Simulation-based ultrasound-guided lumbar puncture training using a flipped classroom: a single-arm pilot programme evaluation.
6 affiliations
- 1School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
- 2Emergency Department, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
- 3Research Assistant Center, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC.
- 4Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC.
- 5Institute for Research into Cancer of the Digestive System (IRCAD) - Taiwan and Asian Institute of TeleSurgery, Show Chwan Health Care System, Changhua, Taiwan, ROC. [email protected].
- 6Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, No. 6 Lugong Road. Lukang Zhen, Changhua, Taiwan, ROC. [email protected].
Abstract
Background
Traditional landmark-guided lumbar puncture (LP) has high failure rates among novice emergency medicine (EM) clinicians. While ultrasound guidance improves success, structured training models remain limited and expensive. We evaluated a cost-effective, simulation-based flipped classroom curriculum for teaching ultrasound-guided LP to EM residents and trainees.Methods
We developed a high-fidelity, custom 3D-printed spinal simulator costing approximately $40 USD per unit. The curriculum utilized a flipped classroom model combining online theoretical modules with hands-on, deliberate practice.Results
Twenty-two participants (9 EM residents, 13 PGY trainees) completed the training programme; paired landmark-versus-ultrasound OSCE data were available for the seven residents who completed both phases. Among EM residents with paired data (n = 7), the ultrasound-guided phase OSCE completion rate was 100%, compared to 43% during the earlier landmark phase (a large but statistically non-significant difference, p = 0.125, McNemar's exact test). The ultrasound-guided phase was associated with higher rubric-rated performance scores and overall ratings (nominally significant, uncorrected for multiple comparisons); needle passes (median 7 vs. 12) and procedure times were also lower but did not reach statistical significance in this small paired sample. Both groups reported significantly lower procedural stress with ultrasound guidance, with a smaller, non-significant increase in confidence.Conclusions
A flipped classroom curriculum utilizing a low-cost, 3D-printed simulator is a feasible and well-received educational innovation for teaching ultrasound-guided LP, with encouraging but preliminary performance findings for EM residents that require confirmation in controlled studies.
Related
- A Multicomponent Simulation-Based Program Incorporating Ultrasound for Lumbar Puncture Training in Medical Students: A Randomized Controlled Educational Trial
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- Pilot Mixed-Methods Evaluation of Simulation-Based Focused Cardiac Ultrasound Teaching for Final-Year Medical Students
- Which classroom anxiety experience should teachers target first? A network-simulation study of foreign language classroom anxiety and enjoyment
- Technical feasibility of an angle-free ultrasound-assisted approach for challenging lumbar puncture in complex spinal anatomy: a two-patient case series
BibTeX
@article{huang2026simulationbased,
title = {{Simulation-based ultrasound-guided lumbar puncture training using a flipped classroom: a single-arm pilot programme evaluation.}},
author = {Chao-Yen Huang and Sai-Wai Ho and Po-Ming Chen and Chia-Ching Chen},
journal = {BMC medical education},
year = {2026},
month = aug,
doi = {10.1186/s12909-026-10070-8},
url = {https://europepmc.org/article/MED/42958232},
note = {CC BY},
}
RIS
TY - JOUR
TI - Simulation-based ultrasound-guided lumbar puncture training using a flipped classroom: a single-arm pilot programme evaluation.
AU - Chao-Yen Huang
AU - Sai-Wai Ho
AU - Po-Ming Chen
AU - Chia-Ching Chen
PY - 2026
DA - 2026/08/01
JO - BMC medical education
DO - 10.1186/s12909-026-10070-8
UR - https://europepmc.org/article/MED/42958232
AB - Background Traditional landmark-guided lumbar puncture (LP) has high failure rates among novice emergency medicine (EM) clinicians. While ultrasound guidance improves success, structured training models remain limited and expensive. We evaluated a cost-effective, simulation-based flipped classroom curriculum for teaching ultrasound-guided LP to EM residents and trainees.Methods We developed a high-fidelity, custom 3D-printed spinal simulator costing approximately $40 USD per unit. The curriculum utilized a flipped classroom model combining online theoretical modules with hands-on, deliberate practice.Results Twenty-two participants (9 EM residents, 13 PGY trainees) completed the training programme; paired landmark-versus-ultrasound OSCE data were available for the seven residents who completed both phases. Among EM residents with paired data (n = 7), the ultrasound-guided phase OSCE completion rate was 100%, compared to 43% during the earlier landmark phase (a large but statistically non-significant difference, p = 0.125, McNemar's exact test). The ultrasound-guided phase was associated with higher rubric-rated performance scores and overall ratings (nominally significant, uncorrected for multiple comparisons); needle passes (median 7 vs. 12) and procedure times were also lower but did not reach statistical significance in this small paired sample. Both groups reported significantly lower procedural stress with ultrasound guidance, with a smaller, non-significant increase in confidence.Conclusions A flipped classroom curriculum utilizing a low-cost, 3D-printed simulator is a feasible and well-received educational innovation for teaching ultrasound-guided LP, with encouraging but preliminary performance findings for EM residents that require confirmation in controlled studies.
SN - 1472-6920
ER -