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Once is not enough
Interns' Success With Clinical Procedures in Infants After Simulation Training. Kessler DO et al. Pediatrics 2013; 13(1): e811-e820.
Reviewed by Anton Alerte


What was the study question?
Can interns learn intravenous line placement and lumbar puncture through a single simulation based session?

How was the study done?
This was a randomized, multi-centre control study. 200 interns were first surveyed on their knowledge, previous exposure and comfort with the two specific procedures (lumbar puncture and intravenous line placement). The study population was divided into two groups. The group that received the Simulation Based Medical Education (SBME) on lumbar puncture served as the control group for the group that received SBME on IV placement and vice versa.

The intervention groups received training via procedural videos, and simulation training until the participants achieved "mastery" (defined as a predetermined level of performance on a skills checklist). Following training, groups were followed for 6 months and asked to keep track of all procedures and report the success rate of LPs and IVs. “Success” was defined as an LP with <1000 red blood cells per hpf and an IV with working catheter on the first attempt.

What were the results?
The lumbar puncture and IV success rates were almost identical in the intervention and control groups (roughly 30% and 50%, respectively). The authors’ conclusion was that a participation in a single event is not sufficient to increase skills and procedural success.

What are the implications of these findings?
The first implication is that this study allowed the measurement of clinical effect of simulation education, something that has been lacking in the literature to this point. However, as simulation becomes more and more prevalent in medical education as a solution to issues of limited oversight, infrequency of procedures and patient safety, it is important to note that it is not completely able to replace repeated practice and experience especially without refreshers.

Editor's note: This well-done study reminds us that our educational sessions need to be repeated and reinforced and that continual practice - with feedback - is required to improve (SLB).

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