Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound-guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study.

Abstract

The serratus anterior plane block (SAPB) is a safe, single-injection alternative for pain control in patients with rib fractures. This pilot study aims to teach the ultrasound-guided SAPB to emergency medicine (EM) residents using a mastery learning approach. A 19-item checklist was created and mastery was determined to be 17 of 19 items correct. This pass score was established using a Mastery Angoff standard-setting exercise with a group of EM experts. Learners participated in baseline testing on a simulated model and performance was assessed by two raters. Learners then watched an instructional video and participated in an individualized teaching session. Learners underwent deliberate practice followed by posttesting until mastery was achieved. Score differences in baseline testing and posttesting were analyzed using a paired t-test. Pre- and posttesting surveys were also completed by participants. Twenty-eight PGY-1 to -4 residents volunteered to participate in the study. The range of reported SAPBs seen previously was 0 to 5. The mean (±SD) number of items correct on the checklist for initial testing was 8.5 of 19 (±2.7), while the mean (±SD) final score was 18 of 19 (±0.6; p<0.001). All participants met mastery standards after the curriculum intervention. Median self-reported procedural confidence was 2 out of 5 on a 5-point Likert scale before the session and 5 out of 5 after the session (Z=-4.681, p<0.001). Using a mastery learning approach and simulated model, we were able to successfully train EM residents to perform the SAPB at a level of mastery and increase their overall confidence in executing this procedure.