Improving Emergency Medicine Resident Pediatric Lumbar Puncture Procedural Performance through a Brief Just-In-Time Video Intervention

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 validated LP evaluation checklist to improve trainee efficiency and competence in LP performance. METHODS Our 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 a previously validated 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. Future research with other procedures, larger learner cohorts, and comparing JIT approaches will be necessary to determine whether JIT videos based on validated assessment checklists are truly “best practice”. Formal evaluation of the effect of similar “standardized” videos on cognitive load of learners and supervisors is also an important avenue of future research.