- Gravina EW.
EMT-paramedic: NSC refresher curriculum.
- Holmboe E
- Edgar L
- Hamstra S.
Construction of a New Orientation Evaluation Method
- Armstrong P.
- Armstrong P.
|Level 1||Level 2||Level 3||Level 4|
|1. Protocol knowledge||Orientee demonstrates, verbalizes, recalls, and recites 100% of PA state protocols||Orientee is able to verbally recite or demonstrate through practice (scenario/patients) 25% to 50% of the Life Flight protocols||Orientee is able to verbally recite or demonstrate through practice (scenario/patients) 50% to 75% of the Life Flight protocols||Orientee is able to verbally recite or demonstrate through practice (scenario/patients) greater than 75% of Life Flight protocols|
|2. Aircraft/CCGT equipment||Easily locates and recites all contents of the primary bag and Propaq MD, Zoll Manufacturing Corporation, Pittsburgh, PA, USA||A. Recites equipment in the pediatric bag B. Recalls location of medication pouch, pump bag, ACLS medications, and ventilator/bag||Able to locate all equipment in the aircraft and can recall contents of the medication pouch, pump bag, ventilator supply bag, pediatric supply bag, arterial line kit, medication drawer, and pouches||A. Can function during flights when equipment is needed and can logistically place equipment during flight as needed for access B. Excellent knowledge of equipment locations|
|3. Airway management||A. Completed OR rotation with positive feedback B. Can perform basic airway skills (jaw thrust, airway adjunct placement, BVM)|
C. Can state location of airway equipment
|A. Readily describes indications for placement of an advanced airway B. Can verbalize LF airway management policy C. Able to identify need for and use ETT cuff manometer||A. Demonstrates proficiency in performing endotracheal intubation with both direct and video laryngoscopy B. Can identify patient with potential difficult airway||A. Demonstrates ability to successfully deploy adjunct airway devices on difficult intubations B. Can discern need for and demonstrate technique for emergent cricothyroidotomy|
|4. Ventilator management||A. Can properly set up ventilator tubing, including filter B. Can turn on ventilator and perform a leak test||A. Can verbalize initial ventilator settings for adult, pediatric, and neonatal populations B. Able to make ventilator adjustments to place patient on BiPap/CPAP policies||A. Assesses alarms and can perform necessary adjustments to clear alarms and ensure proper ventilator function||A. Identifies patients who need ventilator adjustments dependent on clinical condition B. Can execute necessary changes to ventilator dependent on patient assessment|
|5. Aircraft/CCGT operations||A. Completed ASAT training B. Understands cockpit communications (helmet microphone, Vox, radio etiquette)||A. Demonstrates safe operations around aircraft B. Effectively ingress and egress aircraft C. Competent during aircraft operations (rebuckles seat belts, secures all equipment)||A. Operates doors, completes preflight walk around, and can manipulate litter mount without difficulty B. Safely operates during "hot" operations||A. Capable to input GPS coordinates for scene call and hospital identifiers B. Operates cockpit radios|
|6. Propaq MD operations||A. Can turn on monitor B. Easily attaches 4-lead ECG C. Can cycle BP D. Acquires snapshot E. Changes paper||A. Able to initiate ETCO2 monitoring B. Can change patient settings based on age C. Troubleshoots alarms D. Initiates temperature monitoring||A. Demonstrates ability to initiate invasive monitoring (arterial line, CVP, etc.) B. Displays ability to cardiovert, pace, and defibrillate||A. Demonstrates competency with all aspects of the Propaq monitor B. Changes setting and correlates waveforms to patient assessment (every 5 min BP, decreased ETCO2 waveform)|
|7. Braun infusion pump operations||A. Easily turns on pump B. Checks battery level C. Able to assemble proper equipment (pump dependent)||A. Demonstrates ability to draw uA; shows ability to infuse a bolus|
B. Demonstrates ability to run a timed infusion C. Displays ability to edit pump settings, and medications B. Proficient with loading medication into the pump C. Displays ability to begin a basic rate infusion
|A. Shows ability to infuse a bolus B. Demonstrates ability to run a timed infusion C. Displays ability to edit pump settings||A. Determines the proper infusion (mL/h, cg/kg/min, etc.)|
B. Able to use the drug library for dosing
C. Selects correct concentrations D. Demonstrates ability to use dose rate calculator special functions
|8. Life Flight medications||A. Up-to-date with all medications on the PA state protocols B. Identifies indications, contraindication, mechanism of action for those medications||A. Identifies medications on the LF list by both protocol and location B. Basic pharmacologic understanding of frequently used medications (ASA, narcotics, benzo, etc.)||A. Recognizes indications for medications in certain patient populations (ie, norepinephrine–sepsis, labetalol–CVA, mannitol–high ICP)||A. Applies critical thinking to effectively manage infusions and titrate medications based on patient presentation (ie, changes vasoactive rate to increase BP, titrates propofol for adequate sedation)|
|9. Isolette/MVP 10 operations||A. Turns on monitor|
B. Checks gas levels/changes tanks C. Demonstrates knowledge of supplies (ECG, pulse oximetry, oxyhood, etc.)
|A. Connects ventilator circuit B. Can set up and monitor oxygen % with oxyhood C. Attaches monitor and changes settings, properly routes cables into isolette||A. Demonstrates programming ventilator settings (rate, IPAP, EPAP, Fio2) B. Able to program CPAP settings|
C. Sets pressure relief valve
|A. Manages ventilator settings based on patient assessment B. Troubleshoots MVP alarms C. Can easily arrange infant in isolette, can route wires, vent tubing, etc., change from wall gas to tank source|
|10. Pharmacology||A. States correct doses for ACLS/PALS medications (epinephrine 1:10,000, amiodarone 300 mg vs. 150 mg, adenosine 6 mg, 12 mg, etc.) B. Can verbalize the indications for different classifications of medications (pressors, beta blockers, analgesics, antiplatelets, etc.)||A. Calculates and verbally reports proper doses for all RSI medications including sedation and analgesia (ie, etomidate 0.3 mg × weight, fentanyl 1 μg/kg) without use of calculator||A. Verbalizes contraindications to protocolized medications (ie, no succinylcholine with burn/hyperkalemia, metoprolol/ntg with IWMI) B. States the appropriate need for medication titration based on patient assessment (increase pressor dose, redose analgesia, titrate to sedation level)||A. When presented with a patient (actual or scenario based) considers Life Flight medication availability to select the appropriate agent based on mechanism of action, intended effect, and anticipates potential adverse side effects; verbalizes proper choices|
|11. Patient assessment||A. Recognizes and verbalizes when a patient is stable, unstable, or critical (based on scenarios and/or actual transports) B. Demonstrates the ability to perform head to toe physical examination on patients||A. Effectively listens to patient report from referring provider and records information on the hand off form B. Accurately documents pertinent findings (HPI, PMH, all, labs/studies)||A. Verbalizes alteration in patient condition from normal based on assessment findings and disease process or injuries B. Prioritizes relevant information and verbalizes finding on assessment which are concerning or altered from normal)||A. Analyzes ascertained medical information to formulate a potential diagnosis and develop a plan of care based on those findings; discusses POC and differential diagnosis with preceptor|
|12. Analgesia and sedation management||A. Discusses with crewmembers the need to provide analgesia and/or sedation to patient B. Can verbalize both the appropriate medication and appropriate dose of selected medication||A. Verbalizes the potential side effects and contraindications of medication selected||A. Demonstrates the ability to implement an appropriate pain scale to initially assess and reassess pain level before and after analgesia administration B. Documents in EPIC GMC approved pain scale-initial, after any analgesia administration and at time of handoff||A. Verbalizes patients in need of additional therapies if initial measures are unsuccessful (such as additional doses of analgesia, communication with medical command for additional medications) B. Verbalizes technique to monitor sedation/analgesia side effects (respiratory rate, ETCO2, LOC)|
|13. Clinical patient management||A. Demonstrates organized history taking to include HPI, medications, HX, all; recognition of abnormal vital signs|
B. Incorporates patient physical examination into decision making C. Does not consistently use secondary sources of information to arrive at patient diagnosis D. Difficulty arriving at differential diagnosis or patient management plan
|A. Displays full examination including level 1 (A and B) and includes secondary sources (referring facility labs, medications, imaging) during the decision-making process B. Discusses potential patient problem with partner and/or medical command and frequently requires assistance to discern patient's differential diagnosis C. Able to verbalize patient management plan but requires assistance on a continued basis||A. Demonstrates proficiency regarding information gathering and prioritizes a management plan for critically ill/injured patients B. Requires minimal assistance in developing a plan of care for common patient presentations C. Verbalizes when patient diagnosis or problem is emergent vs. urgent and can adapt care based on information||A. Manages patients with multiple diagnoses based on examination and data synthesis B. Identifies aspects of assessment and data that may be rarely seen C. Systematically and consistently integrates an approach to patient care in team setting for critically ill and complicated patient presentations|
|14. Demonstrates professionalism and accountability and incorporates C.I.CARE daily||Yes/no|
Data Collection and Learning Plan Customization
|Item||Not At All (%)||Somewhat (%)||Definitely (%)|
|Prior method adequately assessed performance||9.09||45.45||45.45|
|New method adequately assesses performance||0||18.18||81.82|
|Prior method adequately targeted knowledge deficits||45.45||45.45||9.09|
|New method adequately targets knowledge deficits||0||36.36||63.64|
|Item||Previous (%)||Current (%)|
|As a preceptor, which method provides better performance information||0||100|
|Item||Not Helpful (%)||Somewhat Helpful (%)||Extremely Helpful (%)|
|Rate the overall change in orientation assessment from the old system to the new system||9.09||9.09||81.82|
- Swihart D.
- Gravina EW.
Appendix. Supplementary materials
- Competency-based education and its effect on nursing education: a literature review.Teach Learn Nurs. 2017; 12 (Available at:) (Accessed September 24, 2017): 17-121
- Competency-based education in transitioning nurse practitioner students from education into practice.J Am Assoc Nurse Pract. 2019; 31: 675-682
- EMT-paramedic: NSC refresher curriculum.2001 (Available at:)Accessed September 24, 2017)
- The milestones guidebook.2016 (1-41. Available at:)Accessed September 21, 2017)
- Toward competency-based medical education.N Engl J Med. 2018; 378: 3-5
- Bloom's taxonomy.Vanderbilt University Center for Teaching, 2017 (Available at:)Accessed September 21, 2017)
- Bloom's taxonomy.2017 (Available at:)Accessed October 5, 2017)
- How will a unit-specific competency-based orientation program benefit the new nursing staff coming to my unit?.Strategies for Nurse Managers, Inc, 2010 (Available at:)Published FebruaryAccessed September 22, 2017)