Researchers in the Departments of Medicine and Neurology at Northwestern University Feinberg School of Medicine, Chicago, IL evaluated the effect of simulation-based mastery learning (SBML) on internal medicine residents’ lumbar puncture (LP) skills, assessed neurology residents’ acquired LP skills from traditional clinical education, and compared the results of SBML to traditional clinical education. Residents completed a baseline skill assessment (pretest) and following a 3-hour practice and feedback, residents completed a posttest. PGY1 internal medicine residents (n=58) improved from a mean of 46.3% to 95.7% after SBML (p<001) and all met the minimum passing score (set by an expert panel) at final posttest. PGY2, 3 and 4 neurology residents (n=36) from 3 medical centers completed the same simulated LP assessment without SBML. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p<0.001) and only 6% met the minimum passing score. 
COMMENT. Internal medicine residents who complete SBML show improvement in LP skills, with competence superior to that of traditionally trained neurology residents. Simulation technology increases procedural skill by providing practice opportunity in a relaxed environment. The researchers recommend that residents complete simulation-based training prior to performing a clinical LP. The medical maxim that experience treating the patient translates to procedural expertise is disproven for competence in performing LP . Simulator training and adherence to a procedural checklist are important in the preparation and performance of an LP by residents.