Medical students performing lumbar punctures: are we doing enough?

Medical students are required to achieve certain clinical and procedural competencies before they graduate. However, defining what constitutes a 'competency' or when a student can be deemed competent has been challenging, and clear guidelines are generally still lacking. Moreover, a student's definition of competence can substantially differ from that of supervising personnel.1

In a broad sense however, it is safe to suggest that every medical student in their clinical years (and certainly every doctor) should be able to act alone in emergency situations and with limited resources. This includes supporting life functions, performing diagnostic procedures, establishing a clinical diagnosis, and/or initiating treatment.2

While clinical knowledge can often be obtained from ward-rounds and bedside-teaching, procedural skills require more than that. Familiarising students with a procedure and getting them to perform it under appropriate supervision is crucial to students reaching procedural competence. This process should start in medical school and later be reinforced during postgraduate studies.3

Why is it an important issue?

Lumbar puncture (LP) is a basic procedure performed routinely in emergency departments (EDs), neurology wards and elsewhere in hospitals. It is one of the most difficult procedures in medicine because it requires specialised equipment and a highly skilled practitioner.

When a cohort of US third-year medical students was surveyed, LP was a skill that they perceived to be highly important, but that they commonly lacked confidence in.4 When the same cohort were surveyed again toward the end of their fourth year, there was a significant increase in the number of students performing LPs, as well as in students' self-confidence in the skill.5 However, similar results were not reproduced in another survey of fourth-year medical students.6

Still unfortunately, this has not changed the way that this important procedure is taught to medical students, or how often they are given the opportunity to perform it. Junior residents have been observed to make frequent errors while performing LPs, as they are seldom adequately prepared for the task as medical students.7,8 Therefore, junior housestaff will have to have gained some prior competency with such a skill if they are expected to perform it comfortably later in their careers.9

Medical students performing lumbar punctures

In 2002, the Institute for International Medical Education issued a report on the global minimum essential...