I use a tablet pen and largely prefer to use the tablet pen tapping exclusively if I can. I can hit quarter-beat note streams fairly accurately on songs under 150bpm I think, but during some messes I alternate pen taps with Ctrl - that's right screw z/x I am hardcore and different and use ctrl + pen. 95% of the time I am using just pen taps but that other 5% see the introduction of Ctrl with my left index finger.