Baseline bone marrow biopsy (BMBx) performance relative to a mastery-level standard: A SIM-BMBx interval analysis.

Abstract

9046 Background: BMBx is the gold standard diagnostic test for many pathologies. Bedside BMBx is frequently performed by advanced practice providers (APPs) and is required of Hematology-Oncology (HO) fellows by the ACGME. Apprenticeship-style instruction is inconsistent and promotes variable practice. Simulation-based mastery learning (SBML) standardizes instruction to a mastery performance standard (MPS) and is known to improve skill acquisition, retention, and performance. We developed an SBML curriculum for BMBx and herein provide a report of baseline performance. Methods: We developed a 28-item BMBx checklist based on experience, literature review, and institutional feedback. Eight experts completed a Modified Angoff Method that set the checklist MPS at 27. Maintaining sterile technique was mandatory. HO fellows, HO APPs, and Internal Medicine (IM) residents were invited to participate. Participants completed a survey of their experience and confidence in performing BMBx. Those with < 3 BMBx were considered “novice,” and those with > 3 were “experienced.” Participants completed a baseline simulated BMBx (B1) using the VATA Bonnie Bone Marrow Biopsy Skills Trainer. Performance was assessed by investigators via the checklist. The first 15 simulations were co-evaluated for consistency. The protocol was exempted by Northwestern University’s IRB. The primary endpoint is the change between B1 and post-SBML score. We performed a descriptive analysis of B1 conducted at 50% enrollment. Results: Twenty-five participants completed B1, including 10 APPs, 9 fellows, and 6 residents. Nine were novices (3 APPs, 6 residents). The 16 experienced participants (7 APPs, 9 fellows) had all performed 10 or more BMBx. The median B1 score was 17 (range 6 – 27). One participant, an APP, met the MPS at B1 with a score of 27. The median among APPs, fellows, and residents was 17 (8 – 27), 18 (15 – 23), and 8.5 (6 – 14), respectively. The median among novices was 10 (6 – 19) and among experienced was 18 (12 – 27). Baseline confidence scores were numerically higher for experienced participants (Table 1). Conclusions: For the vast majority of practitioners, regardless of professional training and experience with the procedure, BMBx performance does not meet an expert-derived MPS. Experienced practitioners have high confidence despite this. More consistent education of BMBx technique and best practices is needed and may be achieved with SBML. Participant B1 confidence scores. N ID Biopsy Site Anesthetize Site Obtain Specimen Self-Assess Performance Troubleshoot to Obtain Specimen Post-Procedure Instruction Novice 9 30 (10-70) 30 (10-60) 0 (0-50) 0 (0-50) 0 (0-50) 10 (0-80) Experienced 16 80 (0-100) 90 (0-100) 80 (0-90) 80 (0-100) 70 (0-100) 90 (10-100) Overall 25 70 (0-100) 80 (0-100) 70 (0-90) 60 (0-100) 60 (0-100) 80 (0-100) Median (range) confidence in performing an activity from 0 (very low) to 10 (very high).