jitlp information
TRANSCRIPT
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Improving infant LP skills through simulation-based mastery learning and
just-in-time refreshers
POISE 2010-2011
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Objectives
• Overview of an infant LP educational project targeted at interns
• To describe the “just-in-time” skill refreshers on simulators …and how YOU can help!
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• POISE aims to improve patient outcomes through the development and dissemination of robust educational interventions
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THE PROBLEM• Today’s patients can be harmed in the training of
tomorrow’s practitioners• Pediatricians perform high-stakes low frequency procedures
• Procedural skills require practice to gain proficiency
THE SOLUTION• Simulation allows for skill development in lifelike
circumstances on models without risk to the patient
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HYPOTHESIS• Participation in simulation-based mastery
learning with just-in-time refreshers will lead to improved infant LP success rates
• Our hospital will have simulators available in all clinical areas where LPs occur
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What is mastery training?• Clearly defined target level of performance
– Time varies to achieve mastery of skill– Customized based on learner needs
• Repetitive deliberate practice (coached)– Kinesthetic learning– Practice-Feedback-Correction-Practice --> independence
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1. Online
Survey & Audiovisual
Training
2. Mastery Learning Session
3. JIT:
Just-in-time RefresherSession
4. Clinical Lumbar
Puncture
4. JIT:
Just-in-time RefresherSession
5. Clinical Lumbar
Puncture
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What are just-in-time refreshers?• Brief (<5 minute) coached refresher on sim
– Facilitated by supervising physician for LP• Senior resident, fellow, attending• Additional tool for you to teach the interns!
• Proximal to clinical performance (time/place)• Goal directed
– To bolus skills before clinical performance
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Learning Curve
time
skill
mastery JIT JIT
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Trigger = intern has infant who needs LP1. Assemble practice LP kit and simulator2. Ask learner to demonstrate “the best they can do”
without your help on the simulator3. Give feedback, answer questions, coach practice4. Complete simulator assessment form5. Supervise clinical LP (and complete form)
JIT refresher: detailsDuration: < 5 minutes (already trained to mastery)
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3 steps of JIT
1. Get model and practice LP kit
2. Complete simulator (checklist)– Less than 5 minutes
3. Complete clinical (checklist)
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How to set up the simulator1. Fill bottle with water up to fill-line
2. Insert bottle in pressure bag
3. Inflate bag until pop-off valve hits 150mmHg
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1. After JIT sim session-> complete SIDE 12. After intern attempts clinical LP-> complete SIDE 23. Please make sure all data points completed*Place data collection form into POISE box in clinical area*
Assessment form
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Global rating
• The scale measures level of independence • “Proficient” indicates ability to perform independently• “Expert” level is not expected
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Errors and “near-miss” events
• Record all errors or omissions of critical steps
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Other Information- Sim LP
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Other Information- Clinical LP
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1. Online
Survey & Audiovisual
Training
2. Mastery Learning Session
3. JIT:
Just-in-time RefresherSession
4. Clinical Lumbar
Puncture
4. JIT:
Just-in-time RefresherSession
5. Clinical Lumbar
Puncture
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