Simulation-based education with mastery learning improves residents' lumbar puncture skills.
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.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. jbarsuk@nmh.org
Jeffrey H
JH
Barsuk
Elaine R
ER
Cohen
Timothy
T
Caprio
William C
WC
McGaghie
Tanya
T
Simuni
Diane B
DB
Wayne
D000328:Adult; D003198:Computer Simulation; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D009462:Neurology / Q000193:education*; D013129:Spinal Puncture / Q000379:methods*