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Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments
  1. David O Kessler1,2,
  2. Todd P Chang3,4,
  3. Marc Auerbach5,
  4. Daniel M Fein6,7,
  5. Megan E Lavoie8,9,
  6. Jennifer Trainor10,11,
  7. Moon O Lee12,
  8. James M Gerard13,14,
  9. Devin Grossman15,16,
  10. Travis Whitfill17,
  11. Martin Pusic18
  1. 1Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA
  2. 2Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York, USA
  3. 3Department of Clinical Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
  4. 4Children's Hospital of Los Angeles, Los Angeles, California, USA
  5. 5Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  6. 6Department of Pediatrics, Albert Einstein College of Medicine, New York, New York, USA
  7. 7Children's Hospital at Montefiore, Bronx, NY, New York, USA
  8. 8Department of Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  9. 9The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  10. 10Department of Pediatrics-Emergency Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  11. 11Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  12. 12Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
  13. 13Department of Pediatrics, Saint Louis University Health Sciences Center, Saint Louis, Missouri, USA
  14. 14SSM Cardinal Glennon Children's Medical Center, Saint Louis, Missouri, USA
  15. 15Department of Pediatrics, Emergency Medicine, Stony Brook Medicine, New York, USA
  16. 16Stony Brook Children's Hospital, New York, USA
  17. 17Yale School of Medicine, New Haven, Connecticut, USA
  18. 18Department of Emergency Medicine, New York University Langone Medical Center, New York, New York, USA
  1. Correspondence to David O Kessler; Department of Pediatrics, Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN-1-116, NYC 10032, USA; drkessler{at}


Background Determining when to entrust trainees to perform procedures is fundamental to patient safety and competency development.

Objective To determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success.

Methods This prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique.

Results We analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success.

Conclusions Simulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP.

  • simulation
  • pediatrics
  • patient safety
  • training

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  • Contributors DOK is primarily responsible for the conception and design of the study, drafting of the article and contributed to analysis and interpretation of data. TPC, MA, DMF, MEL, JT, MOL, JMG and DG were site directors primarily responsible for overseeing local data collection and study implementation. They all contributed meaningfully to study design, critically revising the manuscript and approved the final manuscript as submitted. MP and TW were primarily responsible for data analysis and interpretation. They were involved in aspects of study design, drafting and critical revision of the manuscript and approved the final version as submitted.

  • Funding All phases of this study were supported by a non-profit foundation grant (principal investigator: DOK) provided by the R Baby foundation.

  • Competing interests None declared.

  • Ethics approval Columbia University was primary, but all sites had their own local approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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