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The Use of Simulation to Teach Pediatric Lumbar Puncture in Undergraduate and Postgraduate Medical Education: A
Marah Khader Jamal Shaikh Yousef1, Paul E O'Connor2, Roisin M O'Malley2
1Irish Centre for Applied Patient Safety and Simulation.
Objectives:
Lumbar puncture (LP) is an essential skill in which pediatric and emergency medicine trainees should be proficient. Despite its importance, research indicates that LP success rate in new graduates trained using traditional methods is only around 24% to 54%. Simulation provides the ideal grounds for practicing and refining this skill safely. This systematic review aimed to examine the use of simulation in teaching pediatric lumbar puncture to medical students and pediatric and emergency medicine trainees.
Methods:
Five electronic databases (EMBASE, Medline, CINAHL, Web of Science, and PsycINFO) were searched, alongside grey literature and reference list screening. Studies that used simulation-based educational methods to teach pediatric LP in undergraduate and postgraduate pediatric and emergency medicine education were included. Methodological rigor was evaluated using the QuADS tool.
Results:
Of the 17 included studies, most used partial/task trainers (eg, frequency building trials on task trainers; 82.4%) or mixed simulation methods (eg, video-recorded 'informed consent' OSCE followed by simulated LP on an infant simulator; 17.6%). Most simulation sessions were time-based (focused on the amount of time spent practicing clinical skills; n=10, 58.8%), whereas outcome-based learning (focused on the achievement of specific learning objectives) was used by 8 studies (47.1%). Training was frequently assessed in terms of knowledge and skills (70.6% of studies), behavior (52.9%), reactions to the training (17.6%), and attitudes (5.9%). Outcomes were mostly positive (64%) or had no clear effect (36%), with most positive outcomes related to knowledge and skills (75%), reactions (66.7%), and behavior (55.6%).
Conclusions:
Research is needed to determine which modalities suit differing learning outcomes and stages of LP skill development. Studies favored time-based learning, highlighting the need for outcome-based, learner-centric LP programs. Simulation programs positively impacted knowledge and skills; however, behavioral, organizational, and patient impact warrants further research.
