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Dreating the Cath Lab Program | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Cath Lab Academy Curriculum | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Cath Lab Academy Curriculum | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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The Basics of the Cath Lab - Curriculum Week 1 | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
The Basics of the Cath Lab - Curriculum Week 1 | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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Disease States, Complications, and more - Curriculum Week 2 | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Disease States, Complications, and more - Curriculum Week 2 | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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Putting it all Together and Evaluation - Curriculum Week 3 | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Putting it all Together and Evaluation - Curriculum Week 3 | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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Cath Lab Simulation | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Cath Lab Simulation | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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Mentice Simulator | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Mentice Simulator | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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Innovative Learning, Testimonials, and Program Results | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
Innovative Learning, Testimonials, and Program Results | Cath Lab Academy: An Adjunct to an Orientation Program Using an Interprofessional Approach
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Transcript

thank you all right so just a couple things first of all just we have no financial disclosures we have no conflicts of interest but we will be discussing some commercial products and then just a little bit about who Banner Health is it's a large healthcare system

in the Southwest United States and it comprises of 28 facilities within the whole system ten of those facilities have cardiac cath labs and the majority of those are in the Metro Phoenix region one of those being a combination cath

lab an interventional radiology department as well so just with a show of hands they just kind of want to get an idea I would just and I probably have a good assumption of what's gonna happen here how many are I are just I are okay

how about cath lab just a few okay sweet how about both cath lab and I are okay perfect thank you so why did we create this Academy so there was really kind of I we did that so as I'm sure you've seen there's

probably a lot of vacancy rates especially for those that have need experienced staff and so we found that there's this lack of experienced staff and so the newbies are training the newbies essentially and then also

there's there was a problem with retention and also staff satisfaction so really with the creation of this Academy it's helped to really stand with a standardized education program with our preceptors going through a standardized

program themselves to understand adult learning principles and how to apply our tools that we give them in orientation but also to really standardize the education for our new to service people so instead of the people training

everyone and developing bad habits not following policies etc we wanted to make sure that policies were upheld and that they're very well identified and so that they continue to have those correct habits so oftentimes people think well

how do I become a cath lab nurse or RT and so the traditional route really was you know if you worked in as an arti worked really general radiology or you worked interventional radiology or if you were a nurse you could come from ICU

or the emergency room pack uor or PC you are progressive care and work with your preceptors get that on-the-job training and so again there's that whole you know rich waiting you know maybe bad behaviors and creating shortcuts etc and

then you have your cath lab staff so really the early beginnings to our program kind of was twofold so we had an existing virtual program which was basically some modules online working with one of the textbooks that we have

and really working with the preceptors so then we decided how can we create this pipeline for new RTS because we're having a huge shortage of RAD techs and so initially our program was six weeks and then we kind of as we whittled it

down we can went into this three week program now and it's basically an adjunct to their orientation program it doesn't take the place of it it just adds into it and so now the other thing too is what we're looking at is how does

this look like in the future and how do we really truly impact our patient care outcomes so now when someone says how do I become a cath lab RN or RT we have again the traditional route but now we've added in this systemized the

standardized cath lab Academy working with our preceptors and now we have staff our cath lab staff and so in

creating this program there's a lot of things you need to consider so who are our stakeholders that was one of the big

things then we had to consider a budget so what's this program gonna cost what's the curriculum gonna look like how do we continue to evaluate whether or not this is truly an effective program or not our program is pretty

young it's still about a year year-and-a-half old but it's been very successful so far and the our operational leaders love it and then how do we incorporate simulation so those are some of the big things that we had

to consider so here are our stoic stakeholders and there's a lot of them so one of the biggest things is our executive sponsorship so our chief medical officer was really really supportive of having this program

and without that we would probably not be doing as well as probably what we are our operational leaders they are huge they are key to our success as well and they are very much invested in how there are new employees go through education

and how much they're trained our educational leadership definitely helping to support us through getting through any barriers that there may be for getting simulation education etc and then you know Alice and I basically were

the team of two and and so basically then we would work together many many meetings working with some of our other education specialists throughout the system and first different topics so like some of the lectures etc and then

our simulation specialists are again another huge stakeholder that we needed to work with our preceptors and then the cath lab staff we really wanted to get buy-in from our staff too and then the participants we wanted to get their

feedback and see how their program that's program would work for them so let's talk budget just real briefly so really there's a lot of cost you have to consider with a program like this so with educator time that's basically

built in Alice and I are salaried employees so that doesn't really matter per se but we have to consider the participants what time would they be spending time in our academy and so we'll go into more detail as to how that

looks like in a little bit the equipment that we're gonna use so a lot of times we would have that donated or expired equipment so we would use that and the nice thing about having a fairly large health system is that we would get

expired supplies which was really really helpful for our program and then simulation so that was another big thing we had to consider and so our system ended up buying a you know commercial based simulator to help with our program

and so we went with the mentis simulation package I know that Boston Scientific has went outside as well but then we also had to work with our simulation specialist considering their costs and

any simulation space alright thank you

so just as Michael said we've taken a lot of time to develop this program and I think having the background that we have in cath lab as an arti a technologist and as an RN we've pretty

much realized what we need to build this program especially coming from general radiology and entering the cath lab you know I didn't know what a sheath was so if I would have had a program like this I think I would have been a little bit

more successful I'm transitioning into the cath lab the way most of our learners have so what I've done and what Michael and I've done we've reached out to a few of our interventional cardiology partners in the system who

were very passionate about developing a program like this not only does it help our learners and our future staff it does help our cardiologists and our physician providers and fellows who are working with the staff hoping to be a

seamless flow so what we've done is our infant stages of brainstorming you know what do we need to produce a great Academy what do we need to focus on as staff as physicians and so we asked our physician partners what do you want to

see when we're building this program well they want to see new to service or staff in general kind of hitting the ground running right so we want to teach them how to scrub properly how to use the equipment properly how to manipulate

wires how to manipulate catheters learning how to set up power injections anticipating what's coming next during a procedure during a complicated case so those ideas were really essential in developing our program and trying

identify what we can do first for our learners and how we can make them feel comfortable some of these radiology technologists that are coming in from general radiology have no idea what they're coming into there's a little bit

of a difference just knowing that some nurses that do attend the schooling may have heard of you know what an EKG is and what a waveform is whereas some of our red tags have not so we really needed to hone down on the basics okay

so these are some brainstorming ideas that dr. Lee and I and Michael had put together and said here's the pathway we want you to follow follow okay so our again we went from a six-week program now down to a three-week program and

incorporating simulation and so we took a lot of what we wanted to and like what we would recover in our first second and third week and here we're going to go into more detail so really week one as

want you to follow follow okay so our again we went from a six-week program now down to a three-week program and

incorporating simulation and so we took a lot of what we wanted to and like what we would recover in our first second and third week and here we're going to go into more detail so really week one as we talked about the basics so really

just doing some introductions you know what we did was a baseline assessment so we gave them a quiz and then we also talked about aseptic technique the cath lab environment essentially and then we also really talked about the team and

the environment and scopes of practice we really wanted to focus on that because this is kind of the Foundation's the fundamentals of working with a team because I know coming from critical care into the cath lab I was usually like the

one that owned the patient and now I have this team and so it was really kind of a difficult transition for me because they didn't understand the RT role and I think vice-versa so what we do is we have the nurses and

the text and so the nurses look up the RT scope of practice and vice versa and it's really an aha moment for some of those nurses and techs to see really what is our scope of practice and how similar they are yeah it's very

different too and so this is a lot of times we get a lot of good feedback of like oh I didn't know that they could do this or oh wow you know so like I said some really great aha moments and then our second day we go into a great detail

about radiation safety a lot again as a nurse I didn't know a lot about radiation safety the RT but we really wanted to blend the best of both worlds and really help learn from each other so that's the hence the

interprofessional approach and then really just basic cases so left heart calf so what wire is what catheters what do we need for this case and we would bring these wires and catheters to class so that they could look at them they

could play with them so especially if they've never been exposed to something like this before they have that hands-on you know the kinesthetic learning essentially so that they get to look at at some of these

pieces of equipment same with right heart cast some of our interventional procedures and structural heart peripheral etc so we wanted to cover a lot of different cases and then day three we really went into more of that

equipment some of the interventional equipment and then looking at radiographic views so we kind of wanted to like put it all in some sort of sequence and then the third day we went into doing some sort of simulation so we

wanted to introduce them to our simulation software the mentis and then our day four and five this is where they would work back at their home facility and do their clinical practice essentially or their orientation so so

segwaying into some of the examples that we've wanted to show everyone just on the first week of our academy and some examples of the activities that we do with our learners in class is trying to identify different areas of the cardiac

cath lab so essentially is your rhythm right your EKGs I think that's pretty number one important part of working in the cath lab is identifying your EKGs and your rhythms right so again our technologists may not have had this

prior experience so we really do need it we needed to start from the ground up identifying what a rhythm is and we asked them to take a class prior to attending the Academy if possible depending on their hire date and

depending on when they start the Academy I think it benefits them to understand a basic you know EKG rhythm what's a p-wave what's a QRS right so down to the very basics once they do that they can come into

class and we can show them examples of abnormal and normal cardiac rhythms and and have them identify them and and ensure that they understand that you know this is something that you see in the cardiac cath lab you need to raise

your hand and call it out rhythm rhythm hello or making sure that you identify that it is a normal rhythm another example that event an activity that we do is identifying our coronary Anatomy that's pretty important as well

injecting contrast and doing angiograms through the coronary arteries to identify any abnormalities or stenosis and so with that comes a little bit of complicated it's complicated for them to identify those arteries and different

views you know we have the left anterior descending we have a right coronary artery well how does it look in different views and as an RT we understand that every time we move that SI arm the image changes not only for

the artis to identify the coronaries but also the RNs we need them to identify what we're looking at some of these are ents have never seen an geographic views in five different ways so where's your Li D if my image intensifier is REO

caudal where is your right coronary artery if my image intensifiers le oh so we really wanted to incorporate that collaborative effort with both parties our T's and our NS learning this activity all right and no pun intended

but the heart of the program really is the second week and so we really talked about some of those disease states so renal diabetes heart failure getting into some of those basics and so the artis didn't necessarily get that in

school but we wanted to make sure that there's just a really basically a review of systems so that their understanding kind of again the whys behind like why is this important so you know why are we so

obsessed with the renals etc and contrast and then again we do more some basic ECG review day to is pretty much primarily the hemodynamic so we're looking at the heart heart cath we're looking at manipulating our human

dynamic monitoring system etc and then our third day we go into the deteriorating patient doing mock codes etc and looking at what kind of complications can happen and how to treat those or how to intervene if

you're circulating scrubbed in etc and then again day four and five is basically what they're as the clinical experience with their preceptor so again after the second week we've incorporated our real-time monitoring system how many

of you who have used the expert system monitoring system not too many okay it's okay so this is our this is what we monitor our patients with our nurses and our techs are trained to use the real-time monitoring system okay so it

is a little bit of intimidating when you see that especially if you're new to the lab so not only do you have your your normal monitoring system where you measure a lines and your arterial pressures and your blood pressures now

we're measuring waveforms cardiac rhythms possibly you know right heart pressures I'm sorry there's a lot of functions that are involved in our expert monitoring system so we really want to introduce our staff and our

learners to what they're going to expect when they hit the lab this is intimidating so we really want to focus on identifying the basics on these monitors so what is the right heart waveform look like what does right

arterial waveform look like atrial sorry right atrial pressure look like a Oh pressures etc so we really wanted to incorporate that so there's a lot of functions that we basically go over this is another example of an activity where

we ask them to identify waveforms and pressures normal and normal and the other picture is our mock code simulation we have a great simulation facility and our system we have to actually in the system and our

simulation specialists and our sim Center provide us with the one of the best facilities for practicing and simulating different scenarios we have a feedback mannequin it's a high fidelity feedback mannequin and for our

technologists who have not gone through ACLs and have BLS will experience pre learning if you will before they do receive their ACLS certification so compressions showing you effective compressions showing you how to insert

an OPA are you going deep enough are you going fast enough so this is a mock code experience for our technologists and our nurses which helps them prepare them for the lab experience and how many of you probably trained on the job like you

know here this is how we handle the code oh here it is this is what's happening so we want to really go over like what's happening you know kind of define those rules beforehand so that people can know what to expect or at least try to

anticipate what to happen or what to do when a code happens and so the last week

basically putting it all together we go into basically a lot of our adjunctive tools so are a lot of our interventional equipment so I've as rotablator a threat

to me devices etc and so we really rely heavily on our vendors for the support and they're great to work with they love coming in they left to teach and actually and it's also a little bit of a break from for the learners for other

than listening to Alice and I so they like kind of having the vendors come in and they get a chance to play with the equipment as well and then our last day we do basically a wrap-up we'd do it the same quiz at the very beginning and then

we do a final simulation exercise which we have some pictures for as well and then they finish up with their clinical component okay so here are some examples some pictures that we took with our learners

experiencing and playing with the equipment the simulated equipment that our vendors brought in so this is some of the learners I think that's the Arth rectum a device so they did bring a simulated or threat

to me device and so the learners got to play with it got to understand it obviously our techs and nurses are not doing the procedure the physicians are so they never have a chance to actually play with the equipment or or use the

equipment on a real patient so this was kind of an eye-opener for them understanding how the Arthur ectomy works and how it D bulks and how it takes away calcium so that was a fun experience for them and our second

picture is just an example of an Ibis when we brought in our ibis vendors identifying what plaque looks like in an artery and through the intravascular ultrasound right so learning where the plaque is located if the descent Rick it

is not so there's so many different components of our inner vascular ultrasound that they actually learned a lot from as well so a couple examples of that so this is just a live picture of our learners playing with the Arthur

ectomy device I think that's the rotablator and they've improved their rotablator so it's not the nitrous tank that weighs three tons coming in the room we did so they did improve that so again just an example of them using the

simulated equipment and I think they really enjoyed that so again we wanted to really evaluate our learners we also wanted to evaluate our programs so again like I mentioned we did a pre post test and so and afterwards we did a

statistical analysis of their scores to determine really did this make a difference at least in their knowledge and what we found was it was statistically significant as evidenced by the P level of being less than point

zero zero one we also include doing pop quizzes pretty much every week and maybe every other day and so I know that they hated it but it actually helped us to really put into place where we needed to focus and what we needed to

review so that really helped us a lot and then again simulation and we go into that a little bit more too so again with the program overall we really looked at participant feedback through electronic evaluations we also did a start-stop

continue exercise at the very on our very last day because we wanted to get real-time feedback and so now that we've been through it about a year I think we may stop doing that however we will continue to do at least the electronic

evaluations at the end of the course and our learners were very satisfied with this program so a 3.97 out of 4 on a Likert scale really it's telling us that they really enjoy this program and they gave us very valuable feedback we also

got preceptor feedback and we also did a debriefing with what we call our governance team so basically a lot of the stakeholders that I mentioned before especially our operational leaders and our chief medical officer really going

into that and finding out what is it that we needed to really improve how can we continue to support etc and and everything else like that so very

important is having our support right our support from our chief medical

officer who was very involved in a lot of our brainstorming provided us with a lot of essentials and provided us with a lot of information from our fellows all right so we also have our first and second year fellows who were able to

help us throughout this process especially during simulation I wanted to put a an image here of dr. Quan Lee's journal that he published and who was a great supporter of our program and who is who supports education tremendously

so he was one of our biggest fans and he's the one that we brainstormed with the most coming from University Medical Center in Tucson driving all the way to Phoenix to help us develop some of those skills

so he'd published an article monkey see monkey should really do before being set loose so I think that just proves how important and how valuable education is not only didactically but hands-on experience and hands-on pieces he was an

advocate of demonstrating how these all work together and how we can develop a strong foundation and a strong culture in the lab providing our staff with comfort if you will and not being intimidated so I think he really set the

bar high for us because we really wanted to make sure we were able to teach our learners and and experience that hands-on so we thank dr. Lee for that domain so these are some of our some

pictures that we put up here this is our

simulation right so this is our mentis and I think it's very similar to what we have out in Hall there but this really adds a value to practicing and simulation our texts and our nurses were never able to practice during real cases

on real patients injecting contrast using radiation I mean those are the things that we really can't do theoretically and ethically right so this simulation piece was an important and valuable factor where we are able to

identify angiograms injecting contrast not really but simulation and using fluoroscopy again simulated fluoroscopy which is the best part of it is that the nurses can't use the fluoroscopy in Arizona and the techs can administer

medication so this is just an environment of playing this is our sandbox this is where we can come together and feel how the others work so that stimulation piece was was pretty

valuable this program is designed for an interprofessional growth with our scopes with our t's with our ends with providers with fellows with other adjunct staff that are in the lab so we wanted to grow that and and provide that

environment we don't want to segregate the nurses and the text we don't want to segregate that we want to be a team there shouldn't be a role attached to you when you're working everybody works as a team we do understand what our

licenses are we do understand how far we can go with our license but that should be the only thing that differentiates us between working in the lab so we wanted to bring that forward as well and the other piece is creating the simulation

scenario working with the mentis simulator and our simulation partners we wanted to develop a scenario for each of our cases so we we've picked five major cases that we do in that in the cath lab a left heart cath a right heart cath

maybe a pacemaker and we developed a scenario for our learners to actually follow and follow along with so from you know bringing your patient from pre holding or into the lab following them with their lab work making sure the

consents are signed all those priorities that we need to have for the patient to actually come into the lab and continue with the procedure so we did a mock scenario for all of the a mock simulation scenario for all of those so

all those cases that we did so that was also helpful for them to guide guide our learners this is the actual photograph

of the simulation and mentis simulator that we purchased that our system and purchased it's used in conjunction with

the cardiologists and first second third year cardiac fellows interventional fellows who also have the opportunity to practice on this but what I really liked about this and what really surprised me is how real it

is for learners and for our texts that come in our technologists using this piece to move the C arm to move it left to move it right injecting contrast which is actually air but you know we want to say it's contrast I'm moving the

table understanding how to pan the table how to move the CRM there's a lot of different functions that they can use collimation magnification so this board this panel is pretty much what they're going to do on a daily basis so this is

extraordinary and the picture next to it shows us some 3d dimension three-dimensional pictures of the coronary arteries laid out in different projections so depending on how you move your C arm you'll be able to see the

different angles of your coronary arteries again this is live real-time simulation 3d dimensions so we don't have to actually inject the contrast to visualize our coronary arteries in our a Horta there's a function button that you

can push and it automatically displays the three dimensions so it makes it easier for us to identify those arteries without having to inject and show the different views so it's fascinating in more pictures that showing doctor Lee

came who came to Phoenix Banner University Phoenix to help demonstrate so this is our first week after we've introduced the mentis to our learners and had them play with some of the functions again following up with dr.

Lee's visit he's the one that questioned our staff our learners and reiterated what Michael and I have taught in the first week so basically just understanding and reiterating everything that we went through and having our

learners hear it again from the physician what does he want how does he expect his staff to participate in how do his how does he expect his so what are the expectations of our learners so he was really forward he

asked them great questions they answer them because we taught them but we also showed that he also was able to show them some techniques that they as physicians would like the learners to know right so um he is the clinical

expert obviously so it was really nice to see them interacting together and answering questions again just another photograph of one of our learners using the mentis and showing the actual x-ray view on the left and showing the 3d

dimension on the right these are this is our photograph so we took these pictures during our last week of our programs so this is our final wrap-up putting it all together so we basically took them to the lab we we borrowed one of the labs

we asked our operational leaders if we could borrow one of the labs they weren't using that day and we came in and we set it all up we wanted to make sure they knew how to open a tray how does that how to set the table how to

set the back table how to prep the table how to get their power injections their med rads or their assists put together so we really went from A to Z during this wrap up final simulation study so our learners gound and glove they put on

their PPE and we did have the mentis underneath the drape so they were able to drape as if it was a real patient and also manipulating those wires so we had our cardiology fellow interventional fellow first I think it was first year

in second year who came to assist they were gracious enough to come in and help us assist that piece while Michael and I could focus on the learners helping them navigate through that lab calling out for supplies calling out for wires

calling out for stents calling out for balloons so it was pretty realistic and I think I think our learners really enjoyed that this is just another view of our table being set up one of our learners

scrubbed in she was an RN and she was learning kind of moved the table again you don't really get to do that in real life but in simulation all is game so they got to play and here's an image of our cardiology fellow it's not playing

so what it shows is the simulation of the angio angiogram of the coronary arteries so while we inject the contrast you can see the arteries filling in that simulation unfortunately we can't seem to get it to play again more pictures of

me teaching them how to move the table and the position that they needed to be in so and so we also wanted to make it

fun for our learners too so what we did actually just this last cohort was we wanted to integrate basically some

innovation into our program and so basically we used a social media platform and so within our system it's called Yammer and so we warily wanted to like take pictures make it fun have comments what did they learn what kind

of things did they still have questions about different polling questions so really trying to get them more engaged and really understanding and really kind of looping back with each other and trying to network as well so that was

part of why we're using that platform as well we also invited previous cohorts to come back and really like maybe share some tips and tricks that they've learned so that this is still growing and so we're trying to this in a

different method and we also at the very end we really want to celebrate success so we really just truly say you know congratulations to our graduates essentially and it gives them that feeling of empowerment that they have

had some more formal training and that now that this and they know that they're not truly competent after this but it's just really that extra training that they get for the program and these are some of the testimonials

that we've had from our learners based on the evaluations and really it was just integral introduction to the cath lab and so a lot of times they feel very overwhelmed and as you can see this person you know had a better grasp of

the whys of the house and that it's not just the task anymore so they really understood like more that theory to practice component of it you know with us being you know working in the cath lab previously and those subject matter

experts our learners could really ask those questions and and based on our experiences and so they they felt like they could ask any question for that matter and they're just really that they recommend this to everyone who comes who

is new to cath lab for that matter and so really some of the other results that we have from our program too is a reduction in our turnover rate so at the beginning of January of last year the turnover rate as a system overall was 16

and a half and that dropped to 14 at the end of the year so it did have somewhat of a significant impact on our turnover rate within the whole health system in the cath lab and so what's the future now of our program so really it's based

in Phoenix for the majority of it and so now how do we get it to our partners who are down in Tucson and in the northern Colorado region so we're looking at different methods of how can we provide that virtual education how can we

provide it either via some sort of online platform but then when it comes to that time to the hands-on component that's the piece that we're still trying to figure out a lot of and like really how do we work with either a simulation

partners in those regions or how do we maybe videotape or work with our preceptors etc those are things that we still need to look at also - there's also been talk about having a program for our interventional radiology as well

in our electrophysiology so Academy is based on those again so you know trying to develop this program successfully means that we definitely need to have some metrics as you know with any program success is important so how do

we measure that success so focusing on those metrics and those outcomes and especially patient outcomes how did our program really impact the learners did it impact the learners at all um so what we've decided

is that I think measuring evaluating their competency at three months six months nine months and 12 months will give us enough data to ensure that the program was a success some of the tools that we developed on measuring those

outcomes is a post capability survey and this will be used following the Academy and following our cohort cohorts identifying any gaps in their learning and in their orientation also we want to make sure that we follow their pathways

so each of our learners on-boarded will have a pathway and milestones that they will follow with their preceptors and with their managers just to make sure that they're on track and that they need to be where they need to be at that time

we also have our annual competencies that again our new hires will receive upon hire and again following that one-year mark making sure that they are competent and still competent and some of the skills that they've learned in

the Academy obviously and on the job and then our advanced compensate through certifications and I mean I think that's really important this is the way of our future and having those advanced certifications is pretty important so we

really want to focus on how can you advance in the cath lab or an interventional radiology for that matter and develop those skills to help you get your certifications so this is an example of our post capability survey so

after we've completed the Academy with our learners we really want to go back and follow up with them so this is an example of some of the skills that we've had that we have in the cath lab such as procedural sedation close your devices

hemodynamics etc we want to ensure that they have the initial observation using the level of competence survey score from novice to expert and determined by their managers or their preceptors will ensure that they are

moving in the right direction so their initial observation is what they measure followed by subsequent of observations and that is also based on what the managers and the preceptors will feel as subsequent how many subsequent

observations they may need throughout the year to either throughout their orientation process or throughout the 12 months that we want to measure and so just to add on again about the certification so again we want to make

sure that we include so nurses the artis and then what certifications nurses and our teas can get so we really wanted to make sure that they are aware of the different types of certifications out there not that they're gonna get it

right away they need a little bit more experience first but this is just an opportunity for them to again on their pathway or milestone to kind of something to achieve and for anyone who's a big Disney fan like me

you see Hidden Mickey don't you okay

alright and that's everything that we have so we are gonna welcome any questions any feedback comments the cost of the program so roughly that's a really so I want to say initially when

we first rolled it out it cost us roughly what was it two thousand three thousand dollars because again a lot of the supplies were donated a lot of the cost of the equipment cost etc that's really the big cost to us once we got

the mentis device that's added more and so that those devices are those simulation packages can cost in the hundreds of thousands is your question referring to what is the cost to the facility in the

department or to the learners yes can you hear me did we answer your question yes yeah we just yeah so they're the cost to the program for our learners they're they're already hired on so it doesn't cost the learners but about two

to three thousand dollars to start within the department as far as budget

thank you I'm thinking for an excellent presentation my question is around obviously it has to marry up with recruitment and the cause so staff

recruitment and so how many how often are you running the course in how many participants are typically on each course because I would imagine that number could vary significantly from each course so I hope I understood you

right because again there's a little bit of an adherence did you ask how often we do offer one program and how many participants do we usually have yeah yes so we are running the program three times a year

and we have a minimum of four participants and so hopefully if we can get eight to seven to ten usually is our optimal range but we've had a class and a program with four but usually it's about five to seven in the class so what

happens if there's staff get recruited do they just have to wait or do they start training on the job and then three weeks later they start up I mean so theoretically our our employees are hired on from into the cath lab by our

management team and depending on their experience so if we have less than a year of kappab experience you're eligible to join the program okay so preferably we'd like them to have at least one to three months

already in the lab before they come to us and it helps them identify some of the items that we're talking about some of the content that we're referring to as opposed to coming in day one from interventional or from general radiology

or from the IDI as a nurse and not understanding some of the components that we're talking about thank you that was really helpful great thank you she asked what I was pretty much thinking - and have you considered

branching out where other Hospital employees could come and learn for a fee at your campus around the country that's a great question so I think that's one thing that we may bring forward to our educational leaders and say is this

something that maybe we can start offering to other facilities within the metro area etc so that's a great we were actually just talking about that the other night so thank you it's it's very interesting thank you and here's our

references by the way just almost forgot that any other questions with the minister Weiss the simulator are you able to manipulate and tailor it towards what you're doing cath lab IR whether its vessels whether it's biliary drains

are you able to put in input it yourself or is it already a setup program so a lot of the programs are already basically built into the system and so it's just really it's essentially putting in a catheter that's cut off at

the end so that it's reading basically it helps to read and so it's basically based off of our program and so with the coronary program that goes they go in and so with the cardiologists because it's the cardiologists that's going to

be manipulating that component mostly it just helps them to guide those catheters and wires up there and then then it provides that simulation with the injection of the contrast per se did that answer your question or yes and

then another question is we have a high turnover because when we throw them in they think that I are in cath lab is a piece of cake and then they get a rude awakening and with all there's a lot to do rather than just angling and pushing

drugs so you said that this simulator is supposed to help them learn as far as you know turning over so there's two pieces to that question that I really enjoy the simulation is geared towards identifying and understanding how our

functionalities are done right what we do physically in the lab the misconceptions of coming to a cath lab or an interventional radiology suite is that what we're glorified sedation pushers and button pushers right so we

just sit back and we just watch your patients in the lab while the doctor does all the work so we really try to actually we do change that mentality during our first week in our didactic and our lectures once our learners are

in the program about the third week we we all come together and they all come together and it's the same reaction every single time as oh my gosh this is amazing this is a lot this is overwhelming how am I ever going to

learn all of this so it is bittersweet because we're hoping that we're not intimidating to let them leave we want them to stay we want to encourage them but our simulation piece also gives it that solidification now now you really

see what happens in the and and practice so I think it kind of reduces some of the anxiety once they get into the lab and I just want to add to that really it's again the learning doesn't stop once they're done this

right they're gonna continue to learn and it's and a lot of times we've mentioned to them just to say you know what it's what you put into the program to or what you put into your learning understanding the role understanding

what you're gonna do understanding procedures etc you have to really do your homework because you know I mean people just think oh is just spoon-feed it to me but the reality is you have to actually put a lot of effort and really

learning so I just - back for as an example really looking at the cardiac views when I was first new to the cath lab I really wish I had something like this that I would have been able to say oh I'm understanding what I'm really

truly looking at now and like what you know the role of the RT is so I just learned that by asking questions continuously so that's I think that's one of the biggest things - and so traditionally that's kind of the route

that a lot of people take is that it's just again on the job so having this essentially formal structured program really has helped as an adjunct to their learning last question do you have a

formal booklet with objectives as far as

what each modality is and what the learner is going to learn yeah we have a syllabus so that each week they have learning objectives and then also where they have homework assignments as well that are built into that mm-hmm thank

you thank you any other questions thank you everyone first hear a feedback [Applause]

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