“When Every Organ Counts: There Is Only One Time to Get it Right”; Integration of Customized High-Fidelity Simulation Into Organ Procurement Staff Training

Abstract

Background: Despite a wider public acceptance for organ donation, the number of people waiting for transplants is increasing creating a need for more donors and better stewardship of organs in consented donors. In a scenario where every organ counts, Organ Procurement Organizations (OPOs) are challenged to reform their educational training programs beyond the current “see one-do one-teach one” approach. High-fidelity simulation creates a safe and non-threatening training environment where mistakes can be safely made and learnt from in real-time with no organs lost. Simulation also allows for customizing scenarios to address individual learning needs of participants in a small-group format. The use of high-fidelity simulation focusing on the crucial skills needed to manage the unique physiological and psycho-social issues occurring during organ donor management have not been studied systematically. Methods: We developed a High-fidelity simulation based orientation and training program for newly hired organ procurement coordinators (OPC) at OneLegacy (the Organ Procurement Organization in Southern California). We administered a questionnaire to assess baseline knowledge and to identify knowledge deficits regarding Catastrophic Brain Injury Guidelines (CBIG). To assess incremental knowledge gain, a 30 min subject related theory session was then administered, followed by the completion of a post-theory test. Incorrect answers from the pre and post-theory were used to develop customized case scenarios. Using a high fidelity simulation environment consisting of a physiology based human patient simulator, realistic recreation of an ICU environment and using real ICU equipment, OPCs were challenged to resolve individualized objectives in the simulation session that followed immediately. Sessions were recorded, with playback and detailed debriefing facilitated by an instructor. A post-simulation test was administered after the debriefing session to assess further knowledge gain. Knowledge regarding definition, goals, and clinical triggers for CBIG, referral, clinical management was ascertained using 11 multiple choice questions based on the theory content provided. Results: This training program was trialed with four newly hired OPCs, all with similar experience and professional nursing background. All participants completed the tests, simulation sessions, and debriefing sessions. Knowledge regarding definition, goals, and clinical triggers for CBIG, referral, clinical management with the number of correctly answered questions improving from 9.5 ± 1.65 on pre-test to 10 ± 1.22 on post-theory test and 10± 0.5 on post-simulation test (p value 0.12, paired t-test). All four participants strongly agreed that simulation facilitated their learning and was an effective training method. Conclusions: Integration of customized High-fidelity Simulation into new hire orientation training identifies learning needs and used in conjunction with theory content provides the learner an individualized learning environment with real-time feedback of their performance. It enables instructors to establish measurement criteria for standard practice and documentation of professional competency. Simulation based was perceived as extremely helpful by the newly hired organ procurement coordinators. High-fidelity simulation can be an effective education and training tool for organ procurement staff orientation and training to improve overall organ donor management “when every organ counts”.