Kilbane Brendan J, Adler Mark D, Trainor Jennifer L
Rainbow Babies & Children's Hospital, Division of Pediatric Emergency Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Pediatr Emerg Care. 2010 Aug;26(8):558-62. doi: 10.1097/PEC.0b013e3181ea720d.
To assess the baseline ability of pediatric residents to successfully perform a lumbar puncture (LP) and to evaluate the impact of an educational intervention on this skill in both a simulated and clinical environment.
An experimental group of first-year residents and a control group of second-year residents were enrolled in a prospective nonrandomized intervention study. Knowledge and skill at performing LPs were assessed using a written and a simulated LP test. The experimental group was tested at the start of their residency and then received the educational intervention. They were retested 6 months later. The control group did not receive the educational intervention and were tested at the start of their second year. The outcomes of clinical LPs performed by the 2 groups were also recorded.
The experimental group showed significant improvement on both the written and the simulated LP test after the educational intervention. When compared with the control group, they performed the simulated LP significantly better as measured by the number of correctly performed steps. Both groups performed a low number of clinical LPs.
After an educational intervention, pediatric first-year residents performed a simulated LP better than a group of second-year residents who had greater clinical LP experience. The low number of clinical LPs performed limits our ability to determine the educational intervention's impact in the clinical setting and reinforces the concern that recent changes to pediatric residencies may negatively impact residents' procedural experience.
评估儿科住院医师成功进行腰椎穿刺（LP）的基线能力，并评估教育干预在模拟和临床环境中对该技能的影响。
将一组一年级住院医师作为实验组，一组二年级住院医师作为对照组，纳入一项前瞻性非随机干预研究。通过书面和模拟LP测试评估进行LP的知识和技能。实验组在住院医师培训开始时进行测试，然后接受教育干预。6个月后再次进行测试。对照组未接受教育干预，在二年级开始时进行测试。还记录了两组进行临床LP的结果。
教育干预后，实验组在书面和模拟LP测试中均有显著改善。与对照组相比，根据正确执行步骤的数量衡量，他们在模拟LP中表现明显更好。两组进行的临床LP数量都很少。
经过教育干预后，儿科一年级住院医师在模拟LP中的表现优于一组临床LP经验更丰富的二年级住院医师。进行的临床LP数量较少，限制了我们确定教育干预在临床环境中影响的能力，并强化了对儿科住院医师培训近期变化可能对住院医师操作经验产生负面影响的担忧。
