Muñoz-Leija David, Díaz González-Colmenero Fernando, Ramiréz-Mendoza Diego A, López-Cabrera Norma G, Llanes-Garza Hilda A, Palacios-Ríos Dionicio, Negreros-Osuna Adrián A
Radiology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX.
Anesthesiology Service, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX.
Cureus. 2024 Mar 20;16(3):e56567. doi: 10.7759/cureus.56567. eCollection 2024 Mar.
Lumbar puncture (LP) is a common invasive technique considered an essential learning milestone for anesthesiologists due to its application in spinal anesthesia. We aimed to develop an in-house LP simulator, test its effectiveness in learning the steps to perform an LP and analyze its impact on the first-year residents' self-confidence at our hospital.
We used 3D printing and silicone casting to create an LP simulator based on a lumbar spine computed tomography (CT). We divided 12 first-year anesthesiology residents into control and experimental groups. The control group received traditional training, while the experimental group practiced with the simulator for three months. We used a procedure checklist and a Likert scale survey to evaluate their procedural knowledge and self-confidence at baseline, three, and six months. Eighteen months later, we evaluated their LP performance skills.
Both groups showed a significant improvement in their knowledge scores over time. After three months, the experimental group had a higher median knowledge score (10 (10 - 10) median (min-max)) than the control group (9 (8 - 9.5) median (min-max)) (p = 0.03). While there were no apparent differences in median self-confidence scores between the groups at any time point, the experimental group had a significant increase in their self-confidence for performing an unassisted LP, with a median score of 1/5 (1 - 2.3) at baseline and 5/5 (4.8 - 5) after six months (p = 0.006). In contrast, the control group's self-confidence scores decreased from 4/5 (3 - 4) after three months to 3/5 (2 - 5) after six months. The evaluation of performance skills did not yield statistically significant results.
Our study demonstrates that an in-house LP simulator is an effective and practical approach for first-year anesthesiology residents to learn the LP procedure. This approach could be particularly useful in settings with limited resources and a lack of sufficient patients to practice on, as it provides an opportunity for faster learning and increased self-confidence.
腰椎穿刺（LP）是一种常见的侵入性技术，由于其在脊髓麻醉中的应用，被认为是麻醉医生必须掌握的重要学习里程碑。我们旨在开发一种内部LP模拟器，测试其在学习LP操作步骤方面的有效性，并分析其对我院一年级住院医师自信心的影响。
我们使用3D打印和硅胶铸造技术，基于腰椎计算机断层扫描（CT）创建了一个LP模拟器。我们将12名一年级麻醉住院医师分为对照组和实验组。对照组接受传统培训，而实验组使用模拟器练习三个月。我们使用操作检查表和李克特量表调查，在基线、三个月和六个月时评估他们的操作知识和自信心。18个月后，我们评估了他们的LP操作技能。
随着时间的推移，两组的知识得分均有显著提高。三个月后，实验组的知识得分中位数（10（10 - 10）中位数（最小值 - 最大值））高于对照组（9（8 - 9.5）中位数（最小值 - 最大值））（p = 0.03）。虽然在任何时间点两组的自信心得分中位数没有明显差异，但实验组在独立进行LP操作时的自信心有显著提高，基线时中位数得分为1/5（1 - 2.3），六个月后为5/5（4.8 - 5）（p = 0.006）。相比之下，对照组的自信心得分从三个月后的4/5（3 - 4）降至六个月后的3/5（2 - 5）。操作技能评估未得出统计学上的显著结果。
我们的研究表明，内部LP模拟器是一年级麻醉住院医师学习LP操作的一种有效且实用的方法。这种方法在资源有限且缺乏足够患者进行练习的情况下可能特别有用，因为它提供了更快学习和增强自信心的机会。
