2021, Number 1
Concordance between self-reported competence and simulated lumbar puncture performance in residents of a pediatric training program
Pezzani MJ, Besa P
Full text
10.35366/99865
Language: Spanish
References: 9
Page: 22-27
PDF size: 185.14 Kb.
ABSTRACT
Introduction: Lumbar puncture is one of the most common invasive clinical procedures performed by a pediatrician, so The Royal College of Physicians and Surgeons of Canada and the Accreditation Council for Graduate Medical Education suggest that educational experiences must ensure the acquisition of competencies in that procedure. Many studies have shown a lack of formal training and low exposure to said puncture during clinical practice, so many physicians are at risk of completing their residency with inadequate technique and practice of the procedure. Objectives: To determine the capacity of Pediatric residents at the end of their training to execute a lumbar puncture in a simulated environment and to compare their performance with their self-perception of skills. Material and methods: All last-year physicians of a three-year university Pediatrics program were recruited. An online survey was applied where three questions were asked, including the self-perception of competencies in executing a lumbar puncture based on a global evaluation scale already validated. Subsequently, these doctors performed such puncture at the Simulation Center of the Pontificia Universidad Católica de Chile. The videos of each resident were assigned a random number for subsequent analysis by two expert evaluators independently, based on the global evaluation scale with which self-perception of competence was measured in the survey applied to the residents. The inter-observer correlation was performed using the weighted Kappa (wK) coefficient. Results: Eleven of them completed the evaluation. In self-perception, all students considered themselves competent (7 out of 11) or beginners (4 out of 11). The expert evaluators considered most of the participants as novices (19 of 22) and a few beginners (3 of 22), with substantial agreement among both experts (wK 0.62; p < 0.01). All the students who were evaluated as beginners perceived themselves as competent. The agreement between the perception of the resident and the evaluators was poor (wK 0.00; p < 0.01). The average number of lumbar punctures accomplished during the three years of residence averaged 11.41. Of the residents, 58% had never performed a simulated lumbar puncture previously. Conclusions: These physicians assess themselves more competent than they really are. In addition, there is a great variability in terms of exposure to said puncture during residency, associated with little training in the simulation procedure.REFERENCES