This season of the STAR² Center Talks Workforce Success podcast explores the variety of routes and resources health centers can engage with to support Health Professions Education and Training (HP-ET) programs for their workforce and this episode features a plethora of each. Tune in to hear from Meaghan Angers and Amanda Schiessl of the Moses Weitzman Health System as they share their experience as both a health center engaging in clinical and administrative HP-ET programs and as a National Training and Technical Assistance Partner (NTTAP) that facilitates data and learning collaboratives to support HP-ET programs at health centers across the country.

Transcript by Rev.com

Helen Rhea Vernier: Welcome to the STAR² Center Talks Workforce Success podcast series. I’m your host for this episode, Helen Rhea Vernier, Associate Director of Workforce Development at the STAR² Center at the Association of Clinicians for the Underserved, or ACU. This season, we are focusing on health professions pathways as a tool for recruitment and retention. Today I’m talking to Meaghan Angers, Project Manager of the NTTAP or National Training and Technical Assistance Partner. And Amanda Schiessl, Deputy Chief Operating Officer at the Moses Weitzman Health System based in Middletown, Connecticut. Thank you so much for being here.

Amanda Schiessl: Thank you, Helen, for having us.

Meaghan Angers: Thanks for having us.

Helen Rhea Vernier: To get us started, could you introduce yourselves and tell us a little bit about your organization?

Amanda Schiessl: Thanks, Helen. Amanda Schiessl, Deputy Chief Operating Officer of Moses Weitzman Health System, and before I dive in, I just have to say primary care has been at the heart of everything that we’ve done at the Moses Weitzman Health System, all starting with an FQHC in Connecticut with the primary mission really for healthcare as a right and not a privilege Since 1972. Just had our 50th anniversary, and grounded in that mission, Moses Weitzman Health System was established as America’s first health system dedicated to primary care for the underserved populations, which was very exciting for us around our 50th anniversary. Working across the US and beyond, Moses Weitzman focuses on the people in communities most likely to experience health disparities due to many factors including socioeconomic status, race, ethnicity, gender and environmental justice, and all the companies under the system advance the delivery of primary and specialty care through practice research, system transformation, and training the next generation of healthcare leaders.

Just quickly hitting on those companies, I know this is a big introduction, but really we’re the parent company, Moses Weitzman, of the FQHC in Connecticut, which spans across the state of Connecticut providing comprehensive primary care, ConferMED, a national eConsult provider, improving access to specialty care for patients, the National Institute for Medical Assisting Advancement, educating students to become medical assistants, the Consortium for Advanced Practice Providers, which is a membership education, advocacy and accreditation organization for postgraduate advanced practice provider training programs. And last but not least, the Weitzman Institute, which is known nationally, is embedded in the Moses Weitzman Health System, which is our research policy and education arm of the system. And last note though, very exciting, is that the name of the health system actually honors two individuals who were crucial. They were early supporters and board members of our health center, Lillian Reba Moses, and Gerard Weitzman the Weitzman Institute is named after. And so as Deputy Chief Operating Officer, I am lucky enough to be able to support operations and specifically our strategy across the system, within the system into the affiliates as well. I’m very, very lucky and Meaghan’s going to introduce herself and talk about the NTTAP. Thank you for having us today.

Meaghan Angers: Awesome. Hello everyone. Like Helen said, my name is Meaghan Angers and I’m the program manager with the National Training and Technical Assistance Partner or NTTAP for the past three years. In 2015, Community Health Center Inc. was funded by the Health Resources and Services Administration or HRSA as the organization responsible for the NTTAP on clinical workforce development. Under this funding, we’ve been able to provide free training and technical assistance through webinars, activity sessions, learning collaboratives, research and more across seven objectives, two of which focuses on training the next generation through health profession, student training and clinical career pathway development programs like post-graduate nurse practitioner or joint nurse practitioner physician associate training programs.

Helen Rhea Vernier: Awesome. Thank you so much. You all do a ton in this space. We’re so excited to talk to you today. Can you tell us more about the health professions education and training programs that the Moses Weitzman Health System engages in?

Amanda Schiessl: We’ve been providing health professions and education training for decades throughout our history. And in 1981 we hosted our first clinical placement, which is actually a nurse practitioner, and we haven’t stopped since with 300 students annually. These students come from all different disciplines, medical, dental, behavioral health, and even a lot of non-clinical students and residents and fellows. And the students come from partnerships across the state of Connecticut through academic institutions, schools, and hospitals. And one of those initiatives is in partnership with our National Institute for Medical Assisting Advancement, where we’re able to train NIMAA students through an eight-month distance learning program where they’re doing online curriculum while at the same time doing traditional MA training within the health center, which is really exciting. And this program has allowed us and other health centers to develop a grow your own workforce pipeline, really allowing them to have that confidence to deliver the patient centered care.

And if you’ll let me, a program really near and dear to my heart that I get to serve as a preceptor for is our administrative fellowship. And what’s really exciting about this non-clinical training is it really allows for the healthcare organization to train masters level postgraduate students on the management and delivery of healthcare services, roles that are really crucial to running a health center. And sometimes there are in health centers or primary care, comprehensive primary care, a lot of opportunities to learn in this environment. And the programs we see vary between six months and two years. And a lot of them are about one year of curriculum after these individuals graduate from these master’s level programs. And for us, ours is one year and we have rotations across operations of the system. In the introduction I talked a lot about all those different areas of the system that you get experience into, which is just really incredible. And really the value of this is succession planning.

It provides a diverse background and skill set and really helps us train the next generation that is foundational to a lot of the great work we do. And I know we have a lot to share. Meaghan’s going to just highlight one last program for us.

Meaghan Angers: Yeah. The last program I want to highlight is Community Health Center Inc’s postgraduate nurse practitioner residency program, which is a 12-month-long residency program with a one-year commitment post residency for new nurse practitioners. The residency program began in 2007 at Community Health Center Inc. as the country’s first formal postgraduate nurse practitioner residency program. It’s now grown at our health center to include tracks for psychiatric mental health nurse practitioners, adult gerontology nurse practitioners, and pediatric nurse practitioners. And through our work with the funding with the NTTAP, we’ve been able to provide a learning collaborative to spread this model across the country. And there are now more than 100 nurse practitioner or joint nurse practitioner physician associate training programs in federally funded health centers across the country.

Helen Rhea Vernier: Amazing. Again, you all do just so much incredible work. Since you work with so many health centers across the nation, what are some of the greatest challenges you’ve seen health centers face in developing HP-ET programs? And then on the flip side, what are some of the greatest successes you’ve seen at health centers?

Meaghan Angers: Yeah, absolutely. To begin to answer this question, I’m just going to give some background as well. In 2018, HRSA authorized the creation of a survey instrument to measure organizational readiness for implementing health professions training programs at the health centers. Through our NTTAP, we were able to develop and create the RTAT as well as validate the survey instrument as well. That was then administered nationally to health centers in 2020. For strengths of that survey, I really want to highlight this survey response that we received. We received a 72.5% response rate nationwide from health centers across the country as well as US territories. And just highlighting that enormous response rate was during the COVID-19 pandemic, which demonstrates the priority that health center employees had for taking the time to focus on the critical issues of health professions training. From that survey, we learned that the top programs of interest by health center employees were in the medical discipline, including nurse practitioner students, medical assistant students, and medical residents.

From that data, we also were able to see the challenges and the categories with the least amount of readiness or strong areas for needing to develop readiness were in financial resources, implementation team and implementation plan. This is also highlighted in our newest research study, so I’m happy to share some of the preliminary data results as well. This past March we began a mixed methods research study through our NTTAP on health centers that have completed our learning collaborative on post-graduate nurse practitioner residency training programs to better understand the facilitators and barriers to developing and launching a training program in their health center. For background, we’ve had 78 health centers participate in the learning collaborative since the first cohort in 2016. We had 36 health centers respond to that survey, 18 of which have launched a program, 15 have not launched a program, and three are in the process.

The initial data from that research study showed that the three biggest facilitators to developing a post-graduate nurse practitioner residency program are leadership support, clinical support, and dedicated time for planning. On the other end, the three biggest barriers to not launching and developing a program were lack of financial resources, competing priorities and limited dedicated time for planning and implementation. This really echoes the importance of health centers to have dedicated leadership support, as well as dedicated time to developing these programs as well. We see this highlighted as well in our health profession student training learning collaborative, that health centers that get the leadership buy-in to take the time to participate in the six-month learning collaborative opportunity are able to then develop and streamline their processes for training health profession students.

Helen Rhea Vernier: I love the research and data that you’re able to share around these issues, both the challenges and successes. It really gives us a lot of wisdom and that evidence-based information is so great. My next question is how have you seen HP-ET programs affect staff recruitment and or retention at CHC Inc. and other health centers that you’ve worked with and interacted with?

Amanda Schiessl: There’s a lot of incredible research out there about residency training programs. Our Senior Vice President Clinical Director, Margaret Flinter, really pioneered the movement and partnership with incredible colleagues across the country and she’s published a ton. I strongly recommend you research that specifically. But anecdotally for ourselves as an FQHC, we’ve had incredible success stories, specifically people who have came in as students, became residents, became medical directors and had their own panel of patients and then now are vice presidents of a whole region at our organization. And I think though for us, data on residents that stayed as an employee preliminary data for our postgraduate training program learning collaborative where Meaghan supports organizations going from planning to implementation of residency programs. We learned that 215 residents and fellows have graduated from those training programs which were created due to participating in that learning collaborative opportunity, which is massive.

And we know that of those 215 graduates, 86 have stayed on to be employees at the health center. For us, very reflective of Margaret Flinter’s data is that these individuals are well-prepared to stay in primary care and a good percent of them stay in health centers. For us as a health center in 2018, this is something we would hope to replicate again, but of the students, I talked about how we train over 300 annually, CHC has employed 42 of those students following their placements and retained 78% of those employees as of October 2022. It’s really great for us anecdotally to see that and we would love to see those of our peers who are taking on this work nationally, if they really start to partner with organizations like us, the Weitzman’s Institute, we’d love to study and publish the outcomes of this because this really, as Deputy Chief Operating Officer, reinforces the huge value of doing these programs because we know that turnover and recruitment and retention is very costly to the organization and has a lot of those intangibles that have the ripple effect that we really need to alleviate that burden so we can provide the best possible care to our patients.

And I appreciate all the work ACU does in that area as well to help us. Thanks.

Helen Rhea Vernier: Thank you. My final question is what recommendations, tools, or resources do you have for a health center that’s just starting to plan or just starting to build out their own HP-ET program?

Amanda Schiessl: Yeah. Going back to what Meaghan referenced, as part of HRSA’s health professions education and training initiative, we were able to, as we spoke about, develop a tool that’ll actually help health centers assess and improve their readiness to engage in these health profession training programs. And this tool is really special because it was created by the peers of health centers, those individuals and health center organizations who are leading or creating or maintaining these really unique health professions programs. And through their work, they were able to help refine the structure of this tool as Meaghan had talked about. The RTAT is a 41 item, seven subscale structure of the survey. It was really built out to really focus the dimensions of health center readiness that were deemed critical by your peers to evaluate specifically the needs that you needed for that readiness. And so the subscale, so if you use the tool, it really will help you understand seven areas of readiness, readiness to engage evidence, strength and quality of the health profession training program, relative advantage of the health professions training program, financial resources, additional resources, implementation team and implementation plan.

By having in a group, the more the better because many perspectives creates an average that is incredibly helpful. When we did this for ourselves and we plan obviously to replicate it, we actually had all the staff complete the survey. We were able to have a really solid end because you can analyze and look at those all 41 individual items tell you an area that you can improve, the seven subscales, that overall score. We recommend, and our learning collaborative actually supports individuals going through this process, but you can take it on yourself. And it was actually the job that I took on when I started at CHC eight years ago was create a working group, bring together the key stakeholders, that is every leader across your organization, HR, clinical, IT, facilities, everybody touches student training. Have at a minimum or your whole organization, if you have a survey tool, complete the readiness to train assessment tool, review the data, tackle the areas that you need to improve, create a strong foundation, determine the discipline that feels appropriate for your organization. Determine where you have the staff to support it and dive deeper into replicable models.

We referenced a ton. There is a ton of best practices and partnership opportunities that health centers and primary care offers, so you don’t have to do it alone. Really consider your capacity of infrastructure, designate a champion that is crucial, and develop a plan to go from planning to implementation. And that is something as a partner supported by HRSA or NTTAP can provide to you. And Meaghan’s going to highlight a couple more areas to keep in mind as well as you jump into this exciting journey.

Meaghan Angers: Through my work with working with participating health centers and our learning collaborative opportunities, I just want to stress the importance of building relationships with your local academic partners. There is a value both for the health center as well as the academic institution to have these partnerships for the health center. It gives you the ability to understand what is happening in the academic space and how your health center can support these students and set them up for a successful career in community health. As for the academic [institution], it gives them the knowledge of what these students need to be prepared for a success in their career. It also promotes and supports a seamless transition from student to graduate. And I know we’ve touched on this a few times, but I just want to stress the NTTAP learning collaboratives that we have to offer at Community Health Center Inc.’s NTTAP, which focuses on training the next generation. These two different learning collaborative opportunities are free.

They are six months long and they’re designed to take participating health centers from planning to implementation of graphical models, either in health profession student training or post-graduate nurse practitioner or nurse practitioner physician associate residency programs. These learning collaborative opportunities also give you the opportunity to meet peers in the space of having a strategic goal for training the next generation and learn what has worked at their health center or maybe bond over what is not working well and then connect through the learning collaborative opportunity as well.

Helen Rhea Vernier: So great. I love that you all have so many tangible resources and that piece of connecting across the nation to learn from each other and support each other. It’s so wonderful that that is available to folks and that you are such a wonderful resource out there. Meaghan and Amanda, thank you so much for joining us today. And listeners, thank you for tuning in. We hope today’s conversation provided you with ideas, suggestions, and insights into ways you can approach health professions pathways programming for recruitment and retention. Be sure to check out all of our free workforce tools and resources found at chcworkforce.org and check out all Moses Weitzman Health system has to offer at mwhs1.com.