title: Teleconsultation and Training of VHA Providers on Transgender Care: Implementation of a Multisite Hub System.
abstract: BACKGROUND
  The Veterans Health Administration (VHA) is piloting a national program providing teleconsultation and training to clinicians to increase knowledge and comfort with treating transgender veterans and to expand clinical capacity. This program is based on Project ECHO and uses specialist expertise to train and educate front-line clinicians. Over time, the front-line clinicians increase knowledge and skills, enabling them to provide care locally and obviate need for patient travel. This program is innovative in its national scope, interdisciplinary team model, and multihub structure. This article describes development of the program and initial results for the first cohort of learners.
  
  
  METHODS
  Five interdisciplinary clinical teams participated in the 14-session, 7-month program. Most teams had some experience treating transgender veterans prior to participation.
  
  
  RESULTS
  The teams completed at least 12 of 14 sessions. Thirteen of 33 participants completed an evaluation. In general, respondents found the teleconsultation program very helpful and credited the experience with improving their team functioning. Furthermore, respondents reported a significant increase in confidence to treat transgender veterans by the end of the program (59% versus 83%). We explored whether it is possible to recruit VHA clinical teams to participate in lengthy training on a low prevalence but complex condition.
  
  
  CONCLUSIONS
  Early results support the feasibility and effectiveness of this national VHA teleconsultation and training program for transgender care. Lessons learned from the first group of learners have been applied to two concurrent groups with positive results.
authors.affiliation: 1 Lesbian, Gay, Bisexual, and Transgender Program, VHA Patient Care Services , Washington, D.C.|2 VA South Central Mental Illness Research, Education, and Clinical Center , Houston, Texas.|3 Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center , Houston, Texas.|4 Baylor College of Medicine , Houston, Texas.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kauth
authors.affiliation: 1 Lesbian, Gay, Bisexual, and Transgender Program, VHA Patient Care Services , Washington, D.C.|5 VA Boston Healthcare System , Boston, Massachusetts.|6 Women's Health Sciences Division, National Center for PTSD , Boston, Massachusetts.|7 Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Shipherd
authors.affiliation: 2 VA South Central Mental Illness Research, Education, and Clinical Center , Houston, Texas.|3 Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center , Houston, Texas.|4 Baylor College of Medicine , Houston, Texas.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Lindsay
authors.affiliation: 8 Office of Specialty Care, VHA Patient Care Services , Washington, D.C.|9 Case Western Reserve University , Cleveland, Ohio.
authors.forename: Susan
authors.initials: S
authors.lastname: Kirsh
authors.affiliation: 10 VA Greater Los Angeles Healthcare System , Los Angeles, California.
authors.forename: Herschel
authors.initials: H
authors.lastname: Knapp
authors.affiliation: 1 Lesbian, Gay, Bisexual, and Transgender Program, VHA Patient Care Services , Washington, D.C.|5 VA Boston Healthcare System , Boston, Massachusetts.
authors.forename: Lexi
authors.initials: L
authors.lastname: Matza
mesh_terms: D005260:Female; D008297:Male; D006282:Health Personnel / Q000193:education; D009096:Multi-Institutional Systems; D010865:Pilot Projects; D019114:Remote Consultation; D063106:Transgender Persons; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D006801:Humans
keywords: education; military medicine; telehealth; telemedicine; telepsychiatry; transgender medicine