Neurology Residency Programs Confront a Challenge: How to Make Sure Residents Can Do Lumbar Punctures

stacey burling C hanges in medical practice-and in patients-have made it more challenging for neurology trainees to learn what has long been considered an essential procedure: the lumbar puncture (LP).Increasingly, patients who are obese or have spine problems are being sent to interventional radiologists who perform LPs under fluoroscopy, physicians who run neurology residency programs said.That leaves fewer opportunities for residents to master a procedure that is intimidating for them and scary for patients."It was almost like a vital sign for neurology years ago," said David Preston, MD, FAAN, director of the neurology residency program at University Hospitals Cleveland Medical Center."It was a very important part of assessing the nervous system, and I think some of that has been supplanted by advanced imaging." Suma Shah, MD, program director of Duke University' s neurology residency, said attendings and residents on inpatient services are often too busy to perform an LP, which can be time-consuming, while covering acute neurologic emergencies."The spinal tap is starting to fall out of what we can immediately offer as consultants," she said.