Advanced Emergency Nursing Journal

Vol. 40, No. 2, pp. 127–130

Copyright 
C 2018 Wolters Kluwer Health, Inc. All rights reserved.

An Interprofessional Web-Based
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Teaching Module to Enhance

Competency of the Advanced Practice
Nursing Clinical Education in the
Emergency Department
Kumhee Ro, DNP, ARNP
Christy Weiland, PharmD
Mo-Kyung Sin, PhD, RN

Abstract
Many advanced practice registered nursing (APRN) students struggle to thrive in their clinical
rotation due to the wide variability in their clinical knowledge. To address the variability and gaps in
knowledge, we created an interprofessional web-based, self-directed curriculum for APRN students
that is clinically relevant and specific to the emergency department (ED) rotation. The modules are
a product of collaboration between the medical, nursing, and pharmacy faculty at an academic
medical center. This web-based curricular preceptorship model that incorporates new technology
and innovation in clinical rotations can provide an opportunity to enhance the clinical education of the
APRN students in the ED. Key words: APRN web-based education, clinical education, competency,
web-based teaching strategies

T
HE CURRENT advanced practice reg-
istered nurse (APRN) educational pro-
grams are designed to address the
growing demand to prepare highly skilled
graduates of the health care system of the
future (Gidden et al., 2014), especially the
nurse practitioners entering the emergency
department (ED) workforce. Over time, the
Author Affiliations: University of Washington Medi-
cal Center, Seattle (Drs Ro and Weiland); and Seattle
University, Seattle, Washington (Drs Ro and Sin).
Disclosure: The authors report no conflicts of interest.
Corresponding Author: Kumhee Ro, DNP, ARNP,
University of Washington Medical Center, 1959 NE
Pacific St, Seattle, WA 98195 (kamro@uw.edu; rok@
seattleu.edu).
DOI: 10.1097/TME.0000000000000185
complexity of the ED has increased, including
complex patient population, high-acuity pop-
ulation, and large patient volume (Jennings,
McKeown, O’Reilly, & Gardner, 2013; Woo,
Lee, & Tam, 2017). To better meet the needs
of the current and future health care environ-
ment, structured clinical opportunities that
can enhance competencies in clinical rota-
tions are essential to the emergency nurse
practitioner (ENP) pedagogical paradigm for
teaching and learning (Gidden et al., 2014).
The primary purpose of the clinical ro-
tation experience is to provide educational
opportunities for APRN students to apply the
theoretical knowledge and skills necessary
for today’s health care environment (Benner,
Sutphen, Leonard, Day, & Shulman, 2010).

127

Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
 128
These clinical experiences are crucial for
progress of students from novice to prepared
clinician (Benner et al., 2010). One of the
challenges facing current nursing clinical ed-
ucation is lack of sufficient clinical rotations
with qualified and willing preceptors for
more structured learning (Cronenwett et al.,
2011). In addition, inadequate collaboration
and coordination by academic faculty and
preceptors in the design of the clinical
educational experience, leading to a lack of
curricular coherence, have been identified
as a challenge (Roberts, Wheeler, Tyler, &
Padden, 2017). Perhaps, of most concern is
that the clinical rotation experience model is
inconsistent, primarily because students can-
not be assured that they will all acquire high-
quality clinical skills and knowledge due to
significant variability of the quality of the sites
and preceptors (LeFlore & Thomas, 2016).
Therefore, transformation in APRN clin-
ical education emphasizing an interprofes-
sional team approach focusing on rigorous
evaluations, seamless academic progression,
and clinical competency is needed. The pur-
pose of this article is to describe unique
clinical teaching strategies through a web-
based, self-directed curriculum that integrates
technology to facilitate experiential learning.
The web-based module provides pedagogy in
nursing that enhances the overall learning ob-
jectives of clinical education.
DEVELOPMENT OF INTERPROFESSIONAL
WEB-BASED ED CURRICULAR MODULE
The web-based, self-directed curriculum for
APRN students evolved from medical, phar-
macy, and nursing faculty members at an aca-
demic medical center ED who recognized
the need for APRN students to have APRN-
specific content for improved efficiency and
competency in their rotations. Although sim-
ply having a traditional preceptorship model
can help students transfer theoretical learning
into practice, many APRN students struggle
to thrive in the rotation due to the complex
nature of the ED and the wide variability in
their clinical knowledge. To address the vari-
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Advanced Emergency Nursing Journal
ability and gaps in knowledge, the model was
created in a series of web-based, self-directed
clinically specific modules that are integrated
into the ED clinical rotation.
The modules are a product of interpro-
fessional collaboration between the medical,
nursing, and pharmacy faculty at the medi-
cal center. This was used as a supplemental
teaching tool while the students were in their
clinical rotation. The APRN students partic-
ipated in this 9-week preceptorship, afford-
ing them much more than bedside teach-
ing. The web-based ED curricular module
contained comprehensive learning objectives
that aligned with the learning objectives of the
clinical courses. The learning objectives in-
cluded translational research, leadership, and
clinical practice components with specific
goals that were measured at the end of the
quarter.
The content on the website was divided
into two areas: self-directed modules and
skills curriculum. Self-directed modules of-
fered weekly video-captured didactics by the
emergency medicine faculty in the School of
Medicine. The lectures and articles covered
the essential evidence-based theoretical
content of emergency medicine. The topics
included abdominal pain, altered mental
status, chest pain, OB/GYN complaints, phar-
macology case studies, shock, trauma, basics
of ultrasound, and toxicology. All lectures
and case studies were entirely online and
asynchronous. The skills curriculum included
history taking, physical examination, docu-
mentation, clinical reasoning skills, and oral
case presentations. In addition, it included a
2- to 3-hr session with radiologists to allow
APRN students to practice reading plain
radiographs focusing on the chest, muscu-
loskeletal system, and abdomen. This session
was supplemented by a radiology resource
that the students reviewed prior to the ses-
sion. Finally, there was a 4-hr session offered
by certified registered nurse anesthetists
in the operating room focusing on airway
management. The website also included
rotation requirements, student expectations,
and common procedural resources.
 April–June 2018 r Vol. 40, No. 2 Web-Based Teaching Strategies in the Emergency Department
STUDENT ASSESSMENT AND EVALUATIONS
Currently, there are no ENP educational pro-
grams in Washington State nursing schools.
A total of eight APRN students from two
nursing schools participated in this precep-
torship model between 2015 and 2017 over
six academic quarters. The students’ spe-
cialty tracks included Adult/Geriatric Primary
Care, Adult/Geriatric Acute Care, and Family
Nurse Practitioner. The initial assessment in-
cluded a pretest of emergency care knowl-
edge and skills with 10 multiple-choice case-
based questions. The questions were created
by the interdisciplinary faculty members in-
volved, and the questions stemmed from the
topics students were expected to have partic-
ipated in during the preceptorship. The test
was given prior to and at the end of the pre-
ceptorship. In addition, each didactic that was
presented was followed by four to five on-
line posttest questions. Assessment also oc-
curred throughout the 9-week preceptorship
through direct clinical observation and ver-
bal feedback. Written assessment was given
to students using a structured feedback form
created by the School of Medicine. These eval-
uations were based on the following: data-
gathering skills, knowledge of subject, clini-
cal reporting skills and communication skills,
educational attitude and documentation, es-
pecially medical decision making.
Of note, the overall mean pretest score was
49.5% and increased to 75% on the posttest
assessment. These were average percent cor-
rect over the six academic quarters since fall
quarter of 2015. The pre- and posttest scores
were lowest in diagnostic interpretation and
pharmacology questions whereas highest in
approach to abdominal pain test questions.
The students were given an optional survey
to evaluate the experience about the pre-
ceptorship. The students surveyed reported
that their comfort level increased in proce-
dural skills and communication with the in-
terprofessional team. Three of the master’s in
nursing students had no prior nursing expe-
riences. Of the five students seeking doctor
of nursing practice (DNP) tracks, almost 60%
of the DNP students had prior critical care or
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
129
ED nursing experiences. Although these stu-
dents with ED or critical care nursing experi-
ence had a higher baseline knowledge level of
emergency medicine, they also demonstrated
posttest improvements following this web-
based ED curricular module.
Institutional review board approval was not
required for this education quality evaluation.
The students evaluated both their precep-
tors and the clinical experience through qual-
itative interview evaluations through their
schools. Through implementation of this pre-
ceptorship model, the faculty members were
able to identify the knowledge gap and ad-
dress the clinical needs of the students. To
that end, the students’ descriptive feedback
on this preceptorship model has been over-
whelmingly positive and well received. Stu-
dents appreciated the carefully structured
clinical rotation, which they found to be
meaningful and mentally challenging.
IMPLICATIONS FOR APRN EDUCATION
Although many aspects of this preceptorship
are innovative, what is truly unique about this
ED preceptorship model is that the students
were given standardized learning materials,
supplemental web-based learning, and oppor-
tunities for interdisciplinary learning. At the
core of this preceptorship model is an empha-
sis on integrating unique educational strate-
gies that enhance students’ critical think-
ing abilities in clinical rotations. There are
many benefits to creating a web-based cur-
ricular preceptorship model as described ear-
lier. First, the web-based curriculum can en-
sure that the preceptorship is designed to
bridge the gap between practice and edu-
cation so that all students acquire consistent
fundamental clinical skills and knowledge that
they will need in their future practice. Second,
it can ensure that preceptors are appropri-
ately recognized for their knowledge as they
are active participants in the design of the
preceptorship. Third, the assessment of the
students’ knowledge at the beginning of their
rotation can help identify any deficiencies and
allow for development of individual learning
 130
plans. Finally, this preceptorship model can
prepare ENP students to perform at a higher
functioning level during their rotations by re-
inforcing important concepts taught in the
classroom setting or adding content not pre-
viously covered. If the effectiveness of this
preceptorship model is evaluated further, it
can later be replicated in other clinical site ro-
tations. This novel preceptorship model de-
scribes how graduate clinical rotations can
be carefully developed to focus on clinically
relevant materials and resources, with new
strategies to help APRN students learn about
evidence-based emergency patient care.
There is increasing need to investigate and
evaluate the quality of clinical education for
APRN students (Gidden et al., 2014). Reen-
visioning the clinical nursing education of
APRN students is an important challenge that
deserves full attention. This novel preceptor-
ship model that incorporates new technol-
ogy and innovation into the teaching process
in clinical rotations may provide an opportu-
nity for successful collaboration between aca-
demic nursing programs and their respective
community preceptor partners to enhance
the clinical education of the APRN students
in the ED.
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Advanced Emergency Nursing Journal
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