This document describes a simulation-based mastery learning session to teach infant lumbar puncture (LP) skills. The session involves: 1) An initial skills assessment to identify areas for improvement. 2) Coached training on any deficient steps using repetitive practice until performed independently. 3) A final mastery performance test where learners must complete all steps of the LP independently without help. The goal is for learners to achieve mastery of all critical skills through customized, simulation-based training before performing LPs clinically.

1. Train-the-trainer: mastery session Improving infant LP skills through simulation-based mastery learning and just-in-time refreshersPOISE 2010-2011

2. HYPOTHESIS Participation in simulation-based mastery learning with just-in-time refreshers will lead to improved infant LP success rates

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

4. What is mastery training? Extreme form of competency based education Clearly described checklist of component steps Pre-defined target level of performance (mastery) ALL participants achieve mastery Duration and content of session tailored to specific needs

5. Mastery Learning Session 1. Introduction 6. Mastery Performance 3. Skills Assessment 4. Mastery Checklist 5. Coached Training 2. Orientation

6. 1. Introduction Introduce yourself to the intern. Read aloud: You are here to learn and practice your infant LP skills using this simulator. By the end of this session you will master all of the critical steps to perform this procedure.

7. 2. Simulator Orientation Iliac crests- point to spot represented by ridge in plastic

8. 2. Simulator Orientation Umblicus- point to spot where umbilicus would be

9. 2. Simulator Orientation Read aloud When you insert a needle into the proper interspace you will get fluid back in the same way you would on a real patient. I will serve as both your holder and teacher for this exercise. Do you have any questions for me before we begin?

10. Skills assessment Read introduction aloud Show me what you know about this procedure. Treat this simulator as if it is a real baby and start from the beginning of the procedure as you would in real life. Don’t worry if you have never done this before- I just want to get a sense of what you already know to help tailor this session to your needs.

11. During this initial attempt encourage the learner to try their best to perform independently Let mistakes happen Help to identify the specific learning needs Lead to effective learning Will guide the coached component of training

12. Use the mastery checklist to mark any steps Not done Where errors were made The intern required help The checklist will provide a guide to tailor the subsequent training to the providers needs

16. “Proficient” indicates ability to perform independently

18. Read aloud: Now that you have independently tried this procedure are there any areas that you felt were challenging? Address these areas with the learner first In a step-by-step fashion coach the learner on any steps from the mastery checklist where they asked for help, an error occurred or that you identified as deficient. For each step describe or demonstrate the intern’s error and work with them until they can perform the step independently.

19. ✓ ✓ ✓

20. Error: Wrong angle on needle insertion (aimed toward feet) Needle inserted correctly and independently

21. Mastery Performance The session will end once you and the learner feel that ALL STEPS can be performed without help. If the learner does not achieved mastery mark the deficient step(s) and describe the reasons for stopping training

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

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