title: Assessment of lumbar puncture skill in experts and nonexperts using checklists and quantitative tracking of needle trajectories: implications for competency-based medical education.
abstract: CONSTRUCT: With the current shift toward competency-based education, rigorous assessment tools are needed for procedurally based tasks.
  
  
  BACKGROUND
  Multiple tools exist to evaluate procedural skills, each with specific weaknesses.
  
  
  METHODS
  We sought to determine if quantitative needle tracking could be used as a measure of lumbar puncture (LP) performance and added discriminatory value to a dichotomous checklist. Thirty-two medical students were divided into 2 groups. One group was asked to practice an LP once (single practice [SP]) and the other 5 times (multiple practice [MP]). Experts (attending ER physicians, senior ER residents, and a junior anesthesia resident) were used as comparators. Medical students were assessed again at 1 month to assess skill retention. Groups were assessed performing an LP with an electromagnetic tracking device that allows the needle's 3-dimensional movements to be captured and analyzed, and a dichotomous checklist.
  
  
  RESULTS
  Quantitative needle metrics as assessed by electromagnetic tracking showed a decreasing trend in needle movement distance with practice and with experience. The SP group made significantly more checklist mistakes initially as compared to the MP group (1.2 vs. 0.3, p <.05). At 1 month, there was a significant increase in both groups' mistakes (SP 3.4 vs. MP 1.3, p =.01). No correlation existed between individuals' needle motion and checklist mistakes.
  
  
  CONCLUSIONS
  These findings suggest that quantitative needle tracking identifies students who struggle with needle insertion but are successful at completing the dichotomous checklist.
authors.affiliation: a Department of Emergency Medicine , Queen's University , Kingston , Ontario , Canada.
authors.forename: David
authors.initials: D
authors.lastname: Clinkard
authors.forename: Eric
authors.initials: E
authors.lastname: Moult
authors.forename: Matthew
authors.initials: M
authors.lastname: Holden
authors.forename: Colleen
authors.initials: C
authors.lastname: Davison
authors.forename: Tamas
authors.initials: T
authors.lastname: Ungi
authors.forename: Gabor
authors.initials: G
authors.lastname: Fichtinger
authors.forename: Robert
authors.initials: R
authors.lastname: McGraw
mesh_terms: D000328:Adult; D057189:Checklist; D002983:Clinical Competence; D003162:Competency-Based Education; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D013129:Spinal Puncture / Q000592:standards*
keywords: assessment; competency-based medical education; simulation