A Curriculum for Lumbar Puncture Training in Internal Medicine Residency

Background: Lumbar puncture (LP), although not mandatory for internal medicine (IM) residents to perform, remains a vital procedure for hospitalized patients. The optimal method for training residents in LP is not established. Objective: We implemented, and evaluated a curriculum (online video, post-video quiz, group discussion, checklist, simulation training) for training PGY-2 IM residents in performing LPs. Methods: We surveyed residents after completion of the curriculum and compared LP logs for the cohort who participated in this training to the prior year of residents without the curriculum. Results: Overall survey response rate was 65%. 98% of residents found the pre-course materials useful; 92% agreed or strongly agreed that the in-person training session helped them to correctly perform an LP. 90% of residents found simulation training useful and 84% responded that the training session increased their confidence to perform an LP. However, compared to the prior residency class who did not have LP training, the initial class that underwent training did not perform more LPs during their residency: median 2 (inter-quartile range 0-5) vs. 2 (inter-quartile range 0-4.25), respectively (p = 0.98). Conclusion: Despite not leading to an increase in LP rates, our curriculum was very well received by PGY-2 IM residents. Figure 2: Resident LP logs at graduation. A) Scatter plot of resident-performed LPs at graduation for the 2017 graduation class (cohort without LP curriculum, n = 39) compared with the 2018 graduating class (cohort with LP curriculum, n =38). Points are values for individual residents; black lines represent median for each cohort (p = 0.98). B) Residents who did at least one LP by graduation: 66.7% vs. 71.1 % (p=0.68). A) Combined results from two years of resident survey data are shown in Figure 1A-1E. The survey response rate was 62% in the 2016 year (n = 24) and 68% in the 2017 year (n= 26), for a total of 50 responses. 98% of residents agreed or strongly agreed that the pre-course materials were useful (1A). 92% of residents agreed or strongly agreed that the in-person training session (review of quiz, simulation training) helped them to correctly perform an LP (1B). 90% of residents agreed or strongly agreed that the simulation training was useful and 84% of residents agreed or strongly agreed that the training session increased their confidence in their ability to perform an LP (1C, 1D). 88% of residents responded that they knew how to use the LP checklist after attending the session (1E). The training did not lead to an increase in