PICU Overnight INTerprofessional Education of Residents (POINTER): Leveraging Bedside Experience to Improve Resident Bedside Care.

Abstract

Resident education rarely includes training in the hands-on mechanics of care delivery; however, these bedside skills and knowledge are necessary for patient care and crucial when time and resources are limited. Nurses and respiratory therapists are content experts in this arena yet are rarely asked to provide formal education to resident physicians. Leveraging their bedside experience to enhance resident instruction represents a unique opportunity to address this area of need while working to improve interprofessional collaborative practice through interprofessional education (IPE).1At Children's Hospital of Philadelphia, an intensive care unit (ICU) hospitalist, nurse, and respiratory therapist developed a bedside care curriculum to deliver to pediatric and emergency medicine residents during their 1-month ICU rotation using nurses and respiratory therapists as educators. The primary aim of the PICU Overnight INTerprofessional Education of Residents (POINTER) program was to improve resident bedside care knowledge. Secondary aims were to increase resident comfort with and participation in bedside care and promote interprofessional collaboration.An informal needs assessment identified content areas of interest which were formulated into 4 hands-on sessions by the team: code cart and push-pull fluid delivery system (CCPP), arterial lines (AL), central and peripheral venous access (CPVA), and tracheostomy and respiratory management (TR). Thirty-minute sessions were delivered Monday through Thursday nights (content rotated weekly) to align with resident Q4 call schedule and to avoid conflicts with daytime educational opportunities; timing was flexible to accommodate unit acuity as well as educator and resident availability. Sessions were conducted in-unit using available materials and at bedside when feasible (eg, to demonstrate arterial line setup). Educators signed up to teach during regularly scheduled shifts using a shared calendar. The curriculum had no associated developmental or ongoing costs, and maintenance required less than 1 hour of administrative work per week.The POINTER program was prospectively evaluated using pre- and post-surveys to measure resident knowledge, comfort, and participation in bedside care. The curriculum and interprofessional collaboration were assessed using open-ended questions and a modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration survey.Ninety-eight residents and 27 respiratory therapists and nurse educators participated over 10 months (August 2020-May 2021), and residents attended a median of 3 sessions. Survey completion rate (pre- and post-curriculum) was 51% (50 of 98) for residents and 43% (10 of 23) for educators.Residents demonstrated increased bedside care knowledge and comfort overall (both P<.001; Table). Residents who attended the CCPP, AL, or TR session showed improved comfort with these skills (P<.001, P<.001, P=.018, respectively), and residents who attended the AL session increased knowledge (P=.004) and participation (P<.001) compared to those who did not attend. Residents self-reported that POINTER improved their knowledge (84%, 42 of 50), made them better clinicians/residents (72%, 36 of 50 unique residents), increased their pre-post understanding of the nurse/respiratory therapist knowledge base (60%, 30 of 50, P<.001), and the program should continue (76%, 38 of 50). Residents' attitudes toward physician-nurse collaboration did not change, though they were high at baseline (median score 39/40). Educators enjoyed participating (90%, 9 of 10 educators) and felt they became better teachers (80%, 8 of 10).Resident comments included: “Practical,” “Unique way to learn hands-on skills,” “It filled a gap in our knowledge,” and “I loved...to learn from RTs and RNs! They have a lot of knowledge, and we rarely have formalized time for education with them.”Educator comments included: “I enjoyed helping the residents learn…and get hands-on training,” and “I had taken for granted what the residents know.... They don't have as much experience or understanding as I thought, and they need that to help make medical decisions.”In conclusion, we successfully developed and deployed a novel IPE-based resident overnight curriculum utilizing bedside nurses and respiratory therapists as educators at low cost. Participants appreciated its practical, interdisciplinary nature and increased their knowledge, comfort with, and participation in bedside care. Given its flexibility and customizability, POINTER is likely generalizable to any field with bedside care provided by non-physicians willing to educate learners.