Research Article: Specific lumbar puncture training during clinical clerkship durably increases atraumatic needle use

Date Published: June 10, 2019

Publisher: Public Library of Science

Author(s): Xavier Moisset, Bruno Pereira, Carole Jamet, Alexandre Saturnin, Pierre Clavelou, Jong-Ling Fuh.


Atraumatic needles are proposed to lower complication rates after lumbar puncture (LP). Only a minority of physicians use such needles. Here we aimed to assess the impact of specific training in LP during clinical clerkship on the proportion of medical students using atraumatic needles.

We performed a case-control study comparing medical students undergoing clinical clerkship and students undergoing specific LP training. The 176 students of a class underwent training in LP just before beginning their clinical rotations. This training consisted of 45 minutes of theoretical training and a 90-minute practical session with a dummy. Twenty students were selected from the class at random, and their competence was assessed with a multiple choice questionnaire (MCQ) and an objective structured clinical examination (OSCE), nine months after the specific training. These 20 cases were compared with 20 students randomly selected from a class of 180 students who had not undergone specific training in LP and were at the end of their clinical clerkship.

We found that 60% of the students with specific training and 25% of those with classic clinical training used an atraumatic needle during the OSCE (p = 0.025). The mean MCQ (/100) scores obtained were 57±15 and 60±15 for the specific and classic training groups, respectively (p = 0.35). Overall OSCE score was similar in the two groups (63.5±9.3 vs. 65.8±9.3; p = 0.20).

Very few practicing physicians use atraumatic needles, which limits the teaching of their use to medical students. Specific training durably increases the use of appropriate needles.

Partial Text

Pencil point (atraumatic) needles (Fig 1) are recommended over beveled (cutting) needles for lumbar puncture (LP), to prevent complications relating to this procedure and reduce costs to the healthcare system [1]. This is well-known for more than 20 years, especially among neurologists [2,3]. Neurologists are the principal group of doctors performing LP. Nevertheless, many LPs are also performed by other hospital physicians [4]. Very few practicing physicians use atraumatic needles [4,5], which limits the teaching of the use of these needles to medical students.

Both theoretical and practical skills were evaluated in June and July 2018, nine months after the specific LP training for 4th year students and at the end of the 6th year of medical studies for the control group (raw data are available in the S3 Appendix).

Specific training in LP just before the start of clinical clerkship significantly and durably increased the inclination of medical students to use atraumatic needles. Moreover, the medical students undergoing this training had a level of skill and knowledge after one year of clinical rotation similar to that of students who had completed three years of clinical clerkship without the specific training in LP.

The goal of this specific training course was to encourage medical students to use the most appropriate needles right from the start. Indeed, it is easier to learn correctly in the first place than to learn outdated practices and then have to change during medical residency or even later. This study shows that a single specific training can increase the use of atraumatic needles by medical students lastingly.




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