1. Technology –Based Approaches to Competencies in Women’s Health in the VA Michael Stogsdill, PA-C Manager, Simulation Center Dayton VA Medical Valerie Fulmer Director, Standardized Patient Program Hollis Day, MD Associate Professor of Medicine Advanced Clinical Education Center University of Pittsburgh School of Medicine Rosalyn P. Scott, MD, MSHA Medical Director, Simulation Center Dayton VA Medical Center Professor of Surgery Boonshoft School of Medicine Professor of Biomedical, Industrial and Human Factors Engineering College of Engineering Wright State University

2. Women Represent 14.5 % of Active Duty military 18% of National Guard/Reserves 11.6% of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans 6% of VA health care users

3. Women Users of VA Care Have Doubled Since 2000

4. Enhancing Women's Health Competencies in VISN 10 Primary Care Providers Using Novel Computer- and Simulation-Based Educational Strategies VISN 10 has experienced an increase in the Women Veteran enrollees that has exceeded the national growth rate of approximately 5-6% per annum by almost 50%. A significant number of providers work in rural CBOC’s where convenient formal and curbside consultations are not readily available. This project was designed to provide educational experiences using a variety of unique strategies not previously available in the VA.

5. Revised VHA Handbook 1330.01: “VHA Services for Women Veterans” Outlines specific services at facilities and Community Based Outpatient Clinics (CBOCs) Defines “Comprehensive Primary Care for Women Veterans” Requires women be seen by Women’s Health Primary Care Providers Details safety and security requirements Establishes systematic data collection process Includes requirements for ongoing education

6. Educational Strategies Self-directed Online Training – Mini-Residency Lectures Mobile Simulation – Pelvic and Breast Task Trainers – Female Physiologic Mannequin Case Discussion via Teleconferences Standardized Patients – Motivational Interviewing (MI) Programs Virtual Patients – Reinforce MI scenarios

7. Training Sequence 6 monthly modules comprised of 3-4 online lectures and teleconference to summarize key lecture points and discuss cases. 3 simulation rotations with activities related to a lecture in each module – 2 modules/rotation 1 day face-to-face Motivational Interviewing Conference with SP’s Virtual patient cases to reinforce training

9. Delivering Training in a Mobile Unit

10. Pelvic and Breast Trainers Sensors record pressure and palpation of pelvic organs and breast masses. Pelvic palpation performance can be compared to novices and experts Interchangeable pathologies Immediate feedback helps guide learner to mastery

11. Female Mannequin Learners can integrate skills learned on task trainers with patient interaction and diagnosis Medical team can train together Evaluation includes – Interpersonal/Communication Skills – Preparation of Equipment – Examination – Professional Conduct – Patient Education – Processing of Specimens

12. Motivational Interviewing Program The goal of MI is to promote behavior change by eliciting and exploring the person’s own arguments for change and resolving his/her ambivalence Improving communication between primary care providers caring for predominantly male patients and women veterans Sensitive gender-specific topics: Urinary Incontinence, Sexual Dysfunction, Sexually Transmitted Infections, Military Sexual Trauma Added session and scenario on time management during the clinic visit

13. Early Outcomes Invited to apply for renewed funding for FY 13 from Office of Rural Health Network is interested in funding construction of a custom mobile simulation center Appointed Field Consultant to national Women’s Health Education Program Opportunity to use some of same strategies in Palliative Care training

14. Challenges How often should we provide this type of training to primary care provider teams? How best can these strategies be diffused? What is the role for self-guided vs. facilitated learning with task trainers? What role can simulation play in establishing competence for privileging?

15. Committed to Women Veterans Health Care she earned these. It’s our job to give her the best care anywhere.