title: Qualitative Study Exploring Implementation of a Point-of-Care Competency-Based Lumbar Puncture Program Across Institutions.
abstract: To explore the factors that facilitated or hindered successful implementation of a multi-centered infant lumbar puncture (LP) competency-based education program that required interns to demonstrate skills readiness on a task trainer before performing their first clinical LP.
  
  
  
  In 2013, investigators conducted a qualitative study utilizing semistructured interviews and focus groups of site directors (SDs) from the International Network for Simulation-Based Pediatric Innovation, Research, and Education (INSPIRE) who were responsible for implementing the LP competency-based education program. Transcripts were analyzed using grounded theory to identify and verify emergent themes and subthemes.
  
  
  
  Thematic saturation was attained after interviewing 19 SDs in 12 interviews and 3 focus groups. The most significant strategies and barriers were organized into 4 main themes: 1) alignment of different visions to obtain buy-in, 2) balance between providing education versus patient care, 3) acceptance of novel teaching paradigms, and 4) communication logistics. The ability to overcome barriers was influenced by institutional culture on trainee education, patient safety and research; the level of relational coordination between different groups of stakeholders; and the ability of SDs to identify and diversify entrepreneurial strategies.
  
  
  
  INSPIRE SDs reveal the challenges of implementing a network-wide competency-based educational initiative that determines interns' readiness to perform LPs in clinical settings. Strategizing to align the common goals of graduate medical training, patient care and research instructs clinician educators and leaders on how to successfully change educational culture in academic medicine.
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY. Electronic address: julie_pasternack@urmc.rochester.edu.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Pasternack
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
authors.forename: Rita
authors.initials: R
authors.lastname: Dadiz
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY.
authors.forename: Ryan
authors.initials: R
authors.lastname: McBeth
authors.affiliation: Department of Emergency Medicine, Saint Louis University School of Medicine, St Louis, Mo.
authors.forename: James M
authors.initials: JM
authors.lastname: Gerard
authors.affiliation: Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherzer
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn.
authors.forename: Gunjan
authors.initials: G
authors.lastname: Tiyyagura
authors.affiliation: Department of Emergency Medicine, Children's National Health System, George Washington University, Washington, DC.
authors.forename: Pavan
authors.initials: P
authors.lastname: Zaveri
authors.affiliation: Department of Emergency Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn.
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
authors.affiliation: Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003162:Competency-Based Education / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education*; D019095:Point-of-Care Systems; D036301:Qualitative Research; D000066908:Simulation Training; D013129:Spinal Puncture
keywords: competency-based education; educational framework; graduate medical education; lumbar puncture; procedural readiness