(41) Evaluation of Pediatric Resident Lumbar Puncture and Neonatal Intubation Procedural Competency: A Needs Assessment for Creation of a Simulation-based Curriculum

Blair Welch, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Sara Kane, Indiana University, United States

Background: The ACGME requires graduating pediatric residents to develop competency in 14 key procedures, yet studies demonstrate that recent graduates are completing training without this recommended procedural competency.

Objectives: To perform a needs assessment evaluating the current state of Indiana University (IU) pediatric resident competency in performing lumbar punctures (LP) and neonatal endotracheal intubations to guide development of an educational curriculum for these procedures.

Design/Methods: We performed a literature review to determine if a standardized educational curriculum was present. We then designed two needs assessment surveys, one sent to pediatric residents and one sent to faculty and fellows who supervise resident performance of procedures. The surveys evaluated pediatric resident exposure to pediatric LPs and neonatal intubations both in simulation and patient encounters, resident self-reported procedural competency, and supervisor’s perception of IU pediatric resident competency with these procedures.

Results: On review of literature, we found no standard educational curriculum which exists for the purpose of establishing competency in these procedures. A total of 31 pediatric residents (20%) and 22 neonatology faculty and fellows (55%) responded to the survey. Over half of respondents from both groups rated pediatric LP and neonatal intubation as ≥8 on a 10-point scale of importance. Both groups felt that simulation was an important tool in development of procedural competency. Residents reported a median of 3 LP patient attempts during residency, with 22% of respondents never having had a successful patient attempt. 77% of supervising faculty and fellow respondents estimated that at least half of graduating residents were competent to perform LPs, compared to 45% of resident respondents. Residents reported a median of 1 neonatal intubation attempt, with 39% reporting no patient attempts. 59% of supervising faculty and fellows and 71% of residents felt that less than half of graduating residents were competent to perform neonatal intubations.

Conclusion: Pediatric residents and supervising faculty and fellows felt that development of procedural competency for LPs and neonatal intubations were important for graduating pediatric residents, but residents reported limited numbers of patient procedural attempts during residency. We plan to implement a simulation-based curriculum to improve development of procedural competency.