Evaluation of a Simulation-Based ICU Orientation Course

Abstract

Background:

Varying levels of experience and skill pose challenges when orienting new respiratory therapist (RT) graduates. Many orientation processes lack standardization and make verification of the orientee’s readiness for independent patient care assignments difficult. Hypothesis implementation of a standardized simulation-based ICU orientation course for new RT graduates will improve their critical thinking skills, communication, troubleshooting, and confidence.

Methods:

IRB exempt status was granted. Scored ICU orientation preceptor evaluations were obtained for both RTs completing our traditional orientation (control group) and RTs completing our novel simulation-based orientation (intervention group). RTs that attended the intervention were asked to complete pre- and post-course self-assessment evaluations which were used to measure confidence levels. Ordinal ICU orientation preceptor evaluation scores were compared across the orientation styles with Wilcoxon rank-sum tests. Stewart Maxwell and McNemar tests were used to assess changes in self-reported confidence levels among the intervention group. P values ≤ .05 were considered to indicate statistical significance.

Results:

There was a significant shift toward higher RT confidence in 9 out of 15 competencies and 3 of 7 course objectives (P < .05). There was not a significant difference in the minimum or maximum overall preceptor evaluation scores when comparing the orientation styles (P = .33 and P = .13, respectively). For individual evaluation subscales, the intervention group achieved significantly better clinical decision-making subscale scores than the control group (P = .05) when considering their best score.

Conclusions:

Utilizing a simulation-based orientation course led to improvement in self-confidence and critical thinking skills among new RT graduates beginning their ICU orientation. It has also resulted in improved productivity as it is no longer necessary to pull preceptors from patient assignments to complete competencies with their RT orientees. Most importantly, this new orientation course has resulted in the standardization of ICU orientation across multiple hospitals in the Cleveland Clinic Health System. The use of facilitators trained in simulation education has strengthened our ability to provide standardized training and assessment of competence throughout the course. Further investigations and literature are imperative to develop new RT orientation best practices.