AAMC Reporter: December 2006

New Panel to Explore VA/Medical School Relationship

A new collaborative group will examine ways to advance the longstanding affiliations between U.S. medical schools and the U.S. Department of Veterans Affairs (VA).

Appointed last fall by VA Secretary R. James Nicholson, the Blue Ribbon Panel on VA-Medical School Affiliations will begin its work in the spring. Over 18 months, the group intends to explore all potential options for maximizing the relationship, which reached its 60th anniversary in 2006. Both sides said the relationship is strong, but that an effort to find areas to strengthen was appropriate.

"Since [the partnership began], there has not been a comprehensive analysis and evaluation of the success and contributions that the affiliations have made, and the potential for enhancing the impact of the affiliations on medical education, research, and particularly on the patient care mission of the VA," said AAMC President Emeritus and panel chair Jordan J. Cohen, M.D. "The commission will look at both challenges and opportunities inherent in the current relationship between the VA and medical schools."

More than 100 academic medical centers are formally affiliated with the VA. The affiliations provide expanded educational resources and research opportunities for medical students and residents—tens of thousands of whom rotate through the VA at some point in their training—and improve care for veterans by requiring that VA physicians have the same qualifications expected of medical school faculty. (The VA recently announced that it will add 341 new resident positions in July.)

The panel's 14 members represent both large and small medical schools and facilities, research-intensive and clinically oriented medical schools, and urban and rural institutions.

"We wanted to make sure there was diversity in its broadest sense, including geographic diversity, ethnic diversity, and gender diversity," Karen Sanders, M.D., acting deputy chief of the VA's office of academic affiliations said. "We were trying to get a good cross section, so that no issue would go unspoken."

Sanders explained that the panel will take a forwardlooking approach, hoping to anticipate the needs of the two partners over the next 60 years.

"What should the optimal configuration of the VA/ medical school partnership look like? Should it change? What should the oversight mechanism be? How do you measure the success of the partnership? We want to be strategic in terms of how to restructure, refine, and improve these relationships for the next several decades," she said.

Cohen pointed to a number of key areas in which academic medical centers can learn from the VA's successes, including patient safety, quality improvement, performance evaluation, and the use of electronic medical records to document clinical care.

"[The VA centers] have a great deal to teach the whole health care system, and in particular academic medical centers," Cohen said.

He envisions the panel as moving the concept of the relationship between the VA and academic health centers from one of affiliations to something more akin to a formal partnership.

"I think there is a set of mutual interests that we share, and both partners have a great deal to gain from working very closely together. That, to me, is the framing context of the blue-ribbon commission," Cohen said. Panel member Thomas J. Lawley, M.D., dean of Emory University School of Medicine, praised the "outstanding" relationship between Emory and the Atlanta VA Medical Center as an example of a mutually beneficial affiliation.

"To the degree that we can make the overlapping missions of the VA and academic medicine even more coincident than they are now, to me that would be a plus for both organizations and for the veterans," he said. "I hope that we can achieve an understanding of the current relationship and its strengths, and then craft a vision for the future which is compelling and mutually beneficial for all."

According to Sanders, the entire panel will meet two or three times in person and hold several audio and video teleconferences. The panel may also choose to form subcommittees.

At the conclusion of its charter, the panel will issue a series of recommendations to VA Secretary Nicholson.

"For our agency, I hope that some of these recommendations re-emphasize how important our medical school affiliations are and how important trainees are for us," Sanders said. "Not only because they make up onethird of our workforce but because they change our culture and make it better. I would like to see a very high-level endorsement of the concept that trainees in all health professions are a unique asset to the VA," Sanders said. "For the partnerships, I hope to see a vision that results in more effective change processes for the VA and the academic world. Together we can accomplish so much more than either can alone."

Panel meetings will be open to the public and announced in advance in the Federal Register.

—By Gina Shaw, special to the Reporter

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