Measuring LEND Core Competencies Using Trainee Follow-Up Surveys

Abstract

Objectives:

Measuring the value-added impact of Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training on trainees’ leadership and career trajectories is necessary to understand program efficacy. In the current study, we leveraged an existing ex post facto design to develop and test a new measure of LEND competencies and compare outcomes of LEND trainees and comparison peers.

Methods:

We developed the LEND Outcomes Follow-Up Survey using a multi-step, mixed methods process. A series of focus groups and consultations with key stakeholders identified eight important LEND leadership outcomes: (1) interdisciplinary work; (2) advocacy; (3) intersectional approach; (4) systems perspective; (5) life course perspective; (6) leadership; (7) engagement with maternal and child health populations; and (8) research experience. We developed and piloted this novel survey to measure these LEND leadership outcomes. We used data collected from this novel measure and an existing survey that is used nationally by LEND, to compare the outcomes of 43 LEND trainees and 30 comparison peers at two years post completion of LEND training.

Results:

We found that, compared to comparison peers, LEND trainees: (1) worked with a greater number of disciplines; (2) were more likely to be engaged in advocacy; (3) were more likely to utilize a systems perspective in their work; (4) were more likely to work with maternal and child health populations; and (5) were more likely to have experience conducting research.

Conclusions:

Our findings suggested that LEND training improves LEND leadership outcomes at two years post-completion of LEND training.

Introduction

Developing a skilled, interdisciplinary workforce of professionals who provide care to the millions of Americans with intellectual and developmental disabilities is critical to achieving optimal outcomes for this population. The Health Resources and Services Administration’s Maternal and Child Health Bureau’s (MCHB) signature interprofessional training program, Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND), is designed to help allied health professionals and community advocates develop core leadership competencies necessary to improve the systems of care supporting the health and well-being of people with intellectual and developmental disabilities. Understanding the impact of LEND training on leadership and career trajectories is critical to evaluating the efficacy of this program; however, there is limited previous research systematically evaluating differences between LEND trainees and comparison peers who did not receive training. In the current study, we leveraged an existing ex post facto design (Bishop et al., 2022) to test a new measure of LEND competencies and compare outcomes of LEND trainees and comparison peers.

Overview of LEND Training

LEND programs are designed to provide training to individuals from diverse professional disciplines with demonstrated interest in working with people with disabilities. This interdisciplinary (interprofessional) training is intended to prepare trainees to assume leadership roles in their respective fields (Association of University Centers on Disability, 2011). Graduate and professional student trainees participate in LEND training along with people with disabilities and family members of people with disabilities. Each LEND training program is uniquely designed to meet local and institutional needs, but all LEND training programs share core objectives to: (1) advance the knowledge and skills of health professionals to improve health care delivery systems for children, adolescents, and adults with developmental disabilities; (2) provide high-quality interdisciplinary education that emphasizes the integration of services from state and local agencies and organizations, private providers, and communities; (3) provide health professionals with skills that foster community-based partnerships; and (4) promote innovative practices to enhance cultural competency, family-centered care, and interdisciplinary partnerships (Association of University Centers on Disability, 2011). In 2022, approximately 1,350 long-term LEND trainees across 60 program sites completed over 300 hours of LEND training throughout the United States.

Outcome Assessment for LEND Training Programs

Currently, LEND training outcomes are assessed at two, five, and ten years after completion of LEND training using the National Information and Reporting System (NIRS) Graduate Survey. The NIRS Graduate Survey (hereafter referred to as the “Graduate Survey”) is a web-based survey designed for MCHB-funded training programs to measure trainee leadership outcomes (Kavanagh, Menser, Pooler, Mathis, & Ramos, 2015). The Graduate Survey includes questions about a trainee’s participation in leadership activities; professional contact with maternal and child health populations, people with disabilities, and underserved populations; interdisciplinary practice; and direct services provided to people with developmental disabilities.

Studies that assess LEND trainee outcomes using the Graduate Survey find that a high proportion of LEND trainees participate in leadership activities at five years post LEND training (Bishop et al., 2022; Kavanagh et al., 2015). Like past studies evaluating training outcomes in allied health professions, most studies of LEND training outcomes have been retrospective, short-term, uncontrolled studies. This design for outcomes evaluation limits conclusions about the value-added impact of LEND training (Brosco et al., 2018; Devon, Tenney-Soeiro, Ronan, & Balmer, 2019; Humphreys, Kurtz, Portrie, Couse, & Hajnaghizadeh, 2018; Margolis, Rosenberg, Umble, & Chewning, 2013; Weber et al., 2021). Pioneering efforts by our study team representing three LEND programs worked together on the LEND Outcomes Study (hereafter referred to as the ‘Outcomes Study’) to demonstrate that it is feasible to collect annual outcome data from LEND trainees and matched comparison peers using an ex post facto design (Bishop et al., 2022). Preliminary efficacy findings suggest LEND trainees are significantly more likely to work with people with intellectual and developmental disabilities and underserved or vulnerable populations than comparison peers who did not receive LEND training. They are also more likely to engage in interdisciplinary work. LEND trainees began their careers engaged in significantly more leadership activities compared to their peers who did not receive LEND training, and the rate of their participation in leadership activities grew significantly faster than that of comparison peers over time (Bishop et al., 2022).

These outcomes reviewed above, however, resulted from evaluating training outcomes using the Graduate Survey, which was designed for all MCHB-funded training programs and not LEND training programs specifically. Of note, MCHB-funded training programs that utilize the Graduate Survey to assess outcomes include interdisciplinary programs such as LEND, but also Leadership Education in Adolescent Health, pediatric pulmonary centers, and schools of public health, as well as discipline-specific graduate programs (e.g., pediatric dentistry, developmental behavioral pediatrics, and nutrition; Kavanagh et al., 2015). Whether the Graduate Survey truly captures the more nuanced impact of training in LEND core competencies areas has yet to be determined.

Overview of the Current Study

In the current study, we leveraged our existing, multi-site (University of Pittsburgh, University of Wisconsin-Madison, The Ohio State University) ex post facto prospective cohort design (Bishop et al., 2022) to develop and test a new instrument measuring LEND competencies and to compare outcomes of LEND trainees and comparison peers. We further sought to test whether the questions on the existing Graduate Survey performed similarly to questions developed specifically for our new survey instrument to test group differences in outcomes of LEND training. The purpose of this study was to expand upon the Outcomes Study to assess differences between LEND trainees and comparison peers on selected core LEND competencies and outcomes two years after completion of LEND training. Our aims were to: (1) develop a novel survey (i.e., the LEND Outcomes Follow-Up Survey) to assess knowledge, attitudes, and skills related to the core LEND competencies based on input from expert stakeholders; (2) pilot the new survey with 2015 graduates of three LEND training programs and matched comparison peers; and (3) examine group differences between LEND trainees’ and comparison peers’ responses on the new, LEND-specific training outcomes survey and the existing MCHB Graduate Survey. We hypothesized that (1) we would be able to develop and refine a list of forced response and open-ended questions that assessed core LEND competencies; (2) we would be able to recruit ≥ 80% of 2015 LEND long-term trainees and comparison peers to complete both surveys; and (3) LEND trainees would demonstrate greater knowledge, attitudes, and skills related to core LEND competencies on the LEND Outcomes Follow-Up Survey and greater engagement with MCHB leadership activities on the Graduate Survey.

Methods

Survey Development Procedure

We used a multi-step process to develop and pilot the LEND Outcomes Follow-Up Survey. The process and timeline are described below and detailed in Figure 1.

Figure 1.

Study Timeline for the LEND Outcomes Study and the LEND Outcomes Follow-Up Survey Pilot

Initial Development and Pilot.

During the initial phase of this project, we created a 42-question survey designed by study authors (without input from stakeholders). The survey was designed to assess interdisciplinary practice, family-centered care, use of the life course model, comfort with complex care, understanding of autism spectrum disorder, and leadership. We piloted the survey with non-trainee undergraduate and graduate students at the three LEND sites. The non-trainees rated themselves highly on core competencies, and variance was not sufficient (ceiling effect) on most questions. This limited the utility of the questionnaire in evaluating LEND training outcomes.

Focus Groups.

After the failed testing of our initial survey, we elicited stakeholder feedback from LEND staff and faculty via focus groups at the 2016 Association of University Centers on Disability (AUCD) annual meeting. We conducted three focus groups with a total of nine LEND program staff and faculty. We asked participants two questions to distill the “active ingredients” of LEND training: (1) “What types of leadership roles are you training your trainees to take on?”; and (2) “What makes LEND graduates different from their peers who did not receive LEND training?” Focus groups’ responses were recorded and transcribed, and later analyzed using conventional content analysis to identify themes (Hsieh & Shannon, 2005).

Five themes were identified: (1) interdisciplinary work, (2) advocacy, (3) intersectional approach, (4) systems perspective, and (5) life course perspective. Related to the interdisciplinary work theme, focus group responses suggested LEND graduates participate in interdisciplinary teams, have a sense of disciplinary humility; do not see themselves as having a siloed role on a care team; and view people with disabilities and their family members as integral parts of interdisciplinary teams. Second, focus group responses highlighted an advocacy theme. That is, LEND graduates stay involved with advocacy after they complete their LEND training in a manner that is beyond what is typical for their discipline. A third theme identified was an intersectional approach. That is, LEND graduates are comfortable with an intersectional approach to disability, diversity, and inclusion; they focus on diversity in the context of functioning, not on deficits. Fourth, focus group responses highlighted a systems perspective theme. LEND graduates have an appreciation for how systems (e.g., Medicaid, Early Intervention) impact resources and opportunities for people with disabilities and their families; know about local and national resources (including cash benefits and other non-cash benefit social safety net programs); and can refer clients to the resources that fit their needs. Finally, focus group responses suggested a life course perspective theme. LEND graduates receive training on life course issues, specifically major transitions and the changing role of family during the life of an individual with a disability.

Revision and Faculty Pilot.

After identifying themes through focus groups, we developed 100 questions designed to measure the “active ingredients” of LEND training as suggested by our identified themes through forced choice and open-ended questions. We intentionally included a large number of questions knowing that we wanted to reduce the number and choose only the best questions. We then asked 14 LEND and non-LEND faculty and family stakeholders to review the questions. Participants in this phase of survey development suggested ways to reduce the number of questions by shortening and clarifying long questions; removing redundancy; and reducing the focus on the academic arena. We then pared down the survey following these suggestions. We then utilized a revised, 31-question version of the LEND Outcomes Follow-Up Survey for the pilot with trainees and comparison peers.

Pilot of the LEND Outcomes Follow-Up Survey

Participants in the LEND Outcomes Follow-Up Survey pilot study were recruited from the pool of LEND trainees and comparison peers in the 2015 cohort of the Outcomes Study (N = 82 in the full cohort; see Figure 1). The broader LEND Outcomes Study (Bishop et al., 2022) began during the 2014–2015 academic year with the recruitment of the 2015 cohort, with new cohorts of LEND trainees and comparison peers recruited each academic year. While this study (the LEND Outcomes Follow-Up Survey pilot study) recruited participants from the first cohort of the Outcomes Study, it represents additional data collection from the parent study (the Outcomes Study) and was approved as an addition to the parent study by the University of Wisconsin-Madison institutional review board. Data for this study were collected in 2017, two years after the 2015 cohort completed their LEND training. The study timeline is detailed in Figure 1, and more details about the parent study are available in (Bishop et al., 2022).

To recruit participants for the LEND Outcomes Follow-Up Survey pilot study, we emailed each LEND trainee and comparison peer in the 2015 cohort of the Outcomes Study, informing them of the opportunity to participate in this additional study. If potential participants did not respond to our initial email invitation, we followed up by phone until participants chose to participate or not to participate. We obtained informed consent from all participants before any data were collected. Participants received a $25 gift card after completing the pilot survey.

Measures

Demographic Characteristics.

We report on demographic characteristics, including: (1) binary sex (male or female); (2) personal relationship with disabilities (person with a disability, person with a special health care need, parent of a person with a disability, parent of a person with a special health care need, family member of a person with a disability, family member of a person with a special health care need, none, or unrecorded); and (3) professional discipline. Additional demographic data for our full sample are available in (Bishop et al., 2022). In this paper, we report descriptive statistics only for disciplines with five or more LEND trainees to ensure that data are not identifiable.

A Measure of LEND Leadership Outcomes: The LEND Outcomes Follow-Up Survey.

The survey that resulted from our survey development process, the LEND Outcomes Follow-Up Survey, consists of 31 forced-choice and open-ended questions designed to assess eight core competencies of (1) interdisciplinary work; (2) advocacy; (3) intersectional approach; (4) systems perspective; (5) life course perspective; (6) leadership; (7) engagement with maternal and child health populations; and (8) research experience. The LEND Outcomes Follow-Up Survey included questions such as: “Which of the following disciplines do you regularly interact with in your primary work/volunteer/educational setting?” (interdisciplinary work); “In the past year, have you helped a family or individual with their own self-advocacy efforts?” (advocacy); “I demonstrate self-awareness and self-regulation in interactions with diverse communities” (intersectional approach); “In the past year, have you participated in an effort related to systems change (e.g., clinical or public health quality improvement, writing policy or clinical guidelines, translating evidence-based research to practice)?” (systems perspective); “When working with clients, I plan ahead for major life transitions” (life course perspective); “In which of the following areas do you consider yourself a leader?” (leadership); “Do parents or self-advocates provide input as advisors or paid staff in your primary work, volunteer, or school setting?” (engagement with maternal and child health populations); and “In the past year, have you communicated research findings to colleagues or a professional group?” (research experience).

MCHB Leadership Outcomes.

We measured MCHB leadership outcomes using the Graduate Survey (full survey available upon request from the first author or from MCHB), which is a web-based, survey designed to be used by MCHB-funded programs to measure trainee leadership outcomes and is required of all LEND training programs. We identified key leadership outcomes in alignment with outcomes reported by Kavanagh et al. (2015): (1) working with maternal and child health populations (“Does your current work relate to maternal and child health populations [i.e., women, infants and children, adolescents, and their families including fathers and children or young adults with special healthcare needs]?”); (2) working with other disciplines (“Do you regularly work with other disciplines that work with a maternal and child health population?”); (3) working with underserved or vulnerable populations (“Does your current work relate to underserved or vulnerable populations [i.e., immigrant populations, tribal populations, migrant populations, uninsured populations, individuals who have experienced family violence, homelessness, foster care, HIV/AIDS, people with disabilities, etc.]?”); and (4) working in a public health agency or organization (“Do you currently work in a public health organization or agency [including Title V]?”). We also created a summary score of leadership activities (range: 0–10) based on questions from the Graduate Survey that included 10 MCHB leadership activities, including questions such as: “served in a clinical position of influence (e.g., director, senior therapist, team leader, etc.)”; “participated in public policy development activities (e.g., participated in community engagement or coalition building efforts, wrote policy or guidelines), influenced maternal and child health related legislation (provided testimony, educated legislators, etc.)”; “disseminated information on maternal and child health issues (e.g., peer reviewed publications, key presentations, training manuals, issue briefs, best practices documents, standards of care)”; and “procured grant and other funding in maternal and child health areas.”

Data Analysis

We evaluated the feasibility of recruiting participants in the LEND Outcomes Study to this study using descriptive statistics. Preliminary analyses did not reveal any statistically significant differences between LEND trainees and comparison peers on demographic variables, including age, binary sex, race/ethnicity, or discipline. Thus, to conserve power on subsequent analyses, we used bivariate analyses to test group differences on leadership outcome variables. We used Pearson chi-square statistics to test group differences in leadership outcomes on categorical variables. We used independent t-tests to test group differences on continuous variables.

Results

Feasibility and Participant Demographics

We were able to recruit and consent 93.5% (n = 43) of LEND trainees and 83.3% (n = 30) of comparison peers from the LEND Outcomes Study’s 2015 cohort to complete the LEND Outcomes Follow-Up Survey. These participants completed a separate consent process for this round of data collection. All trainees and comparison peers who consented to participate in this study completed both the LEND Outcomes Follow-Up Survey and the NIRS Graduate Survey in 2017. There were no statistically significant differences between LEND Outcomes Study participants who did and did not participate in this study on key demographic variables.

No statistically significant differences between LEND trainees and comparison peers on baseline demographic data were noted. The majority of LEND trainees and comparison peers were female (LEND trainees were 88.4% female; comparison peers were 96.7% female). More LEND trainees (40.0%) than comparison peers (12.0%) were family members of a person with a disability (χ² = 6.63, p < 0.05). Academic disciplines represented by five or more LEND trainees included: psychology (n = 7), speech-language pathology (n = 7), audiology (n = 6), and occupational therapy (n = 5). Disciplines represented by fewer than five LEND trainees included: genetic counseling, medicine, nursing, nutrition, physical therapy, public health, self-advocacy, social work, and other.

LEND and Maternal and Child Health Leadership Outcomes

We first assessed group differences on the LEND leadership outcomes identified by our focus groups and faculty pilot survey using the LEND Outcomes Follow-Up Survey. Compared to comparison peers, LEND trainees worked with a greater number of disciplines (t = 2.518, p < 0.05, d = 0.60), were more likely to be engaged in advocacy (t = 2.217, p < 0.05, d = 0.50), were more likely to utilize a systems perspective (t = 2.003, p < 0.05, d = 0.48), and were more likely to have experience conducting research (t = 2.255, p < 0.05, d = 0.54). LEND trainees and comparison peers did not differ statistically on their reported use of an intersectional approach or a life course perspective, their comfort with leadership skills, or their engagement with maternal and child health populations (when asked about whether they worked with specific groups that can be categorized as maternal and child health populations; Table 1).

Table 1.

Differences between LEND Trainees and Comparison Peers on LEND and Maternal and Child Health Leadership Outcomes

Variable	LEND Trainees	Comparison Peers	χ2	t-value	95% CI	Cohen’s d
LEND Leadership Outcomes (Collected via the LEND Outcomes Follow-Up Survey) A
Number of Disciplines (Interdisciplinary Work), Mean (SD)	5.58 (3.17)	3.87 (2.34)	--	2.518*	0.356, 3.07	0.60
Advocacy, Mean (SD)	2.58 (0.63)	2.10 (1.21)	--	2.217*	0.048, 0.914	0.53
Intersectional Approach, Mean (SD)	3.46 (0.80)	3.77 (1.34)	--	−1.124	−0.871, 0.245	−0.30
Systems Perspective, Mean (SD)	2.14 (0.97)	1.63 (1.19)	--	2.003*	0.002, 1.01	0.48
Life Course Perspective, Mean (SD)	3.23 (0.94)	3.63 (0.79)	--	−1.779	−0.851, 0.050	−0.46
Comfort with Leadership Skills (Leadership), Mean (SD)	34.77 (3.51)	34.70 (3.72)	--	0.079	−1.638, 1.773	0.02
Engagement with Maternal and Child Health Populations, N (%)	40 (93.0%)	28 (93.3%)	0.003	--	--	--
Research Experience, Mean (SD)	2.58 (0.73)	2.10 (1.09)	--	2.255*	0.056, 0.907	0.54
Maternal and Child Health Leadership Outcomes (Collected via the Existing NIRS Graduate Survey) B
Works with Maternal and Child Health Populations, N (%)	30 (85.7%)	12 (28.6%)	9.878**	--	--	--
Works with Underserved/Vulnerable Populations, N (%)	30 (85.7%)	17 (68.0%)	2.696	--	--	--
Works within a Public Health Agency, N (%)	6 (17.1%)	4 (16.0%)	0.014	--	--	--
Number of Leadership Activities, Mean (SD)	2.74 (2.03)	2.00 (1.74)	--	1.458	−0.277, 1.763	0.39

^**p<0.01;

^*p<0.05.

^AIdentified through focus groups and faculty pilot survey;

^BIdentified by Kavanagh et al. (2015)

LEND = Leadership Education in Neurodevelopmental Disabilities and Related Disorders; χ² = chi-square; CI = confidence interval; SD = standard deviation; N = total number who responded affirmatively

We then assessed MCHB leadership outcomes identified by Kavanagh and colleagues (2015) using the Graduate Survey. When asked whether they work with “maternal and child health populations”, LEND trainees were more likely to report working with maternal and child health populations than comparison peers (χ² = 9.878, p < 0.001; Table 1). LEND trainees and comparison peers did not differ statistically in terms of work with other disciplines, work with underserved or vulnerable populations, and work within a public health agency. LEND trainees did not complete a statistically greater number of research activities compared to comparison peers.

Discussion

We aimed to create a novel measure designed specifically to evaluate LEND leadership competencies. We hypothesized that we would be able to recruit ≥ 80% of LEND trainees and comparison peers from a single cohort year of our larger Outcomes Study to participate in this pilot of the follow-up survey. Further, we hypothesized that LEND trainees would demonstrate stronger LEND and MCHB leadership outcomes than comparison peers.

Related to our first aim, we successfully recruited over 90% of LEND trainees and over 80% of comparison peers from the larger 2015 cohort of the LEND Outcomes Study to complete the novel LEND Outcomes Follow-Up Survey pilot. This suggests that this model can be successfully leveraged for additional data collection on trainee outcomes. We previously reported on the feasibility of following LEND trainees longitudinally and found that it was feasible to recruit LEND trainees and comparison peers to the study and retain them with low levels of attrition over five years (0.9%; Bishop et al., 2022). The broader LEND Outcomes Study is also relatively low cost: trainees are not paid for annual participation because they are required to participate in long-term follow-up as part of the training program, whereas comparison peers are paid annually for completing the survey ($25 or less, depending on the program site). Time resources were also relatively limited: study investigators participated in monthly meetings throughout the course of the study, and program staff spent between 10 and 20 hours recruiting and following up with trainees and comparison peers each year. Our model is a feasible and low-resource model that can be used for replication across LEND programs and assessment of long-term outcomes in graduate and professional training programs more generally. Of note, both trainees and comparison peers were compensated $25 for participating in this additional round of data collection for the pilot survey; this incentive may have increased our participation rates.

We successfully tracked and collected information about LEND leadership outcomes using the LEND Outcomes Follow-Up Survey two years post LEND graduation. Two years post graduation, compared to peers, LEND trainees: (1) worked with a greater number of disciplines; (2) were more likely to be engaged in advocacy; (3) utilized a systems perspective in their work; and (4) had experience conducting research. Statistically significant differences between LEND trainees and comparison peers were all large effects. The LEND Outcomes Follow-Up Survey, did not identify significant group differences between LEND trainees and comparison peers ratings on: utilization of an intersectional or life course approach; engagement with maternal and child health populations; or level of comfort with leadership skills. These findings suggest that LEND trainees are more likely to endorse questions on the LEND Outcomes Follow-Up Survey that ask about skills and actions rather than opinions or level of comfort.

We measured MCHB leadership outcomes using the Graduate Survey. On the Graduate Survey, the only area in which LEND trainees differed significantly from comparison peers was working with maternal and child health populations; LEND trainees were significantly more likely than comparison peers to report working with maternal and child health populations. This difference was a large effect; 85.7% of LEND trainees reporting working with maternal and child health populations compared to 28.6% of comparison peers. Of note, the magnitude of group differences for questions on which trainees and comparison peers were not significantly different was similar to the magnitude of group differences that we reported in a recently published study using a larger sample size to longitudinally assess LEND trainee outcomes (Bishop et al., 2022). In fact, these recently published findings (Bishop et al., 2022) suggest that in comparison to peers who did not receive LEND training, LEND trainees are significantly more likely to: work with underserved or vulnerable populations; are more likely to engage in a more leadership activities; and the magnitude of differences between LEND trainees and comparison peers increases over time. Given that data presented in this study consist of responses from participants in this larger study of LEND outcomes (i.e., LEND Outcomes Study; Bishop et al., 2022), our lack of significant findings in this analysis may be related to the fact that we were only powered to detect large effects and used a cross-sectional design in our pilot study.

Our findings suggest that participants may have misunderstood some key phrases in the LEND Outcomes Follow-Up Survey. That is, LEND trainees were more likely than comparison peers to respond affirmatively when asked if they worked with “maternal and child health populations” but responded similarly to comparison peers when asked if they worked with specific types of individuals that fall under the umbrella term of “maternal and child health populations” (i.e.., children, adolescents, children with special healthcare needs, children with autism spectrum disorder). This finding suggests that comparison peers may not have understood who comprises maternal and child health populations. Some LEND trainees also appeared confused about who makes up the “maternal and child health population” as some LEND trainees endorsed working with specific maternal and child health populations but did not endorse working with “maternal and child health populations”. Based on evidence of possible reader confusion, adding explanation or definitions of terms to the broadly and nationally used Graduate Survey, may make responses more accurate in capturing trainees’ actual engagement with maternal and child health populations.

The current study’s data highlight the utility of both the LEND Outcomes Follow-Up Survey and the Graduate Survey in capturing difference in training outcomes for LEND trainees versus those who do not receive this training. Our study results suggest that the questions on the Graduate Survey related to maternal and child health leadership outcomes capture differences between LEND trainees’ and comparison peers’ outcomes two years post-training. Findings also suggest that defining terminology on the Graduate Survey about may increase rater understanding, and thus, accuracy in rater reporting of post-training outcomes.

Limitations

Our findings should be interpreted in the context of several limitations. First, our sample size for this pilot study was relatively small (N=73) and we therefore did not have the power to detect small to medium effects or to adequately assess the psychometric properties of the LEND Outcomes Follow-Up Survey; further validation of the instrument is an important direction for future research. This pilot study cohort were all trained in the same year, and answered the Graduate Survey only 2 years later, which also limits interpretation and generalization of results. Further, the limitations of the parent study, including the homogeneity of the sample and the use of a prospective cohort design rather than a randomized controlled trial design impacts interpretation of our results. These limitations are discussed in greater detail in (Bishop et al., 2022). Finally, although our LEND trainee and comparison peer groups were well-matched on demographic characteristics (Bishop et al., 2022), selection of comparison peers who did not apply to LEND training programs or were not selected to receive LEND training may create bias.

Conclusions

Using a unique LEND Outcomes Follow-Up Survey, we found that LEND trainees are more likely than comparison peers to work on interdisciplinary teams, engage in advocacy, use a systems approach, have experience conducting research, and work with maternal and child health populations two years after completing LEND training. These findings suggest that LEND training influences trainee outcomes and the ways in which LEND trainees differ map on to core competency foci of LEND training programs nationally. LEND training appears to impact trainees’ outcomes in ways intended. Further, results of this study suggest that the design of the Outcomes Study can be used to gain additional assessments of trainee outcomes. Use of this study’s design could provide LEND programs and MCHB with additional means to assess various long-term outcomes of LEND training. Such additional evaluation has the potential to influence future directions of LEND training.

Availability of Data and Code:

De-identified data and code for analyses are available upon request from the first author.