Training and assessment of skills in neuraxial space access: a scoping review of educational approaches to lumbar puncture, epidural anaesthesia, and spinal anaesthesia

Abstract

Background: Neuraxial space access, including lumbar puncture, spinal anaesthesia, and epidural anaesthesia, is important in clinical practise for diagnostics and anaesthesia. Despite frequent use, standardised educational recommendations for training and assessing proficiency in these procedures are not well-integrated. The following research question was formulated: what is known from published literature to guide future educational recommendations for training and skills assessment of neuraxial space access with and without the use of ultrasound? Methods: On May 7, 2024, searches were performed in the Cochrane Library, MEDLINE (Ovid), Scopus, PubMed, CINAHL (EBSCO), and EMBASE (Ovid). Studies were eligible if they involved physicians, medical students, or nurses and focused on training or assessment of neuraxial space access skills. No comparator was required, and all study designs were included if outcomes could be assessed using Kirkpatrick framework. There were no restrictions on language or publication date. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Results: The review included 99 studies, and overall, 28 (28%) of the included studies were of low quality with a MERSQI score <9, whereas 22 (22%) were of high quality with a MERSQI score of ≥14. The designs were primarily cohort studies (68%) and RCTs (24%). Specialities represented were mainly anaesthesia (22%) and paediatrics (17%), but many were not reported (30%). Training modalities varied, predominantly using low-fidelity manikins (55%). Simulation-based methods enhanced procedural confidence and technical skills. Conclusions: Studies on education in neuraxial space access show substantial variation in educational approaches and assessment. Consistent findings indicate that simulation-based training enhances outcomes across multiple Kirkpatrick levels, although the studies generally have low methodological quality. Further high-quality research is needed, especially linking training and assessment to patient outcomes.