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Multi-Level VA System Improvements are Needed to Ensure Equitable and Accessible Gender-Affirming Hormone Therapy
Investigators in this study conducted interviews with transgender and gender diverse (TGD) patients and with VA healthcare providers to determine barriers and facilitators to gender-affirming hormone therapy (GAHT) at the individual (i.e., knowledge, coping mechanisms), interpersonal (i.e., interactions with other individuals or groups), and structural (i.e., societal gender norms, institutional policies) level and also asked participants for recommendations for overcoming perceived barriers. Findings showed that multi-level system improvements are needed within and outside VA to ensure equitable and efficient access to GAHT. To overcome barriers, study participants recommended increasing provider capacity and support, providing opportunities for continual provider education in GAHT, and enhancing communication to both patients and providers around VA policy and training regarding GAHT.
Date: July 12, 2023
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Necessity of Learning Healthcare System Core Competencies to Retain and Empower VA Healthcare Workforce
This article describes current learning health system (LHS)-focused educational and competency-building initiatives in VA. The authors also explain VA’s LHS training ecosystem and core competencies, and discuss how it fits within the larger context of VA LHS research and practice, as well as lessons learned.
Date: August 16, 2022
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Inequities in Enhanced Pension Benefit for Veterans
This study examined sociodemographic, medical, and healthcare use characteristics associated with receipt of the Aid and Attendance (A&A) benefit among Veterans receiving pension. Findings identified potential inequities in Veterans’ receipt of the A&A enhanced pension. Among 89,845 Veterans who received a pension but not the A&A enhanced benefit in FY2016, 8,724 Veterans (10%) newly received the A&A enhanced pension in FY2017. Veteran pensioners who received A&A were significantly older and more likely to be white and married than those who did not receive A&A. Pensioners who were black, Hispanic, or other non-white race had a lower probability of receiving A&A than white Veterans after adjusting for indicators of need. Most indicators of need for assistance (e.g., home health use, dementia, stroke) were associated with significantly higher probabilities of receiving A&A, with notable exceptions: pensioners with PTSD or enrolled in Medicaid had lower probabilities of receiving A&A. Among Veterans receiving pension, receipt of A&A varied by medical center. While provider education and wider dissemination of information about A&A may help reduce observed inequities, action is required at the system level that will eliminate the possibility of bias in which some eligible pensioners are able to access this enhanced pension benefit and others are not.
Date: February 25, 2021
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Relationship between Diagnostic Accuracy and Confidence
This case vignette-based study evaluated physicians’ diagnostic accuracy, confidence, and diagnostic calibration (relationship between diagnostic accuracy and confidence) during the evolution of the diagnostic process. Findings showed that physicians correctly diagnosed 55% of the easier and 6% of the more difficult case vignettes presented. Physicians’ confidence averaged 7 out of 10 (10 being highest confidence) for easier cases and 6 for more difficult cases. Physicians’ level of overconfidence increased with difficult cases (diagnostic calibration was worse). Although confidence increased as cases evolved through the diagnostic process and more data became available, diagnostic accuracy did not. Fewer diagnostic tests were requested when confidence was high, even when accuracy was low.
Date: August 26, 2013
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Interns Spend Relatively Little On-Call Time on Patient Care or Educational Activities
The aim of this study was to determine how internal medicine interns at one VAMC spent their time on call. Findings showed that during on-call periods, internal medicine interns spent relatively small amounts of time on direct patient care and teaching/learning activities: 40% of their time (the largest proportion) was spent in clinical computer work; 30% on non-patient communication; and only 12% of their time was spent at the patient’s bedside. Downtime activities, transit, and teaching/learning accounted for 11%, 5%, and 2% of the interns’ time, respectively. As major changes in graduate medical education are occurring, the results of this study suggest a need to proactively consider strategies to increase intern time with patients and in formal and informal teaching activities when on call.
Date: November 1, 2012
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VA Communication and Information Sharing During H1N1 Influenza Pandemic
This study assessed information sources and communication provided to VA facility infection control departments, and how these departments disseminated information to facility staff during the 2009 H1N1 influenza pandemic. Communication was facilitated when information was timely, organized, disseminated through multiple channels, and included educational materials.
Barriers to effective communication included feeling overwhelmed by the amount of information received, encountering contradictory information, and restrictions on information dissemination due to uncertainty and inconsistent information. Participants offered recommendations for future pandemics, including the need for: standardized educational content, clearer guidance from national organizations, and pre-defined communication plans for hospital staff. The authors suggest that these findings can be used in planning for future pandemics and other emergent situations.
Date: June 23, 2012
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VA Physicians Involved with Research have Higher Job Satisfaction
This study examined whether VA physicians who were involved with research had greater job satisfaction and more positive job characteristics perceptions. Findings showed that VA physicians who spend part of their time involved with research activities are more likely to report favorable job characteristics ratings. They are also more likely to be satisfied with their job. Physicians who were involved with research activities provided higher ratings on all dimensions, the largest differences being autonomy and skill development opportunities. For overall job satisfaction, 78% of physicians involved with research reported a favorable rating compared to 72% of physicians not involved with research. The organizational research funding level was significantly related to higher ratings for all job characteristics; as the level of funding increased, the estimates for favorable responses increased. Physicians working in VAMCs with academic affiliates reported less favorable ratings for skill development opportunities, as well as work and family balance. However, when the academic affiliate was located within walking distance, these ratings were significantly more favorable.
Date: June 20, 2011
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Education Intervention Decreases Inappropriate Prostate Cancer Screening among Veterans
This study tested an e-mail-based intervention called “spaced education” (SE) that was developed to reduce clinicians’ inappropriate screening for prostate cancer. Findings show that during the intervention period (36 weeks), clinicians who received the spaced education intervention ordered significantly fewer inappropriate PSA screening tests than clinicians in the control group. Over the 72-week follow-up period, SE clinicians continued to order fewer inappropriate tests compared to controls, representing a 40% relative reduction in inappropriate screening. The impact of the intervention was unaffected by clincians’ age, gender, or provider type.
Date: November 1, 2010
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Study Assesses Knowledge Gains for SGIM Meeting Attendees
This pilot study assessed the feasibility of surveys to measure the impact of continuing medical education provided at the 2006 Society of General Internal Medicine (SGIM) Annual Meeting on both short- and long-term educational outcomes. Investigators assessed responses to a brief questionnaire administered to SGIM meeting participants who attended one research pre-course, one research methods workshop, and/or one clinical workshop. Findings show that all three sessions showed initial gains in knowledge: the research pre-course gain was large; the clinical workshop gain was moderate; and the research methods workshop gain was modest. Two of the three sessions showed a decrease in knowledge over the subsequent 9 months: the research pre-course decrease was moderate; the clinical workshop’s decrease was small; while the research workshop had a large gain in knowledge levels over the subsequent 9 months.
Date: May 1, 2009
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Spaced Education May Improve Teaching by Surgical Residents
This randomized trial investigated whether feedback given by surgery residents to students could improve using a spaced-education program delivering succinct weekly e-mails. Findings show that succinct e-mails using spaced education methods are an effective tool to significantly improve both the frequency and quality of feedback given by surgical residents to medical students. Authors suggest that spaced-education techniques may help educate busy residents, for whom service and education responsibilities are often at odds with effective teaching strategies.
Date: February 1, 2009
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Spaced Education May Improve Learning for Medical Students
‘Spaced education’ refers to online educational programs that are structured to present information in small increments and reinforce learning by repetition. Medical students in this study who received spaced education e-mails demonstrated significant, topic-specific increases in pre-test scores for both prostate cancer/PSA knowledge and BPH/erectile dysfunction knowledge. However, students demonstrated a substantial decline in their urology knowledge in between the post-test and delayed test in both topic areas. Thus, while prospective spaced education can improve learning and retention, it does not appear to be enough to shift urology learning into long-term memory.
Date: January 1, 2009
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