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. Simulator-trained 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 < 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 < 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.

Figure 1. Flow diagram of study design

PGY = postgraduate year.

Figure 2. Lumbar puncture (LP) simulator

Left: Trainee measuring an opening pressure on the LP simulator. Right: Trainee collecting spinal fluid from the LP simulator.

Figure 3. Clinical skills examination (checklist) performance

Clinical skills examination (checklist) pre- and final posttest performance of 58 first-year simulator-trained internal medicine residents and baseline performance of 36 traditionally trained neurology residents. Three internal medicine residents failed to meet the minimum passing score (MPS) at initial post-testing. PGY = postgraduate year.