2005 OPEN FORUM Abstracts
Competency Based Skills Assessment for Respiratory Therapists.
Comparing traditional methods of training and assessment to simulation based training and assessment.
Edgar Delgado, RRT, Ray Tuttle, RRT-RN, Al Augustine, RRT, Dana Novotny, RRT, Mark Cohen, RRT, Respiratory Care Department, Thomas Dongilli and John Lutz, Peter M. Winter Institute for Simulation Education and Research (WISER), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
INTRODUCTION: Since simulation based medical education and training (SBMET) has been proven to be successful in other fields of medicine, the Respiratory Care department of UPMC Presbyterian campus evaluated SBMET for training and competency verification with an emphasis on patient safety and procedure performance standards. The Mini Bronchoalveolar Lavage (Mini-BAL) procedure was chosen for this evaluation process. Mini-BAL is a blind (non-bronchoscopic) procedure for obtaining lower respiratory tract samples for diagnosis of VAP. The BAL Cath by Kimberly-Clark (REF 141) was utilized for this project. As a literature search reveals, the Respiratory Care Department of UPMC Presbyterian campus is the first hospital nationally to offer Mini-BAL service, performed by all staff respiratory Therapists, in all ICUs. UPMC Presbyterian campus is a large tertiary medical center with 14 ICUs (132 ICU beds total), a census of 90 ventilators/day and 139 Respiratory Therapists.
METHOD: Simulation based training and assessment for Mini-BAL procedure took place at the Peter M Winter Institute for Simulation, Education and Research (WISER). The center utilizes 19 full-body Laerdal SimMan simulators and 12 partial-task trainers and incorporates web-based curriculum, simulation base training, video taped performance, data collection and post scenario debriefing at its core. Educational interventions and Competency Evaluation occurred in three phases. All Therapists were evaluated utilizing standardized procedure criteria and simulation scenario in all phases. The first phase - 24 Therapists were randomly chosen and individually tested to validate current staff performance, which reflected traditional training methods.
Phase two - 60 staff therapists were given access to the WISER web-based curriculum on cognitive aspects of the Mini-BAL procedure, and a video of the procedure for review. The therapists had unlimited access to the material for frequent review. They were then individually re-evaluated.
Phase three - The same 60 therapists then attended a workshop employing simulation-based training and practice followed by re-evaluation. Immediately following this final re-evaluation all deficiencies discovered were addressed privately with each Therapist and additional training and retesting was completed if necessary to ensure safe and standard performance of the procedure.
RESULTS: The mean score of the first phase was 73.4% ± 9.7%, which represented traditional methods of teaching. Mean score for phase two was 79.5% ± 10.9% that represented impact of web-based curriculums. However, the mean score for phase three, which represented SBMET, was 94.9% ± 5.1% (p < 0.01).
Furthermore, post survey of all therapists revealed that 81.3% recommended SBMET become the standard training and competency verification method for this procedure.
CONCLUSION: Upon evaluation of the above data, it appears that SBMET is far superior to traditional methods of training and competency verification. Therefore all staff therapists will be required to attend the Mini-BAL course at WISER institute. It will be the first in a series of critical care courses for competency verification which will be designed for UPMC Respiratory Care practitioners utilizing WISER's simulation approach.