Bryan College of Health Sciences School of Nurse Anesthesia Plan for Assessment of Student Learning 2012-13 Bryan College of Health Sciences Mission The Mission of Bryan College of Health Sciences is to provide education in the health professions emphasizing clinical and academic excellence through collaboration with Bryan Health System and the healthcare community. Bryan College of Health Sciences Goals The Goals of Bryan College of Health Sciences are to prepare graduates who: Are qualified to practice in entry level, mid-level, and advanced practice roles in diverse healthcare environments; Are critically aware of their individuality; Maintain a clear understanding of professional scope of practice; Value life-long learning as a means of personal and professional growth; Participate as responsible citizens within the community; and Are capable of meeting the healthcare needs of an ever-changing society. School of Nurse Anesthesia Philosophy Statement The Faculty of Bryan College of Health Sciences, School of Nurse Anesthesia, believes that: The study of nurse anesthesia is unique in the realm of traditional graduate programming as the theoretical and clinical principles of the art draw from the integration of many disciplines that contribute to the core of professional education. The complexity of contemporary anesthesia practice justifiably requires this integration to enable the nurse anesthetist to practice the humanistic, scientific and technical skills of the profession competently and intelligently. The educational program for the preparation of nurse anesthetists is conducted as a shared responsibility between student and faculty. Students must be intensely committed to achieving their goals through a consistent demonstration of purpose, motivation, responsibility to patients and colleagues, independence of thought, creativity and personal demeanor. Faculty, likewise, are committed to the responsibilities of serving as a competent resource, guide and professional role model. The program seeks to express its commitment to each student through individualized instruction and counsel. Our primary goal is to provide the graduate student with an 1
advanced scientific knowledge base and a comprehensive array of clinical skills that hallmark the standards of care in anesthesia practice. Our obligation to graduates will be to prepare them for full participation in the delivery of anesthesia care in concert with other health care providers. They will be competent in independent judgment as professional nurses. Our responsibility to the community is expressed in the aim of providing an educational program that will ably prepare the nurse anesthetist to meet the health care needs of a culturally diverse population. Our obligation to the profession is to prepare a nurse anesthetist who will serve as an invaluable resource in support of the goals of the American Association of Nurse Anesthetists and to the advancement of the profession of nurse anesthesia. Terminal Objectives: The School of Nurse Anesthesia at Bryan College of Health Sciences has identified terminal objectives that the student will meet upon graduation from the program. Academic Terminal Objectives: 1. The student will develop an advanced level of scientific knowledge supporting the practice of nurse anesthesia. 2. The student will acquire specific pharmacological knowledge applicable to anesthesia practice. 3. The student will identify physiologic abnormalities and interpret and intervene based on monitoring data. 4. The student will develop a body of knowledge sufficient for entrance to clinical practice. Clinical Terminal Objectives: 1. The student will formulate an anesthesia care plan based on didactic knowledge and physiologic principles. 2. The student will appropriately implement the anesthesia plan for patients of all ages and physical conditions for a variety of surgical and medically related procedures. 3. The student will demonstrate acquired knowledge of perioperative anesthesia care including general, regional, and sedation techniques. 4. The student will meet or exceed National Board of Certification and Recertification for Nurse Anesthetists' case requirements. 5. The student will demonstrate ability to transfer theory to practice. Research Terminal Objectives: 1. The student will be a knowledgeable consumer of research literature. 2. The student will complete a senior research project or thesis in which knowledge is created and/or existing knowledge is appropriately critiqued and integrated. 2
3. The student will be able to formally present and defend their research project or thesis in a public forum. Professionalism Terminal Objectives: 1. The student will be able to demonstrate professionalism by collaborative participation in a health care team in concert with other health care providers. 2. The student will be able to demonstrate sensitivity to the ethnic and cultural diversity of patients and other providers. 3. The student will understand the importance of his/her participation in the professional organizations of nurse anesthetists at all levels. 4. The student will teach others and participate in continuing education activities to acquire new knowledge and improve practice. 5. The student will gain an appreciation of occupational risks to include stress management, substance abuse and environmental hazards. Measures and Methods for Assessing Terminal Objectives: The School of Nurse Anesthesia uses the following methods to assess student learning. A description of each assessment is provided followed by an explanation of the relationship of the assessments with the terminal objectives. The exit evaluation, alumni selfevaluation, employer evaluation, and thesis/project evaluation tools are attached. Benchmark data will be monitored annually for trends with the understanding that the small class size of 11 students per year can result in significant variation. Three year composite benchmarking data will be monitored as a statistically more powerful indication of outcomes. 1. Final Clinical Conference A clinical conference is conducted with each student at the completion of Clinical Practicum, 871, the final clinical practicum of the program. A summary of the daily clinical evaluations is reviewed by the Program Administrator and a final evaluation is completed which assesses the student s ability to meet the Level Three Clinical Performance Criteria. The eight categories of clinical performance evaluated include (1) Pre-anesthesia assessment: The student will be able to assess the patient s physical status and identify areas of concern related to anesthesia. (2) Anesthesia plan: The student will be able to formulate an appropriate anesthesia plan for the particular patient, considering the patient s requests, physical condition, and surgical procedure to be performed. (3) Preparation for the administration of anesthesia: The student will be able to prepare the equipment, drugs and the patient for anesthesia. (4) Induction: The student will be able to induce the patient according to the process identified in the anesthesia plan in a smooth, organized, and safe manner. (5) Intraoperative management: The student will be able to monitor the patient during administration of anesthesia and adjust the anesthesia to the patient response. (6) Emergence: The student will be able to manage the emergence from anesthesia according to the anesthesia plan and the instructor s preference. (7) Post- 3
anesthesia management: The student will be able to provide appropriate care of the patient in the post anesthesia care unit, including providing information and direction to the nursing staff. (8) Personal qualities and interpersonal relationships: The student will be able to demonstrate a progressive awareness of the responsibilities of the nurse anesthetist for effective communication and professional inter-personal relationships with the patient and family, physician, OR team, instructors, and peers. Specific behaviors for the eight categories of clinical performance are included in the School of Nurse Anesthesia Clinical Evaluation Handbook. The benchmark is that 100% of graduates will be rated Satisfactory in all categories. 2. Summary of Clinical Case Records The number, and types, of clinical experiences are maintained by each student with a web based program. The clinical experiences are monitored by faculty throughout the program with a summary created at the end of the program. The benchmark is that 100% of graduates will meet the Council on Certification of Nurse Anesthetists requirements for eligibility for the Certification Exam. The benchmark for number of general anesthetics is 575. Regional anesthesia benchmarks include 50 subarachnoid blocks and 50 epidural blocks. The sedation benchmarks are 125 monitored anesthesia care experiences. The open heart procedure benchmark is 20, and the less than 2 years of age pediatric patient benchmark is 20. 3. Self-Evaluation Exam(SEE) The SEE is an in-training, norm referenced exam administer by the Council on Certification of Nurse Anesthetists. Students enrolled in an accredited nurse anesthesia program are eligible to sit for the exam, and BryanLGH students are required to sit for the exam at the end of Phase I and approximately six months prior to graduation. A composite and six content area scores are reported as percentiles for each student. The six content areas are professional and legal aspects; anatomy, physiology and pathophysiology; physical sciences; pharmacology; basic principles of anesthesia; and advanced principles of anesthesia. Three years of data will be pooled for the First Year SEE scores, and for the Second Year SEE scores. The benchmark is that 50% of students will score at, or above, the 50 th percentile rank, and 80% will score at, or above, the 20 th percentile rank for students in the corresponding year. This is for the total scores and for scores in each of the content areas. 4. Certification Exam The Certification Exam is a national exam administered by the Council on Certification of Nurse Anesthetists. An individual must be a graduate of an accredited school of nurse anesthesia to be eligible to sit for the exam and must 4
obtain a passing score to become designated a Certified Registered Nurse Anesthetist. Total scores and scores in five content areas are reported. The five content areas are: basic sciences; pharmacology; equipment, instrumentation, and technology; basic principles of anesthesia; advanced principles of anesthesia; and professional issues. The most recent three years of data will be pooled for evaluation. The benchmark is that the first attempt pass rate for each graduating class will be 90% of the national pass rate. Additionally 50% of graduates will score at, or above, the national mean score. Certification scores will be correlated with individual grade point averages for the current graduating class. 5. Thesis or Senior Research Project Evaluation The research committee will evaluate each student s achievement in six domains related to research and scholarship. The evaluation will be completed following the oral presentation of the thesis/project. The student will be rated from A to D in the six domains on the attached thesis/project evaluation form. A rubric defining the four levels of achievement was developed and will be utilized to evaluate the first class to defend their research in the Spring of 2009. The benchmark is 70% of students will score A or B on the objective following the first attempt at oral defense. 6. Exit Evaluation, Alumni Self-Evaluation, and Employer Evaluation Students complete an exit evaluation upon graduation, and alumni evaluations are mailed to graduates at 1 and 2 years following graduation. An employer evaluation is included with the alumni evaluations to be given to the employer. The benchmark for the exit evaluation is > 70% of alumni who return the evaluation will respond Yes, definitely to the statements, < 30% will respond Yes, somewhat, and 0 % will respond No. The employer evaluation benchmark is > 70% of alumni who return the evaluation will respond Yes, definitely to the statements, < 30% will respond Yes, somewhat, and 0 % will respond No. 7. Employment Rate The Program Director collects employment information on new graduates at three months following graduation. The benchmark is 90% will have obtained employment within three months of graduation. 8. Graduation Rate The graduation rate is calculated each year as the number of graduates completing the program within 35 months (33 months + 2 months) divided by the number who matriculated into the cohort the first semester of the curriculum. The benchmark is 90% will graduate within 35 months of matriculation. 5
9. Intercultural Development Inventory (IDI) The Intercultural Development Inventory is a 50-item, theory-based paper and pencil instrument that measures intercultural sensitivity as conceptualized in Bennett s Developmental Model of Intercultural Sensitivity. The IDI measures an individual s (or group s) fundamental worldview orientation to cultural difference, and thus the individual s or group s capacity for intercultural competence. As a theory-based test, the IDI meets the standard scientific criteria for a valid and reliable psychometric instrument. Each class will complete the IDI first during the 2 nd semester of the curriculum and again during the final semester prior to graduation. The results will be compared to assess individual and group growth. The benchmark is that 75% will score at the Minimization or Acceptance/Adaptation dimension. Academic Terminal Objectives: 1. The student will develop an advanced level of scientific knowledge supporting the practice of nurse anesthesia. SEE results, Anatomy, Physiology, Pathophysiology subject scores. Certification Exam results, Basic Sciences subject scores. Exit Evaluation, response to: The didactic or classroom portion of the program: provided a scientific knowledge base. Alumni Survey, response to: During my education at the Bryan College of Health Sciences, School of Nurse Anesthesia, I acquired sufficient knowledge in the following areas to prepare me for beginning practice as a CRNA: an advanced level of scientific knowledge supporting the practice of nurse anesthesia. Employer Survey, response to: The CRNA alumni of the Bryan College of Health Sciences, School of Nurse Anesthesia has obtained the following knowledge: an advanced level of scientific knowledge supporting the practice of nurse anesthesia. 2. The student will acquire specific pharmacological knowledge applicable to anesthesia practice. SEE results, Pharmacology subject scores. Certification Exam results, Basic Sciences subject scores. 6
Exit Evaluation, response to: The didactic or classroom portion of the program: provided a scientific knowledge base. Alumni Survey, response to: During my education at the Bryan College of Health Sciences, School of Nurse Anesthesia, I acquired sufficient knowledge in the following areas to prepare me for beginning practice as a CRNA: specific pharmacological knowledge applicable to anesthesia practice. Employer Survey, response to: The CRNA alumni of the Bryan College of Health Sciences, School of Nurse Anesthesia has obtained the following knowledge: specific pharmacological knowledge applicable to anesthesia practice. 3. The student will identify physiologic abnormalities and interpret and intervene based on monitoring data. Certification Exam results, Equipment, Instrument, Technology subject score. SEE Exam, Basic Principles subject score. Final clinical conference, the 1, 2, 4, 5, 6, and 7 categories. as a CRNA by providing me with sufficient skill or ability to: identify physiologic abnormalities and interpret and intervene based on monitoring data. identify physiologic abnormalities and interpret and intervene based on monitoring data. 4. The student will develop a body of knowledge sufficient for entrance to clinical practice. SEE results, total score. Certification Exam results, first attempt pass rate, and total scores. Alumni Survey, response to: During my education at the Bryan College of Health Sciences, School of Nurse Anesthesia, I acquired sufficient 7
knowledge in the following areas to prepare me for beginning practice as a CRNA: a body of knowledge sufficient for entrance to clinical practice. Employer Survey, response to: The CRNA alumni of the Bryan College of Health Sciences, School of Nurse Anesthesia has obtained the following knowledge: a body of knowledge sufficient for entrance to clinical practice. Graduation rates Employment rates Clinical Terminal Objectives: 1. The student will formulate an anesthesia care plan based on didactic knowledge and physiologic principles. SEE results, Basic Principles subject scores. Certification Exam results, Basic Principles subject scores. Final clinical conference, category 2. as a CRNA by providing me with sufficient skill or ability to: formulate an anesthesia care plan based on didactic knowledge and physiologic principles. formulate an anesthesia care plan based on didactic knowledge and physiologic principles. 2. The student will appropriately implement the anesthesia plan for patients of all ages and physical conditions for a variety of surgical and medically related procedures. Final clinical conference, categories 1 through 7. Clinical Case Record numbers. Exit Evaluation, response to: I can plan and implement a safe anesthetic: for patients of all physical conditions, ASA Class I-VI; for patients with 8
emergency conditions or traumatic injuries; for a variety of medical and surgical procedures; for patients of all ages. as a CRNA by providing me with sufficient skill or ability to: appropriately implement the anesthesia plan for patients of all ages and physical conditions for a variety of surgical and medically related procedures.. appropriately implement the anesthesia plan for patients of all ages and physical conditions for a variety of surgical and medically related procedures. 3. The student will demonstrate acquired knowledge of perioperative anesthesia care including general, regional, and sedation techniques. SEE results, total score. Certification Exam results, first attempt pass rate, and total scores. Final clinical conference, categories 1 through 7. Clinical Case Record numbers. Exit Evaluation, response to: I can plan and implement a safe anesthetic: for a general anesthetic technique; for regional anesthetic techniques; for a monitored anesthesia care technique. Alumni Survey, response to: During my education at the Bryan College of Health Sciences, School of Nurse Anesthesia, I acquired sufficient knowledge in the following areas to prepare me for beginning practice as a CRNA: knowledge of perioperative anesthesia care including general, regional, and sedation techniques. Employer Survey, response to: The CRNA alumni of the Bryan College of Health Sciences, School of Nurse Anesthesia has obtained the following knowledge: knowledge of perioperative anesthesia care including general, regional, and sedation techniques. 4. The student will meet or exceed the National Board of Certification and Recertification for Nurse Anesthetists case requirements. 9
Clinical Case Records 5. The student will demonstrate ability to transfer theory to practice. Final clinical conference, categories 1 through 7. as a CRNA by providing me with sufficient skill or ability to: transfer theory to practice. transfer theory to practice. Research Terminal Objectives: 1. The student will be a knowledgeable consumer of research literature. as a CRNA by providing me with sufficient skill or ability to: be a knowledgeable consumer of scientific research literature. be a knowledgeable consumer of scientific research literature. 2. The student will complete a senior research project or thesis in which knowledge is created and/or existing knowledge is appropriately critiqued and integrated. 3. The student will be able to formally present and defend their research project or thesis in a public forum. The three research objectives are assessed with the completion of the senior research project or thesis. Each student defends their projectt/thesis with an oral presentation to their faculty research committee in a public forum. The research committee is composed of a primary advisor and two additional faculty members with an interest in the research area. The committee evaluates the written product and the oral defense for the three objectives with the senior thesis/project rubric. Professionalism Terminal Objectives: 1. The student will be able to demonstrate professionalism by collaborative participation in a health care team in concert with other health care providers. Final clinical conference, category 8. 10
Exit Evaluation, response to: My educational experiences in the program developed: my ability to participate collaboratively in a health care team. as a CRNA by providing me with sufficient skill or ability to: demonstrate professionalism by collaborative participation in a health care team in concert with other health care providers. demonstrate professionalism by collaborative participation in a health care team in concert with other health care providers. 2. The student will be able to demonstrate sensitivity to the ethnic and cultural diversity of patients and other providers. Intercultural Development Inventory: Assessed in the final semester of the curriculum, 75% of senior student will score in the Minimization or Acceptance/Adaptation dimensions. Final clinical conference, category 8. Exit Evaluation, response to: My educational experiences in the program developed: my sensitivity to ethnic and cultural diversity of patients and other members of the health care team. as a CRNA by providing me with sufficient skill or ability to: demonstrate sensitivity to the ethnic and cultural diversity of patients and other providers. demonstrate sensitivity to the ethnic and cultural diversity of patients and other providers. 3. The student will understand the importance of his/her participation in the professional organizations of nurse anesthetists at all levels. Exit Evaluation, response to: My educational experiences in the program developed: my understanding of my role in participating in professional organizations of nurse anesthesia. 11
as a CRNA by providing me with sufficient skill or ability to: understand the importance of participation in the professional organizations of nurse anesthetists at all levels. understand the importance of participation in the professional organizations of nurse anesthetists at all levels. 4. The student will teach others and participate in continuing education activities to acquire new knowledge and improve practice. Review of course syllabi: All students will have experiences related to teaching others throughout the curriculum. Exit Evaluation, response to: My educational experiences in the program developed: my ability to teach others. as a CRNA by providing me with sufficient skill or ability to: teach others and participate in continuing education activities to acquire new knowledge and improve practice. teach others and participate in continuing education activities to acquire new knowledge and improve practice. 5. The student will gain an appreciation of occupational risks to include stress management, substance abuse and environmental hazards. Exit Evaluation, response to: My educational experiences in the program developed: understanding of occupational risk; substance abuse, stress management, and environmental hazards. as a CRNA by providing me with sufficient skill or ability to: demonstrate an appreciation of occupational risks to include stress management, substance abuse and environmental hazards. 12
Analysis of Objectives: demonstrate an appreciation of occupational risks to include stress management, substance abuse and environmental hazards. Data obtained through the measures and methods for assessing the terminal objectives will be gathered and presented to the Graduate Studies Committee and the Nurse Anesthesia faculty annually. The Nurse Anesthesia academic faculty will compose the School s assessment committee due to the small size of the faculty. The School of Nurse Anesthesia faculty will analyze the data and compose an annual assessment report identifying the objectives fully met, and gaps in objectives partially met or not met. An objective is fully met if all benchmarks are reached, partially met if some, but not all benchmarks are reached, and not met if no benchmarks are reached. The gaps in achieving objectives will be identified in the report. Data will also be grouped three-year summaries due to the class size. Measures will be reported as both one-year and threeyear, summary data in the annual report. Determination of Contributing Factors for Identified Gaps: Nurse Anesthesia faculty will review individual gaps uncovered in the annual report and investigate possible sources of gaps and the related solutions during faculty meetings. As discussed previously, data will be reviewed annually with the awareness that significant variation can result due to the small class size in the program. Individual instructors will be consulted when warranted and the literature will be reviewed as appropriate. Planned Modifications to Identified Gaps: The Dean in consultation with the faculty will make recommendations for programmatic and/or operational adjustments after consideration of the data. The Dean and faculty may determine additional monitoring may be appropriate if a gap is only present in one-year data. A gap present in the two-year or three-year data will be considered a more compelling case necessitating change in the program. A proposal for recommended adjustments will be presented to the Graduate Studies Committee including the gap(s) identified, and the solution(s) proposed. Planning and Budgeting Processes: Recommended programmatic and/or operational adjustments will be integrated into the annual planning and budgetary process. The Nurse Anesthesia faculty and Dean will prioritize programmatic changes and resultant budgetary requests based upon the assessment data. The requests will be integrated into the annual strategic planning and operational/capital budgetary cycles. Program requests will be submitted to appropriate Faculty Senate committees as needed with operational requests submitted to Leadership 13
Council. The Nurse Anesthesia faculty and Dean will address budget requests occurring throughout the year during faculty meetings. Adjustment and Outcome Correlations: The Nurse Anesthesia faculty will evaluate the outcomes of program adjustments on identified gaps annually. Data gathered prior to, and following, adjustments for specific gaps will be compared and analyzed for trends. A report detailing the adjustments and achievements will be created and reviewed. Any continuing gap(s) will be addressed during the annual review of all data related to the assessment of the terminal objectives. Refining the Assessment Plan and Processes: The assessment instruments and processes will be reviewed annually by the Nurse Anesthesia faculty. The Graduate Studies Committee will be consulted in the development and evaluation of revisions to the assessment plan. 14