Elsevier

Academic Pediatrics

Volume 16, Issue 7, September–October 2016, Pages 621-629
Academic Pediatrics

Research in Pediatric Education
Qualitative Study Exploring Implementation of a Point-of-Care Competency-Based Lumbar Puncture Program Across Institutions

https://doi.org/10.1016/j.acap.2016.04.010Get rights and content

Abstract

Objective

To explore the factors that facilitated or hindered successful implementation of a multi-centered infant lumbar puncture (LP) competency-based education program that required interns to demonstrate skills readiness on a task trainer before performing their first clinical LP.

Methods

In 2013, investigators conducted a qualitative study utilizing semistructured interviews and focus groups of site directors (SDs) from the International Network for Simulation-Based Pediatric Innovation, Research, and Education (INSPIRE) who were responsible for implementing the LP competency-based education program. Transcripts were analyzed using grounded theory to identify and verify emergent themes and subthemes.

Results

Thematic saturation was attained after interviewing 19 SDs in 12 interviews and 3 focus groups. The most significant strategies and barriers were organized into 4 main themes: 1) alignment of different visions to obtain buy-in, 2) balance between providing education versus patient care, 3) acceptance of novel teaching paradigms, and 4) communication logistics. The ability to overcome barriers was influenced by institutional culture on trainee education, patient safety and research; the level of relational coordination between different groups of stakeholders; and the ability of SDs to identify and diversify entrepreneurial strategies.

Conclusions

INSPIRE SDs reveal the challenges of implementing a network-wide competency-based educational initiative that determines interns' readiness to perform LPs in clinical settings. Strategizing to align the common goals of graduate medical training, patient care and research instructs clinician educators and leaders on how to successfully change educational culture in academic medicine.

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.

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