Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e807-e811
World Neurosurgery

Original Article
Evaluation of Problem- and Simulator-Based Learning in Lumbar Puncture in Adult Neurology Residency Training

https://doi.org/10.1016/j.wneu.2017.10.093Get rights and content

Background

Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method—problem- and simulator-based learning (PSBL)—in LP residency training to develop overall skills of neurology residents.

Methods

We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups.

Results

Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements.

Conclusions

Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP.

Introduction

Lumbar puncture (LP) is a common operation in neurology, and readiness to perform LP is very important when diagnosing neurologic diseases or dealing with emergency conditions. LP is an essential part of adult neurology residency training.1 The current assessment tools mostly focus on the technology of the LP operation. In fact, residents often face so many uncertainties regarding performing the procedure, such as patient cooperation, patient obesity, diversity of anatomic structures, and iatrogenic risks, that it may cause them to fail to perform an LP when needed.2 At the present time in China, there are no favorable circumstances for physicians to perform LP on real patients to develop skills. Therefore, effective learning methods and evaluation of performance are important for residency training. Gorman et al.3 suggested that proper training or supervision can result in a good technique and that LP simulators can provide a safe training method for students to practice performing LP. Using simulator training can provide a clearer learning objective and result in residents performing better in practice.4

However, training in performance of LP requires training not only in technologic aspects but also nontechnologic aspects to deal with uncertainties during LP procedures. This is problem-based learning (PBL). Residency training is a fundamental component of medical education. PBL is a student-centered approach based on the real world and has been used in medical education for >50 years.5 PBL has been widely used in various medical curricula. In China, training of medical students traditionally includes using textbooks, attending grand rounds, and learning from experts' experience. PBL can improve the quality of residency education. PBL methods to train students include scripting,6 program director survey,7 and free-text based questions.8 Simulator training can develop students' technologic skills, and PBL can improve students' individual judgment to deal with nontechnologic problems. Combining simulator training with PBL could lead to better training methods to develop overall technical and nontechnical skills. Nevertheless, hardly any studies have evaluated the benefits of simulator training combined with PBL. The purpose of this study was to evaluate the outcomes of problem- and simulator-based learning (PSBL) on LP performance in adult neurology residency training.

Section snippets

Participants

The study design was approved by the local ethics committee. Participants volunteered to participate in the study with informed consent. Our hospital is a standardized residents training center, and every year many residents apply for entry to complete their residency training. From July 2014 to July 2015, 60 neurology postgraduate-year-1 (PGY1) who showed comparable levels of technical knowledge and experience were enrolled from our standardized residents training center and were divided into

Results

The questionnaires, pretest, posttest, and LP training session were completed by 60 PGY1 neurology residents. In the following year, all residents performed 10 cases, and residents in group 2 wrote the scripting list based on each case (Table 2) and gave the list to the bedside attending physician to discuss uncertainties and relevant solutions. Faculty referred to the standards that have been published by Barsuk et al.10 to grade LP performance (Table 1).

Before training, the questionnaires of

Discussion

Our study suggested that using LP simulators to teach and practice visually stimulated students' interests and enthusiasm and increased students' self-confidence. The findings were similar to findings reported by McMillan et al.,2 who followed 54 pediatric PGY1 residents to postgraduate year 4 using a similar pretest versus posttest design. Moreover, Adachi et al.11 and Uppal et al.12 evaluated the effectiveness of LP simulators and proved that simulators were very useful tools for training.

Conclusions

We demonstrated that using an LP simulator combined with PBL can remarkably improve LP operative skills and individual judgment during the LP procedure as well as self-reported self-confidence. Development of individual judgment in LP preparation can improve the success rate of LP. Finally, nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements.

Acknowledgments

The authors thank all the Adult Neurology residents who participated in this project.

References (20)

  • B.L. Gas et al.

    Does scripting operative plans in advance lead to better preparedness of trainees? A pilot study

    Am J Surg

    (2017)
  • I. Valencia et al.

    Program director survey: attitudes regarding child neurology training and testing

    Pediatr Neurol

    (2016)
  • B.R. Nathan et al.

    Does experience doing lumbar punctures result in expertise? A medical maxim bites the dust

    Neurology

    (2012)
  • H.J. McMillan et al.

    Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety

    BMC Med Educ

    (2016)
  • P. Gorman et al.

    A prototype haptic lumbar puncture simulator

    Stud Health Technol Inform

    (2000)
  • M.J.V. Henriksen et al.

    Assessment of residents readiness to perform lumbar puncture: a validation study

    J Gen Intern Med

    (2017)
  • V.R. Neufeld et al.

    The “McMaster Philosophy”: an approach to medical education

    J Med Educ

    (1974)
  • D.P. Lerner et al.

    Neurocritical care education during residency: Opinions (NEURON) Study

    Neurocrit Care

    (2017)
  • F. Li et al.

    An evaluation of constrained randomization for the design and analysis of group-randomized trials with binary outcomes

    Stat Med

    (2017)
  • J.H. Barsuk et al.

    Simulation-based education with mastery learning improves residents' lumbar puncture skills

    Neurology

    (2012)
There are more references available in the full text version of this article.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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