In the late 1990s VA leadership recognized that the VA health system possessed a confluence of organizational assets that provided an appropriate setting for a training program for physicians for improvement of the quality and value of care. These assets included a national health system focused on improvement and safety, an extensive array of academic affiliations with most of 5 the nation's medical schools, and an administrative structure that was authorized to develop formal special learning opportunities. After negotiations with colleagues at The Dartmouth Institute (formerly Center for the Evaluative Clinical Sciences) at Dartmouth Medical School a plan was developed for a two-year post-residency fellowship in the improvement of health care, the VA National Quality Scholars Program (VAQS).

The VAQS Program is designed using a 'hub and spokes' model. The program center (hub) is Dartmouth Medical School. Faculty at Dartmouth run the program and work in direct partnership with the VA Office of Academic Affiliations, which oversees all Special Fellowship Programs in VA. There are six sites (spokes) in different geographic locations across the United States. Each site is located at a VA medical center and partnered with an academic medical center and university. Sites function independently. Each site is directed by a Senior Scholar, an accomplished academic physician with experience in mentoring and research in health care quality. Mentoring is a critical part of the program and Senior Scholars view each fellow as an individual with unique needs. The Senior Scholars' approach is designed to nurture each fellow to develop a career whether in research in quality improvement and health services or in quality improvement practice within the framework or a position in medical administration or clinical practice.