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

Introduction: Our objective was to establish competency and ensure retention in the steps of the lumbar puncture procedure. Methods: This was a prospective cohort study of first-and second-year emergency medicine residents. Residents completed a survey and then viewed a 5-minute Power-Point T 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 >= 19 critical actions correct (>80%). Inter-rater reliability was examined using the intraclass correlation coefficient [ICC(2,k)]. Results: 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. Conclusions: This study demonstrated the achievement and retention of competency in the steps of the lumbar puncture procedure in a task trainer model. (Sim Healthcare 5: 133-138, 2010)