This document describes a simulation-based educational project aimed at improving infant lumbar puncture (LP) skills among interns. The project uses mastery learning sessions followed by "just-in-time" simulation refreshers prior to clinical LPs. The hypothesis is that this approach will lead to improved success rates for infant LPs. Key aspects include clearly defined performance targets, repetitive practice with feedback during mastery sessions, and brief refreshers using simulators located near clinical areas where LPs occur. Data from the simulators and clinical procedures will be collected to assess the impact.

1. Improving infant LP skills through
simulation-based mastery learning and
just-in-time refreshers
POISE 2010-2011

2. Objectives
• Overview of an infant LP educational project targeted at interns
• To describe the “just-in-time” skill refreshers on simulators
…and how YOU can help!

3. • POISE aims to improve patient outcomes through the development
and dissemination of robust educational interventions

4. THE PROBLEM
• Today’s patients can be harmed in the training of
tomorrow’s practitioners
• Pediatricians perform high-stakes low frequency procedures
• Procedural skills require practice to gain proficiency
THE SOLUTION
• Simulation allows for skill development in lifelike
circumstances on models without risk to the patient

6. HYPOTHESIS
• Participation in simulation-based mastery
learning with just-in-time refreshers will
lead to improved infant LP success rates
• Our hospital will have simulators available
in all clinical areas where LPs occur

7. What is mastery training?
• Clearly defined target level of performance
– Time varies to achieve mastery of skill
– Customized based on learner needs
• Repetitive deliberate practice (coached)
– Kinesthetic learning
– Practice-Feedback-Correction-Practice --> independence

8. 1.
Online
Survey &
Audiovisual
Training
2. 3. 4. 4. 5.
Mastery JIT: Clinical JIT: Clinical
Learning Just-in-time Lumbar Just-in-time Lumbar
Session Refresher Puncture Refresher Puncture
Session Session
Orientation July August September October November December

9. What are just-in-time refreshers?
• Brief (<5 minute) coached refresher on sim
– Facilitated by supervising physician for LP
• Senior resident, fellow, attending
• Additional tool for you to teach the interns!
• Proximal to clinical performance (time/place)
• Goal directed
– To bolus skills before clinical performance

10. Learning Curve
mastery JIT JIT
skill
time

11. JIT refresher: details
Duration: < 5 minutes (already trained to mastery)
Trigger = intern has infant who needs LP
1. Assemble practice LP kit and simulator
2. Ask learner to demonstrate “the best they can do”
without your help on the simulator
3. Give feedback, answer questions, coach practice
4. Complete simulator assessment form
5. Supervise clinical LP (and complete form)

12. 3 steps of JIT
1. Get model and practice LP kit
2. Complete simulator (checklist)
– Less than 5 minutes
3. Complete clinical (checklist)

13. How to set up the simulator
1. Fill bottle with water up to fill-line
2. Insert bottle in pressure bag
3. Inflate bag until pop-off valve hits 150mmHg

14. Assessment form
1. After JIT sim session-> complete SIDE 1
2. After intern attempts clinical LP-> complete SIDE 2
3. Please make sure all data points completed
*Place data collection form into POISE box in clinical area*

15. Global rating
• The scale measures level of independence
• “Proficient” indicates ability to perform independently
• “Expert” level is not expected

16. Errors and “near-miss” events
• Record all errors or omissions of critical steps

17. Other Information- Sim LP

18. Other Information- Clinical LP

19. 1.
Online
Survey &
Audiovisual
Training
2. 3. 4. 4. 5.
Mastery JIT: Clinical JIT: Clinical
Learning Just-in-time Lumbar Just-in-time Lumbar
Session Refresher Puncture Refresher Puncture
Session Session