P3D191: Training Pediatric Residents in Ultrasound-assisted Lumbar Punctures: Performance, Self-efficacy, and Acceptance

Background: Pediatric residents are required by the Accreditation Council for Graduate Medical Education (ACGME) to demonstrate competency in performing Lumbar Punctures (LPs). However, the (LP) success rate for graduating pediatric residents is around 54%, and residents often feel uncomfortable performing LPs. Compounding this problem, there have been decreased opportunities to perform LPs over the past decade. With the 2021 AAP guideline on well-appearing febrile infants providing further direction on which febrile infants are at low risk for serious bacterial infection, we suspect experience and confidence in LPs will continue to decline. Previous attempts to improve resident LP success and confidence with didactics and simulation training have overall had some success. To our knowledge, studies have yet to be published evaluating the effect of training pediatric residents in UALP (Ultrasound Assisted Lumbar Puncture).As a relatively new skill set, physicians continue to study how to utilize point-of-care ultrasound (POCUS) in pediatrics. An UALP uses POCUS to visualize key anatomical landmarks for optimal and safe cerebral spinal fluid (CSF) collection. Evidence has shown improved LP success rates in pediatric and adult patients using the UALP approach. In addition, UALP has been shown to increase the confidence of emergency room providers in pediatric LPs.
In contrast to emergency medicine providers, where ACGME mandates competency in POCUS, most pediatric residents currently have little or no formal ultrasound training. We hypothesized that teaching residents how to perform a UALP would improve their self-reported procedural self-efficacy in LPs.

Methods: In this Institutional Review Board-exempt mixed methods study, we implemented an educational innovation teaching pediatric residents UALP. The training consisted of three phases: First, online modules; Second, didactic sessions; Third, in-person workshop with hands-on practice and simulation. Of the 24 residents completing the course, only ten residents completing all the optional dependent measures to enable paired analyses were included in this study (42%).

Results: POCUS knowledge retention and LP knowledge application were assessed during training and 3 months later. UALP knowledge application was not assessed because only one participant reported performing UALPs in clinical practice. There was strong evidence that the residents’ ability to identify and label landmarks increased over a 3-month period. Their estimates of LP success rate over a 3-month period also increased. Self-efficacy and technology acceptance with POCUS was measured and showed a decrease over a 3-month period; however, residents’ self-efficacy in performing LPs via the traditional method increased over time.

Conclusion: Implementing our innovation in UALPs appeared to increase residents’ perceived ability to perform LPs. Self-efficacy and technology acceptance with UALPs was high immediately post-intervention but decreased over a 3-month period. We discuss observations from our experience that are barriers inhibiting pediatric residents from utilizing POCUS in clinical practice and possibly contributing to poor technology acceptance.