title: Qualitative evaluation of just-in-time simulation-based learning: the learners' perspective.
abstract: BACKGROUND
  Just-in-time training (JITT) is an educational strategy where training occurs in close temporal proximity to a clinical encounter. A multicenter study evaluated the impact of simulation-based JITT on interns' infant lumbar puncture (LP) success rates. Concurrent with this multicenter study, we conducted a qualitative evaluation to describe learner perceptions of this modality of skills training.
  
  
  METHODS
  Eleven interns from a single institution participated in a face-to-face semistructured interview exploring their JITT experience. Interviews were audio-recorded and transcribed. Two investigators reviewed the transcripts, assigned codes to the data, and categorized the codes. Categories were modified by 4 emergency physicians. As a means of data triangulation, we performed focus groups at a second institution.
  
  
  RESULTS
  Benefits of JITT included review of anatomic landmarks, procedural rehearsal, and an opportunity to ask questions. These perceived benefits improved confidence with infant LP. Deficits of the training included lack of mannequin fidelity and unrealistic context when compared with an actual LP. An unexpected category, which emerged from our analysis, was that of barriers to JITT performance. Barriers included lack of time in a busy clinical setting and various instructor factors. The focus group findings confirmed and elaborated the benefits and deficits of JITT and the barriers to JITT performance.
  
  
  CONCLUSIONS
  Just-in-time training improved procedural confidence with infant LP, but work place busyness and instructor lack of support or unawareness were barriers to JITT performance. Optimal LP JITT would occur with improved contextual fidelity. More research is needed to determine optimal training strategies that are effective for the learner and maximize clinical outcomes for the patient.
authors.affiliation: Department of Pediatrics (Emergency Medicine), Yale University School of Medicine, New Haven, CT 06518, USA.
authors.forename: Gunjan
authors.initials: G
authors.lastname: Kamdar
authors.forename: David O
authors.initials: DO
authors.lastname: Kessler
authors.forename: Lindsey
authors.initials: L
authors.lastname: Tilt
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Srivastava
authors.forename: Kajal
authors.initials: K
authors.lastname: Khanna
authors.forename: Todd P
authors.initials: TP
authors.lastname: Chang
authors.forename: Dorene
authors.initials: D
authors.lastname: Balmer
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
mesh_terms: D002983:Clinical Competence / Q000592:standards; D005069:Evaluation Studies as Topic; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007858:Learning; D008348:Manikins; D036301:Qualitative Research; D013129:Spinal Puncture / Q000592:standards*; D013337:Students, Medical / Q000523:psychology*; D013997:Time Factors; D014481:United States