title: Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety.
abstract: BACKGROUND
  Pediatric residents must become proficient with performing a lumbar puncture (LP) during training. Residents have traditionally acquired LP skills by observing the procedure performed by a more senior resident or staff physician and then attempting the procedure themselves. This process can result in variable procedural skill acquisition and trainee discomfort. This study assessed changes in resident procedural skill and self-reported anxiety when residents were provided with an opportunity to participate in an interactive training session and practice LPs using a simulator.
  
  
  METHODS
  All pediatric residents at our institution were invited to participate. Residents were asked to report their post-graduate year (PGY), prior LP attempts and self-reported anxiety scores as measured by the standardized State-Trait Anxiety Inventory - State Anxiety Scale (STAI-S) prior to completing an observed pre-test using an infant-sized LP simulator. Staff physicians observed and scored each resident's procedural skill using a previously published 21-point scoring system. Residents then participated in an interactive lecture on LP technique and were given an opportunity for staff-supervised, small group simulator-based practice within 1 month of the pre-test. Repeat post-test was performed within 4 months.
  
  
  RESULTS
  Of the pediatric residents who completed the pre-test (N = 20), 16/20 (80 %) completed both the training session and post-test. Their PGY training level was: PGY1 (38 %), PGY2 (25 %), PGY3 (25 %) or PGY4 (12 %). Procedural skill improved in 15/16 residents (paired t-test; p < 0.001), driven by a significant improvement in skill for residents in PGY1 (P = 0.015) and PGY2 (p = 0.003) but not PGY3 or PGY4. Overall anxiety scores were higher at baseline than at post testing (mean ± SD; 44.8 ± 12.1 vs 39.7 ± 9.4; NS) however only PGY1 residents experienced a significant reduction in anxiety (paired t-test, p = 0.04).
  
  
  CONCLUSIONS
  LP simulation training combined with an interactive training session may be a useful tool for improving procedural competence and decreasing anxiety levels, particularly among those at an earlier stage of residency training.
authors: Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. hmcmillan@cheo.on.ca.
authors: Hugh J
authors: HJ
authors: McMillan
authors: Department of Pediatrics, Division of Critical Care, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors: Hilary
authors: H
authors: Writer
authors: Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, ON, K1N 6N5, Canada.
authors: Katherine A
authors: KA
authors: Moreau
authors: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors: Kaylee
authors: K
authors: Eady
authors: Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
authors: Erick
authors: E
authors: Sell
authors: Department of Pediatrics, Division of Critical Care, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors: Anna-Theresa
authors: AT
authors: Lobos
authors: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors: Jenny
authors: J
authors: Grabowski
authors: Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
authors: Asif
authors: A
authors: Doja
mesh_terms: D000328:Adult; D001007:Anxiety / Q000517:prevention & control*; D002170:Canada; D057189:Checklist; D002648:Child; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D009462:Neurology / Q000193:education; D016544:Patient Simulation; D010372:Pediatrics / Q000193:education*; D010820:Physicians / Q000523:psychology*; D057566:Self Report; D013129:Spinal Puncture / Q000379:methods*
keywords: Anxiety; Lumbar puncture; Medical education; Patient simulation; Pediatric; Training program