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

The major question, namely, whether clinical skills could be taught via distance education, was pivotal. As a result, it was decided that the program would begin by pilot-testing the Basic and Advanced Health Assessment course, referred to as Phase I. The course would be taught using synchronous (live) video teleconferencing. Continuation of the program, Phase II, would be contingent upon a positive evaluation of the course and successful skill attainment by students. The project directors were a USU professor with extensive experience in technology, who would oversee curriculum implementation, and a VA project director (the author) from the NSHG, who would guide administrative implementation and act as liaison to the VA staff.

Two medical centers participated in Phase I. Each had a need for nurse practitioners and one had advanced-practice nurses being displaced through reorganization of inpatient activities. Eleven master's degree-prepared clinical nurse specialists, including one active duty Army nurse, took part in the Phase I instruction. Class content was presented through a weekly 2-hour lecture, followed by a 1-hour laboratory experience supervised by a preceptor at the hospital site. Students also took part in defined clinical activities at the medical centers, as structured by the clinical preceptor. The clinical support system designed for Phase I was key to the pilot program. The VA project director selected sites with experienced clinicians who were committed to serving as student preceptors and ambulatory care managers who were committed to using nurse practitioners.

The purpose of Phase I was to develop and evaluate technical capabilities and teaching strategies and to identify the most appropriate and compatible media for teaching via teleconferencing techniques. The success of Phase I led to the decision to implement the full curriculum or Phase II, which was initiated in autumn 1997 at 10 VA facilities.

When implemented, the Adult Nurse Practitioner Program was an 8-course, 28-credit program with 560 hours of clinical practice, based on the National Organization of Nurse Practitioner Faculty guidelines. Designed to accommodate working nurses, it was taught over a 20-month period, with all classes scheduled from 4:30 to 6:30 p.m. Eastern Time, after working hours for most participants.

Technology

Successful distance education requires superior technology. Research has shown that students are distracted and frustrated by poor technology that is inadequate to support course content and presentation. Furthermore, technology failures can quickly lead to student dropout.

During Phase I, classes originated from an electronic classroom in the National Naval Medical Center. In this classroom, as the instructor taught, a technician controlled all incoming and outgoing transmissions. VA nurses were located in electronic classrooms that were equipped with video teleconferencing dial-up equipment, television monitors, and "smart" cameras that adjusted angle and focus on the basis of sound. The program used synchronous video teleconferencing that was dialed through the VA National Telephone Service (VANTS). Before Phase II implementation, several computer and educational technologies were immediately required to ensure the success of the project. Requirements included an upgrade of the file server at the VANTS hub in Martinsburg, West Virginia; establishment of a video teleconferencing unit at USU; and confirmation of video conferencing capabilities at each site. All required steps were accomplished.