Procedures: Lumbar Puncture
IINTERNAL MEDICINE RESIDENCY PROGRAM
Faculty: Mehtab Mizan, MD, Michael Carroll, MD, Mingtao Wang, MD, MS
Sites: Sites: Carle Clinic Association (CCA), Danville Veterans Administration Illiana Health Care System (DVAIHS), Provena Covenant Medical Center (PCMC)
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DESCRIPTION:
Education experience under the supervision of Dr. Mehtab Mizan, Hospitalist and Carle Site Director.
I. GOALS
Develop the knowledge, and skills for competent performance of lumbar puncture.
II. OBJECTIVES
A. PATIENT CARE:
Objective 1: Demonstrate clinical skills of competent performance of lumbar puncture with supervision and advance to independent performance.
Objective 2: Observe Universal Precautions at all times.
B. MEDICAL KNOWLEDGE:
Objective 1: Describe indications, contraindications, specific technical aspects of the procedure, interpretation of results and complications.
Objective 2: Interpret results of procedure.
C. PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 2: Demonstrate ability in medical decision making based on interpretation of lumbar puncture results.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Communicate clearly, audibly and in lay language to explain the procedure to the patient and family. Avoid medical jargon.
Objective 2: Work effectively with others on interdisciplinary and/or multidisciplinary teams.
E. PROFESSIONALISM
Objective 1: Demonstrate respect and compassion to assure patient’s understanding of the procedure.
Objective 2: Recognize the legal requirements of informed consent.
F. SYSTEM-BASED PRACTICE
Objective 1: Recognize financial issues of heath care, with emphasis on understanding acute and chronic care, and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.
III. METHODS
Residents gain knowledge about lumbar puncture by first reading from standard medical textbooks, e.g. Cecil Textbook of Medicine, Ferri: Practical Guide to the Care of the Medical Patient, and The Merck Manual. S/he must be thoroughly acquainted with the indications, contraindications, specific technical aspects of the procedure, interpretation of results and complications. Universal Precautions must be observed at all times. The resident first observes and then must perform at least three lumbar punctures satisfactorily under direct supervision. S/he must satisfy the cognitive and technical skills before allowed to perform independently.
The resident demonstrates professional and communication skills by explaining the procedure in lay terms to the patient. The resident may gain experience in different ways by performing this procedure on patients at the various sites.
Carle Clinic Association (CCA)
During the Neurology and Emergency Department rotations, and when on the general medical ward, residents receive training as the opportunity arises. Additional training is available with Dr. Carroll, Anesthesiology, as a 2 week elective rotation in Anesthesiology, where opportunity exists for various procedures, including lumbar puncture.
Danville Veterans Administration Illiana Health Care System (DVAIHS)
Residents have the opportunity to train in the DVAIHS when the opportunity arises under the direct supervision of the attending physician.
Provena Covenant Medical Center (PCMC)
At the Provena site, staff neurologists page the resident on call when an opportunity arises to perform a lumbar puncture. Residents may also have opportunities to perform LP's in the emergency department and on the general medical ward
Additional Training
The resident also performs didactic and technical practice on a lumbar puncture model. Regular formal teaching sessions on models are available to residents every six (6) weeks coordinated by the Chief residents at CCA, PCMC, and DVAIHS sites.
Core Conference Curriculum:
The core conference curriculum is an 18 month curriculum, however, lumbar puncture is a scheduled 12 month topic coordinated and taught by the attending physicians.
IV. EVALUATION
ACGME Competencies
According to Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice – Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by assessment of the attending physician or clinician. Procedures performed will be documented.
Medical Knowledge will be evaluated by assessment of the attending physician or clinician.
Practice-Based Learning and Improvement will be evaluated by assessment of the attending physician or clinician.
Interpersonal and Communication Skills will be evaluated by assessment of the attending physician or clinician.
Professionalism will be evaluated by assessment of the attending physician or clinician.
System-Based Practice will be evaluated by assessment of the attending physician or clinician.
V. REFERENCES
Cecil Textbook of Medicine (current edition)
Ferri: Practical Guide to the Care of the Medical Patient (current edition)
The Merck Manual (current edition)
10/18/2005