Research in Pediatric EducationQualitative Study Exploring Implementation of a Point-of-Care Competency-Based Lumbar Puncture Program Across Institutions
Section snippets
Study Approval and Interview Guide
The institutional review board at the University of Rochester approved this study. JRP, RD, and RM created an interview guide to explore factors that facilitated or hindered implementation of the LP program (Online Appendix). Burke and Litwin's framework on organizational change, which has been used to help businesses transform organizational structure and culture, was used to aid development of questions that pertained to curricular change.13 This framework has also been adapted for
Results
Nineteen physicians from 18 institutions participated in 12 interviews and 3 focus groups. Three interviews were conducted by phone, and the rest occurred in person. SDs represented different subspecialties, and 47% were residency or fellowship program directors (Table 1). Of note, 28% of sites were unable to implement CAs, and their interns participated in JITT without CAs. Characteristics of participating SDs and their sites were similar to those not included in the study.
Through interviews
Discussion
Clinician educators face challenges of promoting competency-based education in graduate medical training. Our study revealed that INSPIRE SDs encountered similar barriers that culminated into 4 major themes and highlighted key considerations unique to academic medicine when creating curricular change. The interplay between patient care, education, and research creates competing goals to secure stakeholder buy-in. Many of the barriers that SDs faced operationalizing the program originated from
Conclusion
Implementation of the INSPIRE LP program presented challenges that the majority of SDs were able to overcome. While existing implementation frameworks that guide organizational change may be useful, the unique aspects of balancing patient care, education and research in graduate medical training highlighted the importance of understanding how these domains interact to facilitate curricular change. Referring to a conceptual model that underscores the importance of these domains may help
Acknowledgments
The authors thank the members of INSPIRE, who helped shape this project; RBaby Foundation for providing infrastructure support for INSPIRE; and the Society for Simulation in Healthcare and the International Pediatric Simulation Society for providing physical resources to conduct INSPIRE's annual meetings.
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The authors declare that they have no conflict of interest.