O24 Using deliberate practice and mastery learning in simulation teaching

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

BackgroundSimulation-based medical education (SBME) is a cornerstone for procedural skill training in residency education. Multiple studies have concluded that SBME is highly effective, superior to traditional clinical education, and translates to improved patient outcomes. Additionally it is widely accepted that mastery learning, which comprises deliberate practice, is essential for expert level performance for routine skills; however, given that highly structured practice is more time and resource-intensive, it is important to assess its value for the acquisition of rarely performed technical skills. The bougie-assisted cricothyroidotomy (BAC), a rarely performed, lifesaving procedure, is an ideal skill for evaluating the utility of highly structured practice as it is relevant across many acute care specialties and rare – making it unlikely for learners to have had significant previous training or clinical experience. The purpose of this study is to compare a modified mastery learning approach with deliberate practice versus self-guided practice on technical skill performance using a bougie-assisted cricothyroidotomy model.MethodsA multi-centre, randomized study will be conducted at four Canadian and one American residency programs with 160 residents assigned to either mastery learning and deliberate practice (ML + DP), or self-guided practice for BAC. Skill performance, using a global rating scale, will be assessed before, immediately after practice, and 6 months later. The two groups will be compared to assess whether the type of practice impacts performance and skill retention.DiscussionMastery 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. This multi-centre study will provide generalizable data about the utility of highly structured practice for technical skill acquisition of a rare, lifesaving procedure within postgraduate medical education. Study findings will guide educators in the selection of an optimal training strategy, addressing both short and long term performance.

Simulation-Based Learning as a Strategy to Optimizing Efficiency of Upper Endoscopy and Colonoscopy

TF14 Development of a Distal Radius Fracture Mastery Learning Class

Surgical training using the apprenticeship model of “see one, do one, teach one” originated with Halsted in the 19th century and has continued forward. However, it may not be the most optimal and effective way to train clinicians. Simulation-based training emerged in recent decades and follows a stepwise approach starting with basic skills training, moving on to procedural training culminating in team training in an authentic environment. Simulation is used for specific and specialized skills training, deliberate practice, mastery of learning, and rapid knowledge acquisition, creating a structured teaching and learning framework. Simulation-based education programs must be embedded into a curriculum and should not be an optional add-on. Several curriculum design models exist. In this review, the five-phase ADDIE approach was used to inform a prototype curriculum. ADDIE is the acronym for analyze, design, develop, implement, and evaluate. It is used for systematic instructional design where knowledge and performance gaps have been identified and where every step in the design is dictated by the learning outcomes. The ADDIE model is an iterative instructional design where the results of the formative evaluation of each phase may lead to any of the previous phases. The process validates the procedures and products related to the development of learner-centered learning encounters and adds credibility by analyzing and evaluating procedures and interrelatedness. Sufficient evidence that simulation training improves individual and team performance is available. It has a positive effect on self-confidence, knowledge, and operational performance. Further evidence proves that deliberate practice, procedural simulation, and debriefing can be transferred to operational performance in clinical settings and could result in safer and more efficient care for patients, health-care providers, and health systems.

Mastery Learning in Preclinical Endodontics Using Customized 3D-Printed Tooth Models for Deliberate Practice: An Application of Educational Design Research

Deliberate practice (DP) is a method of mastery learning widely used in healthcare education. Investigations into improved mastery learning environments are important as we move to competency-based educational models. The objective of this pilot project is to create and test the feasibility of a simulation-based learning methodology based on close adherence to the tenants of DP for the acquisition of mastery knowledge. We created a new methodology for simulation-based mastery learning modules after review of the tenants of DP. A module was constructed to highlight important aspects of supraventricular tachycardia (SVT) management in accordance with current American Heart Association practice guidelines and underwent expert review. Ten emergency medicine interns completed the module as part of the pilot. The number of case attempts, critical actions completed, and time to cardioversion of unstable patients were recorded. Resident confidence was reported before and several months after the module via survey instrument. Six cases of patients presenting with SVT were created and critical actions were defined. Cases were ordered in increasing difficulty to form a module in which learners were placed immediately into more complex contexts to practice the skill of SVT management with feedback provided between each case attempt. Residents averaged 2.5 attempts to complete case one. All completed case six on first attempt. All residents completed the six cases within the 2-hour module. Time to cardioversion decreased significantly on repetitive practice. Increased resident confidence in several areas of SVT management was maintained several months postintervention. The best methods for the use of DP to encourage mastery learning have not been well defined. Participation in our pilot case increased novice trainee performance and confidence in the management of SVT. Several challenges inherent in testing mastery knowledge acquisition were encountered and will inform future study of this new educational strategy.

Address rehearsal

Aim: The purpose of this study is to comparison the effect of mastery learning model and WhatsApp assisted learning on teaching psychomotor skills.Material and method: The study was conducted as a triangulation study between 8 March- 16 December, 2016. The students were divided into two groups in a randomized way. One of the groups (n:30) was instructed with mastery learning model concerning the skill of inserting nasogastric catheter; whereas, the other group (n:30) was assisted through WhatsApp. While the quantitative data were collected by using “Nasogastric Catheter Insertion Skill Check List”, the qualitative data were collected through the focus group interview. The data were analyzed by using number, percentage, student-t test, and descriptive analysis method.Results: The skill mean scores for the students learning the skill of nasogastric catheter insertion through WhatsApp assistance were (26.27±5.70) significantly higher than the mean scores of those learning this skill with mastery learning model (22.07±4.06). However, it was found that students learning with mastery learning experienced less stress during the practice. Conclusion: It is considered that in teaching of psychomotor skills, the use of means of social media such as WhatsApp as a support to the courses together with the mastery learning model would be beneficial. Extended English abstract is in the end of PDF (TURKISH) file. ÖzetAmaç: Araştırma, tam öğrenme modeli ile WhatsApp destekli öğretimin psikomotor beceri öğretimine etkilerinin karşılaştırılması [sbf1] amacıyla yapılmıştır.Materyal Metot: Araştırma, Mart- Aralık 2016 tarihleri arasında triangülasyon çalışması olarak yapılmıştır. Öğrenciler, randomize olarak iki gruba ayrılmıştır. Bir gruba (n:30), nazogastrik sonda takma becerisiyle ilgili tam öğrenme modeliyle destek verilirken diğer gruba (n:30) WhatsApp ile destek verilmiştir. “Nazogastrik Sonda Takma Becerisi Kontrol Listesi” kullanılarak nicel veriler, odak grup görüşmesiyle nitel veriler toplanmıştır. Veriler sayı, yüzdelik, student-t testi ve betimsel analiz yöntemiyle analiz edilmiştir.Bulgular: Nazogastrik sonda takma becerisini WhatsApp desteğiyle öğrenen öğrencilerin beceri puan ortalamaları (26.27±5.70), tam öğrenme modeliyle öğrenen öğrencilerin ortalamalarından (22.07±4.06) anlamlı derecede yüksek bulunmuştur. Ancak, tam öğrenme modeliyle öğrenen öğrencilerin uygulamada daha az stres yaşadıkları saptanmıştır. Sonuç:WhatsApp gibi sosyal medya araçlarının, beceri eğitiminde tam öğrenme modeliyle birlikte derslere destek olarak kullanılmasının yararlı olacağı düşünülmektedir.// Annotate Highlight // Annotate Highlight // Annotate Highlight // Annotate Highlight // Annotate Highlight // Annotate Highlight // Annotate Highlight // Annotate Highlight

A Practical Review of Mastery Learning

Surgical education has traditionally relied on apprenticeship, which is limited by the availability of operations and case variability. Deliberate practice (DP) is a structured, goal-directed training method that emphasizes targeted objectives and individualized feedback. This study compared trainee performance in distal radius malunion osteotomy on three-dimensional-printed bone models using naïve practice (NP) versus video-assisted DP. Twelve participants were stratified by expertise level (levels 1 and 2), assigned to either the NP or DP group, and tasked to complete five consecutive trials (E1–E5). Performance was assessed using the Objective Structured Assessment of Technical Skill (score range: 15–75) and analyzed with appropriate statistical methods. Baseline scores (E1) were similar between NP (57.7 ± 7.4) and DP (60.2 ± 9.1; p = 0.87). By E5, DP participants achieved higher scores (72.0 ± 2.8) than NP (67.0 ± 4.5; p = 0.038). Improvement was greatest in level 1 trainees, who demonstrated larger relative gains, despite lower absolute scores compared with level 2 participants These results are consistent with the literature demonstrating the effectiveness of DP in orthopaedics and highlight the complementarity between DP and mental practice. The systematic integration of active, feedback-guided methods—such as video-assisted DP—may shorten the learning curve and raise the performance level of surgical trainees.

Highlights Simulation-based mastery learning allows for time-variable practice. Mastery learning includes a pretest, deliberate practice, and a posttest. Learners meet minimum passing standards to move on to the next training stage.

BackgroundTrainee supervision and teaching are distinct skills that both require faculty physician competence to ensure patient safety. No standard approach exists to teach physician supervisory competence, resulting in variable trainee oversight and safety threats. The Objective Structured Teaching Evaluation (OSTE) does not adequately incorporate the specific skills required for effective supervision. To address this continuing medical education gap, the authors aimed to develop and identify validity evidence for an “Objective Structured Supervision Evaluation” (OSSE) for attending physicians, conceptually modeled on the historic OSTE.MethodsAn expert panel used an iterative process to create an OSSE instrument, which was a checklist of key supervision items to be evaluated during a simulated endotracheal intubation scenario. Three trained “standardized residents” scored faculty participants' performance using the instrument. Validity testing modeled a contemporary approach using Kane's framework. Participants underwent simulation‐based mastery learning (SBML) with deliberate practice until meeting a minimum passing standard (MPS).ResultsThe final instrument contained 19 items, including three global rating measures. Testing domains included supervision climate, participant control of patient care, trainee evaluation, instructional skills, case‐specific measures, and overall supervisor rating. Reliability of the assessment tool was excellent (ICC range 0.84–0.89). The assessment tool had good internal consistency (Cronbach's α = 0.813). Out of 24 faculty participants, 17 (70.8%) met the MPS on initial assessment. All met the MPS after SBML and average score increased by 19.5% (95% CI of the difference 10.3%–28.8%, p = 0.002).ConclusionsThe OSSE is a promising tool to assess faculty supervision performance. Further study should evaluate the effect of OSSE training on supervision in the clinical environment, which may have measurable changes in patient‐centered outcomes and resident teaching.

Online Simulation-Based Mastery Learning with Deliberate Practice: Developing Interprofessional Communication Skill

Deliberate practice is increasingly recognised as necessary for professional development. This paper sets out to explore in what ways student teachers’ learning activities in a teacher education programme can be characterised as deliberate practice. Based on an in-depth exploration of 574 learning activities, our results highlight the different ways in which activities in teacher education programmes can be designed, the different motivations students have to engage in them repetitively, and different ways in which feedback can be organised, within contextual constraints posed by all professional environments. Results also indicate that self-improvement is not the only motivation for engaging in deliberate practice for student teachers, as pupil improvement is also considered important. These results support a context-specific operationalisation of deliberate practice and provide starting points for teacher education programmes to promote deliberate practice in their curriculum.