A Method for Enhancing Specialty Skills of Practicing Psychologists: Independent Learning Plan Experiences among Psychologists working in the Veterans Health Administration

Abstract

The current workforce lacks enough trained psychologists specializing in geriatric mental health (i.e., geropsychologists) to meet the population’s needs. The Veterans Health Administration (VHA) Geriatric Scholars Program—Psychology Track (GSP-P) targets this gap by providing intensive post-licensure training to enhance geropsychology skills and competencies. Further professional development is offered through an advanced workshop that includes structured independent learning plans (ILPs) with subject matter expert consultation over a 6-month period. To evaluate the program, we conducted a survey that included closed-ended questions for perceptions of learning on a 5-point Likert type scale and open-ended questions to characterize the perception of the ILP experience, local challenges and solutions, and impact on the population level. The response rate was 78.9% among 19 scholars. Scholars strongly agreed that participation in the ILPs improved their geropsychology knowledge (M = 4.8 of 5/strongly agreed) and skills (M = 4.5 of 5). Content analysis of activities completed and challenges was conducted. A rapid thematic analytic approach guided by the Kirkpatrick (2016) learning evaluation model was used to analyze scholars’ responses to open-ended prompts. Qualitative findings confirmed a positive reaction to learning, acquisition of new knowledge, skills and competencies, which led to practice change that, in turn, had a positive impact on VHA organizational goals. After completing the ILP, scholars described their commitment to continue and grow in geropsychology training, which suggests that the GSP-P model, with mentored independent learning for continuing professional development, might be expanded within VHA and exported to other healthcare settings.

Introduction

Multiple investigations over the past 35 years have demonstrated a dire and persistent shortage of geriatric mental health providers (Roybal, 1988; Institute of Medicine, 2008; Institute of Medicine, 2012; Hoge et al., 2015; Moye et al., 2019). While the older adult (age ≥ 65) population continues to grow, the percentage of psychologists who identify as geropsychologists or whose caseload is comprised of a meaningful proportion of older adults has declined from 4.4% (Gatz et al., 1991) to 1.2% (Moye et al., 2019).

This shortage of geriatric mental health providers also extends to the Veterans Health Administration (VHA), the largest integrated health care system in the United States where 54% of all patients served are age 65 and older (Washington, 2022). Older Veterans frequently present to VHA care settings with complex and co-occuring physical, cognitive, and mental health conditions. As a result, VHA has invested in the expansion of mental health positions into integrated care settings in VHA where older Veterans are primarily seen, such as home-based primary care (Karlin & Karel, 2013; Mavandadi et al., 2023). Given the lack of available trained geropsychologists, providers who are hired into these positions may not have specialty training to work with older adults and their families. Specialty training should include an understanding of the normal aging process, variations in presentations of mental health concerns across the lifespan, knowledge of age appropriate assessment measures for accurate diagnosis, skills in adapting evidence-based interventions to address age-related concerns, and competency in working with interprofessional teams and families to collaborate and coordinate care with those involved in the older adult’s treatment (American Psychological Association, 2024, Hinrichson, Emery-Tiburcio, Gooblar & Molinari, 2018; Karel, Emery, Molinari 2010). In VHA, addressing the gap between actual and needed mental health providers with geriatric training is especially important due to the number of older Veterans receiving care for their complex medical, cognitive, and mental health needs.

To address this gap in prior training, the Geriatric Scholars Program-Psychology Track (GSP-P; Huh et al., 2020) provides the VHA psychology workforce with intensive post-licensure training to enhance geropsychology competencies in working predominantly with older adults. Between 2013 and 2024, more than 200 VHA psychologists have been trained through the GSP-P ( Gould et al., 2024). Each VHA region nominates psychologists to participate in the program to encourage representation from all regions of the United States. Scholars participate in a weeklong foundational geropsychology competencies course including training in quality improvement (QI). Some topics in the foundational competencies course include, but are not limited to: psychology in palliative care, sensory impairments and communication, cognitive assessment, decision-making capacity assessment, late-life suicide assessment and management, elder abuse, interdisciplinary team-based health care, and working with families/caregivers. The specialized training in QI not only teaches scholars QI skills but also focuses on identifying realistic opportunities for program improvement in their local practice(s), including implementation and evaluation. Scholars in the foundational course have endorsed increased geropsychology knowledge, skills, and job satisfaction at 3-months post-participation (Huh et al., 2021).

Scholars who participated in the GSP-P foundational geropsychology competencies course represent many geographic regions in the US, and individual job settings (e.g., home-based primary care, primary care-mental health integration, VHA nursing homes). Exit feedback is gathered from all scholars completing the foundational course using open-ended queries to assess the course and to identify additional gaps in education and training. Two main themes emerged as a continuing need for professional development: a desire for longitudinal learning and for learning opportunities tailored to their individual job settings. In response to this feedback, GSP-P developed an advanced workshop model to enhance expertise in geropsychology (see Gregg et al., 2022). This advanced workshop model included the implementation of independent learning plans (ILPs)—with the assistance of consultants—for continued, personalized growth following the workshop. Considering the urgent need to enhance geriatric competencies among VHA psychologists, ILPs represent a highly individualized, relatively scalable mechanism with the potential for broad reach to providers across the system. The workforce development approach of using a course followed by ILPs has similarities to approaches used in VHA to train providers in evidence based psychotherapies (i.e., multi-day workshop followed by a period of experiential practice with consultation) for disorders such as posttraumatic stress disorder (Rosen et al., 2016) or for application with specific populations such as Veterans in Home Based Primary Care (Beaudreau et al., 2022).

Advanced Workshop with Independent Learning Plans

To be eligible for the advanced workshop with ILPs, psychologist scholars must have completed the foundational geropsychology competencies course and initiated a QI project focused on geriatrics at their VHA facility. Eligible scholars attended the advanced workshop where they were introduced to the ILPs. During the workshop, scholars were encouraged to identify areas of interest for targeted continued learning. Workshop leads (CEG, RLR, JJG) guided scholars in conceptualizing their ILP learning goals through suggestions to (1) consider ways to extend specific learning from the workshop; (2) reflect on their self-assessment in geropsychology competencies completed prior to the course (Karel et al., 2010); and (3) examine their own learning needs and setting where they deliver care. Scholars were encouraged to identify small, achievable learning activities for each study goal, such as reading an article or book chapter, meeting with an expert, attending a webinar, or administering a specific assessment tool. Scholars began developing their ILPs through devoted time during the advanced workshop.

Groups of three to four scholars met with a geropsychology subject matter expert (n = 6) who served as their consultant during the six months following the workshop in which the ILPs were to be completed. The consultants were geropsychologists who work in VHA outpatient, home-based primary care (HBPC), or long term care settings. An extensive guide was created to standardize the intervention. Consultants were asked to provide suggestions for learning activities, connect scholars with needed resources, assist with limiting the scope of the ILPs, and provide encouragement for timely completion of the ILP. Consultants did not receive any incentive nor protected time to participate. The consultants’ role did not include supervision, case consultation, or sharing of any patients’ personal health information.

Evaluation Aims

This evaluation aims to summarize the ILP activities selected and completed by scholars and identify the challenges encountered by scholars. In order to characterize the overall impact of the ILPs on learning, we selected the Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016) to guide the education evaluation as this model has been successfully used in prior evaluations of the Geriatric Scholars Program (Huh et al., 2021; Kramer et al., 2016). In this model, the four levels of learning encompass: (1) the reaction to the educational activity (Level 1); (2) learning as a result of the educational activity including changes in attitude, knowledge, or skills (Level 2); (3) behavior changes and applications of learning to one’s occupation (Level 3); and (4) impact on organization through leading indicators such as efficiency, quality, and employee satisfaction (Level 4).

Methods

This education evaluation was a retrospective, mixed methods design.

Participants

To be eligible for this education initiative, participants must be employed by VHA as psychologists and have participated in GSP-P between 2013 and 2018. Of the 106 potentially eligible psychologists, 21 attended the workshop. The invitation to participate in the advanced workshop in May 2019 was advertised first to psychologists who completed the foundational course, their QI project, and an elective practicum through the GSP. Any remaining spots were offered to psychologists who completed the foundational course and their QI project. In terms of incentives for participation (aside from personal and professional growth), participants were permitted time away from their standard work duties for the duration of the 3.5-day workshop and their travel and lodging expenses were reimbursed. In addition, participants and their supervisors signed paperwork to allow for weekly time to work on the ILP.

Measures & Procedures

ILP Initial Report and Final Report.

Standardized reports were completed by scholars at two timepoints: (1) within one month of the workshop ending (intial report) and (2) 6-months post-workshop (final report). The ILP initial report summarized the scholars’ learning goals and planned learning activities. The final report asked scholars to review their learning goals and planned activities shared on the initial report, and indicate whether the learning activities were completed. Scholars also were asked to respond to three open-ended prompts about (1) their overall experience [Kirkpatrick Levels 1 & 2], (3) the usefulness of learning [Kirkpatrick Levels 2 & 3], and (3) their intent to pursue further learning in geropsychology [Kirkpatrick Levels 3 & 4].

6-Month Post-workshop Survey.

The 6-month post-workshop survey contained six Likert-type questions that ascertained information regarding Kirkpatrick model levels 1 and 2. Reaction to the educational activity (Level 1) was assessed with four questions regarding whether the scholars were able to complete the activities during the 6-month period, whether scholars could complete the activities without significant disruption in my typical work duties, whether it was beneficial to have a consultant, and whether they were able to access their consultant when they needed guidance. Two questions assessed whether the ILPs impacted the scholar’s geropsychology knowledge and skills (Level 2). Quantitative items were rated on a 5-point scale from strongly disagree to strongly agree (see table for exact questions). Open ended prompts inquired about barriers to participation or challenges encountered and general feedback.

Analysis

Likert-type survey items were summarized using descriptive statistics and frequencies. Content analysis was used to group the open-ended responses regarding barriers and general feedback by three authors who independently reviewed the responses and applied groupings (see Supplemental Material). A consensus meeting was held and any discrepancies were resolved.

The authors (CEG, RLR, JJG, PSM) used a content analysis (Vaismoradi, Turunen, & Bondas, 2013) approach to summarize and categorize the ILP activities described in the final report. The ILP final reports also contained open ended prompts that were analyzed using rapid qualitative analytic techniques (Beebe, 2014; Vindrola-Padros & Johnson, 2020). A template with six categories (see Supplemental Material) was created to summarize the key points and exemplar quotes from the report. The first author provided training on the templated summary approach to the three authors participating in analysis. Analysis began with all four analysts (CEG, RLR, JJG, PSM) summarizing one final report using the template followed by a meeting to review the summary and provide feedback to analysts. This process was repeated for the second report as well. For the next eight reports, each was summarized independently by two analysts who met to review discrepancies before creating a master summary. After these two rounds of summaries were completed, the remaining four reports were summarized by one analyst followed by a second analyst serving as an auditor for the summary.

The next step of analysis consisted of writing narrative summaries for each category to combine the key points and quotes from the summary templates. These narrative summaries facilitated cross-analysis of the scholars’ final reports (e.g., Peeples et al., 2023). The first author (CEG) then reviewed the summaries and applied the Kirkpatrick model as a framework during analysis to organize the findings (Kirkpatrick & Kirkpatrick, 2016; see Supplemental Material). Feedback on the fit of the findings with the Kirkpatrick model was sought through meetings with all co-authors at several timepoints to refine the findings.

A limited quantitative dataset is available from authors upon reasonable request.

Results

Of the 21 scholars who attended the advanced workshop, two were excluded from analyses because they were no longer in VHA employment at the end of the 6-month ILP consultation period. Characteristics of those 19 scholars who were eligible to complete ILPs are displayed in Table 1. Notably, 52% (10/19) of scholars worked in home-based primary care settings. Fifteen of 19 (78.9%) scholars submitted a final report. Scholars who did not submit a final report did not differ from those who did in terms of their work setting (HBPC vs. other) or rurality. Thirteen of 19 (68.4%) completed the survey at 6-months post-workshop.

Table 1.

Characteristics of Scholars (N = 19)

Characteristic	n (%)
Gender  Women  Men	15 (78.9%) 4 (21.1%)
Work setting  Home Based Primary Care  Primary Care (general and geriatric primary care)  Outpatient Mental Health (including telehealth)  Unknown	10 (52.6%) 5 (26.3%) 2 (10.5%) 2 (10.5%)
Rural/Rural Serving Priority Facility	11 (57.9%)

Description of ILP Activities

Analysis of the 15 ILP final reports revealed scholars engaged in a median of four learning activities (M = 3.7, SD = 1.0, range 2 to 6) (see Table 2). All (15/15) scholars used reading, most (13/15) applied what they learned with patients, and most (11/15) engaged with coursework using the VA’s employee virtual learning platform, which includes an online repository of asynchronous trainings (many of which offer continuing education credit) across a wide variety of topics. Most activities were completed; completion rates were 90% to 100% for all activities except for coursework/training (82%) and shadowing (67%). Scholars focused on various topics such as working with Veterans living with dementia and their families, capacity evaluations, end of life/life limiting illness, and treatments for grief (i.e., dignity therapy).

Table 2.

Activity Categories, Completion Rates and Example Activities

Activity Category	n activities identified	n (%) completed activities	Example Activity from ILP
Reading	38	38 (100%)	Read about lifespan developmental theories
Applied with patients	21	19 (90%)	Administer Montreal Cognitive Assessment and make Functional Assessment Staging Tool (FAST) determinations for dementia and interpret using appropriate published norms with patients
Coursework/training	17	14 (82%)	Complete recorded training on palliative care [“Dying Well”]
Consult with others	10	9 (90%)	Discuss use of Writing Exposure Therapy (WET) therapy with consultant.
Podcast	4	4 (100%)	Listen to public radio oral histories podcasts to learn about historical events of local area
Shadowing	3	3 (67%)	Shadow Geriatrics and Extended Care memory clinic evaluation
Teaching	2	2 (100%)	Deliver talk to postdoctoral fellows on aging
Identify articles to read	2	2 (100%)	Made list of articles to continue reading about PTSD and aging
Discussion	2	2 (100%)	Participate in discussion of neurocognitive assessment factors for minority groups (Geropsychology Journal Club)
Reflection	1	1 (100%)	Reflect on my thoughts, feelings, progress by incorporating this topic into my mindfulness practice for 2 days a week for at least a few minutes.

Kirkpatrick Level 1: Reaction to learning

Reaction to learning incorporated data drawn from survey findings and the final reports. The final reports included global reflections on the learning experience, experiences with specific learning activities and different modalities, and identification of barriers to learning and facilitators of learning.

Global reflections on learning expressed were generally positive, with many scholars (n = 9, 64%) describing having positive emotional experiences (e.g., joy, fulfillment) in response to the learning activities and/or the ILP method of learning. One scholar noted appreciation for the freedom to choose their individual learning activities. With regard to the experience with modalities of learning, the scholars’ reaction to the learning activities varied. Some activities, such as reading, listening to audio, or online courses, were perceived as easier to complete than other activities, such as implementing new therapeutic approaches with patients. Reading tasks were viewed as the most accessible of all the activities. Scholars described combining modalities such as reading and applying new therapeutic approaches with patients. Some scholars reflected that in-person learning and/or shadowing resulted in more growth and skills acquisition compared to readings or webinars.

Challenges affected the experience of learning for some scholars as well. Eight (61.5%) respondents noted specific challenges encountered on the 6-mo survey. Similarly, 8 of 15 scholars (53.3%) reported challenges in their final independent learning reports. As noted in both the survey and ILP final reports, finding time to complete learning activities during the workday was the main challenge (n = 5 surveys; n = 3 final reports). Although some scholars encountered difficulty fitting the ILP activities into their regular work schedule, others indicated they were able to complete tasks during the work week, such as listening to podcasts while driving to see patients, and facilitating discussions during team meetings. Other challenges encountered included not being able to locate resources needed for learning activities such as specific courses or finding information on underesearched areas (e.g., cultural appropriateness of brief cognitive assessments). In response to these challenges, scholars received assistance from their consultants with identifying resources and some also found their own creative solutions. One scholar described their solution to a challenge regarding implementing dignity therapy (Chochinov et al., 2005) —a therapeutic intervention which involves conducting a recorded interview with a patient and subsequently transcribing it to share with loved ones selected by the patient—in their setting:

Trying dignity therapy was rewarding but challenging, as our program does not have the support structure to provide assistance with transcription or allow the time to edit a written document as outlined in the therapy protocol. I tried a modified form of dignity therapy creating a legacy recording for the veteran on a handheld voice recorder. I was able to order voice recorders through voluntary services at the VA for this purpose. (Scholar 1, HBPC setting)

Facilitators that positively affected the scholars’ reaction to learning were the inclusion of consultants in the ILP process and specific guidance to set time-limited and achievable goals shared at the workshop and in ILP instructions. Survey findings indicated that consultants were viewed positively (M = 4.6 out of 5) and seen to be integral to the process (see Table 3). In their final report, one scholar described how the encouragement to have a smaller scope helped them begin learning:

Table 3.

Survey evaluation of ILPs (N = 13 respondents)

Item	Strongly Disagree (n (%))	Disagree (n (%))	Neutral (n (%))	Agree (n (%))	Strongly Agree (n (%))	Median	M (SD)
The Individualized Learning Plan increased my knowledge in specific geropsychology competencies.	0 (0%)	0 (0%)	0 (0%)	3 (23.1%)	10 (76.9%)	5.0	4.77 (0.44)
The Individualized Learning Plan increased my skills in specific geropsychology competencies.	0 (0%)	0 (0%)	0 (0%)	6 (46.2%)	7 (53.8%)	5.0	4.54 (0.52)
The 6-month period gave me enough time to complete my activities in the Individualized Learning Plan	0 (0%)	1 (7.7%)	0 (0%)	5 (38.5%)	7 (53.8%)	5.0	4.38 (0.87)
I was able to complete the Individualized Learning Plan activities without significant disruption in my typical work duties.	0 (0%)	1 (7.7%)	0 (0%)	6 (46.2%)	6 (46.2%)	4.0	4.31 (0.86)
It was beneficial to have a consultant to work with on my Individualized Learning Plan.	0 (0%)	0 (0%)	1 (7.7%)	2 (15.4%)	10 (76.9%)	5.0	4.69 (0.63)
I was able to access my consultant when I needed guidance on my Individualized Learning Plan.	0 (0%)	0 (0%)	1 (7.7%)	4 (30.8%)	8 (61.5%)	5.0	4.54 (0.66)

Having encouragement at the development stage regarding keeping the scope manageable was helpful. There are many topics to explore and learn that I simply had not taken steps to address before. Keeping the scope of this project limited was helpful to START learning in these areas, and I have continued to learn in these areas beyond my original learning plan since that time once the ball was rolling. (Scholar 7, HBPC setting)

Kirkpatrick Level 2: Learning defined by the acquisition of knowledge, skills, and confidence

Data supporting the impact of ILPs on acquisition of knowledge, skills, and confidence were drawn from both surveys and the final ILP reports. As shown in Table 3, the survey findings demonstrated that scholars strongly agreed that participation in the ILPs improved their geropsychology knowledge (M = 4.8 of 5) and skills (M = 4.5 of 5). Analysis of reports found that scholars described deepening their knowledge base and expertise in working with aging Veterans, often specific to their clinical settings. A scholar summarized the impact of the ILP on their knowledge and skillset as such:

I found this experience to further enrich my knowledge and skill set when working with aging Veterans. It has provided me with expanded clinical abilities to address our aging Veteran population as well as work with family members of veteran’s struggling with dementia or end of life/life limiting illnesses. It has also provided me with a framework to better articulate my approach to therapy. (Scholar 2, Primary Care setting)

Scholars commented that individualized learning helped them to feel more confident in the services that they are providing in their specific clinical settings. Scholars described that having the opportunity to explore the theory and research behind specific evidence-based practices allowed them to feel more confident in the services they could provide to their patients and families.

Kirkpatrick Level 3: Practice Change

In the final reports, scholars described that having the ILP helped them integrate their new knowledge and skills into their clinical practices. Scholars also elaborated on their plans to utilize the new assessment and treatment methods that they learned in care for older Veterans. One scholar shared an intention to continue to use capacity assessments and they described their use of the ILP to:

…[help me] approach rather than avoid this topic [capacity]…I don’t think I want to pursue making capacity assessments a primary component of my practice, but I do think the learning I have completed will enable me to assist my patients and my team better than I was able to do before. (Scholar 4, HBPC setting)

Several scholars described their intention to continue implementing and adapting interventions related to palliative care and end of life care, such as dignity therapy and acceptance and commitment therapy.

A byproduct of the ILP activities was that they ignited a chain reaction of motivation and actions taken towards future learning. Goals around reading relevant literature to enhance one’s knowledge formed the majority of plans to continue to learn independently. Some scholars discussed continuing to read about topics identified during the ILP process. Others also described their plans to seek out webinars and podcasts to enhance their clinical practice. Another scholar echoed these plans for future learning, acknowledging that while the topics change the learning continues. Scholars noted their intentions to continue with their self-guided education in other more applied areas including working with family systems, learning about and working with those who are bereaved, continuing with shadowing programs to improve their care of patients with dementia, and reaching out to others for geropsychology-related consultation.

Kirkpatrick 4: Effects on organizational goals

In response to the prompts in their final reports, scholars described ways in which they intended to change practice or made organizational impacts through contributing to the VHA workforce, developing new projects, and gaining further specialization in geropsychology to meet the larger VHA workforce needs for aging Veterans. Some scholars expressed intentions to develop future trainings that would impact others such as creating training for psychology interns, offering brief in-services to their teams on different topics, having a dementia training added to the new employee orientation at their medical center, or continuing to work with psychology practice council on older Veteran issues (i.e., clarify mandated reporting requirements and procedures). Other plans included starting new projects within their clinics. Plans described included improving assessment of chronic illness, end of life issues, and grief; involving psychologists in goals of care discussions with patients who have to make complex decisions about feeding tubes and ventilatory support; and starting a Healthy Brain group.

Some scholars noted a continued or deeper commitment to geropsychology, which fits with the VHA’s organizational needs to deliver quality mental health care to older Veterans. One scholar noted a shift in their career through taking a new position to work more closely with aging Veterans with dementia related behaviors and those at end of life. Two scholars described their plans towards seeking board certification in geropsychology, with one noting that “this experience made me realize the importance of getting my certification as a Geropsychologist. I am currently working on that aspect to complete my 3,000 hours of [consultation]” (Scholar 11, HBPC setting).

Discussion

This evaluation demonstrates that learning during a workshop can be extended through independent learning selected to fit the learner’s own setting. This finding is critical as much of the continuing education available to psychologists is based on webinars, workshops, or specific psychotherapeutic approaches. Our mixed methods evaluation helped characterize what activities were selected for learning plans, barriers and facilitators to learning, and the impact of the learning plans across the four levels of the Kirkpatrick model.

Learning plans were highly individualized to scholars’ settings and needs with multiple modalities of learning activities selected for inclusion. Readings were frequently selected, potentially due to multiple factors including the availability of reading materials, perception that reading provides a foundation for new learning, and the flexibility in which reading could be done. Interestingly, applying knowledge and skills with patients was the second most selected activity, which lends further support to the qualitative findings that scholars implemented what they learned in their practice.

Qualitative findings suggest that the learning activities were largely enjoyable with the observation that learning through shadowing or interactions with other professionals may be more impactful on acquisition of skills and knowledge compared with readings and webinars. This finding is consistent with other available studies, suggesting that psychologists’ report greatest benefit from experiential learning opportunities (e.g., Nel, Pezzolesi, & Stott, 2012). Learning activities helped scholars improve their general knowledge related to geropsychology, furthered learning on specific topics, and improved their confidence. The varied topics selected reflected both the content of the advanced course (Gregg et al., 2022) and the individual settings where scholars worked and practiced. These findings provide evidence in support of the impact of ILPs on scholars’ positive reaction to learning (Kirkpatrick level 1) and acquisition of knowledge, skills, and confidence (Kirkpatrick level 2).

Utilizing qualitative analysis allowed us to detect some changes in clinical practice and/or intention to change one’s practice that might not be detected on traditional self-report measures administered after educational activities. Notably, scholars described changes they made in their individual practice with regard to assessment, new interventions adopted for use, and plans to continue learning (Kirkpatrick level 3). Furthermore, the scholars described organizational impacts (Kirkpatrick level 4) they made through delivering trainings to others, developing new projects, and participating on specific committees.. Scholars’ continued engagement in the workforce and their own training fits with broader organizational goals, such as the importance of continued workforce development as stated in the VA Secretary’s strategic plan 2022–2028 (US Department of Veterans Affairs, 2022). These findings suggest that scholars were able to engage in individualized learning that ultimately resulted in improvements across the VHA system, from patient-level interactions to improvements at the higher organizations/systems level. Geriatric Scholars are considered local champions in care of older Veterans, particularly in VHA rural clinics where there are fewer geriatrics specialists.

Despite these positive findings, certain aspects of the ILP process presented some challenges. A primary challenge to implementing the ILPs focused on the difficulty in finding time during the workday to complete learning tasks. While consultants were viewed as being helpful through encouraging scholars during learning plan development to identify targeted, achievable, and time limited activities, some scholars wanted more time and guidance from their consultants. A potential limitation to the current ILP approach includes the limited availability of consultants, who were volunteer subject matter experts without protected time to deliver extensive follow up with each scholar. Future replications of this work should consider having the consultants work with their supervisors to obtain protected time for coaching. For this evaluation, we focused only on outcomes as measured by learning activities of VHA participants engaged in ILP. We did not capture descriptive characteristics about the interactions with consultants (e.g., the number of times, the modality, and the length of contacts that the participant had with their consultant) that might identify which psychologists tend to self-select to attend an ILP training after an intensive foundational course. We acknowledge that the VHA setting might be unique among healthcare organizations because the majority of patients are older than 65 years of age. Our evaluation design does not capture descriptive characteristrics of the VHA workforce participants (e.g., years in practice, duration of employment at VHA, theoretical orientation) that might help identify potential participants who might benefit from or self-select to participate in other healthcare settings. Finally, our findings may not be generalizable as our training (ILP) was limited to individuals who partook in the GSP who had already completed an intensive foundational course and QI project, thus our findings may be biased as we were training individals who were already invested in furthering their own geropsychology training.

Future initiatives could examine the benefit of different levels of consultation and guidance to the successful completion of independent learning plans. In light of the perceived benefit of consultants with geropsychology expertise—and their limited availability (throughout the world), future training opportunities for psychology scholars within the GSP could operate from a train-the-trainer approach in which past scholars would receive training to then serve as consultants for future psychology scholars (Pearce et al., 2012). Additionally, future directions should examine whether this model can be extended to other health care settings outside the VHA, could be replicated without an associated workshop or training, and/or delivered in conjunction with professional conferences. We hypothesize that it can, but it does require organizational commitment from the highest levels. For example, other potential avenues for replication could through Geriatric Workforce Enhancement Programs focused on behavioral health (Buehler & Emery-Tiburcio, 2024). VHA is fortunate as continued workforce development is one of the VA Secretary’s many guiding principles (US Department of Veterans Affairs, 2022). A final area for future research is whether this approach of mentored learning might have any impact on job retention and prevention of burnout through demonstrated investment in the workforce.

In summary, the ILPs were a feasible and acceptable approach to extending learning for the VHA Geriatric Scholars. The scholars gained specialized knowledge related to their practice setting, thus demonstrating the importance of tailored independent learning. Encouragingly, we observered that the ILPs also served as a jumping off point for continued learning. Thus, mentored independent learning shows promise as a novel approach to providing geriatrics education to the workforce.

Public Significance Statement:

The workforce shortage of geriatric mental health clinicians needed to care for older Veterans requires creative educational and training solutions. This article examines how a discrete period of independent learning can be used to enhance knowledge and skills for psychologists caring for older Veterans. The results suggest that the psychologists enjoyed the learning process and learned new knowledge and skills that impacted their practice.

Author Biographies:

CHRISTINE E. GOULD received her MS and PhD in clinical psychology from West Virginia University. She is currently the Associate Director of Education and Evaluation at the VA Palo Alto Health Care System Geriatric Research Education and Clinical Center. She is also a Clinical Associate Professor at Stanford University School of Medicine in the Department of Psychiatry and Behavioral Sciences. Her areas of professional interest include technology delivered interventions with older adults, telehealth with older adults, and geropsychology training.

JEFFREY J. GREGG received his PhD in Clinical Psychology from West Virgina University. He is currently a staff psychologist and psychology training director at the The Durham VA Health Care System in Durham, NC. His areas of professional interest include Posttraumatic Stress Disorder, trauma-focused therapy, geropsychology, and psychology training.

RACHEL L. RODRIGUEZ received her PhD in Clinical Psychology from The University of Alabama and her MPH in Health Behavior from The University of Alabama at Birmingham. She is a board certified geropsychologist. She is currently a staff psychologist with the Home-Based Primary Care Program at The Durham VA Health Care System in Durham, NC. Her areas of professional interest include geropsychology training and supervision, workforce development, adjustment to chronic illness, and palliative care.

PRIYANKA S. MEHTA received her MS in developmental psychology from West Virginia University. She was previously a program manager at the U.S. Department of Veterans Affairs. Her areas of professional interest included adult development and aging, education, and technology. She is currently an IT analyst at Stanford Children’s Health.

B. JOSEA KRAMER received a PhD in anthropology from Columbia University. Currently, she is the founder and director of the national VA Geriatric Scholars Program and is an adjunct professor in the division of geriatric medicine at the David Geffen school of medicine at the University of California, Los Angeles. Dr. Kramer’s professional interests include workforce development to care for vulnerable older adults, healthcare for American Indian and Alaska Native Veterans, and qualitative research.