Baylor College of Medicine

Abstract Authors: Natalie Villafranco, MD, Julia B. Lawrence, RRT, Miesha Jolly, RRT, Lisa Traplena, RRT, Jennifer A. Rama, MD, Med

2016 abstract: http://www.thoracic.org/professionals/career-development/fellows/innovations-in-fellowship-education/2016/ baylor-college-of-medicine.php

BACKGROUND

The Pediatric Pulmonology Fellowship Program at Baylor College of Medicine has been delivering an interactive Respiratory Therapy (RT) curriculum during orientation for five years. The purpose of this curriculum is to enhance skills and knowledge in: 1. oxygen delivery devices 2. spirometry 3. metered dose inhalers (MDI) and 4. airway clearance devices. This abstract describes the curriculum’s five year process and outcomes evaluation and highlights Kolb’s experiential learning theory as a framework for its success. In brief, the instructional design enabled the fellow to follow Kolb’s four stages of learning: experiencing, reflecting, conceptualizing, and experimenting.

METHODS

Description needs assessment results informed the curriculum content and the basis of case based scenarios. Initially, each fellow underwent a concrete experience by performing a skill such as providing inhaler instruction through role playing. This experience served as the pre-assessment and provided an opportunity for the fellow to reflect on his/her level of competence. Subsequently, an experienced RT delivered a didactic lecture and reviewed the cases which allowed the fellow to conceptualize new information. Finally, fellows had an opportunity to experiment with the different devices and apply their newly acquired knowledge and skills to new cases as part of the post-assessment. This intentional progression of events enabled the fellow to engage in effective learning. Assessment Fellows performed skills under direct observation of experienced RTs during pre- and post-assessments. The RT instructors completed itemized checklists to assess the fellow’s performance.

Evaluation

Evaluation of the curriculum was done with individual tutorial and overall curriculum evaluation forms. To capture the impact on other stakeholders, the RT instructors were also given the opportunity to evaluate the curriculum through written and verbal comments.

RESULTS

Assessment results Over five years, 18 fellows participated in the curriculum. Using the Wilcoxon

matched pair test, the median scores of providing proper instruction with inhalers and spacers, acapella, flutter, and threshold positive expiratory pressure devices were statistically higher during the

post-assessment as compared to pre-assessment, p<0.05, n= 18. One year later, the median scores

remained significantly improved compared to pre-assessment, p<0.05 n=12. Similarly, the median scores in the oxygen and spirometry stations were statistically higher during post-assessment as compared to pre-assessment, p<0.05, n=18. However after one year, though the median score change was positive, it was not statistically significant, p>0.05, n=12, 8. Probable reasons include less number of fellows in the one year follow-up analysis or less opportunity for clinical application and thus, less retention, as compared to the other stations. Process evaluation results Fellow rated highly many aspects of the program including its organization, content, and method of instruction. Feedback on scheduling led to consolidating the curriculum in fewer but longer days and having the RTs provide immediate feedback on fellow performance. Outcome evaluation results All

18 fellows completed the individual tutorial and overall curriculum evaluations. Data revealed a significant self-reported improvement in all learning objectives p<0.05. All fellows reported improving their skills and acquiring new knowledge in all four areas. Furthermore, all fellows indicated that they were highly satisfied with their instruction and that the curriculum should be offered yearly. The RT instructors reported that their participation enhanced their own interdisciplinary relationships and teaching skills.

CONCLUSION

A robust evaluation over five years demonstrates that this curriculum is valuable to both pulmonary fellows and RT instructors. The curriculum is being implemented as intended and is achieving its desired outcomes. It successfully fills a previous gap in training as well as strengthens interdisciplinary relationships. Instruction guided by Kolb’s stages of learning explains why the curriculum has been a success.