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

Abstract

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.