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VHA Office of Rural Health

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Enterprise-Wide Initiative (EWI) - Workforce Training and Education

Clinical Skills Training in Women Veterans Health Care

Background

The number of women Veterans receiving care in the Veterans Health Administration (VHA) has grown quickly, increasing the need for high‑quality women’s health services. At the end of fiscal year (FY) 2024, nearly one million women Veterans were enrolled in the VHA system, which is a large increase since this workforce training program began in FY 2017.

A significant share of women Veterans who use VHA care live in rural or highly rural areas. Many of these Veterans receive primary care in Community Based Outpatient Clinics (CBOCs) and other local sites. VHA policy states that all newly enrolled women Veterans should be assigned to a Women’s Health Primary Care Provider (WH‑PCP) and sets a goal that at least 85% of women Veterans will be assigned to a designated WH‑PCP. The policy also says that each primary care site, including CBOCs, should have at least two WH‑PCPs to ensure coverage when one provider is absent.

Despite these goals, access to women’s health care in rural areas is often limited. Studies show that rural areas, both inside and outside VHA, may lack enough clinicians with gynecology and maternity care skills. Women Veterans who are assigned to a designated WH‑PCP receive higher‑quality care and report better experiences than those assigned to other primary care providers. They are also less likely to stop using VHA care.

Access to WH‑PCPs and primary care nurses who understand the unique clinical and environmental needs of women Veterans is essential for reducing disparities in rural women’s health. Better access to trained providers can lead to improved clinical outcomes and more equitable care for rural women Veterans.

The Clinical Skills Training in Women Veterans Health Care—often called the Rural Women’s Health Mini‑Residency—is a workforce training initiative that builds this expertise. It focuses on increasing the women’s health skills of primary care providers and nurses who care for rural women Veterans. The program uses an implementation approach that has already been shown to increase providers’ and nurses’ women’s health knowledge and confidence.

The partnership between VHA’s Office of Rural Health and Office of Women’s Health supports this Clinical Skills Training. Through this collaboration, VHA continues to expand access to a well‑trained, highly skilled WH‑PCP and nurse workforce serving rural women Veterans.

Goals and Objectives

The Clinical Skills Training in Women Veterans Health Care is part of the Rural Women’s Health Mini‑Residency Enterprise‑Wide Initiative. Its overall goals are to:

  • Increase the number of recently trained WH‑PCPs and nurses who are delivering women’s health care in rural areas.
  • Address shortages in women’s health expertise by bringing blended learning (online and in‑person) mobile training to rural VHA sites across the country.

The program aims to increase the number of rural women Veterans who receive care from primary care providers and nurses with specific training and expertise in women’s health. By doing so, it supports VHA’s goal of assigning women Veterans to WH‑PCPs and ensuring that rural sites have enough trained staff to provide comprehensive women’s health services.

Methodology

The Clinical Skills Training uses a blended learning model that combines self‑paced online education with an intensive, one‑day, on‑site training at rural VHA clinical sites.

The training process includes:

  • Independent online learning: Participants complete recorded lectures on core women’s health topics through the Talent Management System (TMS). This protected learning time allows providers and nurses to build foundational knowledge before the in‑person session.
  • On‑site interactive training: After completing the online modules, providers and nurses attend a one‑day, face‑to‑face training at their local rural site. This session focuses on interactive, hands‑on learning.

Key components of the on‑site day include:

  • Small‑group case discussions that explore real‑world women’s health scenarios.
  • Hands‑on practice of breast and pelvic exam skills using simulation equipment.
  • Instruction and examination practice with a Gynecologic Teaching Associate (GTA), a trained female instructor who uses her own body to teach breast and pelvic examination techniques in a safe, respectful setting.
  • Demonstrations, displays, and guided exercises to help participants create action plans for improving women’s health care at their own clinics.

A four‑person training team travels to rural VHA sites to deliver the on‑site training. The team usually includes a physician instructor, a nurse instructor, a Gynecologic Teaching Associate, and a support staff member who manages equipment and logistics.

Providers and nurses who complete the Clinical Skills Training report gaining new knowledge and skills and feeling more comfortable managing women Veterans’ health needs. This increased confidence supports better care for women Veterans in rural primary care settings.

Impact on Rural Veteran Health

By providing effective and comprehensive women’s health training to primary care providers and nurses, the Clinical Skills Training program strengthens VHA’s rural workforce and expands access to women’s health services for rural women Veterans.

Documented impacts include:

  • Increased WH‑PCP capacity overall: Among all primary care providers who attended the training between FY 2018 and FY 2023, the percentage designated as WH‑PCPs nearly doubled after training—from about 42% before training to about 77% after training. This means more providers are recognized as women’s health specialists within VHA.
  • Improved WH‑PCP staffing at rural CBOCs: At rural CBOCs, the percentage of clinics with at least two WH‑PCPs increased, while the percentage with only one or no WH‑PCPs decreased. This change supports VHA’s directive that each primary care site should have enough WH‑PCPs to provide continuous coverage.
  • Better provision of contraception: Primary care providers who took part in the Clinical Skills Training showed significant improvements in providing contraception between baseline and one‑year follow‑up. This suggests that the training helps expand access to important women’s primary care services, including family planning.

Overall, the program has expanded access to women’s health services in rural areas by equipping more VHA clinical sites with trained WH‑PCPs and nurses who can deliver comprehensive care to women Veterans. The growing number of trained clinicians supports services such as cervical and breast cancer screening, contraception counseling, menopausal care, and management of chronic women’s health conditions within primary care teams.

Key Takeaways

The Clinical Skills Training in Women Veterans Health Care has played a major role in expanding women’s health services for rural women Veterans across the VHA system.

From FY 2017 through FY 2024, the partnership between the Office of Rural Health and the Office of Women’s Health:

  • Hosted hundreds of training sessions (Rural Women’s Health Mini‑Residencies) for primary care providers and nurses at VHA sites nationwide.
  • Reached thousands of clinicians and increased the number of sites with trained WH‑PCPs and nurses.

Key points include:

  • VHA conducts many Rural Women’s Health Mini‑Residency training sessions each year through this initiative, increasing access to services such as cervical and breast cancer screening, contraception, and menopausal care within primary care settings.
  • Demand for the training remains high due to the growing population of women Veterans, ongoing clinician turnover, and active hiring efforts. Many rural primary care sites have not yet hosted the training and are potential future sites, while sites that completed training in earlier years often request additional sessions for newly hired staff.
  • The program supports VHA’s efforts to function as a learning health system by using data and experience to refine training, expand reach, and address gaps in rural women’s health care.

Overall, the Clinical Skills Training initiative helps ensure that rural women Veterans receive care from providers and nurses who are specifically trained in women’s health, improving access, quality, and continuity of care across rural VHA sites.

PROGRAM NAME Overview PDFDownload the Printable PDF for Healthcare Providers and Researchers.

References

  • Veterans Service Support Center – Enrollment Cube data for women Veteran enrollees in FY 2016 and FY 2024.
  • Women’s Health Evaluation Initiative FY23 Cohort data for rural and highly rural areas (unpublished).
  • Veterans Health Administration. VHA Directive 1330.01(6), Health Care Services for Women Veterans.
  • Friedman S, Shaw JG, Hamilton AB, et al. Gynecologist supply deserts across the VA and in the community. Journal of General Internal Medicine.
  • Studies on maternity care deserts and limited obstetric services in the United States.
  • Bastian LA, et al. Associations between women Veterans’ experiences with VA outpatient care and designation as women’s health providers in primary care clinics. Women’s Health Issues.
  • Bean‑Mayberry B, et al. Associations between provider designation and female‑specific cancer screening in women Veterans. Medical Care.
  • Friedman S, Frayne S, Berg E, et al. Travel time and attrition from VHA care among women Veterans.
  • Sanders AM, Golden RE, Kolehmainen C, Brenton JK, Frayne SM. Implementation experience and initial assessment of a rural women’s health training program in support of VA as a learning health system. Learning Health Systems.
  • Golden RE, Sanders AM, Frayne SM. RE‑AIM applied to a primary care workforce training for rural providers and nurses: the VA Rural Women’s Health Mini‑Residency. Frontiers in Health Services.

Contact

  • Aimee M. Sanders, MD, MPH, Physician Educator, Women’s Health Education, VHA Office of Women’s Health. Aimee.Sanders2@va.gov
  • Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00559.
  • Suggested Citation: Sanders, A. M., & Grant, N. (2024). Clinical Skills Training in Women Veterans Health Care. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

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