Improving infant LP skills through simulation-based mastery learning and just-in-time refreshers

POISE 2010-2011

Train-the-trainer: mastery session

HYPOTHESIS• Participation in simulation-based mastery

learning with just-in-time refreshers will lead to improved infant LP success rates

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

What is mastery training?

• Extreme form of competency based education– Clearly described checklist of component steps– Pre-defined target level of performance (mastery)– ALL participants achieve mastery

• Duration and content of session tailored to specific needs

Mastery Learning Session

3. Skills

Assessment

1. Introduction

2. Orientation

4. Mastery Checklist

5. Coached Training

6. Mastery

Performance

1. Introduction• Introduce yourself to the intern.• Read aloud:

– You are here to learn and practice your infant LP skills using this simulator.

– By the end of this session you will master all of the critical steps to perform this procedure.

2. Simulator OrientationIliac crests- point to spot represented by ridge in plastic

2. Simulator OrientationUmblicus- point to spot where umbilicus would be

2. Simulator OrientationRead aloud• When you insert a needle into the proper interspace you will get

fluid back in the same way you would on a real patient.

• I will serve as both your holder and teacher for this exercise.

• Do you have any questions for me before we begin?

Read introduction aloud• Show me what you know about this procedure.• Treat this simulator as if it is a real baby and start from the

beginning of the procedure as you would in real life.• Don’t worry if you have never done this before- I just want to

get a sense of what you already know to help tailor this session to your needs.

3. Skills assessment

• During this initial attempt encourage the learner to try their best to perform independently

• Let mistakes happen– Help to identify the specific learning needs – Lead to effective learning– Will guide the coached component of training

• Use the mastery checklist to mark any steps – Not done– Where errors were made– The intern required help

• The checklist will provide a guide to tailor the subsequent training to the providers needs

Global rating

• The scale measures level of independence • “Proficient” indicates ability to perform independently• “Expert” level is not expected

– Repetitive deliberate practice– Hands-on practice, kinesthetic learning– Practice-Feedback-Correction-Practice -->

independence/mastery• Customized to learner needs• Time varies to achieve mastery of skill • ALL participants achieve mastery

3. Coached Deliberate Practice

Read aloud:

• Now that you have independently tried this procedure are there any areas that you felt were challenging?

– Address these areas with the learner first

• In a step-by-step fashion coach the learner on any steps from the mastery checklist where they asked for help, an error occurred or that you identified as deficient.

• For each step describe or demonstrate the intern’s error and work with them until they can perform the step independently.

✓✓

✓

Error: Wrong angle on needle insertion (aimed toward feet)

Needle inserted correctly and independently

• The session will end once you and the learner feel that ALL STEPS can be performed without help.

• If the learner does not achieved mastery mark the deficient step(s) and describe the reasons for stopping training

3. Mastery Performance

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

• POISE aims to improve patient outcomes through the development and dissemination of robust educational interventions