Evaluation of the ability of emergency medicine assistants to perform lumbar puncture under ultrasound guidance with low-budget simulation model-based training

Objective: Evaluation of USG guided lumbar puncture skill training for emergency medicine residents with a low-budget simulation model. Material and Method: The study was conducted with the participation of 50 emergency medicine residents who had no previous LP experience. 50 people were randomly divided into 2 equal groups. While Group 1 was given 30 minutes of didactic and 10 minutes of video training, Group 2 was given practical training on the simulation model (phantom) we developed, accompanied by USG, in addition to these trainings. This phantom, pelvis and lumbosacral CT sections of a patient with consent were converted to STL format and printed on a 3D printer. The wearable mannequin was cut and its caudal and cephalic ends were cold siliconized with a wooden plate. After the 3D print created was mounted inside the prepared model, it was filled with 15% liquid gelatin. Two weeks after the training, two independent, blind lecturers (jury) were asked to perform the stages of the LP procedure on our simulation model under USG and scored the assistants' performances according to the validated LumPAT checklist consisting of 11 critical elements. Results: Of the 50 residents participating in the study, 23 (46%) were female and 27 (54%) were male. There was a significant difference in the "post-training confidence level" and "LP follow-up number" of group 2 compared to group 1 (p: <0.001, p: 0.029; respectively). The "LP success" of the participants in group 2 was significantly higher than group 1 (p:0.004). For both groups, the level of confidence increased after the training compared to the pre-training (p<0.001), but the confidence level was significantly higher after the training in Group 2, which had practical training (p<0.001). Considering the total score given to the groups by Jury 1, a significant difference was found between the groups and group 2 got a higher score. The same situation applies to the total points given by the jury 2. Considering the average of the total scores of each group from the juries, a significant difference was found between the groups, and group 2 got a higher score(p=0.004, p=0.001 and -p=0.001; respectively). Considering the fit analysis between the two juries, it was shown that there was a good degree of agreement (between 0.75-0.90). Conclusion: LP training with a low-budget, reusable simulation model was more successful in performing the LP procedure compared to traditional medical training. Keywords: Lumbar Puncture, Phantom, Simulation Training, Ultrason, 3D Printer