Competence and Retention in Performance of the Lumbar Puncture Procedure in a Task Trainer Model

Abstract

Our objective was to establish competency and ensure retention in the steps of the lumbar puncture procedure. This was a prospective cohort study of first- and second-year emergency medicine residents. Residents completed a survey and then viewed a 5-minute PowerPoint slide presentation and a 15-minute video on performing the procedure. They completed a baseline assessment of competency using a lumbar puncture simulator, received feedback on their performance, and practiced the procedure. They self-recorded the number of practice attempts and performed a second procedure for assessment. Within 3 to 6 months, they performed the procedure for a third observation. The assessments were performed with the same simulator and directly observed by two raters. A previously validated critical actions checklist consisting of 23 critical actions was used. Competency was defined as > or =19 critical actions correct (>80%). Inter-rater reliability was examined using the intraclass correlation coefficient [ICC(2,k)]. Seventeen first-year residents and nine second-year residents completed the initial training. Sixteen first-year residents and eight second-year residents completed the retention assessment. An additional four second-year residents were trained several months into their second year. Twelve of 17 first-year residents and 10 of 13 second-year residents demonstrated competence on the baseline evaluation. All residents demonstrated competence after practice (N = 30) and at the retention check (N = 24). The mean (SD) number of practice attempts before the postpractice assessment was 3.6 (1.1) for first years and 2.4 (2.3) for second years. This study demonstrated the achievement and retention of competency in the steps of the lumbar puncture procedure in a task trainer model.