Introduction: Infant lumbar puncture (LP) is such a common procedure performed by pediatric house staff that the ACGME states it is a required essential pediatric residency skill. However, as new learners enter a clinical setting, they may be asked to perform an LP without having had any experience on a live infant. The purpose of the materials in this mastery learning module is to provide a comprehensive simulation-based training and assessment package related to the infant LP procedure. Methods: This multimodal package will use simulation as a formative assessment medium to review LP training on a simulator prior to performing an LP on a live infant patient. The simulated environment provides a means for trainees to achieve a specific competency level via practice without affecting live patients. In the context of the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) phases of training (i.e., learn, see, practice, prove, do, maintain), this simulation addresses the first four of these phases: (1) initial instruction about the procedure, (2) faculty-led demonstration, (3) hands-on simulation-based training, and (4) assessment on a simulator. Materials provided in this resource include an instruction guide, session outline/rating checklist, and a train-the-trainer video. Results: Our work has demonstrated that under the right conditions participation in a simulation-based mastery learning with deliberate practice intervention improves infant LP skills. Fifty-one residents reported 32 clinical encounters. Sixteen of 17 subjects (94%) who received this module and performed a clinical infant LP obtained cerebrospinal fluid compared with 7 of 15 subjects (47%) in the control group. Discussion: The use of this formative assessment in LP training has potentially broad implications in terms of resident education and improved clinical outcomes. If errors are identified and resolved in a simulated situation, not only will the trainee feel more confident, but also could lead to an improved clinical outcome on a live patient.
- Conduct a scripted mastery learning session.
- Demonstrate expert modeling of the procedure with deconstruction into the subcomponent tasks of the procedure on a simulator.
- Explain the subcomponent tasks of the procedure while demonstrating.
- Utilize the Mastery Learning Checklist to guide formative feedback.
- Assess the learner’s performance on the simulator using the mastery checklist.
- Provide formative feedback on sub-component steps of the procedure.
- Coach the learner through repetitive deliberate practice on a simulator to achieve a minimum passing score.
- Explain the subcomponent steps on the mastery checklist.
- Verbalize the sub-component tasks of the deconstructed procedure.
- Self-reflect on performance using the checklist.
- Demonstrate the sub-component tasks on the simulator to a minimum passing standard after repetitive deliberate practice.
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