[Assessment of lumbar puncture skills in students, interns and residents attending hospital internship].

Although lumbar puncture is recognized as a great contributor to the diagnosis of some neurological diseases, the modalities of learning this procedure are still poorly defined in training programs for students attending their hospital internships. Apprehension related to the lack of experience and the fear of failure accelerates the abandonment of the practice. This study aims to assess lumbar puncture skills in the students at the Faculty of Medicine in Nouakchott as well as their subjective experience of this procedure. We conducted a survey of TCEM and DCEM 4 interns, residents and students in May 2017. An anonymous questionnaire on teaching and lumbar puncture practice was elaborated and completed by 92 participants. Data were analyzed using SPSS 20 software. Out of 105 question sheets, only 92 were workable, reflecting a participation rate of 87.6%. Sixty-seven boys and twenty-five girls participated in the survey. Twelve participants had never performed lumbar puncture, most often because they had low self-esteem. Nearly 10% of students had never learned to do this procedure and 22% had learned it without a supervisor (senior doctor). Lumbar puncture failure rate was 45% among our trainees. Few of them recognized (7.5%) that they had prescribed sedation or local anesthesia to patients before lumbar puncture. Sitting position was much more used than lateral decubitus, but 30% of students reported that they had used both. Lumbar puncture was used to help diagnosis in 69% of cases but in 25% of cases it was performed for diagnostic and therapeutic purpose. Diagnostic indications were dominated by meningitis and meningoencephalitis while normal pressure hydrocephalus was the primary motivation for therapeutic lumbar puncture. Our interns reported that complications mainly included traumatic lumbar puncture followed by headache. Lumbar puncture was mainly performed in the Department of Pediatrics (35%), followed by the Department of Neurology (29%), the Emergency Department (19%) and Internal Medicine (9%). The results of our survey show that lumbar puncture practice is still difficult and risky for many students and that they are not sufficiently prepared for it. The modalities of procedure teaching and learning should be reviewed by supervisors, who could integrate new techniques, such as medical simulation dummies, as in most developed countries.