Impact of Just-in-Time and Just-in-Place Simulation on Intern Success With Infant Lumbar Puncture

Kessler, David; Pusic, Martin; Chang, Todd P.; Fein, Daniel M.; Grossman, Devin; Mehta, Renuka; White, Marjorie Lee; Jang, Jaewon; Whitfill, Travis; Auerbach, Marc

doi:10.1542/peds.2014-1911

Cited by 78 publications

(84 citation statements)

References 40 publications

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“…This was similar for both years of the study with 95/248 (38%, 95% CI 32% to 44%) successful in the first year of enrolment and 79/184 (43%, 95% CI 36% to 50%) successful in the second year of the study. The 40% success rate among participators in the assessment was similar to that of our historical group where 152/399 (38%) were successful on the first attempt (95% CI diff −4% to +9%) 16. In our study cohort, there was no statistical difference in success between those who participated in the readiness assessment (per protocol) and those who did not participate in the readiness assessment as intended (40% vs 35%; 95% CI diff −2% to +12%).…”

Section: Resultssupporting

confidence: 73%

“…For residents, we have previously reported on their generally low prior experience and poor performance of LP in clinical settings 2 3 14 16 20. The success rate of 43% seen in the final year of this study is slightly higher than those achieved in any of our prior studies (34–42%); however, this is still a disturbingly low success rate.…”

Section: Discussioncontrasting

confidence: 46%

“…At orientation prior to first year of residency, all residents completed a standardised published LP curriculum composed of watching videos, demonstrating performance on a simulator (BabyStap Laerdal Medical, Stavenger, Norway) and having individually coached practice sessions until a predefined mastery performance standard was achieved 16 18 19…”

Section: Methodsmentioning

confidence: 99%

“…Our primary aim was to determine whether supervisor screening of residents using simulation-based assessments immediately prior to the first supervised attempt at infant LP would increase resident success. We hypothesised that screening residents for readiness would increase their successful first needle insertion beyond the rate of 38% (95% CI 34% to 43%) established by our prior cohort of 399 first year residents 16. We anticipated that the assessment could increase LP success rates in one of two ways: either low-performing participants would not be entrusted to perform the LP, or residents would practise on a simulator with their supervisor becoming better prepared for the imminent procedure.…”

Section: Introductionmentioning

confidence: 99%

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Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments

Kessler

Auerbach

Fein

et al. 2016

BMJ Simul Technol Enhanc Learn

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BackgroundDetermining when to entrust trainees to perform procedures is fundamental to patient safety and competency development.ObjectiveTo determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success.MethodsThis prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique.ResultsWe analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success.ConclusionsSimulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP.

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Section: Resultssupporting

confidence: 73%

Section: Discussioncontrasting

confidence: 46%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments

Kessler

Auerbach

Fein

et al. 2016

BMJ Simul Technol Enhanc Learn

Self Cite

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“…In a study of JIT training in infant LP, 12 frequency of procedural success was not affected by JIT training. Other markers of procedural proficiency, however, such as accurate initial placement of central lines, improved after JIT practice.…”

Section: Discussionmentioning

confidence: 87%

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department

Thomas

Uspal

Oron

et al. 2016

Journal of Graduate Medical Education

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Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015

Heitz

Coates

Farrell

et al. 2017

AEM Education and Training

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Objective: The objectives were to critically appraise the medical education research literature of 2015 and review the highest-quality quantitative and qualitative examples.Methods: A total of 434 emergency medicine (EM)-related articles were discovered upon a search of ERIC, PsychINFO, PubMED, and SCOPUS. These were both quantitative and qualitative in nature. All were screened by two of the authors using previously published exclusion criteria, and the remaining were appraised by all authors using a previously published scoring system. The highest scoring articles were then reviewed.Results: Sixty-one manuscripts were scored, and 10 quantitative and two qualitative papers were the highest scoring and are reviewed and summarized in this article.Conclusions: This installment in this critical appraisal series reviews 12 of the highest-quality EM-related medical education research manuscripts published in 2015.I n 2012, the Academic Emergency Medicine consensus conference called for an increase in high-quality, hypothesis-driven education research.1 The intervening years have seen a growth in education research, as described in prior articles in this series.2-9 Highlighting this trend, beginning in 2017, Academic Emergency Medicine journal devoted an entire separate publication to emergency medicine educational research, Academic Emergency Medicine Education and Training (AEM E&T). 10Prior installments of this series were published in Academic Emergency Medicine Journal, 2-9 using modifications of methodology for medical education literature review as described by the Alliance for Clinical Education for other specialties and based on that used for bench and clinical research. 11,12 In this eighth installment of the annual critical appraisal series, reviewers have critically analyzed and ranked the emergency medicine (EM) education research from 2015. This article will highlight and summarize the most highly rated studies of 2015, which pertain to teaching and education in EM. Of note the focus is on research that advances the science of EM education, not necessarily research that uses education to affect patient care. Current trends in EM education research, as they can be inferred from this review, are summarized and compared to the previous year's trends. It is hoped that this article will serve as a valuable resource for EM educators and researchers invested in educational scholarship. 13 METHODS Article IdentificationA medical librarian reproduced a previously used Boolean search strategy to identify all education research publications relevant to EM education. 2 Medical subject heading (MeSH) and keyword terms, including keyword variations to ensure completeness, were used. MeSH and keywords incorporated the following: emergency medicine and medical education, medical student, residents, continuing medical education, academic medical center and teaching hospital, to search MEDLINE through PubMed. Other databases searched included Scopus, Education Resources Information Center (ERIC), and PsychInfo. Pu...

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Impact of Just-in-Time and Just-in-Place Simulation on Intern Success With Infant Lumbar Puncture

Cited by 78 publications

References 40 publications

Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments

Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015

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