Improving infant LP skills through simulation-based mastery learning and

just-in-time refreshers

POISE 2010-2011

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!

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

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

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

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

1. Online

Survey & Audiovisual

Training

2. Mastery Learning Session

3. JIT:

Just-in-time RefresherSession

4. Clinical Lumbar

Puncture

4. JIT:

Just-in-time RefresherSession

5. Clinical Lumbar

Puncture

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

Learning Curve

time

skill

mastery JIT JIT

Trigger = intern has infant who needs LP1. Assemble practice LP kit and simulator2. Ask learner to demonstrate “the best they can do”

without your help on the simulator3. Give feedback, answer questions, coach practice4. Complete simulator assessment form5. Supervise clinical LP (and complete form)

JIT refresher: detailsDuration: < 5 minutes (already trained to mastery)

3 steps of JIT

1. Get model and practice LP kit

2. Complete simulator (checklist)– Less than 5 minutes

3. Complete clinical (checklist)

How to set up the simulator1. Fill bottle with water up to fill-line

2. Insert bottle in pressure bag

3. Inflate bag until pop-off valve hits 150mmHg

1. After JIT sim session-> complete SIDE 12. After intern attempts clinical LP-> complete SIDE 23. Please make sure all data points completed*Place data collection form into POISE box in clinical area*

Assessment form

Global rating

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

Errors and “near-miss” events

• Record all errors or omissions of critical steps

Other Information- Sim LP

Other Information- Clinical LP

1. Online

Survey & Audiovisual

Training

2. Mastery Learning Session

3. JIT:

Just-in-time RefresherSession

4. Clinical Lumbar

Puncture

4. JIT:

Just-in-time RefresherSession

5. Clinical Lumbar

Puncture