Evaluation of VA Women’s Health Fellowships: Developing Leaders in Academic Women’s Health

Abstract

BACKGROUND:The Department of Veterans Affairs (VA) instituted the VA Women's Health Fellowship (VAWHF) Program in 1994, to accommodate the health needs of increasing numbers of female veterans and to develop academic leaders in women's health. Despite the longevity of the program, it has never been formally evaluated. OBJECTIVE: To describe the training environments of VAWHFs and career outcomes of female graduates. DESIGN AND PARTICIPANTS: Cross-sectional webbased surveys of current program directors ( ) and VAWHF graduates (1995. RESULTS: Responses were received from six of seven program directors (86 %) and 42 of 74 graduates (57 %). The mean age of graduates was 41.2 years, and mean time since graduation was 8.5 years. Of the graduates, 97 % were female, 74 % trained in internal medicine, and 64 % obtained an advanced degree. Those with an advanced degree were more likely than those without an advanced degree to pursue an academic career (82 % vs. 60 %; P<0.01). Of the female graduates, 76 % practice clinical women's health and spend up to 66 % of their time devoted to women's health issues. Thirty percent have held a VA faculty position. Seventy-nine percent remain in academics, with 39 % in the tenure stream. Overall, 94 % had given national presentations, 88 % had received grant funding, 79 % had published in peer-reviewed journals, 64 % had developed or evaluated curricula, 51 % had received awards for teaching or research, and 49 % had held major leadership positions. At 11 or more years after graduation, 33 % of the female graduates in academics had been promoted to the rank of associate professor and 33 % to the rank of full professor. CONCLUSIONS: The VAWHF Program has been successful in training academic leaders in women's health. Finding ways to retain graduates in the VA system would ensure continued clinical, educational, and research success for the VA women veteran's healthcare program.KEY WORDS: VA women's health; fellowship; academic productivity; female leadership; women in academic medicine.

Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation

“…Mentorship is crucial for women to maintain and hold academic positions. 28 Research on the VA WH graduates have shown that since graduation, nearly half have gone on to hold major leadership positions and that 79% of that population has remained in academics since graduation, compared with 35% of women in academic medicine that do not pursue fellowships, 14 a value that the OWH initially cited as one of the core reasons to develop the National Centers of Excellence in Women's Health. Moreover, many WH fellowships also offer other advanced degrees, such as a dual MBA or MPH that is achievable during fellowship, 9 providing women even more potential as valuable resources for patients, colleagues, future fellows, and society.…”

Women's Health Fellowships: Examining the Potential Benefits and Harms of Accreditation

“…2 By 2010, 87 physicians had completed a VA AFWH. 3 Recognizing the importance of WH leadership beyond medicine and congruent with its efforts to foster interprofessional training and practice, 4 in 2012, the VA extended training at six recurring and two new sites to nonphysician postdoctoral fellows in clinical fields such as nursing and psychology 5 and developed a National AWHP Coordinating Center. An annual directory of women's health residency and fellowships lists nine 2-year WH fellowships in addition to the eight from VA AFWH, eight 1-year fellowships (two limited to psychiatry), and eight WH residencies.…”

“…An annual directory of women's health residency and fellowships lists nine 2-year WH fellowships in addition to the eight from VA AFWH, eight 1-year fellowships (two limited to psychiatry), and eight WH residencies. 6 We sought evidence to support Foreman et al's assumptions of benefit as well as evidence for potential harms of pursuing WH fellowship accreditation by reviewing the descriptions of existing WH fellowships and residencies in the Directory of Residency and Fellowship Programs in Women's Health, 6 ACGME requirements for 2-year fellowships 7 , the evaluation of the VA AFWH programs, 3 the case of ACGME accreditation of geriatric fellowships in 1988 leading to a Certificate of Added Qualification, the experience of general internal medicine (GIM) fellowships which remain unaccredited, 8 physician trends away from primary care specialties, [9][10][11] American Boards of Internal Medicine (ABIM) fellowship matching data, 12 and research on gender and status. Table 1 summarizes our assessment of the evidence supporting and opposing accrediting WH fellowships.…”

“…17 Unaccredited fellowships allow fellows sufficient time for academic skill development and many complete advanced degrees during fellowship. 3,8 ACGME and ABMS accreditation will require 12 months of clinical work, which will constrain the ability to individualize training and prepare fellows for academic careers.…”

“…Tilstra et al conducted an evaluation of the Veterans Health Administration AFWH by surveying program directors and physician graduates. 3 The outcomes of this evaluation are relevant because the Veterans Health Administration fellowships account for almost half (8/ 17) of all 2-year WH fellowships and 1-year programs have insufficient time in which to develop the foundation for an academic career. 6,8,16,17 Tilstra et al were able to contact 77 of the 87 AFWH graduates.…”