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Simul Healthc. 2016 Apr;11(2):126-33. doi: 10.1097/SIH.0000000000000135.

The Correlation of Workplace Simulation-Based Assessments With Interns' Infant Lumbar Puncture Success: A Prospective, Multicenter, Observational Study.

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From 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.



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.


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.


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).


A simulation-based assessment of interns conducted in the workplace before their first ILP has some value in predicting clinical ILP success.

[Indexed for MEDLINE]

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