Simulation-based education with mastery learning improves residents' lumbar puncture skills

Abstract

Objective:To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods:This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulatortrained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores.Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p Ͻ 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p Ͻ 0.001) and only 6% met the MPS. Conclusions:Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. Neurology Lumbar puncture (LP) is commonly performed by physicians-in-training who often learn vicariously by observing procedures performed by peers. This method leads to uneven skill acquisition and trainee discomfort. 1The American Board of Psychiatry and Neurology, 2 the American Association of Neurology, 3 and the Accreditation Council for Graduate Medical Education 4 have no formal policies to ensure the competence of neurology residents at performing LP. The American Board of Internal Medicine does not require procedural competence in LP, but advises use of simulation training before procedures are performed on patients.5 Despite this, many residents will ultimately practice in a setting where competence in LP is required.Simulation technology increases procedural skill by providing the opportunity for deliberate practice in a safe environment. 6 Researchers at Northwestern University use simulation-based education to train medical residents to mastery skill levels in procedures such as central venous catheter insertion, 7-9 thoracentesis, 10 and advanced cardiac life support. 11 Mastery learning is a stringent form of competency-based education that requires trainees to acquire clinical skill mea-

Impact of Just-in-Time and Just-in-Place Simulation on Intern Success With Infant Lumbar Puncture

“…34 Other studies using similar educational frameworks have also demonstrated improved confidence or skill in a simulated environment but were unable to reliably show a clinical improvement with actual patients. [35][36][37][38] Even though our intervention was unable to globally improve clinical success rates, we did notice improvement in specific physician behaviors (Kirkpatrick level 3). 39,40 There was a notable increase in the use of preprocedural analgesia and the early stylet removal technique, both of which were emphasized in our intervention, because they have been associated in previous studies with improved procedural success.…”

Simulation techniques in the anatomy curriculum: review of literature

“…It can be simulation-based laparoscopic training program for surgeons and as well as training in lumbar puncture or central venous catheter insertion for internal medicine and emergency medicine residents [6,7,33].…”

Simulation in neurology

“…They pointed out that while traditional lectures can provide a ''solid knowledge base'', simulation in a protected environment allows the consolidation of this knowledge that is necessary in order to ensure safe and effective interventions in the field. This has since been confirmed in the more strictly neurological setting by Barsuk et al [8], in relation both to diagnostic-therapeutic management (status epilepticus, ischemic stroke) and to procedures (lumbar puncture).…”