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Rural Health Information Hub

Learning Exchange Reverse Demonstration (LERD) Model

  • Need: To make it easier for rural nurses to continue their education by decreasing the need to travel.
  • Intervention: An innovative, online health assessment course used telehealth to allow rural RN-BSN students to demonstrate skills acquisition.
  • Results: Rural participants had similar learning outcomes to those participating in the onsite version of the course, with fewer travel costs, less time away from work, and higher overall satisfaction.


Promising (About evidence-level criteria)


With funding from a Health Resources and Services Administration (HRSA) Innovative Nursing Education Technologies (INET) grant, the University of Missouri-Kansas City School of Nursing and Health Studies developed the Rural Nurse Initiative RN-BSN program to meet the needs of rural nurses seeking to continue their education.

Traditional distance education for rural nursing students typically requires onsite periods to cover topics related to skills acquisition. This places a burden on students, taking them away from their jobs and their communities while incurring travel expenses. The Rural Nurse Initiative program developed a proprietary approach, the Learning Exchange Reverse Demonstration (LERD) Model, to allow rural students to develop and demonstrate skills acquisition from their home communities.

Graphic showing the Learning Exchange Reverse Demonstration (LERD) Model process
The LERD Model Process

Services offered

Rural Nurse Initiative students were provided with laptops and internet access. Students were enrolled in an online-only health assessment course that used the telehealth-based LERD approach to provide the health assessment skills component:

  • 2-3 practice sessions per week for 16 weeks
  • At the rural location: small groups of 8-10 students
  • At the university: a faculty member, videographer, and standard patient

To develop and then demonstrate their health assessment skills, the distance students used telehealth equipment and guided their instructors in conducting a health assessment on a patient present at the faculty member's location. Instructors provided feedback to the students as they developed their skills.


To determine the effectiveness of the LERD Model, the same health assessment course was offered to two groups of students. The non-rural group participated in a 4-day onsite health assessment skills component, while the rural students used the telehealth-based LERD approach. Other aspects of the 16-week-long course, including the instructors and other learning components, were identical for both groups.

Rural distance students, compared to the non-rural group, had:

  • Similar learning outcomes
  • Less time away from work
  • No travel expenses
  • Slightly higher satisfaction with the course
  • Exposure to telehealth tools and concepts that may be applicable to their future work

Aside from an initial investment in technology for the LERD Model, the cost of providing the health assessment skills component online was only slightly more than the traditional 4-day onsite approach.

Based on the results of this study, the LERD Model was expanded to all students in the RN-BSN program. It has become an integral part of the RN-BSN program and continues to produce positive outcomes.

For more details about program results:

Klaassen, J., Schmer, C., & Skarbek, A. (2013). Live Health Assessment in a Virtual Class: Eliminating Educational Burdens for Rural Distance Learners. Online Journal of Rural Nursing and Health Care, 13(2), 6-22. Article Abstract


Initially, the major barriers included experimenting with a delivery design, obtaining equipment, and training personnel. One significant barrier was some faculty's resistance to a new model for health assessment instruction: Faculty were skeptical that this particular design would work.


Make sure that all needed space and equipment are available and that appropriately skilled faculty are assigned. Faculty must have an excellent grasp of technology and online instruction.

This approach could be adapted to other distance education courses that have typically required an in-person component, reducing barriers for developing the rural health workforce.

Health workforce education and training

States served
National/Multi-State, Missouri

Date added
July 14, 2014

Date updated or reviewed
July 6, 2021

Suggested citation: Rural Health Information Hub, 2021. Learning Exchange Reverse Demonstration (LERD) Model [online]. Rural Health Information Hub. Available at: [Accessed 19 May 2022]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.