Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance

Introduction: Mastery learning, which deconstructs a complex task into sequential sub-steps combined with deliberate practice to achieve each step in sequence, represents an important method to enhance simulation-based procedural skills training. However, the evidence to support the effectiveness of this theory to improve learning is lacking. This study compared mastery learning using deliberate practice with self-guided practice on skill performance of a rarely performed, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC). Methods: In this multi-centre, randomized study at five North American emergency medicine (EM) residency training programs, we assigned 166 EM postgraduate trainees to either mastery learning and deliberate practice (ML + DP) or self-guided practice for BAC. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test) and after (post-test) each training session. The primary outcome was post-test skill performance using a 5-point global rating score (GRS). A secondary outcome, defined a priori, was performance time to complete the BAC skill (chronometry). Results: There was no significant difference in post-test BAC performance after ML + DP or self-guided practice. Performance scores improved for both groups by 13% from the pre-test to post-test (F (1,138) = 43, p < 0.001). Overall, time to complete the BAC improved significantly from pre-test (87.6 seconds) to posttest (54.1 seconds), (F, 1,149) = 122, p < 0.001). At post-test, the ML + DP group performed the skill 7.4 seconds faster than the self-guided practice group (F (1,150) = 6.77, p < 0.01). Conclusion: Mastery learning coupled with deliberate practice provides systematic and focused feedback during skill acquisition. However, it is resource intensive and its efficacy is not fully defined. In this study, MP + DP did not result in improved global performance; it did result in faster performance times, a relevant finding for time-sensitive procedures. These results are important for educators who seek to optimize technical skills training in a competency-based model of medical education. Our findings suggest that time-sensitive procedures might benefit from ML + DP teaching strategies to enhance time to procedural performance.

Download Full-text

Optimizing Mastery Learning Environments: A New Approach to Deliberate Practice for Simulation-based Learning

AEM Education and Training ◽

10.1002/aet2.10083 ◽

2018 ◽

Vol 2 (2) ◽

pp. 77-81 ◽

Cited By ~ 1

Author(s):

Julie Rice ◽

Rodney Omron ◽

Hugh Calkins

Keyword(s):

Learning Environments ◽

Mastery Learning ◽

Deliberate Practice ◽

New Approach ◽

Simulation Based

Download Full-text

Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

Anesthesiology Research and Practice ◽

10.1155/2014/659160 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Ankeet D. Udani ◽

Alex Macario ◽

Kiruthiga Nandagopal ◽

Maria A. Tanaka ◽

Pedro P. Tanaka

Keyword(s):

Clinical Performance ◽

Mastery Learning ◽

Deliberate Practice ◽

Intervention Group ◽

Control Group ◽

Baseline Assessment ◽

Simulation Based ◽

Improved Performance ◽

Time Required ◽

Anesthesia Residents

Introduction.Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB.Methods.21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR).Results.Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03). The OR time required to perform SAB was not different between groups.Conclusions.The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

Download Full-text

An enhanced approach to simulation-based mastery learning: optimising the educational impact of a novel, National Postgraduate Medical Boot Camp

Advances in Simulation ◽

10.1186/s41077-021-00157-1 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Emma L. Scahill ◽

Nathan G. Oliver ◽

Victoria R. Tallentire ◽

Simon Edgar ◽

James F. Tiernan

Keyword(s):

Skill Acquisition ◽

Thematic Analysis ◽

Mastery Learning ◽

Deliberate Practice ◽

Peer Learning ◽

Likert Scale ◽

Assessment Process ◽

Peer Observation ◽

Educational Impact ◽

Simulation Based

Abstract Background Simulation-based mastery learning (SBML) is an effective, evidence-based methodology for procedural skill acquisition, but its application may be limited by its resource intensive nature. To address this issue, an enhanced SBML programme has been developed by the addition of both pre-learning and peer learning components. These components allowed the enhanced programme to be scaled up and delivered to 106 postgraduate doctors participating in a national educational teaching programme. Methods The pre-learning component consisted of an online reading pack and videos. The peer learning component consisted of peer-assisted deliberate practice and peer observation of assessment and feedback within the SBML session. Anonymised pre- and post-course questionnaires were completed by learners who participated in the enhanced programme. A mixture of quantitative and qualitative data was obtained. Results Questionnaires were distributed to and completed by 50 learners. Both sections of the pre-learning component were highly rated on the basis of a seven-point Likert scale. The peer learning component was also favourably received following a Likert scale rating. Peer observation of the performance and assessment process was rated similarly by first and second learners. The thematic analysis of the reasons for which peer-assisted deliberate practice was considered useful showed that familiarisation with equipment, the rehearsal of the procedure itself, the exchange of experiences and sharing of useful tips were important. The thematic analysis of the reasons why peer observation during ‘performance, assessment and feedback’ was useful highlighted that an ability to compare a peer’s performance to their own and learning from observing a peer’s mistakes were particularly helpful. Conclusion The SBML programme described has been enhanced by the addition of pre-learning and peer learning components which are educationally valued and allow its application on a national scale.

Download Full-text