Simulation-Based Mastery Learning Improves Ventricular Assist Device Self-Care Skills

Abstract

Introduction No recognized standards exist for teaching patients and their caregivers crucial ventricular assist device (VAD) self-care skills. We created a simulation-based mastery learning (SBML) VAD self-care curriculum for patients and caregivers. SBML is an intense form of competency-based learning wherein all learners are required to meet or exceed a minimum passing standard (MPS) on skills assessed on a simulator before completion of training. This study compares the effectiveness of a VAD SBML self-care training curriculum with usual VAD self-care training. Hypothesis We hypothesized that SBML-training would provide superior learning outcomes compared to usual training for VAD self-care skills at hospital discharge. Methods From June 2017 to February 2019, VAD patients and their caregivers at a high volume, tertiary care VAD center, were randomized to SBML or usual training. The SBML-trained group completed a simulated pretest on 3 VAD self-care skills (controller, power source, and driveline dressing changes), then viewed videos, and participated in deliberate practice on the simulator. SBML participants took a posttest on the simulated skills and were required to meet or exceed an MPS for each skill. The usual training group (patient and caregiver) was taught using the existing institutional VAD self-care teaching protocol. Before hospital discharge, the SBML and usual training groups took the same 3 VAD self-care skills tests on the actual patient (controller change tests used the simulator). We compared demographic and clinical information, self-confidence, total participant training time, and skills performance between groups. Results Forty participants (patient and caregiver pairs) completed the study in each group. There were no differences in demographic and clinical information, self-confidence or training time between groups. Significantly more participants in the SBML group met the MPS compared to the usual training group for controller [37/40 (93%) vs. 25/40 (63%; p=0.001)], power source [36/40 (90%) vs. 9/40 (23%, p Conclusions In this first study using SBML to train patients and caregivers, SBML provided superior learning outcomes compared to usual training. This study has significant implications for patient safety due to the morbidity and mortality associated with improper VAD self-care.