title: A randomized trial of simulation-based deliberate practice for infant lumbar puncture skills.
abstract: BACKGROUND
  Infant lumbar puncture (LP) is mandated by the Accreditation Council for Graduate Medical Education for all pediatric trainees. Current training usually involves the apprenticeship model of "see one, do one, teach one" where a trainee's first LP attempt occurs in a high-stakes environment. Simulation training promotes skill development in a safe environment before patient contact.
  
  
  OBJECTIVE
  To demonstrate that deliberate practice simulation-based training after audiovisual training (AV) improves infant LP skills compared with a control group receiving AV training only.
  
  
  METHODS
  This was a randomized trial of simulation-based training + AV versus AV only for pediatric residents. On enrollment, the subjects' infant LP skills were evaluated through their performance on a simulator. A questionnaire and brief quiz were administered to collect information on the subjects' infant LP experience, knowledge, and confidence. All subjects viewed an educational AV presentation. The intervention group went on to participate in a simulation-based deliberate practice session on the infant LP simulator while the control group did not. Our primary outcome was self-reported clinical success on the first infant LP after training. Secondary outcomes were rates of traumatic clinical LPs, infant LP skills (measured via observed structured clinical examinations on the simulator 6 months after training), and change in participants' knowledge and confidence.
  
  
  RESULTS
  Fifty-one residents reported 32 clinical encounters. Sixteen of 17 subjects (94%) in the intervention group who performed a clinical infant LP obtained cerebrospinal fluid compared with 7 of 15 subjects (47%) in the control group (difference = 47%; 95% CI = 16%-70%). There was no difference between groups at 6 months on observed structured clinical examination performance, knowledge, or confidence.
  
  
  CONCLUSIONS
  Participation in a simulation-based deliberate practice intervention can improve infant LP skill.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA. dk2592@columbia.edu
authors.forename: David O
authors.initials: DO
authors.lastname: Kessler
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
authors.forename: Martin
authors.initials: M
authors.lastname: Pusic
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Foltin
mesh_terms: D001296:Audiovisual Aids; D003162:Competency-Based Education; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010372:Pediatrics / Q000193:education*; D013129:Spinal Puncture / Q000592:standards*; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods*