Does an interprofessional post-graduate health professional training program in primary care influence future career choice? mixed methodological evidence from the VA Connecticut healthcare system center of excellence in primary care education (CoEPCE)

Primary care (PC) providers are in high demand. In addition to increasing access to health insurance coverage, the United States population continues to grow and age. In response, the U.S. Department of Veterans Affairs (VA) launched a new initiative in which five Centers of Excellence in Primary Care Education (CoEPCE) were created. Established in 2010, the VA Connecticut Healthcare System (VACHS) is one site that currently trains medicine interns/residents and nurse practitioner (NP) fellows to co-manage longitudinal panels of patients with complex and competing needs.

To determine if participation in the VACHS CoEPCE has an effect on attitudes towards PC as a career, a mixed methodological study was conducted. Physician and NP fellow trainees completed longitudinal semi-structured interviews prior to program implementation, midway through the program and at year's end (n = 30). They also completed the Learner Perception and Primary Care Survey (LPS) pre- and post- program (n = 8). Qualitative methods were used to analyze interview data using Atlas.ti.9.0 and the Wilcoxon Signed Rank Test assessed differences in trainees' pre- and posttest attitudes towards selecting primary care as a profession.

Trainees were initially unsure whether they would pursue PC. However, quality of mentoring within the CoEPCE significantly increased attraction towards PC (p = .08). NP Fellows were especially affected by the additional faculty attention. “I really wanted to come here and be able to have preceptors and have a lot of good guidance.” Also, trainees who were unsure if their continuity clinic experience would influence PC career choice were much more positive by year's end (p = .05); “I've always wanted to be involved in quality improvement and health outcomes and the CoE's really fermented that…seeing how good practices work and then afford[ing] change through institutionalizing good practices… that's definitely fortified my interest in the career in primary care.” Feelings about taking care of chronically ill patients (p = .07), time and workload demands (p = .02), and paperwork/charting requirements (p =.03) all appear to have become less negatively influential over time.

Early evidence from this interprofessional training initiative suggests trainees' attraction to PC as a viable and rewarding career option improved over the course of an academic year. The close faculty attention and clinical education have a positive effect and the roles and responsibilities that once stigmatized PC became less negatively perceived in a program that highlights teamwork, collegial relationships between professions, and sustained relationships with patients.