Implementation experience and initial assessment of a rural women's health training program in support of the U.S. Department of Veterans Affairs as a learning health system

Introduction: 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. Methods: 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). Results: 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-followup survey were completed by 52 PCPs (32.9%) and 93 nurses (32.2%) and revealed significant sustained improvements in 18 out of 22 KAPS (p < 0.01-0.03) areas assessed for PCPs and all 17 KAPS (p < 0.01) areas assessed for nurses. Conclusions: 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.