Sanders Aimee M, Golden Rachel E, Kolehmainen Christine, Brenton Jonna K, Frayne Susan M
U.S. Department of Veterans Affairs Office of Women's Health Washington District of Columbia USA.
VA HSR&D Center for Innovation to Implementation (Ci2i) U.S. Department of Veterans Affairs, Palo Alto Health Care System Palo Alto California USA.
Learn Health Syst. 2022 Aug 24;6(4):e10334. doi: 10.1002/lrh2.10334. eCollection 2022 Oct.
The increasing number of women Veterans receiving health care from the Veterans Health Administration (VHA) has spurred the need for more women's health primary care providers (PCPs) and nurses, including in rural areas nationwide. Here we report on the implementation of a women's health rural workforce training program, demonstrate initial evidence of its effectiveness within VHA as a Learning Health System, and present lessons learned and implications for other workforce training programs.
The Women's Health Primary Care Mini-Residency for Rural Providers and Nurses (Rural WH-MR) is a mobile VHA training initiative adapted from a national training model. The Rural WH-MR uses asynchronous blended learning paired with in-person hands-on instruction delivered directly at rural VHA sites. Mixed methods evaluation using quantitative data, qualitative interviews, and observational feedback assessed the program's implementation feasibility, fidelity, acceptability, and appropriateness. Longitudinal survey data were used to assess the initial program impact via changes in participating PCP and nurse knowledge, attitudes, practices, and skills (KAPS).
Inclusive of the pilot and fiscal years 2018 and 2019 Rural WH-MR trainings, 181 PCPs, and 320 nurses were trained through 56 training events nationwide. Cumulative survey data using 5-point measures showed high participant satisfaction, achievement of program-specific objectives, and usefulness of training activities to the rural practice of both PCPs and nurses. Both a pre-training and 6-month-follow-up survey were completed by 52 PCPs (32.9%) and 93 nurses (32.2%) and revealed significant sustained improvements in 18 out of 22 KAPS ( < 0.01-0.03) areas assessed for PCPs and all 17 KAPS ( < 0.01) areas assessed for nurses.
This adapted training program benefitted VHA's rural clinical workforce thereby contributing to the VHA goal of increasing the numbers of rural women Veterans with access to PCPs and nurses with women's health expertise.
从退伍军人健康管理局（VHA）接受医疗保健服务的女性退伍军人数量不断增加，这促使全国范围内，尤其是农村地区，需要更多的女性健康初级保健提供者（PCP）和护士。在此，我们报告一项女性健康农村劳动力培训计划的实施情况，展示其在VHA作为一个学习型健康系统内有效性的初步证据，并介绍所汲取的经验教训以及对其他劳动力培训计划的启示。
面向农村提供者和护士的女性健康初级保健微型住院医师培训项目（农村WH-MR）是一项从全国培训模式改编而来的VHA移动培训计划。农村WH-MR采用异步混合学习，并在农村VHA站点直接提供面对面的实践指导。使用定量数据、定性访谈和观察反馈的混合方法评估该计划的实施可行性、保真度、可接受性和适宜性。纵向调查数据用于通过参与培训的PCP和护士的知识、态度、实践和技能（KAPS）变化来评估该计划的初步影响。
包括试点年以及2018年和2019财年的农村WH-MR培训，通过全国范围内的56次培训活动，共培训了181名PCP和320名护士。使用5分制的累积调查数据显示，参与者满意度高，实现了特定计划目标，且培训活动对PCP和护士的农村实践有用。52名PCP（32.9%）和93名护士（32.2%）完成了培训前和6个月随访调查，结果显示，在为PCP评估 的22个KAPS领域中的18个（<0.01 - 0.03）以及为护士评估的所有17个KAPS领域（<0.01）中，均有显著的持续改善。
这个经过改编的培训计划使VHA的农村临床劳动力受益，从而有助于实现VHA的目标，即增加能够接触到具备女性健康专业知识的PCP和护士的农村女性退伍军人数量。
