The study examines the effectiveness of simulation-based mastery education (SBME) and just-in-time (JIT) refresher training on pediatric interns' success rate in performing infant lumbar punctures. Results showed no significant improvement in clinical success rates with the combination of SBME and JIT training compared to SBME alone. The research indicates future directions focusing on bedside competency assessments and increased self-directed practice opportunities.

1. Impact of a Simulation-Based Just-In-Time Refresher Training for Interns on Their Clinical Success Rate with Infant Lumbar PunctureDavid Kessler, MD, MScAssistant Professor of Clinical PediatricsDirector of Clinical OperationsDivision of Pediatric Emergency MedicineCo-director of the POISE research networkDaniel Fein, Todd Chang, DeweshAgrawal, Jennifer Reid, Joshua Rocker, Martin Pusic, Laura Haubner, Marc Auerbachon behalf of the POISE Investigators

3. Conflict of InterestOn behalf of myself (and any co-presenters of the papers I am responsible for), I declare to my knowledge, there are no conflicts of interest that would prevent me from presenting this work at the IPSSW2011.The POISE Network is funded by a grant by

4. BackgroundSimulation is effective for skills training

5. The ideal timing and duration of training needed to make a clinical impact are largely unknown

6. BackgroundSimulation based mastery education (SBME) is a method of training to a predefined endpointBackgroundSimulation based mastery education (SBME) is a method of training to a predefined endpoint

7. Metanalysis of SBME using deliberate practice vs traditional clinical education

8. Inclusion: SBME intervention, comparison group, skill outcome

9. 3742 articles screened, 14 included

10. Effect size: 0.71 (95% confidence interval, 0.65–0.76; P .001)McGaghie W, Issenberg B, Cohen E, Barsuk J, Wayne D. Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of The Evidence. Acad Med. 2011;86:706–711

11. BackgroundJust-in-time (JIT) training is a refresher session that occurs temporally close to the actual clinical encounter / skill being performedBackgroundJust-in-time (JIT) training is a refresher session that occurs temporally close to the actual clinical encounter / skill being performed

12. Rolling refreshers for CPR

13. Practice compressions on simulator (to mastery)

14. High frequency >2 refreshers per month

15. Low frequency <2 refreshers per month

16. High frequency group achieved mastery fasterNilesa D, Sutton R, Donoghuea A, Kalsic M, Roberts K, Boyled L, Nishisakia A, Arbogaste K, Helfaerb M, Nadkarni V. “Rolling Refreshers”: A novel approach to maintain CPR psychomotor skill competence. Resuscitation 80 (2009) 909–912

17. ObjectivesTo compare the impact of 2 different training strategies on clinical success rates with the infant lumbar puncture (LP) procedure.Asingle simulation based mastery education session using coached deliberate practice (SBME) SBME plus just-in-time (JIT) refreshers on clinical success rates with the infant lumbar puncture (LP) procedure.

18. MethodsDesign: Multicenter prospective study with historical control groupSetting: 21 academic training centersPopulation: Pediatric interns

19. Methods2009-2010 cohort SBME2010-2011 cohort SBMEOrientationTime = 0

20. Methods2009-2010 cohort SBME2010-2011 cohort SBMEOrientationTime = 0

21. Methods2009-2010 cohort SBMELP Clinical encounter #1JIT2010-2011 cohort SBMELP Clinical encounter #1OrientationTime = 0

22. Methods2009-2010 cohort SBMELP Clinical encounter #1LP#2,3…JITJIT 2010-2011 cohort SBME*LP#2,3…LP Clinical encounter #1OrientationTime = 00 to 6 months

23. Methods2009-2010 cohort SBMELP Clinical encounter #1LP#2,3…JITJIT 2010-2011 cohort SBME*LP#2,3…LP Clinical encounter #1OrientationTime = 00 to 6 months

24. Methods2009-2010 cohort SBMELP Clinical encounter #1LP#2,3…JITJIT 2010-2011 cohort SBME*LP#2,3…LP Clinical encounter #1OrientationTime = 00 to 6 months

25. Primary outcome: atraumatic infant LP (<1000 rbcs/hpf)