Transcript Sim One, Do One” Infant Lumbar Puncture Simulator Builds

“Sim One, Do One”
Infant 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
BACKGROUND
PRELIMINARY RESULTS
KNOWLEDGE
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
100
P=.018
Pre-Test
Post-Test
Simulators that replicate the experience of an infant LP exist for training
OBJECTIVES
60
We hypothesize that “practice makes perfect” interactive skill training on
an LP simulator improves resident LP knowledge, confidence & skills
40
We hypothesize that competence on the simulator will lead to improved
clinical performance (success with next clinical LP)
10
50
30
20
METHODS
Control
N=51
This is a randomized clinical trial of a simulation educational intervention
Pediatric Residents are randomized to EARLY or LATE simulator training
CONTROL
(LATE SIM TRAINING)
INTERVENTION
(EARLY SIM TRAINING)
RANDOMIZED
BASELINE PRE-ASSESSMENT
KNOWLEDGE: 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”
SKILLS: LP on simulator videotaped for blind rater& scored on 16 item “critica LPl steps” checklist
100
Intervention
24
15(63)
10(42)
7(29)
7(29)
7(29)
7(29)
22(92)
13(54)
4.7
5.2
Control
27
24(89)
9(33)
9(33)
9(33)
9(33)
6(22)
25(93)
13(48)
4.6
5.5
Intervention
CONFIDENCE
P=.014
LP simulator training improves knowledge, confidence and skills
LEARNER VARIABLES
N
Female (%)
PGY1(%)
PGY2(%)
PGY3(%)
Prior LP didactics(%)
Prior manikin experience(%)
LPs Observed(%)
Success with last LP(%)
Mean #ILPÕs obse
rved
Mean #ILPÕsperformed
70
0
Both groups had short-term improvements in knowledge & confidence
P=.001
90
80
CONCLUSIONS
Pre-Test
Post-Test
Clinical Outcomes
P=.005
Control
Intervention
90
SIMULATOR TRAINING
"practice makes perfect"
(try LP until successful)
BASELINE POST ASSESSMENT
KNOWLEDGE
CONFIDENCE
80
Clinical outcomes self-reported after next LP
Current progress in timeline
(6-12months later)
SIMULATOR TRAINING
"practice makes perfect"
(try LP until successful)
FINAL ASSESSMENT: KNOWLEDGE, CONFIDENCE, SKILLS & CLINICAL OUTCOMES
FUTURE DIRECTIONS
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
70
60
Planning underway to expand trial to multiple sites and to start including
emergency medicine residents
P=.026
Clinical
Success
50
40
30
N=16
ACKNOWLEDGEMENTS
10
0
Control
N=51
Intervention
SKILLS (Simulator)
SKILLS (on simulator)
LP simulators could provide a safe environment for skill
development and the demonstration of provider competency
Is competence on manikin associated with clinical success?
(independent of group)
20
VIDEO TRAINING: Both groups watch LP and infant LP training video
LP simulator training promotes success with next clinical LP
P=.00004
100
90
80
70
60
50
40
30
20
10
0
(Intervention Only)
Pre
Post
0
20
40
60
80
100
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P=.005
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
Critical Skills
N=24
Obtained Fluid