don't have standout research or leadership credentials differentiate themselves in the interview? 

DR. WORSWICK: While leadership, and less so research experience, is a trait valued highly by most if not all dermatology programs, it is only a part of what an applicant can offer a program. Most programs employ holistic review and consider several factors, probably most commonly grades in medical school, leadership experience, mentorship, teaching, volunteering, Step 2 scores, and letters of recommendation. Any given applicant does not need to excel in all of these. If an applicant has not done a lot of research, they may not match into a research-heavy program, but it doesn’t mean they won’t match. They should determine in which areas they shine and signal the programs that align with those interests/strengths. 

How should applicants discuss nontraditional experiences in a way that adds value rather than raising red flags? 

DR. WORSWICK: In general, my recommendation would be to explain what happened leading up to the change or challenge so that someone reading the application clearly understands the circumstances of the experience, then add value to the description by explaining what was learned and how this might relate to the applicant being a dermatology resident. For example, if a resident took time off for financial reasons and had to work as a medical assitant for a year, a concise description that explains the need for the leave (financial) as well as what value was gained (a year of hands-on patient care experience that validated their choice of going into medicine) could be very helpful.

What qualities are dermatology programs looking for that may be different from 5 years ago? 

DR. WORSWICK: Every dermatology residency program is different, and as a result, each program is looking for different qualities in its applicants. Overall, I don’t think there has been a huge change in what programs are generally looking for, though. While each program may have a particular trait it values more than another, in general, programs are looking to find residents who will be competent and caring doctors, who work well in teams, and who could be future leaders in our field. 

What are common mistakes you see in dermatology residency interviews, and how can applicants avoid them? 

DR. WORSWICK: Most dermatology applicants are highly accomplished and empathic soon-to-be physicians, so I haven’t found a lot of “mistakes” from this incredible group of people that we have the privilege of interviewing. From time to time, an applicant will lie in an interview, usually out of a desire to appear to be a certain way, and occasionally, they may be nervous and stumble over their words. The former is a really big problem when it happens, and I would recommend that applicants be honest in all their encounters. The latter is not a major problem, and in some cases, might be avoided by lots of practice in advance. 

What types of questions do you recommend applicants ask their interviewers to demonstrate genuine interest in the program? 

DR. WORSWICK: Because of the signaling system, I think that programs assume interest at baseline once an applicant has sent the signal. So, “demonstrating interest” is generally not something I would recommend to applicants during the interview day. It is important for applicants to determine on interview day if a program is a fit for them, so applicants should showcase their unique strengths and skills and find out about what makes any given program different from another. The match generally works well and gets applicants into a program that closely aligns with their strengths and interests. So, think of interview day as your time to figure out how good a fit a program is for you, and not the other way around. 

How can applicants who feel they don't have standout research or leadership credentials differentiate themselves in the interview? 

DR. WORSWICK: While leadership, and less so research experience, is a trait valued highly by most if not all dermatology programs, it is only a part of what an applicant can offer a program. Most programs employ holistic review and consider several factors, probably most commonly grades in medical school, leadership experience, mentorship, teaching, volunteering, Step 2 scores, and letters of recommendation. Any given applicant does not need to excel in all of these. If an applicant has not done a lot of research, they may not match into a research-heavy program, but it doesn’t mean they won’t match. They should determine in which areas they shine and signal the programs that align with those interests/strengths. 

How should applicants discuss nontraditional experiences in a way that adds value rather than raising red flags? 

DR. WORSWICK: In general, my recommendation would be to explain what happened leading up to the change or challenge so that someone reading the application clearly understands the circumstances of the experience, then add value to the description by explaining what was learned and how this might relate to the applicant being a dermatology resident. For example, if a resident took time off for financial reasons and had to work as a medical assitant for a year, a concise description that explains the need for the leave (financial) as well as what value was gained (a year of hands-on patient care experience that validated their choice of going into medicine) could be very helpful.

What qualities are dermatology programs looking for that may be different from 5 years ago? 

DR. WORSWICK: Every dermatology residency program is different, and as a result, each program is looking for different qualities in its applicants. Overall, I don’t think there has been a huge change in what programs are generally looking for, though. While each program may have a particular trait it values more than another, in general, programs are looking to find residents who will be competent and caring doctors, who work well in teams, and who could be future leaders in our field. 

What are common mistakes you see in dermatology residency interviews, and how can applicants avoid them? 

DR. WORSWICK: Most dermatology applicants are highly accomplished and empathic soon-to-be physicians, so I haven’t found a lot of “mistakes” from this incredible group of people that we have the privilege of interviewing. From time to time, an applicant will lie in an interview, usually out of a desire to appear to be a certain way, and occasionally, they may be nervous and stumble over their words. The former is a really big problem when it happens, and I would recommend that applicants be honest in all their encounters. The latter is not a major problem, and in some cases, might be avoided by lots of practice in advance. 

What types of questions do you recommend applicants ask their interviewers to demonstrate genuine interest in the program? 

DR. WORSWICK: Because of the signaling system, I think that programs assume interest at baseline once an applicant has sent the signal. So, “demonstrating interest” is generally not something I would recommend to applicants during the interview day. It is important for applicants to determine on interview day if a program is a fit for them, so applicants should showcase their unique strengths and skills and find out about what makes any given program different from another. The match generally works well and gets applicants into a program that closely aligns with their strengths and interests. So, think of interview day as your time to figure out how good a fit a program is for you, and not the other way around. 

How can applicants who feel they don't have standout research or leadership credentials differentiate themselves in the interview? 

DR. WORSWICK: While leadership, and less so research experience, is a trait valued highly by most if not all dermatology programs, it is only a part of what an applicant can offer a program. Most programs employ holistic review and consider several factors, probably most commonly grades in medical school, leadership experience, mentorship, teaching, volunteering, Step 2 scores, and letters of recommendation. Any given applicant does not need to excel in all of these. If an applicant has not done a lot of research, they may not match into a research-heavy program, but it doesn’t mean they won’t match. They should determine in which areas they shine and signal the programs that align with those interests/strengths. 

How should applicants discuss nontraditional experiences in a way that adds value rather than raising red flags? 

DR. WORSWICK: In general, my recommendation would be to explain what happened leading up to the change or challenge so that someone reading the application clearly understands the circumstances of the experience, then add value to the description by explaining what was learned and how this might relate to the applicant being a dermatology resident. For example, if a resident took time off for financial reasons and had to work as a medical assitant for a year, a concise description that explains the need for the leave (financial) as well as what value was gained (a year of hands-on patient care experience that validated their choice of going into medicine) could be very helpful.