Student experiences with VALOR Track:

1. What made you choose VALOR?

   I chose VALOR which involves doing IM, Surgery, Psych, Neuro, and anesthesia at the SFVA. Obgyn and Pediatrics were at different sites.

   I heard great reviews about the VALOR program from prior MS4s. Notable comments included the following:

1. Quality of teaching at the VA. Most of the faculty are either directly involved or do research in medical education. 

2. Relatively slow pace compared to other sites. This gives you more time to discuss cases with residents and attendings and ask questions. 

3. Great for "bread-and-butter" medicine cases.  Helps you with repeated exposure to some of the most common clinical cases HFrEF, COPD, T2DM, SBO, Inguinal Hernias etc. 

4. Patients are great to work with and have incredible life experiences and stories that they generously share with medical students. Great for someone interested in narrative medicine. The "my life, my story" initiative which is now practiced across all sites was borne out of the VA. 

5. Some patients are socially complex, and a vast majority have challenges with substance use and housing.

6. Opportunity to learn a different healthcare setting, EMR, patient population, and system of healthcare delivery. 

7. Sense of community. MS3 year can be a very isolating time and VALOR does a great job in creating a supportive environment and a sense of community. Navigating third year would have been a lot more difficult for me if not for my VALOR cohort. 

2. What aspects did you enjoy about the program/being in VALOR?

• I will answer this question by saying that all the comments in point 2 were accurate and added to my overall experience at the VA. I enjoyed the teaching and the opportunity to learn from patients who presented with "bread and butter" medicine cases. Although we didn't have a dedicated cardiology week (as in other sites) I carried many patients who presented with common cardiology problems such as heart failure and AFIB. As an MS3 my fund of knowledge was limited and the VA setting felt like the ideal environment to work on my fundamentals and get comfortable with the more common/basic clinical presentations. I appreciated not being rushed and having more time during rounds to ask questions from my attending and residents. We were encouraged to attend morning report and had afternoon didactics. Occasionally, instead of didactics, we were asked to present an interesting case to the other medical students in a morning report-style format. I found these to be fun and highly educational. 

3. What aspects did you dislike about it?

   • It is universally acknowledged by all who have worked at the VA that the EMR (CPRS) is archaic and extremely difficult to use. I did eventually get used to CPRS but it does take time and a lot of practice. Getting access to CPRS and the PIV card is also a time-consuming process that needs to be initiated as early as possible. Because there's less patient volume at the VA than at other sites there is a limit to the number, breadth, and diversity of cases you will see at the VA. The patient population at the VA is primarily elderly, white, and male - therefore exposure to other patient populations will be limited. 

4. Advice for studying for shelf exams within your track?

• I used the following guide to prepare myself for rotations: Clerkship advice

  For shelf prep specifically, I relied primarily on Uworld and supplemented my weaker content areas by listening to podcasts from Divine Intervention. I would highly recommend doing a practice shelf under timed conditions at least a week out from the actual shelf. Reading up on my patients also helped prepare me for the exam. Resources for shelf practice can be found here

5. If you could go back in time, what did you wish you would have known about your track, prior to submitting preferences for your 3rd year rotation track?

• I wish I had known more about CPRS. I don't recall doing any dedicated training modules for CPRS (as we do for EPIC) which made it all the more challenging to use.  

6. Any other advice for people considering your track? (Heads up, things to consider, surprising things, etc.)

   -Reach out to administration early for the onboarding process. The issuing of PIV cards takes forever at the VA and without one you cannot access the EMR. 

   -Ask for laptops early. Valor students are given VA-issued laptops with built-in card readers. Note, however, that our class had to push for this to happen and the earlier you ask about it the better. Computers are generally in short supply at the VA therefore having your own VA laptop helps maximize efficiency and improves your workflow. 

   -You can use your personal laptop at the VA however you will need to borrow a card reader from the PIV Office. The reader has a USB type A cable that can be connected to a laptop. These can be finicky sometimes and often have trouble connecting. However, they are useful to have until you get your VA laptop. The readers will need to be returned to the PIV office at the end of the year. 

   -If you lose your PIV card or accidentally leave it at home it's not the end of the world. You can call IT service desk at the VA and they can give you a security code that will help you bypass the PIV card. This will only work for a few days so you will need to apply for a replacement PIV card ASAP. 

   -If you are stuck trying to navigate CPRS you are not alone! Have a low threshold to ask for help either from a fellow med student or resident. I found this to be a much more efficient strategy than trying to figure it out myself.