Original Publication
Open Access

A Comprehensive Infant Lumber Puncture Novice Procedural Skills Training Package: An INSPIRE Simulation-Based Procedural Skills Training Package

Published: March 13, 2014 | 10.15766/mep_2374-8265.9724

Included in this publication:

  • INSPIRE ILP Mastery Training Resource Guide.pdf
  • INPSIRE ILP Instructor Guide.pdf
  • Mastery Learning Instructor Guide and Checklist.pdf
  • Train the Trainer Video.mp4
  • Train the Trainer Module folder

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


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.

Educational Objectives

By the end of this session, facilitators will be able to:

  1. Conduct a scripted mastery learning session.
  2. Demonstrate expert modeling of the procedure with deconstruction into the subcomponent tasks of the procedure on a simulator.
  3. Explain the subcomponent tasks of the procedure while demonstrating.
  4. Utilize the Mastery Learning Checklist to guide formative feedback.
  5. Assess the learner’s performance on the simulator using the mastery checklist.
  6. Provide formative feedback on sub-component steps of the procedure.
  7. Coach the learner through repetitive deliberate practice on a simulator to achieve a minimum passing score.
  8. Explain the subcomponent steps on the mastery checklist.

By the end of this session, the learner will be able to:

  1. Verbalize the sub-component tasks of the deconstructed procedure.
  2. Self-reflect on performance using the checklist.
  3. Demonstrate the sub-component tasks on the simulator to a minimum passing standard after repetitive deliberate practice.

Author Information

  • Marc Auerbach, MD, MSci: Yale School of Medicine
  • Todd Chang: Children's Hospital Los Angeles
  • Daniel Fein: Albert Einstein College of Medicine of Yeshiva University
  • Marjorie White: University of Alabama at Birmingham
  • Renuka Mehta: Medical College of Georgia at Georgia Regents University
  • James Gerard: Saint Louis University School of Medicine
  • Pavan Zaveri: Children's National Medical Center
  • Maybelle Kou: George Washington University School of Medicine and Health Sciences
  • Jennifer Reid: University of Washington School of Medicine
  • Dewesh Agrawal: Children's National Medical Center
  • Wendy Van Ittersum: Case Western Reserve University School of Medicine
  • Daniel Scherzer: Nationwide Children's Hospital
  • Elsa Vasquez: University of Illinois College of Medicine at Peoria
  • Sujit Iyer: University of Texas Southwestern-Austin
  • Anita Thomas: University of Washington School of Medicine
  • Taylor Sawyer: University of Washington School of Medicine
  • David Kessler: Columbia University College of Physicians and Surgeons

None to report.

None to report.


Auerbach M, Chang T, Fein D, et al. A comprehensive infant lumber puncture novice procedural skills training package: an inspire simulation-based procedural skills training package. MedEdPORTAL. 2014;10:9724. https://doi.org/10.15766/mep_2374-8265.9724