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Learning Needs of VHA Women’s Health Providers

Zuchowski J, Hamilton A, Washington DL, Cordasco KM. Learning Needs of VHA Women’s Health Providers. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.


Research Objective: Although a growing number of women Veterans are using Veteran Health Administration (VHA) services for their health care, they are still a minority within the VHA patient populations. Many VHA providers have had historically small caseloads of women patients and therefore may need to supplement their current knowledge and skills in topics specific to caring for women Veterans. In primary care, new women patients are now preferably assigned to designated women's health primary care providers (PCPs) in an effort to concentrate female caseloads. Potential learning needs of these women's health PCPs have not been previously assessed. We explored the learning needs of VHA women's health PCPs. Study Design: Using mixed methods, we conducted semi-structured telephone interviews with 10 VHA women's health PCPs in Southern California and Oklahoma. Interviewees were asked about their learning needs relevant to women's health. All interviews were audio recorded, professionally transcribed, and summarized. A summary template was used to capture key points within each domain of the interview guide. Summaries were analyzed for specific women's health topics that participants frequently identified as being of interest. We additionally administered 16 e-mail surveys to PCPs, 8 of whom were interviewees, and 8 have not yet been interviewed. Survey respondents were asked to rate their interest in getting additional education on a list of women's health topics using a four point Likert scale ("not at all interested," "mildly interested," "moderately interested," "very interested"). For each topic, we assessed the percentage of respondents that rated it as "very interested." Population Studied: VHA women's health PCPs in Southern California and Oklahoma. Principal Findings: Interviewees most frequently expressed interest in the topic of chronic pain management. Interviewees also frequently expressed interest in the following women's health topics: the impact of military service on women (e.g. military sexual trauma); abnormal uterine bleeding; medications during pregnancy and lactation. Other topics mentioned, but less frequently, included: dyspareunia; intimate partner violence; abnormal Papanicola smears; contraception; and caring for transgender patients. Interviewees also frequently mentioned a desire to receive updates on changing guidelines for best practice. Among survey respondents, topics with the highest percentage indicating that they are "very interested" were: management of abnormal Pap smear (67%); contraception counseling (63%); and evaluation of abnormal uterine bleeding (63%). Topics with the lowest percentage of respondents indicating they are "very interested" were: intimate partner violence screening (13%); screening for military sexual trauma (13%); and emergency contraception (19%). Conclusions: VHA women's health PCPs express a wide range of learning needs. A fuller assessment of these learning needs, as well as the best ways in which PCPs' learning needs can be met, is needed. Implications for Policy and Practice: VHA should work with medical education and women's health experts, both within VHA and at affiliated universities, to continue assessing and addressing these learning needs so that VHA's women's health PCPs are equipped to provide optimal care to women Veterans. With the growing population of women Veterans, educational programs on the impact of military service on women will likely have relevance for PCPs both within and outside VHA.

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