Lessons Learned: A Successful Distance Learning Collaborative between the Department of Veterans Affairs and the Department of Defense

Military Medicine, May 2005 by Beason, Charlotte F

Academic, business, and government organizations are increasingly looking to distance education to meet workforce learning needs. This modality differs from classroom education, however, and simply transferring content from a traditional classroom to a distance learning application can result in poor outcomes. The Department of Veterans Affairs and the Uniformed Services University of the Health Sciences Graduate School of Nursing implemented a program preparing adult nurse practitioners solely through the medium of distance education, with no university "in-residence" requirement. Lessons learned from this success can prove useful to organizations that are planning distance education initiatives.

Introduction

With its variety of resources, the geographical dispersion of its workforce, and the rich diversity of clinical and research expertise in federal medicine, distance modalities can be used as the approach of choice for training and education. Distance education, as used here, refers to the application of electronic technology to teaching and learning. It also includes any educational activity in which students are separated from faculty and peers.1 Distance education affords flexible opportunities to quickly target groups in any geographical location and has the ability to access subject matter experts from across the country, exposing students to diverse opinions, theories, and applications of knowledge.2 One of the earliest and arguably one of the most successful distance learning programs for health care education was the Department of Veterans Affairs (VA)/ Department of Defense (DoD) Post-Master's Certificate Program for Adult Nurse Practitioners. The lessons learned from this program offer valuable data to public and private sector managers who are planning distance education initiatives.

Background

In 1997, the VA and the DoD entered into a unique educational collaboration that resulted in the development of a national first, a clinical nursing curriculum taught entirely through distance education but equal in academic rigor and clinical intensity to the traditional, campus-based program at the Uniformed Services University of the Health Sciences (USU) Graduate School of Nursing (GSN). Even today, few schools offer clinical degrees taught solely through the medium of distance education.

The impetus for the program came from the VA's radical reorganization from an inpatient health care system to one based on primary care, with an emphasis on ambulatory care delivery. This shift created the need for a projected 200% increase in the number of primary care providers employed by the VA. Nurse practitioners would figure prominently in the VA's new care scheme, and securing additional nurse practitioners would be critical to the success of this organizational transformation.

At the same time, VA Headquarters' Nursing Strategic Healthcare Group (NSHG) was aware that a shortage of nurse practitioners existed nationwide. VA facilities reported difficulties in hiring these nurses and reported that local nurse practitioner programs frequently had lengthy admission waiting lists. VA nurse executives also began to note that the reorganization to primary and ambulatory care was resulting in certain clinical nurse specialists and other advanced-practice nurses being displaced from their inpatient practice; not all of these nurses had the skills to move to primary care assignments. Faced with these facts, the NSHG determined that one approach for increasing the number of nurse practitioners would be to educate existing clinical nurse specialists as nurse practitioners through a postmaster's certificate program. Because the nurses were located across the country and local nurse practitioner programs could not admit all qualified students who applied, a distance learning program seemed to be an ideal approach.

The natural partner for this VA nursing initiative was the USU GSN, which already sponsored an accredited, successful, family nurse practitioner program. The VA's proposal for an adult nurse practitioner program was greeted enthusiastically by Dean Faye Glenn Abdellah and the faculty of the GSN, and they approached the challenge of designing an additional curriculum and providing it through a new medium with keen interest.

Curriculum Design

Concluding that existing curricula or lesson plans can simply be transferred to a distance modality can lead to cost inefficiencies and high levels of dissatisfaction among students. The GSN dean and faculty were well aware that, although they could use existing courses as a foundation, the design and implementation of the new curriculum must be specific to distance transmission. Faculty members would also be challenged to initiate and sustain communication that transmitted content while stimulating student participation.3

The new program design began with a myriad of questions, Can clinical skills be taught via distance technology? How can safe practice be ensured? Many more questions were also posed. From the beginning, there were skeptics, individuals certain that clinical skills could never be taught in any setting other than a traditional classroom.