Abstract
BackgroundLow levels of success in performing lumbar puncture have been observed among paediatric trainees. This study assessed the efficacy of simulation-based education with frequency building and precision teaching for training lumbar puncture to behavioural fluency.MethodsThe intervention group was assessed at baseline, at the final training trial, in the presence of distraction, and a minimum of one month after the cessation of the intervention in order to ascertain whether behavioural fluency in lumbar puncture was obtained. Subsequently, the performance of this intervention group (10 paediatric senior house officers) was compared to the performance of a comparator group of 10 more senior colleagues (paediatric registrars) who had not received the intervention. Retrospective chart audit was utilised to examine performance in the clinical setting.ResultsIntervention group participants required a mean of 5 trials to achieve fluency. Performance accuracy was significantly higher in the intervention group than the comparator group. Learning was retained at follow-up and persisted during distraction. Retrospective chart audit revealed no significant difference between the performance of the intervention group and a comparator group, comprised of more senior physicians, in the clinical setting, although the interpretation of these analyses are limited by a low number of lumbar punctures performed in the clinical setting.ConclusionsThe programme of simulation-based education with frequency building and precision teaching delivered produced behavioural fluency in lumbar puncture among paediatric trainees. Following the intervention, the performance of these participants was equivalent to, or greater than, that of senior paediatricians. This study supports the need for further research exploring the effectiveness of simulation-based education with precision teaching to train procedural skills to fluency, and the consideration of how best to explore the impact of these on patient outcomes.
Highlights
Low levels of success in performing lumbar puncture have been observed among paediatric trainees
While simulation-based education results in improvements in paediatric trainees’ performance of lumbar puncture [5,6,7], studies have shown that improvements decay over time [5, 6], and/or do not generalise to the clinical setting [8, 9]
Phase one: intervention Intervention group performance Participants required a mean of five trials (SD = 1.2) to achieve fluency and mean total training time was 95 mins, 24 s (SD = 31 mins, 6 s)
Summary
Low levels of success in performing lumbar puncture have been observed among paediatric trainees. This study assessed the efficacy of simulation-based education with frequency building and precision teaching for training lumbar puncture to behavioural fluency. Research suggests success (i.e., absence of traumatic lumbar puncture) occurs in 24–54% of performances of lumbar puncture by paediatric residents [4]. While simulation-based education results in improvements in paediatric trainees’ performance of lumbar puncture [5,6,7], studies have shown that improvements decay over time [5, 6], and/or do not generalise to the clinical setting [8, 9]. One means of addressing the deficits of simulationbased education may be to teach procedural skills to behavioural fluency. Fluent behaviour retains (i.e., persists over time), is stable (i.e., does not deteriorate during distraction), and generalises to novel settings [10, 11]
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