Utilizing the Flipped Classroom, Simulation-Based Mastery Learning and Group Learning to Teach and Evaluate Lumbar Puncture Skills
This lumbar puncture curriculum was developed and implemented to educate and evaluate incoming intern Emergency Medicine (EM) residents. This curriculum can also be used to educate and evaluate senior medical students and senior residents.
Procedural competency is an important component of healthcare education. With the implementation of milestones, the need for valid assessment tools to determine procedural competency has increased. Simulation-based mastery learning (SBML) with the incorporation of deliberate practice has been shown to be an effective way to teach and evaluate procedural skills.1-8 These studies, however, highlight one of the major barriers to successful integration of SBML into existing medical curricula: they require a significant investment of time. One reason for this is the performance of the pre-test evaluation of the learners’ procedure skills prior to commencement of training. Although necessary for research endeavors to evaluate curricula effectiveness, the need for pre-testing specifically on studies where the goal of the curricula is procedural competency, as measured by learners’ performance on the post-testing, has not been described. Consequently, we decided a more effective use of limited time was to allow our learners the opportunity for deliberate practice and conducting the post-test. Since the ultimate goal of our educational endeavors is to ensure that our learners achieve defined standards of performance, evaluation of their performance prior to training may not be necessary. Another reason for the significant time investment for SBML curricula is the utilization of individualized instruction with one facilitator providing corrective feedback to one learner. Although Cohen et al. reference the use of groups of learners for procedure training9, it is not explicitly delineated how the group instruction is conducted. In other disciplines, training team protocols such as dyad training (pair of learners), where learners practice a task in teams in order to achieve the goal of performing the task individually, has been shown as an effective strategy to teach motor skills.10-12 This type of learning consists of a learner performing the procedure while the other learners actively observe, then alternate roles. In addition, recent studies have illustrated the improved efficiency with utilization of a flipped classroom with online educational materials when implementing mastery learning curriculums13-14. We designed a curriculum that utilizes a flipped classroom and a group learning protocol to improve the efficiency and ease of integration of a SBML lumbar puncture (LP) curriculum.
The goal of the curriculum is to teach and evaluate senior medical students / emergency medicine residents on the performance of a lumbar puncture using a group learning protocol. At the completion of the training session, learners should be able to: 1) Demonstrate how to perform a LP on an adult patient by achieving the minimum passing standard on the checklist, 2) state the indications and contraindications of performing a LP, and 3) state the potential complications that can occur after performing a LP.
Small group session
Lumbar puncture, group learning, flipped classroom, mastery learning, simulation.