ipssw impact on lp success
DESCRIPTION
Dr. David Kessler presents the impact on LP success rates by interns using simulation-based Mastery Training and Just-in-Time TrainingTRANSCRIPT
S
Impact of a Simulation-Based Just-In-Time Refresher Training for Interns on Their Clinical
Success Rate with Infant Lumbar Puncture
Daniel Fein, Todd Chang, Dewesh Agrawal, Jennifer Reid, Joshua Rocker, Martin Pusic, Laura Haubner, Marc
Auerbach
on behalf of the POISE Investigators
David Kessler, MD, MScAssistant Professor of Clinical Pediatrics
Director of Clinical OperationsDivision of Pediatric Emergency Medicine
Co-director of the POISE research network
Conflict of Interest
S On 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.
S The POISE Network is funded by a grant by
Background
• Simulation is effective for skills training
• The ideal timing and duration of training needed to
make a clinical impact are largely unknown
Background
• Simulation based mastery education (SBME) is a method of training to a predefined endpoint
Background
• Simulation based mastery education (SBME) is a method of training to a predefined endpoint
• Metanalysis of SBME using deliberate practice vstraditional clinical education
• Inclusion: SBME intervention, comparison group, skill outcome
• 3742 articles screened, 14 included
• 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
Background
• Just-in-time (JIT) training is a refresher session that occurs temporally close to the actual clinical encounter / skill being performed
Background
• Just-in-time (JIT) training is a refresher session that occurs temporally close to the actual clinical encounter / skill being performed
• Rolling refreshers for CPR
• Practice compressions on simulator (to mastery)
• High frequency >2 refreshers per month
• Low frequency <2 refreshers per month
• High frequency group achieved mastery faster
Nilesa 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
Objectives
S To compare the impact of 2 different training
strategies on clinical success rates with the infant
lumbar puncture (LP) procedure.
1. A single simulation based mastery education session using
coached deliberate practice (SBME)
2. SBME plus just-in-time (JIT) refreshers on clinical success
rates with the infant lumbar puncture (LP) procedure.
Methods
S Design: Multicenter prospective study with historical
control group
S Setting: 21 academic training centers
S Population: Pediatric interns
Methods
SBME
Orientation
Time = 0
2009-
2010
cohort
2010-
2011
cohort
SBME
Methods
SBME
Orientation
Time = 0
2009-
2010
cohort
2010-
2011
cohort
SBME
Methods
SBME
Orientation
Time = 0
JIT
LP Clinical encounter #12009-
2010
cohort
2010-
2011
cohort
SBMELP Clinical encounter #1
Methods
SBME
Orientation
Time = 0
JIT
LP Clinical encounter #1
JIT
2009-
2010
cohort
0 to 6 months
2010-
2011
cohort
SBME*
LP#2,3…
LP#2,3…LP Clinical encounter #1
Methods
SBME
Orientation
Time = 0
JIT
LP Clinical encounter #1
JIT
2009-
2010
cohort
0 to 6 months
2010-
2011
cohort
SBME*
LP#2,3…
LP#2,3…LP Clinical encounter #1
Methods
SBME
Orientation
Time = 0
JIT
LP Clinical encounter #1
JIT
2009-
2010
cohort
0 to 6 months
2010-
2011
cohort
SBME*
LP#2,3…
LP#2,3…LP Clinical encounter #1
Primary outcome: atraumatic
infant LP (<1000 rbcs/hpf)
Results
104 interns enrolled 51 interns report 102 LPs2009-2010
(SBME)
Results
501 interns enrolled
104 interns enrolled
161 interns report 228
LPs
51 interns report 102 LPs
2010-2011
(SBME + JIT)
2009-2010
(SBME)
Results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
SBME SBME+JIT
Intern Clinical Success Rate
with Infant Lumbar Puncture
45%(102/228)
45%(46/102)
2009 cohort 2010 cohort
(95% CI for difference: -0.1 to 0.1)
Results
Limitations
• Historical controls
• Reporting bias
• Novice learners
Conclusions
S SBME plus subsequent JIT is not superior to SBME alone in improving interns’ LP success rates
Future directions
• Bedside competency assessment as predictor of success
• Increased opportunity for self-directed practice
Acknowledgements
POISE Study Investigators:
S Akron Children’s Hospital (Holder), AI Dupont (Stryjewski), Cardinal Glennon SLU (Gerard, Scalzo), Children’s Hospital of Boston (Kothari), Children's Hospital of Los Angeles (Keeler, Mody, Ostrom), Children’s Hospital at Montefiore (Avner, Fein), Children's Hospital of New York Presbyterian (Kessler, Pusic, Tilt), Children's Hospital of Pittsburgh (Zuckerbraun, McAninch), Children’s National Medical Center (Zaveri, Chang, Birch, Agrawal, Seelbach), Cohen Children's Medical Center of New York (Rocker, Israel, Bruckner, Sherman), Emory University (Hebbar), Inova-Fairfax (Kou, D'Andrade, Hwang), University of Iowa Children's Hospital (Lindower, Rabe), Mayo Clinic (Arteaga, Matthews), Medical College of Georgia (Mehta, Sharma, Lane), Mount Sinai Medical Center (Paul, Strother), Nationwide Childrens Hospital (Scherzer), NYU Medical Center (Ching, Torch, Foltin, Cleary), Robert Wood Johnson (Pratt), Seattle Children’s Hospital (Cico, Klein, Reid), Tulane Hospital for Children (Keane, Krantz, Petrescu, Washko), University of South Florida (Haubner, Nations), University of Texas Southwestern (Srivastava), Weill Cornell (Shah, Weinberg, O'Malley), Yale University (Auerbach, Kamdar, Duran)