“Once they learn here…they can work pretty much anywhere”: Perspectives on clinical education in rural veterans affairs hospitals

BACKGROUND: One of the Department of Veterans Affairs (VA)'s greatest contributions to US Healthcare is its commitment to education. Rural VAs are tasked with increasing the number of health professions trainees they teach, but little is known about the current experience of teaching in rural VA hospitals. OBJECTIVES: This evaluation explores the experiences of rural VA hospitalists and identifies and describes barriers and facilitators to engagement in clinical teaching. METHODS: Using qualitative descriptive evaluation, we conducted six focus groups and one interview with hospitalists and others invested in the VA educational mission (n = 27) across six hospitalist divisions at rural VAs (VA systems caring for a population that is approximately 50% rural or greater). Focus group and interview questions were developed based on literature, a hospitalist needs assessment, and clinical experience. We used rapid qualitative analysis to report findings on the domains of VA Educational Mission-Rural Perspective, VA Rural Medicine, Rural VA Work/Life Balance, and Burnout among rural VA hospitalists. RESULTS: VA educational mission contributed to rural hospitalists' decisions to work at VA, yet how teaching impacted burnout and work/life balance varied. Rurality impacted topics taught and trainee recruitment. Rural VA teaching barriers included administrative challenges, generational differences, and lack of specialty resources. Facilitators included professional growth, amplified personal and institutional impact, and serving rural Veterans. CONCLUSIONS: This evaluation identified several actionable areas to target in faculty development programs that can support rural hospitalists, including how to leverage the additive curriculum of rural medicine as an asset.