The following is the summary of “Utilizing Competence-Based Simulation to Improve Orientation Outcomes” published in the December 2022 issue of Respiratory Care by Pezzimenti, et al.

No matter what their educational background is, newly licensed respiratory therapists (RTs) are only given a rudimentary grounding in the diagnosis and treatment of neonatal and pediatric conditions. Most seasoned RTs only have experience with adults and not children. To ensure a more fruitful orientation, we designed a curriculum using competence-based simulation.  To guarantee that all new recruits acquire the knowledge and skills necessary to carry out pediatric clinical responsibilities, a 9-week orientation program curriculum was established with simulation-based competency assessment. During the first and final weeks of orientation, all new hires worked through the same set of simulation scenarios on their own. 

Results from simulations and actual on-the-job knowledge and abilities gained during and after orientation were used to adjust the curriculum gradually. Researchers performed t-tests, both paired and unpaired, considering a value of (P<.05) significant. The program was updated 3 times between January 2017 and February 2020. All time periods included both noninvasive ventilation and decompensating patient situations. There were a total of 92 new hires oriented over 4 time periods: period 1=29 (new graduate RTs = 20, experienced RTs = 9), period 2 = 17, (new graduate RTs = 10, experienced RTs = 7), period 3 = 24, (new graduate RTs = 21, experienced RTs = 3), and period 4 = 22 (new graduate RTs = 22). 15 % of new hires needed extra help during orientation. After completing the course, 71% of the students were accepted into an intensive care unit orientation. Each member of staff showed growth in performance from pre- to post-simulation results across the board (mean difference ±SD period 1: new graduate RTs 32.0 ± 17.0, P<.001; experienced RTs 28.0 ± 18.9, P<.001; period 2: new graduate RTs 23.0 ± 15.2, P<.001; experienced RTs 29.0 ± 12.1, P<.001; period 3: new graduate RTs 26.0 ± 15.8, P<.001; experienced RTs 27.0 ± 15.1, P=.007; and period 4: new graduate RTs 19.0 ± 14.5, P<.001, paired t test.  

(P<.001) for RTs in the first period for both the new and experienced graduates; (P< .001) for RTs in the second period for both groups; (P<.001) for RTs in the third and fourth periods for both groups; and (P=.007) for the difference between the third and fourth periods for both groups. Although there was no statistically significant difference in post-simulation ratings between recent grads and veterans in period 1 (P=.35), there was a difference of P=.040 (unpaired t test) in periods 2 through 4. Adopting a competence-based orientation program demonstrated academic progress and aided in defining satisfactory completion of orientation.