Highlights
COVID-19 disrupted VA training experiences by reducing in-person clinical exposure, limiting procedural and bedside learning, and increasing concerns about infection risk and personal safety.
Despite these constraints, health professions trainees were perceived as important contributors to the VA pandemic response, including direct clinical care, telehealth implementation, patient communication, and workforce support.
The study suggests that trainees should be considered operational assets, not only learners, in future emergency preparedness planning across integrated health systems.
The findings also underscore a central tension in medical education during crises: protecting trainees while preserving educational quality and leveraging their skills in service delivery.
Background
The COVID-19 pandemic forced health systems to make rapid changes in staffing, patient flow, infection prevention, outpatient access, and use of telehealth. Academic and teaching environments were especially affected because they had to balance service needs with supervision, trainee safety, and educational continuity. The US Department of Veterans Affairs is one of the largest training environments in the country, supporting substantial numbers of medical, nursing, and allied health learners across its national care network. Because trainees are deeply embedded in daily patient care and quality improvement activities, changes to their participation have implications not only for education, but also for workforce capacity and care delivery.
During the early pandemic period, many institutions restricted trainee involvement in face-to-face care, especially in high-risk settings, to preserve personal protective equipment, reduce exposure, and simplify staffing models. At the same time, the pandemic accelerated virtual care, reorganized inpatient and ambulatory workflows, and created new demands for patient outreach, emotional support, and health communication. In this context, understanding how trainees were affected and how they contributed becomes important for both medical education policy and health-system resilience.
The present study by Kawentel and colleagues addresses that question within the VA system. Rather than measuring educational outcomes quantitatively, the investigators used qualitative methods to capture the experiences of trainees, service chiefs, and educational leaders across selected VA sites. This design is well suited to examining a complex, system-level phenomenon in which perceptions, local practices, and rapidly changing policies all shape what happened on the ground.
Study Design and Methods
Design
This was a qualitative study using semi-structured interviews conducted in 2021. The investigators applied descriptive content analysis to identify recurring themes related to the influence of COVID-19 on VA health professions trainees and the contributions of trainees to the VA response.
Setting and Participants
Using stratified sampling, the research team selected 10 VA medical sites. From these sites, 83 participants were purposefully sampled across three stakeholder groups: health professions trainees at different levels of training and from three disciplines, service chiefs representing the disciplines in which trainees were embedded, and educational leadership. This sampling approach appears intended to capture variation across role, hierarchy, and local operational context rather than to produce statistical representativeness.
Approach
Semi-structured interviews allow investigators to ask common core questions while still probing local details and unanticipated themes. In a topic such as pandemic-era training, where institutional responses varied substantially across time and site, this flexibility is a methodological strength. Descriptive content analysis is also appropriate when the goal is pragmatic interpretation of experiences and operational lessons rather than development of a new theory.
As with most qualitative studies, however, the findings should be interpreted as explanatory and hypothesis-generating. They illuminate what participants observed and how they made sense of events, but they do not quantify the frequency of each experience across the entire VA system.
Key Findings
1. Training opportunities were reduced, especially for in-person and experiential learning
A dominant theme was that COVID-19 reduced learning opportunities for trainees. This is unsurprising but still important. Clinical education depends heavily on in-person patient contact, bedside interaction, procedural exposure, immediate feedback, and participation in team-based care. Pandemic restrictions disrupted each of these elements. Depending on specialty and site, trainees likely encountered fewer face-to-face visits, less exposure to routine patient volumes, fewer elective procedures, and modified rounding structures. These changes may have been especially consequential for early-stage trainees and for disciplines in which skill acquisition depends on repeated real-world encounters.
The educational losses described in the study should not be viewed only as temporary inconvenience. In competency-based training, missed clinical experiences can affect confidence, autonomy, professional identity formation, and readiness for later responsibilities. Although many programs adapted with virtual teaching and alternative supervision models, the study suggests that these substitutions did not fully replace direct clinical learning.
2. Safety concerns were a major part of the trainee experience
Trainees reported increased safety concerns related to COVID-19 during their VA placements. These concerns likely included risk of infection, uncertainty about protocols, fear of transmitting infection to family members, and anxiety about being asked to work in settings with rapidly evolving guidance. Such concerns were common across healthcare workforces during the pandemic, but trainees occupy a particularly vulnerable position. They are both learners and workers, often with less control over their schedules and assignments than attending clinicians.
Safety concerns can also alter educational engagement. A trainee who feels physically unsafe or insufficiently informed may participate less fully in clinical tasks, defer bedside encounters, or experience heightened stress that impairs learning. These findings reinforce the importance of transparent communication, access to protective equipment, psychological support, and clear expectations during public health emergencies.
3. Trainees made tangible contributions to direct clinical care
Although training was constrained, participants across groups viewed trainees as making meaningful contributions to clinical care. This is a central finding of the paper. It challenges a simplistic narrative that trainees were merely educational casualties of the pandemic. Instead, trainees appear to have functioned as a flexible and valuable component of the care team, helping meet patient needs during a period of intense operational strain.
The article’s abstract does not provide discipline-specific examples or quantitative estimates of workload contribution, but the qualitative conclusion is clear: trainees were not peripheral observers. They participated in care delivery in ways that mattered to services and to veterans.
4. Trainees supported the VA’s rapid transition to telehealth
One of the most notable contributions identified was support for telehealth. Across healthcare systems, COVID-19 caused a major acceleration in remote care, often compressing years of digital implementation into a few weeks or months. Trainees may have been especially useful in this transition because they were adaptable, comfortable with digital tools, and able to assist with logistics, patient onboarding, virtual workflow redesign, and direct telehealth encounters under supervision.
This finding has broader relevance beyond the VA. Telehealth is no longer simply an emergency workaround; it has become a durable feature of ambulatory care. Training programs that teach virtual communication, remote assessment, digital professionalism, and technology-enabled care coordination are therefore addressing a lasting competency domain. The study suggests that trainees were not only learners in telehealth but active agents in making it operational.
5. Trainees provided informational and emotional support to veterans
Another important theme was the role of trainees in providing informational and emotional support to veterans. During the pandemic, patients often faced uncertainty, isolation, reduced access to loved ones, changing public health advice, and interruptions in routine care. Trainees can be particularly effective in communication-intensive roles because they often have more protected time for patient contact and may bring a fresh, relationship-centered approach to care.
In veteran populations, this contribution may be especially meaningful given the high burden of chronic illness, mental health conditions, and social vulnerability in some patient groups. Clear communication and emotional support can improve trust, continuity, and adherence, even when diagnostic or treatment options are constrained by crisis conditions.
6. Trainees contributed to planning, decision-making, and team culture
Participants also described trainees as contributing to COVID planning and decision-making and helping foster a positive work environment. This broadens the concept of trainee value beyond service throughput. In emergencies, local problem-solving depends on people who can identify workflow bottlenecks, generate practical solutions, and maintain team morale. Trainees, because they move across settings and often see systems from both frontline and educational perspectives, may notice gaps that more senior staff overlook.
The observation that trainees helped sustain a positive work environment is particularly worth noting. Pandemic care was emotionally exhausting, and team culture influenced burnout, adaptability, and retention. Even informal contributions such as collegiality, shared purpose, and willingness to help can have real operational effects during prolonged stress.
Clinical and Operational Interpretation
The study’s most useful message for clinicians and health-system leaders is that trainees should not be framed only as individuals in need of protection from service demands. They are indeed learners whose safety and educational needs require careful stewardship, but they are also a trained workforce segment capable of supporting care delivery in multiple domains. The challenge for future emergencies is to operationalize both realities at once.
This means that preparedness planning should include explicit roles for trainees, rather than excluding them by default or incorporating them ad hoc. Such plans might define tiered clinical responsibilities based on training level, outline supervision standards for telehealth and remote work, specify communication channels for rapid policy updates, and create mechanisms for redeploying trainees without undermining competency progression. Preparedness should also include safeguards: personal protective equipment access, psychological support, infection-risk education, and processes for raising concerns without fear of reprisal.
The findings are also relevant to debates about workforce capacity. In integrated systems like the VA, trainees can amplify reach in patient communication, virtual care, follow-up, and coordination tasks that are essential during disruptions but often under-resourced. Building these functions into emergency plans could improve system resilience while preserving educational value.
Strengths of the Study
The study has several strengths. First, it addresses an understudied but operationally important population within the pandemic response: health professions trainees in a large federal healthcare system. Second, it incorporates perspectives from multiple stakeholder groups rather than relying on trainees alone. This triangulation strengthens credibility because it allows convergence between learner experiences and leadership perceptions. Third, the multisite design improves contextual breadth and reduces the risk that findings reflect a single institution’s unique practices.
Finally, the focus on both harms and contributions is a conceptual strength. Much of the pandemic-era literature has emphasized educational disruption, burnout, or moral distress. Those issues are essential, but this study adds a more balanced systems perspective by documenting how trainees also added value.
Limitations
Several limitations should temper interpretation. As a qualitative study, the findings cannot establish prevalence or magnitude. The sample of 83 participants across 10 sites is appropriate for thematic analysis but not for system-wide quantification. Experiences may also have varied by discipline, site leadership, local pandemic severity, and timing within 2021, but the abstract does not provide enough granularity to determine which themes were most common in which settings.
Purposeful sampling introduces the possibility that participants with particularly strong experiences, positive or negative, were more likely to be included or more likely to speak extensively about them. In addition, interview-based studies are subject to recall bias and retrospective interpretation. Participants may reconstruct events in ways shaped by later experiences or institutional narratives.
Generalizability is another issue. The VA is a distinctive healthcare environment with integrated infrastructure, a veteran patient population, and a longstanding educational mission. Findings may not translate directly to community hospitals or fragmented outpatient systems. Even so, the core themes are likely broadly relevant to academic health systems and large public-sector networks.
Relationship to the Broader Literature
The findings align with broader literature showing that the pandemic disrupted clinical education while accelerating adoption of virtual care. Reports from medical, nursing, and allied health training programs have documented reduced bedside exposure, cancellation of elective rotations, concerns about preparedness, and increased reliance on simulation and online teaching. At the same time, many programs found that trainees contributed through telemedicine, patient outreach, triage, public health communication, and quality improvement. The present VA study fits well within that pattern, while adding the distinctive perspective of a national integrated health system.
The study also resonates with literature on healthcare worker well-being during COVID-19. Safety concerns, uncertainty, and rapidly changing expectations were common sources of distress. Trainees often experienced these pressures while navigating assessment requirements and disrupted career progression. The implication is that emergency planning for education cannot be separated from occupational well-being planning.
Implications for Practice and Policy
For VA and other integrated systems
Emergency response plans should explicitly include trainee deployment models, supervision structures, and communication strategies. Health systems should identify which trainee activities are educationally rich and operationally valuable, particularly in telehealth, follow-up communication, and interdisciplinary care coordination.
For training programs
Programs should treat telehealth competency as a core educational domain, not a temporary adaptation. Curricula should include virtual interviewing, remote physical assessment limits, documentation standards, patient technology troubleshooting, and equitable access issues.
For trainee well-being
Programs and clinical sites should ensure clear safety guidance, access to protective resources, and mental health support. During crises, uncertainty can be as damaging as workload; consistent communication from leadership is therefore essential.
For research
Future studies should link qualitative insights with quantitative outcomes, such as effects on competency attainment, patient access, telehealth performance, burnout, and retention. Comparative analyses across disciplines and training levels would help clarify where trainees add the most value and where educational loss is most severe.
Conclusion
Kawentel and colleagues provide an important account of how COVID-19 affected VA health professions trainees and how those trainees, in turn, supported the VA response. The pandemic reduced learning opportunities and heightened safety concerns, confirming the vulnerability of training pathways during health emergencies. Yet the study also shows that trainees were far from passive recipients of disruption. They contributed to direct care, facilitated telehealth adoption, supported veterans emotionally and informationally, participated in planning, and strengthened team functioning.
For clinicians, educators, and health-system leaders, the practical lesson is straightforward: trainees should be incorporated into emergency preparedness as both learners and contributors. Protecting educational quality and trainee safety remains essential, but doing so should not obscure the real operational and human value that trainees can bring during crises. In the next public health emergency, systems that plan for this dual role will likely be better positioned to sustain both care delivery and workforce development.
Funding and Trial Registration
NIH trial registry number: Not applicable.
Funding details were not provided in the abstract.
Citation
Kawentel LM, Vitous CA, Nelson SM, Yahya GM, Doredla JS, Sanders K, Bowersox NW. COVID-19 and VA Medical Education Training Programs: Influence on Trainees and Contributions of Trainees to VA’s Pandemic Response. Journal of General Internal Medicine. 2026-05-27. PMID: 42204053. Available at: https://pubmed.ncbi.nlm.nih.gov/42204053/
