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

Because this was a national program, faculty members consistently reviewed content and, if necessary, made modifications to remain consistent with clinical practice and to satisfy nurse practitioner curricular guidelines for the various states. Faculty members also made ongoing use of student feedback. Not all innovations received positive reviews, however. During one semester, pathophysiology was taught by using a series of videotapes that students viewed independently, followed by discussion with faculty members. Students found this approach unsatisfactory, and the practice was not used with subsequent groups.

Use of Human Simulated Patients

In April 2000, USU opened the National Capital Area Medical Simulation Center, a center housing virtual-reality technology, computer-controlled mannequins, and human simulated patients. With access to this facility, the distance learning faculty pilot-tested the use of human simulated patients to teach health assessment skills. Students were able to interview patients and critique physical examinations performed in the studio. To our knowledge, this use of simulated patients in a distance learning format was also a nursing education "first."

Course Preparation

As reported in the literature, faculty members found that a significant cost of distance learning was time. It took approximately 6 hours of preparation for 1 hour of distance learning instruction, compared with 2 hours of preparation commonly attributed to classroom instruction. It is estimated that transferring 1 hour of instruction to the World Wide Web can take from 6 to 8 hours.4

Because there are specific challenges in teaching through distance education, the faculty developed guidelines for guest lecturers that presented ways to minimize confusion to distant students and stressed the importance of interacting with the entire class by asking questions and switching camera action from site to site. It also became critical to stress that guest faculty must adhere to class timelines. It was calculated that the costs for lectures running overtime were approximately $100 per minute; this included the cost of overtime pay for staff members overseeing the dial-in at the VANTS bridge.

Report to Congress

Throughout its operation, the distance learning program was the object of keen and positive interest from Congress. In response to a legislative directive, USU and VA prepared a report on the Phase I and II activities of the program. The VA/DoD Post-Master's Adult Nurse Practitioner Distance Learning Program: From Concept to Graduation is an inclusive roadmap for implementing a distance learning program, making available the program curriculum, learning strategies, assessment methods, and transmission methods to others interested in distance learning and health professions education.5

Clinical Outcomes

The model implemented for clinical supervision proved successful. Clinical practice took place in ambulatory care and mental health clinics in VA medical centers and in health departments and local hospitals when VA facilities could not provide the required clinical experiences. When rated by preceptors, the clinical skills of the distance learning students were consistently observed to be equal to or better than the skills of local nurse practitioner students from traditional programs that the preceptors had supervised. Both preceptors and students rated the process as highly satisfactory. This clinical success was attributed to the close contact between faculty members and the lead preceptors, the training materials provided, and on-site observation of clinical training. Students particularly valued the use of familiar clinical sites.