A Quality Improvement Project to Enhance Precepting in a Primary Care Nurse Practitioner Residency Program

Background: The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, Educator (RIME) framework to measure progress are used successfully in physician training programs. Currently, little is known about use of these tools in nurse practitioner (NP) training. Objectives: To answer the following: In NP trainees, does a standardized case presentation using the OMP, compared with the current approach, improve diagnostic reasoning skills as measured by the RIME framework competency evaluation in six weeks? Methods: Quality improvement project using Plan, Do, Study Act (PDSA) cycles performed at the Veteran’s Affairs NP Residency in Los Angeles. Eleven preceptors and 4 NP trainees participated in a 12-week intervention using OMP techniques to support trainee diagnostic reasoning scored weekly using the RIME framework. Preceptor knowledge of the OMP and RIME framework assessed pre-intervention was supplemented with a 1-hour workshop to address knowledge gaps. Preceptors performed return demonstrations of OMP techniques, RIME scoring, then educated trainees on OMP and RIME [PDSA Cycle 1; weeks 1-6]. PDSA Cycle 2 was one-to-one meetings between trainees and program director with preceptor feedback for individualized plans for improvement [weeks 7-12]. RIME scores, preceptor self-efficacy, and use of teaching skills were measured pre-and post-intervention and a survey completed by preceptors and trainees at the end of the study. Demographic characteristics and survey responses were assessed with descriptive statistics and paired sample t-test for mean scores pre- and post-intervention. Results: Mean RIME scores improved (1.62 [0.17] vs. 2.23 [0.38], p<.001) post 12-week intervention [PDSA Cycle 1 and 2]. After PDSA Cycle 1, individual scores revealed an outlier not at goal. PDSA Cycle 2 started weeks 7-12. Mean RIME scores improved between PDSA Cycle 1 and 2 (2.07 [0.25] vs. 2.48 [0.39], p<.001), respectively. Preceptor self-efficacy and use of the teaching skills scores improved but not significantly. Program evaluation surveys showed the majority of preceptors (91%) and trainees (100%) found the OMP model and RIME framework helpful. Conclusion: Use of the OMP improved precepting standardization and diagnostic reasoning in NP trainees. RIME scoring facilitated improvement discussions. A multi-site evaluation in a larger cohort is needed to validate findings