Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy

Abstract

Introduction Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency. There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT. Methods We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests. Results Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001). Conclusion This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure.

Standard Setting in Simulation-based Training of Surgical Procedures

“…In the category of item-centered standard setting methods, the Angoff method was used in 9 studies. 29,35,[53][54][55][56][57][58][59] This method allows content experts to make judgement on each individual item, then to determine if a borderline trainee who is just at the edge of minimal competence will pass that exact part of the task or checklist. We found the method to be applied with a number of variations, which were more or less in concordance with the original method.…”

Simulation-based Mastery Learning Improves Emergency Medicine Residents’ Ability to Perform Temporary Transvenous Cardiac Pacing

“…These findings add to existing literature that shows SBML to be a highly effective form of competency-based medical education, particularly for Western Journal of Emergency Medicine infrequently performed invasive procedures. [15][16][17] The rigorous MPS set for this curriculum -93.3% -is similar to the high standards set for other mastery learning interventions. 18,21 While mastery, defined as meeting the MPS, is ultimately a dichotomous variable, analyzing performance by checklist score allowed for a more granular understanding of a learner's Western Journal of Emergency Medicine 6…”

“… 13 , 14 SBML is a proven method for assessing and improving trainee performance for a variety of invasive procedures in the EM scope of practice, including lumbar puncture, 15 central venous catheter insertion, 16 and emergency department (ED) thoracotomy. 17 SBML seems well-suited to improving TVP training and performance; however, to our knowledge no mastery learning curriculum exists for this procedure.…”

Development of an expert consensus checklist for emergency ultrasound

“…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.…”

“…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 .…”