Utilizing Competence-Based Simulation to Improve Orientation Outcomes

Abstract

Background: New graduate respiratory therapists (NG), regardless of degree program, receive limited preparation in neonatal/pediatric diseases and management. Experienced therapists (Exp) typically have adult knowledge, but limited exposure to pediatrics. We implemented a competence-based simulation program to help improve successful completion of orientation.

Methods: A 9-week orientation program curriculum with simulation-based competence assessment was developed to assure all new hires gain foundational knowledge and skills to perform pediatric clinical tasks. Each new hire individually completed the same simulation scenarios during the first week (pre) and last week of orientation (post). Curriculum changes were made based on the performance in the simulations as well as their on-the-job training knowledge and skills during and after orientation. The scoring system changed at the time of curriculum update (between period 1 and 2). Paired and unpaired t-tests with P < 0.05 as significant. Exemption was granted from local IRB.

Results: From Jan 2017–Feb 2020, the program had two curriculum updates (Period 1-3). Period 2 introduced weighted checklists for both simulations and Period 3 introduced 7 weekly didactic sessions. Noninvasive ventilation and decompensating patient scenarios were completed for all periods. Ninety-three new staff were oriented [period 1 = 29 (NG 20, Exp 9); period 2 = 42 (NG 31, Exp 11), period 3 = 22 (NG 22)]. Mitigation during orientation occurred in 16% of the staff. 67% successfully advanced on to ICU orientation after completion of the program. All staff improved scores between pre vs. post simulations in all periods: mean difference ± standard deviation [Period 1: NG 32.1 ± 17.0 P < 0.001; Exp 28.1 ± 18.9, P < 0.001; Period 2: NG 27.2 ± 19.9, P < 0.001; Exp 28.8 ± 12.8, P < 0.001; Period 3: NG 19.6 ± 14.5,P < 0.001, paired t-test]. The scores between NG and Exp during post-simulation were not significantly different for Period 1 (P = 0.346), however was significantly different for Period 2 and 3 (P = 0.040, unpaired t-test).

Conclusions: Use of a competence-based orientation program effectively shows educational advancements from orientation and assists with analysis of readiness for orientation completion.

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