““Sim One, Do One”Sim One, Do One”

Infant Lumbar Puncture Simulator Improves Resident Confidence and SkillsInfant Lumbar Puncture Simulator Improves Resident Confidence and Skills David Kessler, Marc Auerbach, Dennis Heon, Michael Tunik, Jessica Foltin

NYU Langone Medical Center / Bellevue Hospital Center, Departments of Pediatrics and Emergency Medicine

““Sim One, Do One”Sim One, Do One”

Infant Lumbar Puncture Simulator Improves Resident Confidence and SkillsInfant Lumbar Puncture Simulator Improves Resident Confidence and Skills David Kessler, Marc Auerbach, Dennis Heon, Michael Tunik, Jessica Foltin

NYU Langone Medical Center / Bellevue Hospital Center, Departments of Pediatrics and Emergency Medicine

Infant Lumbar Puncture (LP) is a skill pediatric residents should achieve

Resident confidence in skills is less for LP than for other procedures

Most programs currently train residents using the apprenticeship model

Simulators that replicate the experience of an infant LP exist for training

Infant Lumbar Puncture (LP) is a skill pediatric residents should achieve

Resident confidence in skills is less for LP than for other procedures

Most programs currently train residents using the apprenticeship model

Simulators that replicate the experience of an infant LP exist for training

Both groups had short-term improvements in knowledge & confidence

LP simulator training improves knowledge, confidence and skills

LP simulator training promotes success with next clinical LP

LP simulators could provide a safe environment for skill development and the demonstration of provider competency

Both groups had short-term improvements in knowledge & confidence

LP simulator training improves knowledge, confidence and skills

LP simulator training promotes success with next clinical LP

LP simulators could provide a safe environment for skill development and the demonstration of provider competency

LEARNER VARIABLES Intervention Control N 24 27 Female (%) 15(63) 24(89) PGY1(%) 10(42) 9(33) PGY2(%) 7(29) 9(33) PGY3(%) 7(29) 9(33) Prior LP didactics(%) 7(29) 9(33) Prior manikin experience(%) 7(29) 6(22) LPs Observed(%) 22(92) 25(93) Success with last LP(%) 13(54) 13(48) Mean #ILPÕs observed 4.7 4.6 Mean #ILPÕs performed 5.2 5.5

BACKGROUND BACKGROUND

We hypothesize that “practice makes perfect” interactive skill training on an LP simulator improves resident LP knowledge, confidence & skills

We hypothesize that competence on the simulator will lead to improved clinical performance (success with next clinical LP)

We hypothesize that “practice makes perfect” interactive skill training on an LP simulator improves resident LP knowledge, confidence & skills

We hypothesize that competence on the simulator will lead to improved clinical performance (success with next clinical LP) After data collection is completed we will analyze groups to compare:

improvement rates in knowledge, confidence & skills clinical success rates & confidence with next clinical ILP skill retention in the intervention group

Is competence on manikin associated with clinical success? (independent of group)

Planning underway to expand trial to multiple sites and to start including emergency medicine residents

After data collection is completed we will analyze groups to compare: improvement rates in knowledge, confidence & skills clinical success rates & confidence with next clinical ILP skill retention in the intervention group

Is competence on manikin associated with clinical success? (independent of group)

Planning underway to expand trial to multiple sites and to start including emergency medicine residents

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KNOWLEDGEKNOWLEDGEKNOWLEDGEKNOWLEDGE

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P=.018 P=.001

P=.005P=.014This is a randomized clinical trial of a simulation educational interventionPediatric Residents are randomized to EARLY or LATE simulator trainingThis is a randomized clinical trial of a simulation educational interventionPediatric Residents are randomized to EARLY or LATE simulator training

Thank you to the Pediatric House Staff, Dr. Rhonda Graves, Dr. Steve Paik, Karl Santiago, the division of Pediatric Emergency Medicine & the Pediatric Simulation Center at Bellevue Hospital for all of their support

Research supported by Rbabyfoundation.org and KiDS of NYU

Thank you to the Pediatric House Staff, Dr. Rhonda Graves, Dr. Steve Paik, Karl Santiago, the division of Pediatric Emergency Medicine & the Pediatric Simulation Center at Bellevue Hospital for all of their support

Research supported by Rbabyfoundation.org and KiDS of NYU

Clinical OutcomesClinical OutcomesClinical OutcomesClinical Outcomes

SKILLS (Simulator)SKILLS (Simulator)SKILLS (Simulator)SKILLS (Simulator) QuickTime™ and a decompressor

are needed to see this picture.

N=16

N=51

N=51

P=.026

OBJECTIVESOBJECTIVES

METHODSMETHODS

PRELIMINARY RESULTSPRELIMINARY RESULTS

FINAL ASSESSMENT: KNOWLEDGE, CONFIDENCE, SKILLS & CLINICAL OUTCOMESFINAL ASSESSMENT: KNOWLEDGE, CONFIDENCE, SKILLS & CLINICAL OUTCOMES

SIMULATOR TRAINING "practice makes perfect" (try LP until successful)

Current progress in timeline

(6-12months later)

Clinical outcomes self-reported after next LPClinical outcomes self-reported after next LP

BASELINE POST ASSESSMENTBASELINE POST ASSESSMENT

VIDEO TRAINING: Both groups watch LP and infant LP training videoVIDEO TRAINING: Both groups watch LP and infant LP training video

BASELINE PRE-ASSESSMENTBASELINE PRE-ASSESSMENT

INTERVENTION(EARLY SIM TRAINING)

INTERVENTION(EARLY SIM TRAINING)

CONTROL(LATE SIM TRAINING)

CONTROL(LATE SIM TRAINING)

RANDOMIZEDRANDOMIZED

CONFIDENCECONFIDENCECONFIDENCECONFIDENCE

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Clinical Success

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Critical Skills Obtained Fluid

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KNOWLEDGE: 6 item quiz of infant LP questionsKNOWLEDGE: 6 item quiz of infant LP questions

CONFIDENCE: 4 point Likert scale “I feel confident in my ability to perform an LP on an infant”CONFIDENCE: 4 point Likert scale “I feel confident in my ability to perform an LP on an infant”

SKILLS: LP on simulator videotaped for blind rater& scored on 16 item “critica LPl steps” checklist SKILLS: LP on simulator videotaped for blind rater& scored on 16 item “critica LPl steps” checklist

KNOWLEDGEKNOWLEDGE

CONFIDENCECONFIDENCE

SKILLS (on simulator)SKILLS (on simulator)

SIMULATOR TRAINING "practice makes perfect" (try LP until successful)

CONCLUSIONSCONCLUSIONS

FUTURE DIRECTIONSFUTURE DIRECTIONS

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

(Intervention Only)(Intervention Only)

N=24

P=.00004 P=.005