Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety

Abstract

BackgroundPediatric residents must become proficient with performing a lumbar puncture (LP) during training. Residents have traditionally acquired LP skills by observing the procedure performed by a more senior resident or staff physician and then attempting the procedure themselves. This process can result in variable procedural skill acquisition and trainee discomfort. This study assessed changes in resident procedural skill and self-reported anxiety when residents were provided with an opportunity to participate in an interactive training session and practice LPs using a simulator.MethodsAll pediatric residents at our institution were invited to participate. Residents were asked to report their post-graduate year (PGY), prior LP attempts and self-reported anxiety scores as measured by the standardized State-Trait Anxiety Inventory - State Anxiety Scale (STAI-S) prior to completing an observed pre-test using an infant-sized LP simulator. Staff physicians observed and scored each resident’s procedural skill using a previously published 21-point scoring system. Residents then participated in an interactive lecture on LP technique and were given an opportunity for staff-supervised, small group simulator-based practice within 1 month of the pre-test. Repeat post-test was performed within 4 months.ResultsOf the pediatric residents who completed the pre-test (N = 20), 16/20 (80 %) completed both the training session and post-test. Their PGY training level was: PGY1 (38 %), PGY2 (25 %), PGY3 (25 %) or PGY4 (12 %). Procedural skill improved in 15/16 residents (paired t-test; p < 0.001), driven by a significant improvement in skill for residents in PGY1 (P = 0.015) and PGY2 (p = 0.003) but not PGY3 or PGY4. Overall anxiety scores were higher at baseline than at post testing (mean ± SD; 44.8 ± 12.1 vs 39.7 ± 9.4; NS) however only PGY1 residents experienced a significant reduction in anxiety (paired t-test, p = 0.04).ConclusionLP simulation training combined with an interactive training session may be a useful tool for improving procedural competence and decreasing anxiety levels, particularly among those at an earlier stage of residency training.

Factors Associated with Lumbar Puncture Participation in Alzheimer’s Disease Research

“…AD research centers may seek to bolster LP participation rates with improved clinician training protocol to increase the rate of successful LP. While there is no standardized training procedure for clinicians per-forming research LPs, simulation-based learning has been effective for medical residents learning to perform LPs [24,25]. Training could focus on increasing clinician comfort with the procedure, since clinician stress has been associated with increased risk of post-procedure headache and is linked to patient's confidence [26].…”

A Future for Simulation in Acute Neurology

“…There are few devices in use, and currently only fundoscopy training as well as lumbar puncture training has been used for simulation-based methods training in neurology residency-each using commercially available (Kyoto Kagaku America Inc) simulators. [6][7][8][9] In neurocritical care, however, few so-called scenarios (a written script superficially resembling a screenplay) have been systematically tested. We and others have developed scenarios for the determination of brain death, which includes a combination of pitfalls and confounders.…”

Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety

“…In contrast, evidence suggests that negative emotions, such as stress and anxiety, impair processing of information in a way that would hinder optimal performance. 32 Previous studies have identified that novices and even more experienced residents improve their performance and decrease their anxiety by simulation-based training. 25,28 However, the effects of simulation-based training on stress and performance in the clinical setting remain to be demonstrated for the LP procedure.…”