The US Department of Veterans Affairs (VA) operates the largest integrated health care system in the United States, providing physical and mental health care to more than 9 million veterans enrolled each year through a national system of inpatient, outpatient, and long-term care settings. 1 As 1 of 4 statutory missions, the VA conducts the largest training effort for health professionals in cooperation with affiliated academic institutions. From 2016 through 2020, an average of 123,000 trainees from various professions received training at the VA. 2 Physician residents comprised the largest trainee group (37%), followed by associated health students and residents (20%), and nursing professionals (21%). 2 In VA, associated health professions include all health care disciplines other than allopathic and osteopathic medicine, dentistry, and nursing. The associated health professions encompass about 40 specialties, including audiology, dietetics, physical and occupational therapy, optometry, pharmacy, podiatry, psychology, and social work.
The VA also trains a smaller number of advanced fellows to address specialties important to the nation and veterans health that are not sufficiently addressed by standard accredited professional training. 3 The VA Advanced Fellowship programs include 22 postresidency, postdoctoral, and postmasters fellowships to physicians and dentists, and associated health professions, including psychologists, social workers, and pharmacists. 3 From 2015 to 2019, 57 to 61% of medical school students reported having a VA clinical training experience during medical school .4 Of current VA employees, 20% of registered nurses, 64% of physicians, 73% of podiatrists and optometrists, and 81% of psychologists reported VA training prior to employment. 5
Health professions education is led by the designated education officer (DEO) at each VA facility. 6 Also known as the associate chief of staff for education (ACOS/E), the DEO is a leadership position that is accountable to local VA facility executive leadership as well as the national Office of Academic Affiliations (OAA), which directs all VA health professions training across the US. 6 At most VA facilities, the DEO oversees clinical training and education reporting directly to the facility chief of staff. At the same time, the ACOS/E is accountable to the OAA to ensure adherence with national education directives and policy. The DEO oversees trainee programs through collaboration with training program directors, faculty, academic affiliates, and accreditation agencies across > 40 health professions.
The DEO is expected to possess expertise in leadership attributes identified by the US Office of Personnel Management as essential to build a federal corporate culture that drives results, serves customers, and builds successful teams and coalitions within and outside the VA.7 These leadership attributes include leading change, leading people, driving results, business acumen, and building coalitions. 7 They are operationalized by OAA as 4 domains of expertise required to lead education across multiple professions, including: (1) creating and sustaining an organizational work environment that supports learning, discovery, and continuous improvement; (2) aligning and managing fiscal, human, and capital resources to meet organizational learning needs; (3) driving learning and performance results to impact organizational success; and (4) leading change and transformation through positioning and implementing innovative learning and education strategies (Table 1). 6