Assessment of Just-in-Time Training on Provider Self-Efficacy During the COVID-19 Pandemic (1090-003640) (Research Abstract Professor Rounds: Group 3)
Start time: Thursday, January 28, 2021, 11:30 AM End time: Thursday, January 28, 2021, 12:30 PM Session Type: Research Abstracts (Completed Studies)
The novel coronavirus (SARS-CoV-2, severe acute respiratory syndrome coronavirus) is a pandemic with more than 6 million confirmed cases worldwide and over 100,000 deaths in the US to date (7). The pandemic has overwhelmed hospital resources throughout the world. And, has been previously reported from both Italy (13) and Singapore (9), non-intensivists and support providers received training to treat COVID-19 patients. MedStar Health’s Simulation Training and Education Lab (SiTEL) has launched a similar effort, utilizing their ‘Mobile Sim’40-foot straight-truck simulation unit (8) to train acute care providers to augment ICU surge capacity (hereafter ICU Mobile Sim (IMS)). SiTEL’s simulation team also supported orientation training in basic life-saving skills for personnel assigned to MedStar’s Alternative Care Site (ACS) at the Washington Convention Center. We assessed the potential impact of these training activities on provider self-efficacy.
Perceived self-efficacy (SE) contributes to cognitive functioning through cognitive, motivational, affective and selective processes (2). The stronger the perceived SE, the higher the goal challenges people set for themselves and the firmer their commitment to them (3). We constructed retrospective pretest/post-tests (RPPs) following guidance (4) for design of traditional self-efficacy scales. RPPs present the learner with a single instrument at the close of the intervention and learners are asked to record judgments regarding their pre- and post-intervention states (12). Conventional pretest-posttests, requiring two delivery events, consume time that is better spent on program delivery (10). The study was determined to be exempt by MedStar’s IRB. At each of the training events, participants were provided with an opportunity to complete an RPP. Analysis was conducted via within-subjects t-tests in SPSS v. 26. The Holm-Bonferroni correction was utilized to control error rates (1).
41/41 (100%) ACS and 11/15 (73%) IMS day 2 participants completed surveys. ACS learners reported significant pre/post gains in self-efficacy ratings in airway insertion [4.4 vs 8.9, ?=4.5 (95%CI 3.4-5.7) p<0.01], BVM ventilation [6.3 vs 9.1, ? =2.8 (95%CI 1.7-3.9) p<0.01], “analyze button” use [5.4 vs 9.3, ?=3.9 (95%CI 2.9-4.9) p<0.01], delivering AED shock [6.8 vs 9.4, ?=2.6 (95%CI 1.7-3.7) p<0.01], and Lucas® device use [2.2 vs 8.8, ?=6.6 (95%CI 5.4-7.7) p<0.01] as did IMS learners in specifying initial ventilator settings [4.0 vs 8.2, ?= 4.2 (95%CI 2.3-6.0) p<0.008], identifying PiP waveforms [4.6 vs 8.5, ?=3.9 (95%CI 2.3-5.5) p<0.007], plateau pressures [5.1 vs 8.9, ?=3.8 (95%CI 2.0-5.6) p<0.008] and ventilator complications [5.1 vs 9.1, ?=4.0 (95%CI 2.6-5.3) p<0.007], resolving ventilator complications [4.6 vs 8.1, ?= 3.5 (95%CI 2.1-5.0) p<0.007], obtaining consult [2.7 vs 9.1, ?= 6.4 (95%CI 4.6-8.2) p<0.007] and intraosseous access [3.8 vs 8.5, ?=4.7 (95%CI 3.1-6.4) p<0.007].
Our findings indicate that just-in-time training in healthcare skills can be effective in boosting providers’ SE levels. Mavis (11) notes in a medical context that competent functioning in a in a particular situation requires the necessary knowledge and skills as well as personal beliefs of efficacy to meet the demands of a specific situation. Our just-in-time training boosted those beliefs. The skills training in our ACS orientation module is similar to elements of our successful First Fives hospital first-responder training where we have previously demonstrated increases in provider SE after First Fives training (5). Self-efficacy gains may be especially important in the COVID-19 pandemic context where health care roles are fluid and unpredictable (6, 9, 13).