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The Correlation of Workplace Simulation-Based Assessments With Interns' Infant Lumbar Puncture Success: A
Marc Auerbach1, Daniel M Fein, Todd P Chang
1From the Yale University School of Medicine (M.A., T.W.), New Haven, CT; Albert Einstein College of Medicine (D.M.F.), Children's Hospital at Montefiore, Bronx; Stony Brook Children's (D.G.), Stony Brook; Hofstra North Shore-LIJ School of Medicine (J.R.), Cohen Children's Medical Center, New Hyde Park; and New York University Langone Medical Center (M.P.); and Columbia University Medical Center (D.O.K.), New York, NY; Children's Hospital Los Angeles (T.P.C.), University of Southern California, Los Angeles, CA; Saint Louis University School of Medicine (J.G.), SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO; The George Washington University School of Medicine and Health Sciences (P.Z.), Children's National Health System, Washington, DC; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (W.V.I.), Cleveland, OH.
Introduction:
Little data are available to guide supervisors' decisions regarding when trainees are prepared to safely perform their first procedure on a patient. We aimed to describe the correlation of simulation-based assessments, in the workplace, with interns' first clinical infant lumbar puncture (ILP) success.
Methods:
This is a prospective, observational subcomponent of a larger study of incoming interns at 33 academic medical centers (July 2010 to June 2012) assessing the impact of just-in-time training. When an intern's patient required an ILP, a just-in-time simulation-based skills refresher was conducted with his or her supervisor. At the end of the refresher, supervisors assessed interns' ILP skills on a simulator in the workplace before clinical performance using a four point anchored scale. The primary outcome was the correlation of supervisors' assessment and interns' procedural success. The number needed to assess for this instrument (1 / absolute risk reduction) was calculated.
Results:
A total of 1600 interns were eligible to participate, and 1215 were enrolled. A total of 297 completed an assessment and a subsequent clinical ILP. Success rates for each scale rating were 29% (18/63) for novice, 39% (51/130) for beginner, 55% (46/83) for competent, and 43% (9/21) for proficient. The correlation coefficient was 0.161 (95% confidence interval, 0.057-0.265), indicating a weak correlation between supervisor rating and success. Success rate was 53% for the ratings of competent or proficient compared with 35% for the ratings of novice or beginner. Using the global rating scale for the summative assessment to determine procedural readiness could lead to 1 fewer patient experiencing a failed ILP for every 6 interns tested (6.2; 95% confidence interval, 4.0-8.5).
Conclusions:
A simulation-based assessment of interns conducted in the workplace before their first ILP has some value in predicting clinical ILP success.
