Article Text

other Versions

Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay
  1. Jeremy B Branzetti1,2,
  2. Adeyinka A Adedipe1,
  3. Matthew J Gittinger1,
  4. Elizabeth D Rosenman1,
  5. Sarah Brolliar1,
  6. Anne K Chipman1,
  7. James A Grand3,
  8. Rosemarie Fernandez1
  1. 1Department of Medicine, Division of Emergency Medicine, University of Washington, Seattle, Washington, USA
  2. 2Department of Emergency Medicine, New York University Langone Medical Center, New York City, New York, USA
  3. 3Department of Psychology, University of Maryland, College Park, Maryland, USA
  1. Correspondence to Dr Rosemarie Fernandez, Department of Medicine, Division of Emergency Medicine, University of Washington, 325 Ninth St, Seattle, WA 98104, USA; fernanre{at}


Background A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay.

Objective To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event.

Methods This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included board-certified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only).

Results Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen’s d effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen’s d effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen’s d effect size −1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen’s d effect size 0.65). System Usability Scale scores demonstrated excellent usability.

Conclusion A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures.

  • emergency department
  • patient safety
  • simulation
  • continuing education, continuing professional development

Statistics from


  • Contributors JBB and RF designed the study, secured funding and provided project oversight. JBB, AAA, AKC, EDR, MJG and RF were responsible for implementation of the study and data collection. SB and JAG performed the statistical analyses. All authors were responsible for data interpretation. RF and JBB drafted the manuscript, and all other authors were involved in providing comments and revisions. All authors have approved this version of the manuscript for publication.

  • Funding This study was funded in part by grants from the University of Washington Patient Safety Innovations Program (JBB, RF), the Agency for Healthcare Research and Quality (1R18HS020295, (RF,SB, EDR)) and the Department of Defense (W81XWH-15-1-0403 , (RF, EDR)).

  • Competing interests RF, EDR received funds from Physio-Control for scientific research unrelated to this project.

  • Ethics approval University of Washington Human Subjects Division Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles