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Simulation-Based Educational Curriculum for Lumbar Puncture to Improve Operator Confidence and Efficiency 2014

Category Interventional Austin Bourgeois, MD, BS
Thomas McLaren, MD, BS
Kathleen Hudson, MD
Alexander Pasciak, PhD, BS
Austin R. Faulkner, MD, MSC, BS
Eric Heidel, PhD, BS
Yong Bradley, MD
Purpose The use of anthropomorphic detail phantoms in simulation-based medical education has rapidly increased in the past few decades, aimed at improving operator confidence and patient outcomes. However, further adaptation of simulation-based procedural instruction is often cost-prohibitive and provides uncertain clinical benefit. We describe the integration of a novel, low-cost, durable lumbar spine phantom and formal educational curriculum for performing lumbar punctures (LP) with the aim to increase operator efficiency and confidence. Materials & Methods Following IRB approval, 6 PGY-2 residents were enrolled in an educational curriculum including 2 formal didactic lectures, an instructional video, and 20 simulated fluoroscopically-guided lumbar punctures performed on a novel phantom created for the purposes of this study. Data from 114 lumbar punctures performed by the six enrolled residents were compared with retrospective data from 514 LP’s performed by 17 residents who underwent no formal training. A 10-question survey analyzing the operators’ confidence, understanding of anatomic landmarks and knowledge of procedural risks was administered to the test group before and after their first 15-25 LP’s. Results The LP curriculum test group had significantly decreased procedural fluoroscopy time (0.87 min) compared to the control group (1.09 min) for all lumbar punctures, including both diagnostic LP and LP for myelogram on an aggregate basis (p = 0.002). This relationship is preserved when independently accounting for diagnostic LP alone (p = 0.002) and LP for myelogram alone (p = 0.001). No statistically significant relationship in failed LP’s between the two groups or variability in outcomes among different clinical indications for LP were observed. Survey-based subjective measures of operator confidence showed improvement following completion of the curriculum. Conclusion The didactic and simulation-based curriculum for fluoroscopically guided lumbar puncture produces tangible improvement in operator confidence, procedural efficiency, and likely reduces patient radiation exposure. References [1] J. A. Harvey, R. E. Moran, M. M. Hamer, G. A. DeAngelis, and R. A. Omary, “Evaluation of a turkey-breast phantom for teaching freehand, US-guided core-needle breast biopsy.,” Acad Radiol, vol. 4, no. 8, pp. 565–569, Aug. 1997. [2] J. J. Nicotra, S. B. Gay, K. K. Wallace, B. C. McNulty, and R. D. Dameron, “Evaluation of a breast biopsy phantom for learning freehand ultrasound-guided biopsy of the liver.,” Acad Radiol, vol. 1, no. 4, pp. 385–387, Dec. 1994. [3] C. A. Harper, Handbook of Plastics, Elastomers, and Composites. McGraw Hill Professional, 2002. [4] Wiley-VCH, Ullmann's Encyclopedia of Industrial Chemistry. Wiley-VCH, 2003.