Women Veterans Health Care

Location: VA Boston Healthcare System, 150 S Huntington Ave, Jamaica Plain, MA

Academic Affiliations: Boston University (BU) - School of Medicine

Fellowship Site Focus: Training a new generation of clinical scholars who are well-positioned to serve as VA leaders and experts in women Veterans Health. An important strength of our program is our Women's Health Sciences Division of the National Center for PTSD. This has produced combined clinical programs, presentations, and publications. Recent graduates have gone on to academic roles in research, education and administration.

Research Foci: PTSD; trauma exposure and health outcomes; and gender disparities.

Fellowship Related Links: VA Boston Healthcare System Women Veterans and PTSD National Center Women's Health Sciences Division

Director: Dr. Kate Iverson, Katherine.Iverson@va.gov

Psychology Track Projects/Focus Area Examples: Post-Deployment Adjustment Among Post-9/11 Veterans; Stress, Health and Aging Research Program; Intimate Partner Violence, Health and Health Care Among Women Veterans; The Psychophysiology and Neurobiology of PTSD across the Menstrual Cycle; Comorbidity of PTSD and Disordered Eating; Stress and Suicidality; Longitudinal Investigation into Gender, Health, and Trauma; Interventions to Increase Engagement in VA Care; Optimizing Evidence-Based PTSD Treatments; Examining Efficacy Medications such as MDMA to Potentiate Evidence-based PTSD treatments; Stress, Trauma, and Reproductive Health; PTSD Treatment during Pregnancy; Sociocultural Determinants of PTSD and Mental Health; Peer Support; Family Engagement in PTSD Treatment; Couples Therapy; PTSD and Physical Health; Holistic Well-Being Following separation from Military Service.

Psychology Track Clinical Activities: Clinical training occurs across two clinical contexts.

1. Intervention delivery within VA Boston's Women's Trauma and Recovery Team (WTRT) working with women Veterans diagnosed with a range of mental health conditions associated with traumatic stress exposure. Clinical experiences in the WTRT include psychological assessments, individual and group psychotherapy, and supervised clinical supervision of more junior trainees.
2. Therapist on cutting-edge treatment outcome studies addressing stress and PTSD within the Women's Health Sciences Division of the National Center for PTSD.

Location: VA Greater Los Angeles Healthcare System, 16111 Plummer Street Sepulveda, CA

Academic Affiliations: University of California (UCLA) - Los Angeles, Schools of Public Health and Medicine

Fellowship Site Focus: To train creative, independent, ethical, and productive leaders in health services research and related fields.

Director: Dr. Jennifer Martin (Jennifer.Martin@va.gov), Dr. Lisa Altman (Lisa.Altman@va.gov), and Dr. Alison Hamilton (Alison.Hamilton@va.gov)

Fellowship Site Goal: The goal is to provide a program with enough structure and resources to enable fellows to progress in multiple areas while recognizing they are independent adults whose interests and goals will primarily determine the path they will follow. The aim is to produce outstanding practitioners (proficient as researchers, clinicians, and educators) for academic VA positions in the area of women's health, in order to advance and improve VA women's healthcare as well as the VA women's healthcare delivery system.

Location: William S Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI

Academic Affiliations: University of Wisconsin (UW)-Madison, School of Medicine and Public Health

Fellowship Site Goal: To train future leaders in academic health sciences who will be engaged in research teaching and program development that will improve the health of women.

Research Foci: Sex and gender issues in health, disease and academic career development.

Directors: Dr. Madelyn Weiker (Madelyn.Weiker@va.gov) and Dr. Nicole Rogus-Pulia (nicole.pulia@va.gov)

Education and Training: A full spectrum of supplemental clinical, didactic, basic, or applied research activities are available. Each fellow completes an individualized career development plan (ICDP) around 4 core areas essential to a successful research-based academic career There is also regular local and national activities on developing your career and leadership skills.

Research Activities: The major, ongoing research activities at our Madison site include:

1. Sex and gender issues across the health care continuum, especially in a geriatric population;
2. Addressing health disparities through medical education and the intersectionality of race, class, and gender;
3. Sex and gender issues in academic career development. Fellows identify a research mentor who must be committed to their career development.

Clinical Program: In addition to research and academic career training, fellows spend 25% of their time in the VA Women's Health Clinic. An array of clinical experiences are available to meet the training needs of each fellow. For psychologists, the requisite clinical supervision is provided.

Location: Clement J. Zablocki VA Medical Center, 5000 W National Ave, Milwaukee, WI 53295

Academic Partnerships: Medical College of Wisconsin (MCW) and University of Wisconsin-Milwaukee School of Nursing and Marquette University School of Nursing

Fellowship Site Focus or Goals: We seek academically motivated physicians, psychologists, and nurse researchers for our fellowship program which offers the unique opportunity to train in an interdisciplinary setting. Our goal is to develop our fellows to become leaders in advancing the care of women in the VA and beyond.

Directors: Dr. Amy Farkas (Amy.Farkas@va.gov), Dr. Colleen Heinkel (Colleen.Heinkel@va.gov), and Dr. Qiyan Mu (Qiyan.Mu@va.gov)

Education and Training: Beyond focused clinical training in women's health, fellows engage in inter-disciplinary conferences including didactics, works in progress meetings, and research skill development workshop to meet their individual needs and goals. Fellows have the opportunity to complete a Master's program in Clinical and Translational Science through MCW's CTSI program.

Research Opportunities: Fellows can pursue their own research interest as it relates to women's health with the guidance of mentors in medicine, psychology, and nursing. Unique strengths of our program include research focuses include trauma-informed care, reproductive health, perinatal care, sexual health, breast health, clinical education, and women's health leadership. The Milwaukee VA is part of the VA's Women's Health Practice Based Research Network and the National Center for PTSD providing fellows with unique opportunities to collaborate across VA. Additionally, collaboration with our academic partners providers access to additional mentors and resources to advance their career goals.

Location: VA Pittsburgh Healthcare System, UPMC Montefiore Hospital, 200 Lothrop Street Pittsburgh, PA 15213

Academic Affiliations: University of Pittsburgh Medical Center (UPMC)/University of Pittsburgh, School of Medicine

Fellowship Site Goal and Focus: This fellowship aims to develop academic physicians and scholars in women's health and care for women veterans. Depending on their career trajectory, fellows may participate in advanced training in either medical education or research. Relevant clinical duties are carried out through the Pittsburgh VA Women's Health Clinic, a twice-designated VA National Clinical Center of Excellence.

Directors: Dr. Deborah DiNardo (Deborah.DiNardo@va.gov) and Dr. Sonya Borrero (Sonya.Borrero@va.gov)

Medical Education: The goal of the program is to train physician leaders and educators within the realm of women's health and medical education. Fellows focused on medical education will pursue an MS in medical education, which is offered by the Institute for Clinical Research Education (ICRE) through the University of Pittsburgh. Fellows also participate in an integrated program of observed teaching experiences that enhance their skills in classroom and clinical instruction, curriculum development, professional leadership, medical education, and medical administration. In addition, fellows take core research curriculum courses, complete a mentored research or curriculum development project, and participate in teaching activities across levels from undergraduate medical education through faculty development. Finally, clinical activities include 25% time spent caring for women veterans and supervising trainees in clinical care in both the inpatient and outpatient settings.

Research: The goal of this post-doctoral program is to cultivate women's health researchers to develop careers that will contribute to the VA's core mission of delivering high quality, equitable care to women Veterans. Individualized, mentored research and clinical training (if appropriate) is combined with a curriculum that emphasizes research methods, statistics, epidemiology, quality improvement methods, education, and service delivery.

Research Foci: Disparities in women's healthcare; Sexual and reproductive health care and outcomes; Women's healthcare service delivery; Patient-centered outcomes research.

Location: VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA

Academic Affiliations: University of California San Diego (UCSD)

Fellowship Site Focus or Goals: Provide interdisciplinary training to prepare fellows as independent women's healthcare specialists. Specific goals include: providing clinical training experiences that will teach fellows to provide coordinated comprehensive and evidence-based clinical care for women Veterans; applying a scientist-practitioner training model; and providing mentored teaching and leadership experiences to impart skills and knowledge that will allow the fellows to serve as advocates, educators and mentors in the field of women's health within the VA system.

Research Foci: Military Sexual Trauma (MST), Interpersonal Trauma (IPT), Trauma-Related Guilt and Shame, Suicidality, Emotion Dysregulation/Distress Intolerance, Treatment Outcome Predictors and Women's Health education and the Patient Aligned Care Team (patient-centered medical home) and their impact on team functioning and efficiency (e.g., metabolic function, weight), Couple therapy, Psychedelic-assisted therapy.

Fellowship Related Links: Clinical Psychology Research Postdoctoral Residency Program at San Diego.

Directors: Dr. Julie Kangas (Julie.Kangas@va.gov) and Dr. Karuna Ahuja (Karuna.Ahuja@va.gov)

Research Projects: All fellows complete a research project with evaluation by a mentorship team. Recent projects include peer-support suicide prevention for LGBTQ+ Veterans, psychedelic-assisted couples therapy, and diabetes management.

Education and Leadership Training: Fellows attend local and national seminars covering the state of the art women's health research and practice, professional development, and advanced topics relevant to the fellows' individualized training plan. Fellows are trained in and expected to contribute to program administration through participation on the Women's Health Committee, local outreach and performance improvement activities, and/or dissemination of women's health information to staff and trainees through in-service seminars.

Clinical Activities: Clinical psychology fellows can choose clinical rotations that best meet their individual training goals. Recent clinical placements have been in LGBTQ+ Clinic, Behavioral Medicine, Eating Disorders treatment team, and Family Mental Health Program. IM fellows provide comprehensive care in the Primary Care Clinic and one or more specialty care clinics—Gynecology, Musculoskeletal, and Weight Control Clinic at the VASDHS, or the Women's HIV Clinic, Women's Cardiology Clinic, Breast Clinic and Gynecology Specialty Clinics at UCSD.

Location: San Francisco VA Medical Center (SFVAMC), 4150 Clement Street San Francisco, CA 94121

Academic Affiliations: University of California, San Francisco (UCSF)

Fellowship Site Goals: To provide outstanding, focused, structured, mentored and nurturing training for clinicians and health professionals across disciplines who are committed to becoming leaders in the health issues of women Veterans and to pursuing a career in Women's Health at a VA, university or in public health. The individually tailored training and mentoring attends to scientific and clinical progress, career strategy and life balance issues for fellows. Opportunities exist for fellows to complete various course offerings including NIH-supported UCSF Advanced Training in Clinical Research and Masters in Clinical Research.

Research Foci: menopause, urinary incontinence, PTSD, depression, substance abuse, clinical education, cardiovascular disease, osteoporosis, aging, breast cancer, sleep gastric bypass, microbiome, psychoneuroendocrinology, psychoneuroimmunology

Directors: Dr. Karla Kerlikowski (Karla.Kerlikowske@va.gov) and Dr. Sabra Inslicht (Sabra.Inslicht@va.gov)

Research Projects: Dr. Karla Kerlikowske is Co-PI of a program project grant "Risk-based Breast Cancer Screening in Community Settings" that involves creating and evaluating new risk models and their association with breast imaging performance in clinical practice in 2 million women across the United States. Dr. Sabra Inslicht, the primary mentor for the site's Women's Health fellows with doctorates in psychology, is PI of a study examining sex differences in fear conditioning in PTSD. She also has research funding to study sex-specific hormones, neuropeptides, and metabolomic markers of HPA axis and sleep impairments in PTSD. Dr. Shira Maguen is PI of a grant examining eating behaviors in female Veterans with trauma exposure.

Clinical Activities: In addition to research and academic career training, fellows spend 25% of their time in the Women's Health Clinic. An array of clinical experiences are available to meet the training needs of each fellow. For psychologists, the requisite clinical supervision is provided. The San Francisco Women's Clinic has incorporated University of California-San Francisco obstetrics and gynecology residents in their clinic to enhance teaching of women's health to medical residents.

Community: The San Francisco VA Medical Center is affiliated with UCSF, one of the top ranked medical schools in the country. In addition to its broader commitment to the veteran population and education, SFVAHCS has the largest funded research program in the Veterans Health Administration with more than $87 million in annual research expenditures. Our Medical Center is the top-ranked VA Medical Center in terms of research grants.

Location: VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516

Academic Affiliations: Yale School of Medicine, VA Central Office

Fellowship Goal: To provide an outstanding training program that will contribute to the improvement of clinical practice by educating Comprehensive Women's Health Clinicians who are truly expert in the care of women Veterans who will also be able to contribute to the scholarly pursuit of women's health research and policy development.

Research Foci: Gender disparities in cost, utilization and medical and mental health outcomes after combat exposure in Iraq and Afghanistan (The Women Veterans Cohort Study); medical informatics; chronic pain in women Veterans; the overlap of trauma and pain, gender disparities in cardiovascular risk and outcomes; implementation of comprehensive women's health in the Veteran's Health Administration.

Directors: Dr. Sally Haskell (Sally.Haskell@va.gov), Dr. Mary Driscoll (Mary.Driscoll3@va.gov), and Dr. Cindy Brandt (Cynthia.Brandt@va.gov)

Research Projects:

1. Women Veterans Cohort Study II (WVCS) is a longitudinal study of returning male and female OEF/OIF Veterans designed to examine gender disparities in healthcare utilization and outcomes.
2. Veterans Aging Cohort Study (VACS) is an observational study that compares HIV positive and negative Veterans in care to better understand how outside forces, such as alcohol use, smoking, and other diseases and infections, can influence people living with HIV.

Clinical Activities, Education, Training and Health Policy: In addition to research and academic career training, fellows spend 25% of their time in the VA Women's Health Clinic. An array of clinical experiences are available to meet the training needs of each fellow. For psychologists, the requisite clinical supervision is provided.

Fellows participate in a Comprehensive Women's Clinic that provides Primary Care to women Veterans with co-located Gynecology and Mental Health Services with opportunities for teaching and direct patient care. The research training curriculum is provided by Yale University. Fellows may participate in health policy or quality-related projects through VA Central Office of Women's Health Services.

Overview of VA Connecticut Healthcare System (VACHS): VACHS consists of an integrated system of healthcare delivery encompassing the full range of ambulatory care services as well as a tertiary care inpatient facility at its West Haven campus, Primary Care Centers of Excellence at the Newington and West Haven campuses, six Community Based Outpatient Clinics, three Veterans Outreach Centers, and a recovery-oriented community Care Center. Representative specialty care accessible within the VACHS includes intensive care units, neurology inpatient and outpatient services, comprehensive mental health services, rehabilitation medicine, hospice and palliative medicine, and specialized services for specific clinical problems.

Overview of Pain Research, Informatics, Multimorbidities, and Education Center of Innovation: VACHS is home to the Health Services Research & Development (HSR&D) funded PRIME Center. PRIME is one of 19 HSR&D Centers of Innovation (COIN), and it is the only Center with targeted research in pain, women's health, and LGBTQ+ health. The PRIME Center provides expert professional, scientific, and biostatistical support through its five Cores:

1. Education, Dissemination & Implementation (Steve Martino, PhD; Director);
2. Medical Informatics (Cynthia Brandt, MD; Director);
3. Methodology and Biostatics (Joseph Goulet, PhD; Director);
4. Qualitative (Kristin Mattocks, PhD; Director), and
5. Administration and Coordination (Alicia Heapy, PhD; Director)

As part of its mission statement, the PRIME Center of Innovation is committed to assisting junior investigators performing health services research within and outside the areas of pain, women's health, and LGBTQ+ health, and fostering collaborations within and across VA facilities.

Overview of Intimate Partner Violence Center for Innovation and Research (IPV-CIR): Located in, and supported by, the PRIME Center at VACHS, the goal of the IPV-CIR is to develop, disseminate, implement, and evaluate innovative, high-quality, veteran-centered, trauma-informed, and recovery-oriented practices for intimate partner violence (IPV) detection, prevention, and treatment.

Overview of Women's Health Services at VACHS: VA Connecticut has had a Comprehensive Women's Health Center since 1997. This is a separate clinic, located in a private, newly renovated area on the 7th floor, where women Veterans receive team-based primary care from designated women's health primary care providers and a women's health patient aligned care team (PACT) staff, with co-located mental health and gynecology services. Fellows typically provide clinical care in this space, though arrangements can be made in other clinics throughout the hospital as time and space permit.