A randomized controlled trial of simulation‐based mastery learning to teach the extended focused assessment with sonography in trauma

Abstract

Background: Mastery learning has gained popularity for training residents in procedural skills due to its demonstrated superiority over traditional methods. However, no studies have compared the efficacy of traditional versus mastery learning methods in residency point-of-care ultrasound education. We hypothesized that mastery learning would improve residents' skills in performing the extended focused assessment with sonography in trauma (eFAST).Methods: All first-year emergency medicine (EM) resident physicians at a single university hospital underwent a crossover randomized controlled trial to receive masterylearning eFAST training either at the beginning of the academic year or 6 months into intern year. Participants were taught using a checklist validated by a panel of experts using Mastery Angoff methods and were given feedback on missed tasks until each trainee completed the eFAST with a minimum passing standard (MPS). Our primary outcome was technical proficiency between the two groups for eFAST examinations performed in the emergency department during the academic year.Results: Sixteen interns were enrolled; eight were randomized to each group. The group that received mastery training at the beginning of the year had mean clinical eFAST proficiency scores above the MPS in the first two quarters of the academic year, while the control group did not. Once the control group underwent eFAST mastery training at the midpoint of the year, both groups had mean proficiency scores above the MPS for the remainder of the year. Conclusion:Simulation-based mastery learning is an effective method of teaching the eFAST examination. This training during intern orientation conferred early proficiency in clinical performance of eFAST among EM residents. This difference in proficiency was no longer present after the control group received mastery learning education halfway through the academic year.

Development of an expert consensus checklist for emergency ultrasound

“…Our study helps to fill remaining gaps in the evolving EUS assessment literature. Prior checklists were often based on a search of available literature and local expert opinion at a single institution, instead of a recognized standard for EUS imaging and national expert consensus 10,17,22,23 . Others have proposed general checklists for EUS, which may have limited applicability to the unique steps of specific applications 16,17,23 .…”

“…Prior checklists were often based on a search of available literature and local expert opinion at a single institution, instead of a recognized standard for EUS imaging and national expert consensus. 10,17,22,23 Others have proposed general checklists for EUS, which may have limited applicability to the unique steps of specific applications. 16,17,23 Moreover, published EUS checklists often have limited validity and reliability evidence.…”

“…5 Checklists may help guide individualized deliberate practice with mastery learning and better inform competency assessments. [6][7][8][9][10][11][12] Checklists have previously been proposed for EUS, focused echocardiography by surgical residents, fetal assessment ultrasounds (USs) for obstetrics residents, and abdominal ultrasonography by radiology trainees. 10,[13][14][15][16][17] However, checklists are not widely utilized due partly to remaining gaps in the literature.…”

“…[6][7][8][9][10][11][12] Checklists have previously been proposed for EUS, focused echocardiography by surgical residents, fetal assessment ultrasounds (USs) for obstetrics residents, and abdominal ultrasonography by radiology trainees. 10,[13][14][15][16][17] However, checklists are not widely utilized due partly to remaining gaps in the literature. Prior checklists were often based on local expert opinion at a single institution and lacked reliability and validity evidence.…”

“…Today's competency‐based medical education mandates both individualized learning and standardized outcomes 5 . Checklists may help guide individualized deliberate practice with mastery learning and better inform competency assessments 6–12 . Checklists have previously been proposed for EUS, focused echocardiography by surgical residents, fetal assessment ultrasounds (USs) for obstetrics residents, and abdominal ultrasonography by radiology trainees 10,13–17 .…”