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McGuire SS, Finch AS, Thomas JM, Lazaro O, Hevesi SA, Mullan AF, Homme JL. Improving emergency medicine resident pediatric lumbar puncture procedural performance through a brief just-in-time video intervention. BMC MEDICAL EDUCATION 2024; 24:682. [PMID: 38902689 PMCID: PMC11188195 DOI: 10.1186/s12909-024-05654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Emergency medicine (EM) trainee comfort level with lumbar puncture (LP) has decreased over time due to changing practice guidelines, particularly amongst pediatric patients. We implemented a "just in time" (JIT) brief educational video based on a previously published LP Performance Scoring Checklist to improve trainee efficiency and competence in LP performance. METHODS Our pilot quasi-experimental study took place January-June 2022 within a large, academic Midwestern emergency department (ED) with an established 3-year EM residency program. All 9 interns performed a timed diagnostic LP on an infant LP model in January, scored according to the LP Performance Scoring Checklist. In June, interns repeated the timed LP procedure directly after watching a brief educational video based on major checklist steps. The study was deemed exempt by the Institutional Review Board. RESULTS All interns completed both assessments. At baseline, interns had logged performance of median 2 (IQR 0-5) LPs and spent 12.9 (10.3-14.4) minutes performing the procedure. Post-intervention, interns had logged an additional median 2 (0-5) LPs and completed the procedure faster with an average time of 10.3 (9.7-11.3) minutes (p = 0.004). A median of 5 (4-7) major steps were missed at baseline, compared to 1 (1-2) at time of post-intervention assessment (p = 0.015). CONCLUSION Development of a brief educational video improved efficiency and competency amongst our intern class in performing an infant LP when viewed Just-In-Time. Similar efforts may improve education and performance of other rare (or decreasing in frequency) procedures within EM training.
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Affiliation(s)
- Sarayna S McGuire
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Alexander S Finch
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jenna M Thomas
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Octavio Lazaro
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sara A Hevesi
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jim L Homme
- Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Lilja H, Talvisara M, Eskola V, Heikkilä P, Sievänen H, Palmu S. Novice providers' success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle. BMC MEDICAL EDUCATION 2024; 24:520. [PMID: 38730411 PMCID: PMC11088096 DOI: 10.1186/s12909-024-05505-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Lumbar puncture (LP) is an important yet difficult skill in medical practice. In recent years, the number of LPs in clinical practice has steadily decreased, which reduces residents' clinical exposure and may compromise their skills and attitude towards LP. Our study aims to assess whether the novel bioimpedance needle is of assistance to a novice provider and thus compensates for this emerging knowledge gap. METHODS This randomized controlled study, employing a partly blinded design, involved 60 s- and third-year medical students with no prior LP experience. The students were randomly assigned to two groups consisting of 30 students each. They performed LP on an anatomical lumbar model either with the conventional spinal needle or the bioimpedance needle. Success in LP was analysed using the independent samples proportion procedure. Additionally, the usability of the needles was evaluated with pertinent questions. RESULTS With the conventional spinal needle, 40% succeeded in performing the LP procedure, whereas with the bioimpedance needle, 90% were successful (p < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases (p = 0.006), respectively. Providers found the bioimpedance needle more useful and felt more confident using it. CONCLUSIONS The bioimpedance needle was beneficial in training medical students since it significantly facilitated the novice provider in performing LP on a lumbar phantom. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.
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Affiliation(s)
- Helmiina Lilja
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland
| | - Maria Talvisara
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland
| | - Vesa Eskola
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland
- Tampere University Hospital, Elämänaukio 2, Tampere, 33520, Finland
| | - Paula Heikkilä
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland
- Tampere University Hospital, Elämänaukio 2, Tampere, 33520, Finland
| | | | - Sauli Palmu
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland.
- Tampere University Hospital, Elämänaukio 2, Tampere, 33520, Finland.
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Nguyen EL, Cunanan K, Liu Y, Hilgenberg SL. Pediatric Residents' Procedural Competency Requirements: A National Needs Assessment of Program Directors and Chief Residents. Acad Pediatr 2024; 24:549-553. [PMID: 38159599 DOI: 10.1016/j.acap.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is increased learner competition for a shrinking pool of procedural training opportunities and indications in pediatrics. This study aimed to describe pediatric residency program directors' (PDs) and chief residents' (CRs) perspectives about whether procedural requirements for pediatric residents should be reformed and individualized. METHODS This was a survey-based, mixed methods study of PDs and CRs affiliated with the Association of Pediatric Program Directors (APPD). We used descriptive statistics to analyze demographics and perspectives, logistic regressions to examine individual and program factors, and thematic analysis for qualitative data. RESULTS Forty-seven percent (95/203) of PDs and 16% (64/392) of CRs responded, representing APPD membership across program setting, size, and region (average standard mean deviation 0.28). Ninety-one percent of PD respondents considered one or more of the current Accreditation Council for Graduate Medical Education (ACGME) required procedures nonessential; 74% favored individualizing procedural training. CR responses mirrored PD responses. Program size, setting, and access to procedural teams did not significantly associate with likelihood to favor individualization. CONCLUSIONS The majority of PD and CR respondents believe that current ACGME procedures should be reformed and individualized to future career goals. This change could allow maximization of limited time in residency in this era of decreased opportunity.
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Affiliation(s)
- Elizabeth L Nguyen
- Department of Pediatrics (EL Nguyen and SL Hilgenberg), Stanford University School of Medicine, Palo Alto, Calif.
| | - Kristen Cunanan
- Division of Biomedical Informatics Research (K Cunanan and Y Liu), Stanford University School of Medicine, Palo Alto, Calif.
| | - Yuhan Liu
- Division of Biomedical Informatics Research (K Cunanan and Y Liu), Stanford University School of Medicine, Palo Alto, Calif.
| | - Sarah L Hilgenberg
- Department of Pediatrics (EL Nguyen and SL Hilgenberg), Stanford University School of Medicine, Palo Alto, Calif.
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Collins K, Dudas RA. Procedural Training in Pediatric Hospital Medicine: One Size Fits None. Hosp Pediatr 2023; 13:e387-e389. [PMID: 37927111 DOI: 10.1542/hpeds.2023-007439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
| | - Robert A Dudas
- Johns Hopkins All Children's Hospital, St Petersburg, Florida
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Hatt D, Zimmerman E, Chang E, Vane J, Hollenbach KA, Shah A. First-Person Point-of-View Instructional Video on Lumbar Puncture Procedure. Pediatr Emerg Care 2023; 39:953-956. [PMID: 38019714 DOI: 10.1097/pec.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Tutorial videos filmed from a first-person point of view (FP-POV) are generally well received. Pediatric residents are expected to be competent in performing the lumbar puncture (LP). The educational effectiveness of a FP-POV in lumbar puncture procedure training for resident physicians has yet to be evaluated. We compared a FPPOV LP video with a standard in-person demonstration of the LP. METHODS We designed an assigned cohort study to compare a FP-POV procedural instructional video of a simulated pediatric LP to the standard in-person procedure demonstration.After the intervention, residents completed an LP observed by one of two blinded reviewers who assessed the procedure using a modified, published assessment tool.Participants completed preintervention and postintervention surveys to rate self-confidence and usefulness of the FP-POV educational method. The data was analyzed using a Wilcoxon Rank sum test. z Scores were calculated on the raw assessment scores. RESULTS Eighteen first year pediatric residents participated, nine in each group. The median modified assessment tool score was 17 in the FP-POV group (min, 14; max, 17; IQR:, 1.5) and 14 in the standard demonstration group (min, 6; max, 17; IQR, 4.5), with the higher score being more successful. There was a statistical difference between the assessment scores between the 2 groups (z score = 2.18, P = 0.04). Postintervention survey data demonstrated relative satisfaction with the FPPOV educational method. CONCLUSIONS This study supports the educational effectiveness of a FP-POV procedure tutorial.Future studies with a larger sample size are needed.
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Affiliation(s)
| | | | | | | | | | - Ashish Shah
- Pediatric Emergency Department, University of California, San Diego, CA
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Chong SL, Niu C, Ong GYK, Piragasam R, Khoo ZX, Koh ZX, Guo D, Lee JH, Ong MEH, Liu N. Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections. Sci Rep 2023; 13:15845. [PMID: 37740004 PMCID: PMC10516995 DOI: 10.1038/s41598-023-42854-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023] Open
Abstract
We aimed to derive the Febrile Infants Risk Score at Triage (FIRST) to quantify risk for serious bacterial infections (SBIs), defined as bacteremia, meningitis and urinary tract infections. We performed a prospective observational study on febrile infants < 3 months old at a tertiary hospital in Singapore between 2018 and 2021. We utilized machine learning and logistic regression to derive 2 models: FIRST, based on patient demographics, vital signs and history, and FIRST + , adding laboratory results to the same variables. SBIs were diagnosed in 224/1002 (22.4%) infants. Among 994 children with complete data, age (adjusted odds ratio [aOR] 1.01 95%CI 1.01-1.02, p < 0.001), high temperature (aOR 2.22 95%CI 1.69-2.91, p < 0.001), male sex (aOR 2.62 95%CI 1.86-3.70, p < 0.001) and fever of ≥ 2 days (aOR 1.79 95%CI 1.18-2.74, p = 0.007) were independently associated with SBIs. For FIRST + , abnormal urine leukocyte esterase (aOR 16.46 95%CI 10.00-27.11, p < 0.001) and procalcitonin (aOR 1.05 95%CI 1.01-1.09, p = 0.009) were further identified. A FIRST + threshold of ≥ 15% predicted risk had a sensitivity of 81.8% (95%CI 70.5-91.0%) and specificity of 65.6% (95%CI 57.8-72.7%). In the testing dataset, FIRST + had an area under receiver operating characteristic curve of 0.87 (95%CI 0.81-0.94). These scores can potentially guide triage and prioritization of febrile infants.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Chenglin Niu
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Gene Yong-Kwang Ong
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Rupini Piragasam
- KK Research Centre, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Zi Xean Khoo
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Zhi Xiong Koh
- Department of Emergency Medicine, Singapore General Hospital, 1 Hospital Crescent, Outram Road, Singapore, 169608, Singapore
| | - Dagang Guo
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, 1 Hospital Crescent, Outram Road, Singapore, 169608, Singapore
| | - Jan Hau Lee
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Marcus Eng Hock Ong
- Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, 1 Hospital Crescent, Outram Road, Singapore, 169608, Singapore
- Health Services Research Centre, Singapore Health Services, 8 College Road, Singapore, 169857, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, 1 Hospital Crescent, Outram Road, Singapore, 169608, Singapore
- Health Services Research Centre, Singapore Health Services, 8 College Road, Singapore, 169857, Singapore
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Rudloff J, Lendrum E, Semenova O, Lipshaw MJ, Valentino C. The Success of Resident-Associated Lumbar Punctures at a Large, Single-Center Children's Hospital. Pediatr Emerg Care 2023; 39:432-435. [PMID: 36728895 DOI: 10.1097/pec.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The frequency of lumbar punctures (LPs) has declined across US children's hospitals over the past decade, potentially decreasing procedural learning opportunities for pediatric resident trainees. Our study sought to determine whether the proportion of successful LPs performed by our pediatric residents has significantly changed over time. METHODS This study is a single-center retrospective study to evaluate our pediatric resident LP success. We evaluated our primary outcome, proportion of overall LP success over time, using linear regression. We similarly used linear regression for proportion of successful resident-associated LPs over time. We calculated the median number of LPs of all pediatric residents during the study period. RESULTS We analyzed 3143 LPs from April 2012 to December 2019. Both the overall number of LPs performed and the proportion of LPs that were successful have not significantly changed over an 8-year period ( P > 0.05, P > 0.05). Similarly, the number of our resident-associated LPs and the proportion of successful resident-associated LPs have not changed over the study period ( P > 0.05, P > 0.05). Our pediatric residents performed a median of 3 LPs (interquartile range: 2-4) in the pediatric emergency department (PED) over residency. CONCLUSIONS Despite national trends showing decreased LP rates at pediatric hospitals, we demonstrated stable proportions of LPs and success by our pediatric residents. Pediatric residents perform a relatively low number of LPs in the PED setting alone. Future research is needed to demonstrate whether these overall low numbers in the PED translate to procedural competency after residency graduation.
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Affiliation(s)
- James Rudloff
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Elizabeth Lendrum
- From the Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Olga Semenova
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Bonadio W. In Search of an Ideal Protocol to Distinguish Risk for Serious Bacterial Infection in Febrile Young Infants. J Pediatr 2021; 231:32-34. [PMID: 33144116 DOI: 10.1016/j.jpeds.2020.10.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022]
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