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VA-sponsored residency programs address challenges

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VA-sponsored residencies immerse HPTs in Veteran-centric health care.

By Jeannie Howard, management analyst for the VHA Office of Academic Affiliations
Tuesday, January 23, 2024

In recent years, the small Caribbean Island of Puerto Rico has faced multiple crises including Hurricanes Maria and Irma that devasted the infrastructure and threatened the public health of the island. Puerto Rico has also faced another crisis – seeing 50% of physicians leave the island since 2009 and the reality of too few training opportunities for new physicians. The VA Caribbean Healthcare System (VACHS) realized this challenge several years ago, establishing VA-sponsored accredited graduate medical education (GME) residency programs in several clinical specialties to train new physicians to care for Veterans and the community.

While most GME residencies in the U.S. are sponsored by academic affiliates, VACHS did not have that option when they first began their GME programs in 1946. So, under national guidance, they established the curriculum, gained accreditation through the American Colleges of Graduate Medical Education, and began training physicians in such areas as critical care medicine, sleep medicine and spinal cord rehabilitation – specialty training not found elsewhere in the Caribbean.

“We don’t have enough physicians and there are more students that graduate from medical school than there are positions to receive or train them,” said Maricarmen Cruz-Jimenez, MD, FAAPMR, Associate Chief of Staff for Education at VACHS in San Juan, Puerto Rico. “If we didn’t have the VA programs to accept students here, they would have to go somewhere else.”

Nearly half of the island’s medical students leave because of insufficient residency positions. The residency positions at VACHS are not a fix to the larger challenges faced by the medical community in Puerto Rico, but they are an opportunity for medical students to train in their community providing care to Veterans.

Because many physicians work where they trained, these VA-sponsored residencies are a critical part of creating a more robust health care workforce in Puerto Rico. In fact, nearly 40% of VACHS’s clinician educators are alumni of VACHS’s residency programs, now teaching the next generation of physicians in the programs where they trained.

Health professions trainees (HPTs) enrolled in VACHS’s residency programs spend a core portion of their training on rotations in VA. There, they are fully immersed in VA’s interprofessional model of providing care to meet the complex needs of Veterans. Backed by VA’s breadth of resources, VACHS offers a unique training experience where residents learn to work in teams to address the whole health needs of their patients.

“Caring for a single Veteran, health professions trainees learn about mental health conditions, toxic exposure, the difficulties of re-engaging with family, and so many lessons from history,” said Cruz-Jimenez.

While maintaining accreditation is complex, the commitment to training the next generation of health care professionals is worth it, according to Cruz-Jimenez. So much so that in addition to sponsoring more than ten residency programs, VACHS provides 40 additional programs in partnership with academic affiliates to train nearly 800 HPTs annually. Overall, VACHS health professions education (HPE) programs account for nearly a quarter of all physician residency positions and HPE training programs across numerous clinical disciplines in Puerto Rico.

The GME residency programs at VACHS are essential to ensuring there are highly skilled physicians to care for Veterans throughout Puerto Rico and the U.S. Virgin Islands while supporting the public health in these geographically challenged locations.

“We are not only forming and providing amazing physicians for VA, but we are producing unique physicians for the community,” said Cruz-Jimenez. “We have the honor of caring for and learning from a very special population. Coming here is a whole school just learning from the Veteran population.”

VA is a national leader in health professions education, setting the standard for physicians and health professions training in more than 60 professions with more than 1,400 educational institutions affiliates to train future health professionals. These academic affiliations, some of which began more than 75 years ago, are coordinated by VA’s Office of Academic Affiliations (OAA). Find out more about VA’s academic mission by watching this video and visiting the Office of Academic Affiliations website.


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