Oral Themed Presentation
Context: : The assessment of clinical competency is a difficult concept to both define and measure. Literature suggests that traditional annual competency training may in fact be inadequate. As a result, patient outcomes are potentially impacted by poor clinical performance despite assessments that suggest adequate skill and knowledge acquisition. Based on a need’s assessment of competency deficiencies in our ICU, we replaced traditional lecture-based competency training with simulation-based training. We aimed to improve the content and delivery of our annual PICU competency training by replacing it with a multidisciplinary, learner centered Rapid Cycle Deliberate Practice based simulation training.
Description: : PICU annual competency training which is typically lecture based, was replaced with multidisciplinary simulation training. Competency domains included teamwork skills, technical skills related to airway management, and medical fund of knowledge related to respiratory failure. Distinct learning objectives were identified for 3 groups of learners; physicians/NPs, nurses, and respiratory therapists based on a need’s assessment. Training workshops were divided into two tiers based on years of PICU experience. RCDP was blended with traditional reflective debriefing in order to coach and hardwire the predetermined objectives. Learners from each role were coached by a trained educator for their respective discipline. Facilitators paused the entire group for each predetermined hard and soft stop, allowing coaches to provide feedback to their respective learners.
Observation/Evaluation: : Over a 10-month period, 41 annual competency simulations were conducted, lasting 4 hours each. 109 nurses, 12 PICU fellows, 24 respiratory therapists, and 3 NPs were trained. One primary facilitator trained in simulation debriefing led a team of coaches from individual disciplines. Coaches completed a competency check list for each workshop, marking skills that required coaching. Most common errors included lack of role assignment by team leader, lack of prioritization when giving drug orders, lack of checking for air leak post intubation, and incomplete verification of the 5 rights when delivering medications. All groups required clarification on appropriate use of an airway checklist bundle (NEARS for KIDS), use of an intubating D-blade, and management of bronchospasm. All nurses required coaching with bag/mask ventilation in an intubated infant.
Discussion: : We applied a unique methodology of RCDP training which allowed a multidisciplinary team to be trained by educators in their individualized discipline providing each learner with a coach expert from their respective field. Forcing the entire group to listen to each coaches' feedback allowed for a unique opportunity for the nurses, therapists, and physicians to better understand each other’s perspective. This type of training helped us to identify learners that lacked competency in certain skills, something that had been overlooked in previous unit-based competency trainings. As a result, and unlike prior years, staff required remediation training following simulation. This type of training is also limited by resources as multiple coaches were required for each training session.