Implementation of a Standardized,Organizational Approach to Transition From Academics to Practice: A Case-Based Discussion

The journey to excellence in healthcare is a path that requires a constantly cultivated environment. Paying attention to and adapting this environment is key to sustaining competency and consistency, 2 important factors in delivery of safe, quality nursing care. For the new graduate registered nurse (RN), ensuring a nurturing environment for transition from academia to practice is essential if sustainability of excellence in healthcare is to be achieved—the goal of hospitals and nursing practices across the United States.     

Improving Practice Guideline Adherence Through Peer Feedback: Impact of an Ambulatory Cardiology Curriculum

Problem: Graduate medical trainees must be prepared to practice in a quality-driven system that values adherence to and documentation of evidence-based care. Few validated approaches exist to teach these skills. Our objective was to develop, implement, and evaluate an ambulatory practice improvement curriculum capitalizing on peer feedback aimed at improving cardiology fellow guideline knowledge, adherence, and chart documentation. Intervention: Four outpatient topics were reviewed in dedicated 1-hour sessions: stable ischemic heart disease, heart failure, atrial fibrillation, and aortic valvular disease. Each session began with peer review, critique, and guideline adherence discussion of deidentified outpatient fellow clinic charts, followed by discussion of clinical guidelines. The open discussion of real clinic notes provided a forum for peer feedback exchange. Before each session and after the final session, participants completed a multiple-choice knowledge assessment and self-assessment of comfort with the guidelines. To evaluate the potential effect on patient care, random clinic chart audits were conducted before and after the curriculum using a chart scoring system. Context: Although the format is broadly applicable, the specific curriculum content was designed for a cardiology fellowship cohort in a large academic medical center. It was organized and implemented by 2 cardiology fellows under the direction and supervision of program directors. The curriculum was implemented during prescheduled noon conference hours. The intention was to carry forward this ambulatory curriculum in subsequent years and to use the first 4 sessions to study its potential successes and opportunities for improvement. Outcome: All 22 general cardiology fellows attended at least two sessions (M = 3.1). Knowledge test scores rose from 52.6% to 73.0% (20.4% increase, p < .001), 95% confidence interval (CI) [13.6%, 27.2%]. Self-reported guidelines knowledge improved by 15.1% (p = .002), 95% CI [6.2%, 24.0%], and self-reported documentation improved by 12.5% (p = .008), 95% CI [3.8%, 21.7%]. Chart audit scores improved by 17.8% (p < .001), 95% CI [10.6%, 25.0%], driven in part by 16.4% improvement in adherence to Class I therapies (p = .001). Lessons Learned: A targeted curriculum combining peer chart review, feedback, and guideline discussion was associated with significant improvement in fellows' knowledge and adherence to evidence-based therapies. Peer assessment and group-based education and feedback can be leveraged to improve trainee education and impact patient care.     

CB5-01: Where Science, Management and Administration Meet: Lessons Learned from Large Multi-site Programs

Background/Aims Within the HMORN multi-site collaborations are routine but as they grow in size and scope, the common challenges of managing these projects becomes more complex. As funders look to the HMORN as a model for distributed research, it is important to document best practices across projects and institutions. Methods Using examples from across the HMORN, we will explore best practices and common challenges for successfully implementing large scale projects. Topics will include: strategies for large scale communication working with external partners privacy and human subjects contracting and budgeting general management of large scale network projects. Each topic will feature examples of common issues across HMORN programs and highlight a lesson learned from the Cancer Research Network, Mini-Sentinel and other large collaborations. Effective innovations or approaches, as well as barriers and challenges will be highlighted. Discussion As one of the most successful health care research networks, the experience and expertise of the HMORN can provide strategies and guidance to enhance and expand new and ongoing collaborations.     

Transition to Nursing Practice: A Capstone Simulation for the Application of Leadership Skills in Nursing Practice

A large-scale capstone simulation was implemented to fully immerse nursing students into the authentic role of the professional nurse by giving them the autonomy to independently manage the care of multiple complex patients with competing priorities in a realistic hospital environment. This innovative learning experience gave students an opportunity to transfer theory into practice. Overwhelmingly positive feedback from students supports the implementation of a capstone simulation to promote a smoother transition into the nursing workforce.     

Transition Best Practice: Who is Responsible for Preparing our Educators to Promote Transition Related Best Practice?

Graduate students taking a class on transition for students with disabilities surveyed personnel of school districts in which they lived and worked to determine if the districts were engaging in transition best practices. Ten school districts in Southeast Texas were surveyed. The majority of these districts did not engage in transition best practices. There was a gap between what was being taught in the graduate class and what was actually happening in the public school classrooms. Implications for educator preparation programs and public school professional development programs are discussed.     

A Survey of Characteristics of Transition to Practice Nurse Practitioner Programs

Postgraduate training programs have emerged as a small but growing phenomenon for nurse practitioner graduates. Many programs are situated in community health centers to assist new graduates in developing competency in caring for patients with complex medical and social needs. We surveyed program directors of community-based health centers about the characteristics of their postgraduate training programs, number and length of programs, location, size and predicted growth, the structure of educational experiences and demographics of the centers, and the patient populations served. This study adds to the emerging literature and suggests that postgraduate training programs are a growing, permanent trend.     

A Rich Experience: Clinical Clerkship in Family Practice

This article demonstrates a year's experience in which the clinical clerkship in family practice is integrated within the curriculum of the University of Calgary Medical School.