WIP 23 - Impact of deliberate practice and just in time simulation on clinical outcomes of pediatric resident-performed infant lumbar puncture

Poster Number: WIP 23
Publication Number: WIP 23.2487

Background: As clinical management guidelines have changed, pediatric residents have fewer opportunities to perform infant lumbar punctures (LPs). Simulation is an effective means for teaching low frequency, high stakes procedural skills such as LPs. Simulation studies have shown improved resident confidence and scores on mastery checklists; however, there has been limited data on clinical outcomes. Prior studies failed to demonstrate improved clinical outcomes on interns’ first clinical LP after deliberate practice and just in time simulation training.

Objective: The purpose of this study is to determine if the combination of deliberate practice and just in time simulation longitudinally improves residents’ clinical success in performing infant lumbar punctures.

Design/Methods: The study was conducted at a single, tertiary, academic medical center. Pediatric residents enrolled in the IRB approved study by completing a pre-survey and participating in a deliberate practice workshop modeled after the INSPIRE Network infant LP simulation curriculum. From July 2023 through March 2024, pediatric residents working in the emergency department performing LPs on infants less 6 months of age will participate in a guided just in time simulation prior to each LP attempt. Clinical outcomes from these LPs will be tracked, including success in obtaining CSF, number of attempts, and atraumatic taps defined as < 1000 RBC/hpf. Baseline data across all hospital units was collected from LPs performed by residents during the 2022-2023 academic year for clinical success comparison of lumbar punctures performed without deliberate practice, with deliberate practice but no just in time simulation, and deliberate practice and just in time simulation in the ED. Results will be stratified by years of training to determine if just in time simulation has a greater effect on learners with more experience. A secondary outcome is the effect of the intervention on self-perceived confidence and competence.