• Sheri A Keitz, David C Aron, Judy L Brannen, John M Byrne, Grant W Cannon, Christopher T Clarke, Stuart C Gilman, Debbie L Hettler, Catherine P Kaminetzky, Robert A Zeiss, David S Bernett, Annie B Wicker, and T Michael Kashner.
• VA Loma Linda Healthcare System, Research Service (151), 11201 Benton St, Loma Linda, CA 92357. Email: michael.kashner@va.gov.
• Am J Manag Care. 2019 Apr 1; 25 (4): e111-e118.

ObjectivesRecruiting professional staff is an important business reason for hospitals allowing health trainees to engage in supervised patient care. Whereas prior studies have focused on educational institutions, this study focuses on teaching hospitals and whether trainees' clinical experiences affect their willingness to work (ie, recruitability) for the type of healthcare center where they trained.Study DesignA pre-post, observational study based on Learners' Perceptions Survey data in which respondents served as their own controls.MethodsConvenience sample of 15,207 physician, 11,844 nursing, and 13,012 associated health trainees who rotated through 1 of 169 US Department of Veterans Affairs (VA) medical centers between July 1, 2014, and June 30, 2017. Generalized estimating equations computed how clinical, learning, working, and cultural experiences influenced pre-post differences in willingness to consider VA for future employment.ResultsVA recruitability increased dramatically from 55% pretraining to 75% post training (adjusted odds ratio [OR], 2.1; 95% CI, 2.0-2.1; P <.001) in all 3 cohorts: physician (from 39% to 59%; OR, 1.6; 95% CI, 1.5-1.6; P <.001), nursing (from 61% to 84%; OR, 2.5; 95% CI, 2.4-2.6; P <.001), and associated health trainees (from 68% to 87%; OR, 2.7; 95% CI, 2.6-2.9; P <.001). For all trainees, changes in recruitability (P <.001) were associated with how trainees rated their clinical learning environment, personal experiences, and culture of psychological safety. Satisfaction ratings with faculty and preceptors (P <.001) were associated with positive changes in recruitability among nursing and associated health students but not physician residents, whereas nursing students who gave higher ratings for interprofessional team culture became less recruitable.ConclusionsAcademic medical centers can attract their health trainees for future employment if they provide positive clinical, working, learning, and cultural experiences.

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