ABSTRACT
SETTING AND PARTICIPANTS: Over 400 VA primary care providers (PCPs) attending one of three virtual Women's Health Mini-Residencies (WHMR) held during the summer of 2021 DESCRIPTION: The VA WH-MR is a three-day faculty development conference aimed at ensuring VA PCPs have the clinical knowledge needed to provide gender-specific care to women Veterans. The face-to-face (F2F) program incorporates both large-group didactic, small group case-based discussion sessions, and hands-on breast and pelvic clinical skills. The WHMR has been shown to improve provider comfort with gender specific care and has been associated with improved PCP retention. Secondary to the COVID19 pandemic, the WH-MR was converted to virtual program (VP) utilizing a flipped classroom model in which providers watched recorded didactic lectures prior to attending 4 half-day virtual conference sessions. Each half-day session began with a recap of key material, followed by small group case-based discussions sessions. Clinical instruction on the breast and pelvic exams were reviewed using video presentations. The WH-MR was presented in the VP format 3 times during the summer of 2021. EVALUATION: Similar to the traditional F2F conference, the VP was evaluated using an immediate post survey to assess participants' self-reported acquisition of new knowledge and skills and satisfaction. When comparing 2019 F2F data with that from the VP, we found that average scores were acceptably high, but uniformly lower. This was particularly true for subject matter related to physical exam skills: breast and pelvic exam 4.64 vs 4.36, F2F program vs VP respectively. A similar trend was noted in satisfaction scores when comparing F2F and VP data: overall satisfaction 4.72 vs 4.41 and training environment was effective 4.66 vs 4.20. Within free-text responses on VP evaluations, providers indicated their preference for F2F learning for many reasons including: 1) frequent interruptions as a result of clinical demands, 2) timing challenges related to dissemination across multiple times zones, and 3) the desire for hands on training DISCUSSION / REFLECTION / LESSONS LEARNED: As we emerge from the COVID-19 pandemic, there will be questions about how best to optimize and deliver clinical training. While virtual learning does provide benefits, including reduced cost and easier access, F2F education appears preferable for skills-based training. Additionally, F2F conferences allow for opportunities to network and build community, which are thought to attribute to improved job satisfaction and reduced attrition. Regardless of the modality, it is critical to ensure that attendees have dedicated time away for clinical demands so that they can fully engage in the training. Though virtual learning will have a place after the pandemic remits, it will be up to the medical education community to use our collective experiences to help determine when F2F versus virtual learning environments are most appropriate.
ABSTRACT
SETTING AND PARTICIPANTS: 106 VA primary care providers (PCPs) attending a virtual Women's Health Mini- Residency (WH-MR) programs during the summer of 2021. DESCRIPTION: The VA WH-MR is a three-day faculty development conference aimed at ensuring VA PCPs have the clinical knowledge they need to provide high quality gender-specific care to women Veterans. Secondary to the COVID-19 pandemic, the WH-MR was converted to a flipped virtual classroom model taking into consideration adult learning theory of spaced practice and knowledge application. Prior to attending the 4 half-day virtual conference, providers watched recorded didactic lectures. Each half-day session began with a recap of key material, followed by small group case-based discussions sessions for knowledge application. Clinical skills were reviewed using video presentations of the breast and pelvic exam. In past years, evaluation of the training was based on participant self- assessed comfort in managing the training topics and satisfaction with the training. This year we advanced to add knowledge-based assessments to assess higher Kirkpatrick level learning outcomes and that have a closer approximation to clinical significance. EVALUATION: To assess higher level learning outcomes, we piloted a 22- question knowledge-based assessment using a pre/post-evaluation. Seventy-six participants completed the pretest with 71 completing the posttest (response rate 93%). Most participants were physicians (48.7%) with the remainder being nurse practitioners and physician assistants. A large portion of participants in endorsed limited experience with women Veterans with 26.4% not currently caring for women Veterans and another 17.1% providing care to women Veterans for less than a year. 20 of the 22 questions demonstrated improvement in the percent correct from pre to post assessment with an average increase of 19.4%. DISCUSSION / REFLECTION / LESSONS LEARNED: This brief knowledge pilot demonstrated a consistent increase in clinical knowledge across all domains taught within the WH-MR, suggesting that this program improves participants knowledge with regards to gender specific care. This finding is particularly impressive given that many participants entered the training with a limited clinical experience in caring for women Veterans. It is notable that of the two questions that did not demonstrate an increase in knowledge on post-course evaluation data, neither topic was covered within a corresponding case discussion. These data, then, also demonstrates the importance of incorporating tenants of adult learning theory (e.g., spaced practice, opportunities for knowledge application) when developing and implementing continuing medical education efforts. Going forward, for both the WH-MR, and more broadly for any faculty development program, it will be important to ensure that application of best practices for adult learning in order to achieve a high-quality program that achieves its educational objectives.