Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture

David Kessler, Martin Pusic, Todd P. Chang, Daniel M. Fein, Devin Grossman, Renuka Mehta, Marjorie White, Jaewon Jang, Travis Whitfill, Marc Auerbach, Michael Holder, Glenn R. Stryjewski, Kathleen Ostrom, Lara Kothari, Pavan Zaveri, Berry Seelbach, Dewesh Agrawal, Joshua Rocker, Kiran Hebbar, Maybelle Kou & 26 others Julie Lindower, Glenda Rabe, Audrey Paul, Christopher Strother, Eric Weinberg, Nikhil Shah, Kevin Ching, Kelly Cleary, Noel Zuckerbraun, Brett McAninch, Amanda Pratt, Jennifer Reid, Steve Cico, James Gerard, Matei Petrescu, Laura Haubner, Geetanjali Srivastava, Denis Oriot, Grace Arteaga, Daniel Lemke, Wendy Van Ittersum, Alisa McQueen, Stephen M. Blumberg, Sandra Arnold, Peggy O'Cain, Melissa Cercone

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVE: Simulation-based skill trainings are common; however, optimal instructional designs that improve outcomes are not well specified. We explored the impact of just-in-time and just-in-place training (JIPT) on interns' infant lumbar puncture (LP) success. METHODS: This prospective study enrolled pediatric and emergency medicine interns from 2009 to 2012 at 34 centers. Two distinct instructional design strategies were compared. Cohort A (2009-2010) completed simulation-based training at commencement of internship, receiving individually coached practice on the LP simulator until achieving a predefined mastery performance standard. Cohort B (2010-2012) had the same training plus JIPT sessions immediately before their first clinical LP. Main outcome was LP success, defined as obtaining fluid with first needle insertion and <1000 red blood cells per high-power field. Process measures included use of analgesia, early stylet removal, and overall attempts. RESULTS: A total of 436 first infant LPs were analyzed. The LP success rate in cohort A was 35% (13/37), compared with 38% (152/399) in cohort B (95% confidence interval for difference [CI diff], -15% to +18%). Cohort B exhibited greater analgesia use (68% vs 19%; 95% CI diff, 33% to 59%), early stylet removal (69% vs 54%; 95% CI diff, 0% to 32%), and lower mean number of attempts (1.4 ± 0.6 vs 2.1 ± 1.6, P < .01) compared with cohort A. CONCLUSIONS: Across multiple institutions, intern success rates with infant LP are poor. Despite improving process measures, adding JIPT to training bundles did not improve success rate. More research is needed on optimal instructional design strategies for infant LP.

Original languageEnglish (US)
Pages (from-to)e1237-e1246
JournalPediatrics
Volume135
Issue number5
DOIs
StatePublished - May 1 2015

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Spinal Puncture
Process Assessment (Health Care)
Confidence Intervals
Analgesia
Internship and Residency
Needles
Erythrocytes
Prospective Studies
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Kessler, D., Pusic, M., Chang, T. P., Fein, D. M., Grossman, D., Mehta, R., ... Cercone, M. (2015). Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture. Pediatrics, 135(5), e1237-e1246. https://doi.org/10.1542/peds.2014-1911

Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture. / Kessler, David; Pusic, Martin; Chang, Todd P.; Fein, Daniel M.; Grossman, Devin; Mehta, Renuka; White, Marjorie; Jang, Jaewon; Whitfill, Travis; Auerbach, Marc; Holder, Michael; Stryjewski, Glenn R.; Ostrom, Kathleen; Kothari, Lara; Zaveri, Pavan; Seelbach, Berry; Agrawal, Dewesh; Rocker, Joshua; Hebbar, Kiran; Kou, Maybelle; Lindower, Julie; Rabe, Glenda; Paul, Audrey; Strother, Christopher; Weinberg, Eric; Shah, Nikhil; Ching, Kevin; Cleary, Kelly; Zuckerbraun, Noel; McAninch, Brett; Pratt, Amanda; Reid, Jennifer; Cico, Steve; Gerard, James; Petrescu, Matei; Haubner, Laura; Srivastava, Geetanjali; Oriot, Denis; Arteaga, Grace; Lemke, Daniel; Van Ittersum, Wendy; McQueen, Alisa; Blumberg, Stephen M.; Arnold, Sandra; O'Cain, Peggy; Cercone, Melissa.

In: Pediatrics, Vol. 135, No. 5, 01.05.2015, p. e1237-e1246.

Research output: Contribution to journalArticle

Kessler, D, Pusic, M, Chang, TP, Fein, DM, Grossman, D, Mehta, R, White, M, Jang, J, Whitfill, T, Auerbach, M, Holder, M, Stryjewski, GR, Ostrom, K, Kothari, L, Zaveri, P, Seelbach, B, Agrawal, D, Rocker, J, Hebbar, K, Kou, M, Lindower, J, Rabe, G, Paul, A, Strother, C, Weinberg, E, Shah, N, Ching, K, Cleary, K, Zuckerbraun, N, McAninch, B, Pratt, A, Reid, J, Cico, S, Gerard, J, Petrescu, M, Haubner, L, Srivastava, G, Oriot, D, Arteaga, G, Lemke, D, Van Ittersum, W, McQueen, A, Blumberg, SM, Arnold, S, O'Cain, P & Cercone, M 2015, 'Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture', Pediatrics, vol. 135, no. 5, pp. e1237-e1246. https://doi.org/10.1542/peds.2014-1911
Kessler, David ; Pusic, Martin ; Chang, Todd P. ; Fein, Daniel M. ; Grossman, Devin ; Mehta, Renuka ; White, Marjorie ; Jang, Jaewon ; Whitfill, Travis ; Auerbach, Marc ; Holder, Michael ; Stryjewski, Glenn R. ; Ostrom, Kathleen ; Kothari, Lara ; Zaveri, Pavan ; Seelbach, Berry ; Agrawal, Dewesh ; Rocker, Joshua ; Hebbar, Kiran ; Kou, Maybelle ; Lindower, Julie ; Rabe, Glenda ; Paul, Audrey ; Strother, Christopher ; Weinberg, Eric ; Shah, Nikhil ; Ching, Kevin ; Cleary, Kelly ; Zuckerbraun, Noel ; McAninch, Brett ; Pratt, Amanda ; Reid, Jennifer ; Cico, Steve ; Gerard, James ; Petrescu, Matei ; Haubner, Laura ; Srivastava, Geetanjali ; Oriot, Denis ; Arteaga, Grace ; Lemke, Daniel ; Van Ittersum, Wendy ; McQueen, Alisa ; Blumberg, Stephen M. ; Arnold, Sandra ; O'Cain, Peggy ; Cercone, Melissa. / Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture. In: Pediatrics. 2015 ; Vol. 135, No. 5. pp. e1237-e1246.
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abstract = "BACKGROUND AND OBJECTIVE: Simulation-based skill trainings are common; however, optimal instructional designs that improve outcomes are not well specified. We explored the impact of just-in-time and just-in-place training (JIPT) on interns' infant lumbar puncture (LP) success. METHODS: This prospective study enrolled pediatric and emergency medicine interns from 2009 to 2012 at 34 centers. Two distinct instructional design strategies were compared. Cohort A (2009-2010) completed simulation-based training at commencement of internship, receiving individually coached practice on the LP simulator until achieving a predefined mastery performance standard. Cohort B (2010-2012) had the same training plus JIPT sessions immediately before their first clinical LP. Main outcome was LP success, defined as obtaining fluid with first needle insertion and <1000 red blood cells per high-power field. Process measures included use of analgesia, early stylet removal, and overall attempts. RESULTS: A total of 436 first infant LPs were analyzed. The LP success rate in cohort A was 35{\%} (13/37), compared with 38{\%} (152/399) in cohort B (95{\%} confidence interval for difference [CI diff], -15{\%} to +18{\%}). Cohort B exhibited greater analgesia use (68{\%} vs 19{\%}; 95{\%} CI diff, 33{\%} to 59{\%}), early stylet removal (69{\%} vs 54{\%}; 95{\%} CI diff, 0{\%} to 32{\%}), and lower mean number of attempts (1.4 ± 0.6 vs 2.1 ± 1.6, P < .01) compared with cohort A. CONCLUSIONS: Across multiple institutions, intern success rates with infant LP are poor. Despite improving process measures, adding JIPT to training bundles did not improve success rate. More research is needed on optimal instructional design strategies for infant LP.",
author = "David Kessler and Martin Pusic and Chang, {Todd P.} and Fein, {Daniel M.} and Devin Grossman and Renuka Mehta and Marjorie White and Jaewon Jang and Travis Whitfill and Marc Auerbach and Michael Holder and Stryjewski, {Glenn R.} and Kathleen Ostrom and Lara Kothari and Pavan Zaveri and Berry Seelbach and Dewesh Agrawal and Joshua Rocker and Kiran Hebbar and Maybelle Kou and Julie Lindower and Glenda Rabe and Audrey Paul and Christopher Strother and Eric Weinberg and Nikhil Shah and Kevin Ching and Kelly Cleary and Noel Zuckerbraun and Brett McAninch and Amanda Pratt and Jennifer Reid and Steve Cico and James Gerard and Matei Petrescu and Laura Haubner and Geetanjali Srivastava and Denis Oriot and Grace Arteaga and Daniel Lemke and {Van Ittersum}, Wendy and Alisa McQueen and Blumberg, {Stephen M.} and Sandra Arnold and Peggy O'Cain and Melissa Cercone",
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T1 - Impact of just-in-time and just-in-place simulation on intern success with infant lumbar puncture

AU - Kessler, David

AU - Pusic, Martin

AU - Chang, Todd P.

AU - Fein, Daniel M.

AU - Grossman, Devin

AU - Mehta, Renuka

AU - White, Marjorie

AU - Jang, Jaewon

AU - Whitfill, Travis

AU - Auerbach, Marc

AU - Holder, Michael

AU - Stryjewski, Glenn R.

AU - Ostrom, Kathleen

AU - Kothari, Lara

AU - Zaveri, Pavan

AU - Seelbach, Berry

AU - Agrawal, Dewesh

AU - Rocker, Joshua

AU - Hebbar, Kiran

AU - Kou, Maybelle

AU - Lindower, Julie

AU - Rabe, Glenda

AU - Paul, Audrey

AU - Strother, Christopher

AU - Weinberg, Eric

AU - Shah, Nikhil

AU - Ching, Kevin

AU - Cleary, Kelly

AU - Zuckerbraun, Noel

AU - McAninch, Brett

AU - Pratt, Amanda

AU - Reid, Jennifer

AU - Cico, Steve

AU - Gerard, James

AU - Petrescu, Matei

AU - Haubner, Laura

AU - Srivastava, Geetanjali

AU - Oriot, Denis

AU - Arteaga, Grace

AU - Lemke, Daniel

AU - Van Ittersum, Wendy

AU - McQueen, Alisa

AU - Blumberg, Stephen M.

AU - Arnold, Sandra

AU - O'Cain, Peggy

AU - Cercone, Melissa

PY - 2015/5/1

Y1 - 2015/5/1

N2 - BACKGROUND AND OBJECTIVE: Simulation-based skill trainings are common; however, optimal instructional designs that improve outcomes are not well specified. We explored the impact of just-in-time and just-in-place training (JIPT) on interns' infant lumbar puncture (LP) success. METHODS: This prospective study enrolled pediatric and emergency medicine interns from 2009 to 2012 at 34 centers. Two distinct instructional design strategies were compared. Cohort A (2009-2010) completed simulation-based training at commencement of internship, receiving individually coached practice on the LP simulator until achieving a predefined mastery performance standard. Cohort B (2010-2012) had the same training plus JIPT sessions immediately before their first clinical LP. Main outcome was LP success, defined as obtaining fluid with first needle insertion and <1000 red blood cells per high-power field. Process measures included use of analgesia, early stylet removal, and overall attempts. RESULTS: A total of 436 first infant LPs were analyzed. The LP success rate in cohort A was 35% (13/37), compared with 38% (152/399) in cohort B (95% confidence interval for difference [CI diff], -15% to +18%). Cohort B exhibited greater analgesia use (68% vs 19%; 95% CI diff, 33% to 59%), early stylet removal (69% vs 54%; 95% CI diff, 0% to 32%), and lower mean number of attempts (1.4 ± 0.6 vs 2.1 ± 1.6, P < .01) compared with cohort A. CONCLUSIONS: Across multiple institutions, intern success rates with infant LP are poor. Despite improving process measures, adding JIPT to training bundles did not improve success rate. More research is needed on optimal instructional design strategies for infant LP.

AB - BACKGROUND AND OBJECTIVE: Simulation-based skill trainings are common; however, optimal instructional designs that improve outcomes are not well specified. We explored the impact of just-in-time and just-in-place training (JIPT) on interns' infant lumbar puncture (LP) success. METHODS: This prospective study enrolled pediatric and emergency medicine interns from 2009 to 2012 at 34 centers. Two distinct instructional design strategies were compared. Cohort A (2009-2010) completed simulation-based training at commencement of internship, receiving individually coached practice on the LP simulator until achieving a predefined mastery performance standard. Cohort B (2010-2012) had the same training plus JIPT sessions immediately before their first clinical LP. Main outcome was LP success, defined as obtaining fluid with first needle insertion and <1000 red blood cells per high-power field. Process measures included use of analgesia, early stylet removal, and overall attempts. RESULTS: A total of 436 first infant LPs were analyzed. The LP success rate in cohort A was 35% (13/37), compared with 38% (152/399) in cohort B (95% confidence interval for difference [CI diff], -15% to +18%). Cohort B exhibited greater analgesia use (68% vs 19%; 95% CI diff, 33% to 59%), early stylet removal (69% vs 54%; 95% CI diff, 0% to 32%), and lower mean number of attempts (1.4 ± 0.6 vs 2.1 ± 1.6, P < .01) compared with cohort A. CONCLUSIONS: Across multiple institutions, intern success rates with infant LP are poor. Despite improving process measures, adding JIPT to training bundles did not improve success rate. More research is needed on optimal instructional design strategies for infant LP.

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