Are Pediatric Interns Prepared to Perform Infant Lumbar Punctures?

Abstract

There are few data describing pediatric interns' experiences, knowledge, attitudes, and skills related to common procedures. This information would help guide supervisors' decisions about interns' preparedness and training needs. This study aimed to describe pediatric interns' medical school experiences, knowledge, attitudes, and skills with regard to infant lumbar punctures (LPs) and to describe the impact of these factors on interns' infant LP skills. This prospective cross-sectional descriptive study was conducted at 21 academic medical centers participating during 2010. Participants answered 8 knowledge questions, 3 attitude questions, and 6 experience questions online. Skills were assessed on an infant LP simulator using a 15-item subcomponent checklist and a 4-point global assessment. Eligible interns numbered 493, with 422 (86%) completing surveys and 362 (73%) completing skills assessments. The majority 287/422 (68%) had never performed an infant LP; however, 306 (73%) had observed an infant LP during school. The mean (SD) knowledge score was 63% (±21%). The mean (SD) subcomponent skills checklist score was 73% (±21%). On the global skills assessment, 225 (62%) interns were rated as beginner, and 137 (38%) were rated as competent, proficient, or expert. Independent predictors of an above-beginner simulator performance included infant LP experience on a patient (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.4-3.5), a knowledge score greater than 65% (OR, 2.4; 95% CI, 1.5-3.7), or self-reported confidence (OR, 3.5; 95% CI, 1.9-6.4). At the start of residency, the majority of pediatric interns have little experience, poor knowledge, and low confidence and are not prepared to perform infant LPs.