This study aims to determine the facilitators and barriers to implementing competency assessments for trainees performing infant lumbar punctures (LPs). Sites in the INSPIRE study that achieved over 50% compliance in administering competency assessments will be compared to those achieving under 50% compliance. Interviews and focus groups will be conducted with site directors to identify themes around factors that affected compliance levels. The results could help improve strategies for administering mandatory competency assessments across institutions.

1. ALERT Presentation
Exploring the Facilitators and Barriers to
Implementing Simulation-Based Competency
Assessments to Determine Trainees’ Readiness
for the Infant Lumbar Puncture (LP) Procedure
Julie Pasternack, Ryan McBeth, Rita Dadiz (University of Rochester)
Marc Auerbach, Gunjan Kamdar (Yale)
Todd Chang (Children’s Hospital of LA)
Sujit Iyer (University of Texas Southwestern)
Megan Lavoie (CHOP)
Rebecca Matthews, Daniel Scherzer (Nationwide)
Pavan Zaveri (Children’s National)
David Kessler (Columbia) IMSH 2013: Orlando, Florida / USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. Background
• INSPIRE study: Improving Infant LP Clinical
Outcomes among Novices
• Interns participate in a competency assessment prior to
performing their first LP.
• Interns rated as competent or proficient were more likely
to be successful at performing their first LP than novice or
beginners. 100%
80%
60%
40% Failure
20% Success
0%
Novice Beginner Competent Proficient
International Network for Simulation-based Pediatric Innovation, Research and Education

3. Background
• This year, performing competency
assessments was a mandatory pathway at
many of the sites.
• Compliance for performing competency
assessments are variable among institutions.
International Network for Simulation-based Pediatric Innovation, Research and Education

4. PICO Question
P: Institutions participating in the INSPIRE study:
“Improving Infant Lumbar Puncture Clinical
Outcomes Among Novices”
I: Sites that achieve >50% compliance with the
competency assessment pathway
C: Sites that achieve <50% compliance
O: Determine the facilitating and inhibiting factors that
affected compliance through qualitative research
methods
International Network for Simulation-based Pediatric Innovation, Research and Education

5. Approach / Design
1. Conduct one-on-one interviews and focus
groups of site directors
• 7-9 scripted questions
• 16-20 interviews and 2-3 focus groups
• Audiotaped for later transcription
2. Abstract themes until obtain thematic
saturation, using principles of grounded theory
• Obtain consensus on identified themes between 2-3
reviewers
• Determine frequency of themes
International Network for Simulation-based Pediatric Innovation, Research and Education

6. 3 Questions to improve study
1. What is the best strategy for purposeful
sampling?
• Homogenous vs. heterogenous focus groups?
2. What are other factors to consider?
• Number of years sites involved in study?
• Emergency medicine vs. pediatric residencies?
• Size of residency program?
3. How can we triangulate methods?
International Network for Simulation-based Pediatric Innovation, Research and Education

7. Contact Information
Name: Julie Pasternack or Rita Dadiz
Institution: University of Rochester Medical Center
Email: julie_pasternack@urmc.rochester.edu
rita_dadiz@urmc.rochester.edu
Phone: (585) 463-2940
International Network for Simulation-based Pediatric Innovation, Research and Education