Development, Implementation, and Evaluation of a Structured Teaching Module for Lumbar Puncture Training Among Medical Interns

Background Lumbar puncture (LP) is an essential diagnostic and therapeutic bedside procedure. However, many medical interns have limited opportunities for supervised training before performing LP on patients, resulting in inadequate procedural competence and reduced confidence. Simulation-based education using the demonstration, observation, assistance, and performance (DOAP) approach offers a safe and effective method for teaching procedural skills. This study evaluated the effectiveness of a structured simulation-based teaching module in improving knowledge, confidence, procedural competence, and learner perceptions regarding lumbar puncture. Methods A pre- and post-intervention study was conducted in the Department of Anesthesiology and the Skills Laboratory Center at Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India, between January 1, 2025, and June 30, 2025. A total of 33 participants, including Bachelor of Medicine and Bachelor of Surgery (MBBS) medical interns, were enrolled. Participants underwent a structured teaching module using the DOAP method consisting of an interactive lecture, mannequin-based demonstration, supervised hands-on practice, and faculty feedback. Outcomes were assessed before and immediately after training using the investigator-developed Lumbar Puncture Training Assessment Questionnaire (LPTAQ), which evaluated knowledge, confidence, procedural competence, and post-training perceptions. Paired categorical responses were analyzed using the exact McNemar test. Results The mean age of participants was 24.15±1.44 years, and 57.6% were male. Significant improvements were observed in knowledge regarding termination of the adult spinal cord (54.5% vs. 84.8%, p=0.002), anatomical landmarks (69.7% vs. 93.9%, p=0.008), preferred vertebral level (57.6% vs. 93.9%, p<0.001), and indications for lumbar puncture (9.1% vs. 87.9%, p<0.001). Participants expressing confidence in performing lumbar puncture increased from 24.2% before training to 90.9% after training (p<0.001). Knowledge regarding the role of the stylet improved significantly (57.6% vs. 84.8%, p=0.004), while self-reported adequate procedural training increased from 9.1% to 90.9% (p<0.001). Confidence in identifying anatomical landmarks also improved significantly (63.6% vs. 93.9%, p=0.002). Significant gains were observed in knowledge related to post-procedure care, first-line management of post-lumbar puncture headache, and recognition of infection following LP. Overall, 90.9% of participants agreed that the structured teaching module improved their practical skills, 90.9% found mannequin-based demonstration helpful, 90.9% reported that the DOAP method improved procedural technique, and 93.9% felt confident performing lumbar puncture on real patients after training. Conclusions The structured simulation-based teaching module using the DOAP approach significantly improved knowledge, confidence, and self-reported procedural competence, as well as learner perceptions of lumbar puncture among medical interns. Incorporating structured simulation-based LP training into undergraduate and postgraduate medical education may enhance procedural preparedness, support competency-based medical education, and improve patient safety before interns perform lumbar puncture in clinical practice.