Table 2.

Training Elements Reported as Not Provided or Inadequate to Prepare MSAs for Their Role

Training needs	Illustrative excerpts from interview notes
Reported by Call Center and PC MSAs
On-the-job, hands-on, or in-person training	MSA would have rather had on the job training than 3 days in the classroom. —Notes from PC MSA interview
Training from people with clinical or primary care experience	It’s important to get trained by someone from the department you’re going into. A lot of MSAs coming in get trained by someone with no PC experience. —Notes from PC MSA interview
Training centered around communication and listening skills	MSA didn’t get training on the back and forth [with patients]. It’s not mentioned at all and makes the calls longer. There should be training on communication and listening skills. —Notes from CC MSA interview
Reported by PC MSAs only
Longer duration of training	It’s intimidating for new people. MSAs have to have their A-game when dealing with patients in person. They should extend the training. —Notes from PC MSA interview
Training tailored specifically for MSA leads	There is a lack of training for leads. They are trying to create that now, but this is an idea that they had in the past and tried to do but haven’t succeeded. —Notes from PC MSA interview
Reported by call center MSAs only
Training on how to handle or deescalate stressful calls	MSA has not been trained to handle angry patients. It’s difficult to deal with these patients, hard to calm them down, hard not to raise your voice. Some MSAs hang up if Vets are too difficult or yelling at them. —Notes from CC MSA interview
Training on mental health issues/mental health education	There needs to be more training face-to-face for mental health. There are a lot of Vets with PTSD and there are a lot of scenarios, like learning how to say the right thing. —Notes from CC MSA interview

CC, call center