Assessment of lumbar puncture skill in experts and nonexperts using checklists and quantitative tracking of needle...

CONSTRUCT: With the current shift toward competency-based education, rigorous assessment tools are needed for procedurally based tasks.

Multiple tools exist to evaluate procedural skills, each with specific weaknesses.

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.

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.

These findings suggest that quantitative needle tracking identifies students who struggle with needle insertion but are successful at completing the dichotomous checklist.