Simulation-based Mastery Learning Research Articles

Varied Trainee Competence in Cold Snare Polypectomy - Results of the COMPLETE Randomized Controlled Trial.

Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy technique and quality has been established, the learning curve and impact of targeted training on CSP are unknown. Video feedback has shown promise as an effective pedagogy to improve performance among surgical trainees. We aimed to compare CSP performance between trainees who received video-based feedback to conventional apprenticed-based concurrent feedback. We hypothesized that video feedback would accelerate competence. We conducted a single-blinded, randomized controlled trial on competence for CSP of polyps <1cm, comparing video to conventional feedback. We randomly assigned de-identified consecutively recorded CSP videos to blinded raters to assess using the CSP Assessment Tool (CSPAT). We shared cumulative sum (CUSUM) learning curves every 25 CSPs with each trainee. The video feedback trainees also received biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence. We also assessed competence across domains and change over polypectomy volume. We enrolled and randomized 22 trainees; 12 to video and 10 to conventional feedback, and evaluated 2339 CSPs. The learning curve was long; two trainees (16.7%) in the video feedback achieved competence, after a mean of 135 polyps, and no one in the control (p=0.481) achieved competence. Overall and in all steps of CSP, a higher percentage of the video feedback group met competence, increasing 3% every 20 CSPs (P=0.0004). Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine if such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov: NCT03115008.

Virtual Simulation-Based Mastery Learning Ensures Competence in Breaking Bad News for Emergency Medicine Residents: A Multi-Institutional Study (Sci260)

Virtual Simulation-Based Mastery Learning Ensures Competence in Breaking Bad News for Emergency Medicine Residents: A Multi-Institutional Study (Sci260)

Simulation-based Mastery Learning Improves Critical Care Skills of Advanced Practice Providers.

Advanced practice providers (APPs) are essential members of intensive care unit (ICU) interprofessional teams and are expected to be competent in performing procedures. There are no published criteria for establishing when APPs can independently perform procedures. Simulation-based mastery learning (SBML) is an effective strategy for improving critical care skills but has not been applied to practicing ICU APPs. The purpose of this study was to evaluate if an SBML curriculum could improve the critical care skills and procedural self-confidence of ICU APPs. We performed a pretest-posttest study of central venous catheter (CVC) insertion, thoracentesis, and mechanical ventilation (MV) management skills among ICU APPs who participated in an SBML course at an academic hospital. For each skill, APPs underwent baseline skills assessments (pretests) on a simulator using previously published checklists, followed by didactic sessions and deliberate practice with individualized feedback. Within 2 weeks, participants were required to meet or exceed previously established minimum passing standards (MPS) on simulated skills assessments (posttests) using the same checklists. Further deliberate practice was provided for those unable to meet the MPS until they retested and met this standard. We compared pretest to posttest skills checklist scores and procedural confidence. All 12 eligible ICU APPs participated in internal jugular CVC, subclavian CVC, and MV training. Five APPs participated in thoracentesis training. At baseline, no APPs met the MPS on all skills. At training completion, all APPs achieved the mastery standard. Internal jugular CVC pretest performance improved from a mean of 67.2% (standard deviation [SD], 28.8%) items correct to 97.1% (SD, 3.8%) at posttest (P = 0.005). Subclavian CVC pretest performance improved from 29.2% (SD, 32.7%) items correct to 93.1% (SD 3.9%) at posttest (P < 0.001). Thoracentesis pretest skill improved from 63.9% (SD, 30.6%) items correct to 99.2% (SD, 1.7%) at posttest (P = 0.054). Pretest MV skills improved from 54.8% (SD, 19.7%) items correct to 92.3% (SD, 5.0%) at posttest (P < 0.001). APP procedural confidence improved for each skill from pre to posttest. SBML is effective for training APPs to perform ICU skills. Relying on traditional educational methods does not reliably ensure that APPs are adequately prepared to perform skills such as CVC insertion, thoracentesis, and MV management.

Simulation-based mastery learning improves physical exam-indicated cerclage skills among OB/GYN residents

The use of physical exam-indicated cerclage (PEIC) has been associated with a reduction in perinatal morbidity and prolonged gestational latency. However, it is a technically challenging, infrequent procedure with associated risks. Simulation-based mastery learning (SBML) is an evidence-based teaching modality that has been shown to improve competency among medical trainees, especially for low frequency, high acuity procedures. We aimed to develop a SBML curriculum to teach PEIC placement to first and second-year OB/GYN residents.

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

Temporary transvenous cardiac pacing (TVP) is a critical intervention that emergency physicians perform infrequently in clinical practice. Prior simulation studies revealed that emergency medicine (EM) residents and board-certified emergency physicians perform TVP poorly during checklist-based assessments. Our objective in this report was to describe the design and implementation of a simulation-based mastery learning (SBML) curriculum and evaluate its impact on EM residents' ability to perform TVP. An expert panel of emergency physicians and cardiologists set a minimum passing standard (MPS) for a previously developed 30-item TVP checklist using the Mastery Angoff approach. Emergency medicine residents were assessed using this checklist and a high-fidelity TVP task trainer. Residents who did not meet the MPS during baseline testing viewed a procedure video and completed a 30-minute individual deliberate practice session before retesting. Residents who did not meet the MPS during initial post-testing completed additional deliberate practice and assessment until meeting or exceeding the MPS. The expert panel set an MPS of correctly performing 28 (93.3%) checklist items. Fifty-seven EM residents participated. Mean checklist scores improved from 13.4 (95% CI 11.8-15.0) during baseline testing to 27.5 (95% CI 26.9-28.1) during initial post-testing (P < 0.01). No residents met the MPS at baseline testing. The 21 (36.8%) residents who did not meet the MPS during initial post-testing all met or exceeded the MPS after completing one additional 30-minute deliberate practice session. Emergency medicine residents demonstrated significantly improved TVP performance with reduced variability in checklist scores after completing a simulation-based mastery learning curriculum.

Pilot Study Using Decision Trees to Diagnose the Efficacy of Virtual Offshore Egress Training

For the offshore energy industry, virtual environment technology can enhance conventional training by teaching basic offshore safety protocols such as onboard familiarization and emergency evacuation. Virtual environments have the added benefit of being used to investigate the impact of different training approaches on competence. This pilot study uses decision tree modeling to examine the efficacy of two pedagogical approaches, simulation-based mastery learning (SBML) and lecture-based training (LBT), in a virtual environment. Decision trees are an inductive reasoning approach that can be used to identify learners’ egress strategies in offshore emergencies after training. The efficacy of the virtual training is evaluated in three ways: 1) analyzing participants’ performance scores in test scenarios; 2) comparing the decision tree depiction of participant's understanding of emergency egress to the intended learning objectives; and 3) comparing the decision strategies developed under a different pedagogical approach. A comparison of the resulting decision trees from the SBML training with trees generated from the LBT showed that the different training methods influenced the participants’ egress strategies. The SBML approach resulted in concise decision trees and better route selection strategies when compared to the LBT training. This pilot study demonstrates the diagnostic capabilities of decision trees as training assessment tools and recommends integrating decision trees into virtual training to better support the learning needs of individuals and deliver adaptive training scenarios.

Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care.

We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.

Improving performance and self-efficacy of novice nurses using hybrid simulation-based mastery learning.

Acute chest pain is a commonly encountered symptom in hospital medical/surgical units; however, almost half of nurses in their second year of clinical experience in our facility have reported struggling to care for acute chest pain patients. We developed, implemented, and examined the effectiveness of a simulation-based, mastery learning clinical nursing educational program to improve self-efficacy and performance in caring for patients with acute chest pain. The study adopted a single-site, single-cohort design using simulation-based performance assessment and self-efficacy surveys on a convenience sample of 37 second-year clinical nurse participants in multi-stage hybrid mastery learning educational intervention using asynchronous e-learning, and hands-on simulation training and assessment with feedback on caring for chest pain patients. Performance assessments and self-efficacy surveys were administered pre-, post-, and 5 months post-intervention. Clinical performance on the post- and 5 months follow-up assessments were significantly higher than those for the pre-test (P < .0001). The self-efficacy scores for the post- and the 5 months follow-up assessments were significantly higher than the pre-course scores (P < .0001). Participants' self-efficacy perceptions were positively correlated with their performances at 5 months post-intervention. Performance and self-efficacy of novice nurses in caring for acute chest pain patients improved significantly with the multi-stage hybrid mastery learning educational intervention, with improvements retained 5 months post-intervention. The results suggest the applicability of simulation-based mastery learning in a clinical setting for novice nurses to attain specific skills, and raise their self-perception of competence to care for patients in acute settings.

Enhanced simulation-based mastery learning for the attainment of procedural skills competence for acute common care stem (ACCS) trainees

A new curriculum for Acute Common Care Stem (ACCS) trainees was introduced in 2021 and included a mandatory requirement to have specific practical assessments performed, known as Direct Observation of Procedural Skills (DOPS). These aimed to provide evidence of competence and enable progression through training. The curriculum change prompted the creation of a novel one-day skills-based course in order to ensure that all the ACCS trainees met the required level of competence. An enhanced simulation-based mastery learning method was used to ensure that trainees have the clinical knowledge to identify when future practical emergency skills are indicated and have the psychomotor skills necessary to perform these procedures safely and efficiently. This study was aimed at exploring the impact of a simulation-based mastery learning (SBML) [1] in a one-day procedural skills course. New curriculum content was reviewed in order to establish the different practical skills required for the second year of ACCS training. Regional trainees were then sent an online survey to ask which specific procedures they would like included on a skills course. There were five procedures requested: chest drain insertion (Seldinger and open), aspiration of air, DC cardioversion, and external cardiac pacing. Meetings with the local training programme director and simulation lead assisted in the formation of the skills day. Faculty were formed by registrars and consultants in Emergency Medicine. Trainees aimed to reach a competence level that would mean they still need in hospital supervision for any future procedures. Eight ACCS trainees attended a one-day skills-based course in May 2022. The course was preceded by multiple online e-learning resources and videos. The SBML day consisted of a demonstration with deliberate practice followed by DOPS assessments using simulation and trainee-focused feedback. Anonymised pre- and post-course questionnaires were completed by all trainees containing questions surrounding their experience and confidence in performing these procedural skills. All trainees achieved the required level of competence needed at their stage in training. Each trainee stated that their confidence levels improved in performing all five procedures after attending the course ( Mean confidence levels in procedures pre- and post-course using Likert scale (1–5) An enhanced SBML method in a one-day course enabled efficient, standardised procedural skills practice and assessment for a group of ACCS trainees. Training, practice, and assessment in necessary curricular competences were achieved together while improving the level of confidence in trainees performing these procedures. 1. Scahill E, Oliver N, Tallentire V, Edgar S, Tiernan J. An enhanced approach to simulation-based mastery learning: optimising the educational impact of a novel, National Postgraduate Medical Boot Camp. Advances in Simulation. 2021;6(1).

160 Emergency Medicine Attending Physician Performance of Pigtail and Thoracostomy Tube Insertion in a Simulated Environment

Emerging evidence suggests that attending physicians demonstrate variable performance of some bedside procedures. The primary objective of this study was to assess emergency medicine attending physician performance of pigtail and tube thoracostomy insertion in a simulated environment. Secondary objectives were to evaluate: 1) if a simulation-based mastery learning intervention improved performance, and 2) for potential correlations between baseline performance and participant comfort level or recent reported clinical experience.

Simulation-based mastery learning in gastrointestinal endoscopy training.

Simulation-based mastery learning (SBML) is an emerging form of competency-based training that has been proposed as the next standard method for procedural task training, including that in gastrointestinal endoscopy. Current basic gastrointestinal endoscopy training relies on the number of procedures performed, and it has been criticized for its lack of objective standards that result in variable skills among trainees and its association with patient safety risk. Thus, incorporating simulators into a competency-based curriculum seems ideal for gastrointestinal endoscopy training. The curriculum for SBML in gastrointestinal endoscopy is currently being developed and has promising potential to translate into the clinical performance. Unlike the present apprenticeship model of “see one, do one, teach one,” SBML integrates a competency-based curriculum with specific learning objectives alongside simulation-based training. This allows trainees to practice essential skills repeatedly, receive feedback from experts, and gradually develop their abilities to achieve mastery. Moreover, trainees and trainers need to understand the learning targets of the program so that trainees can focus their learning on the necessary skills and trainers can provide structured feedback based on the expected outcomes. In addition to learning targets, an assessment plan is essential to provide trainees with future directions for their improvement and ensure patient safety by issuing a passing standard. Finally, the SBML program should be planned and managed by a specific team and conducted within a developed and tested curriculum. This review discusses the current state of gastrointestinal endoscopy training and the role of SBML in that field.

The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland

BackgroundIntercostal chest drain (ICD) insertion is a skill that medical trainees lack confidence in performing. This study explores the impact of a national programme of Simulation-Based Mastery Learning (SBML) on procedural confidence, including the impact of time intervals between booster sessions and interim clinical experience.MethodsInternal Medicine Trainees in Scotland were surveyed about confidence and clinical experience with ICD insertion before and immediately after SBML and booster session. Data were matched and analysed using paired sample t-tests. Short interval and long interval groups were compared using Student’s unpaired t-test. The impact of interim clinical experience was assessed using Analysis of Variance.ResultsMean confidence in ICD insertion rose following SBML, fell between initial and booster session, and increased again following booster session (P = < 0.001). 33 of 74 trainees had successfully inserted an ICD between sessions. Fall in confidence was unaffected by the time interval between training sessions, but was mitigated by interim clinical experience.ConclusionsSBML boosts trainee confidence in ICD insertion. However, there is evidence of confidence decay, possibly due to a lack of clinical experience between sessions. More research is needed to explore barriers to transfer of skills from simulated to real-world environments.

Simulation-Based Mastery Learning Course for Tube Thoracostomy.

IntroductionTube thoracostomy is a relatively infrequent, high-risk procedure that is a required competency for emergency medicine residents. Simulation-based mastery learning is the gold standard for procedure training and has been used to successfully train residents in high-risk procedures.MethodsWe developed a simulation-based mastery learning course for tube thoracostomy for PGY 2 emergency medicine residents. The course included (1) precourse work, (2) baseline assessment using a modified version of the TUBE-iCOMPT checklist, (3) anatomy/radiology review, (4) deliberate practice to master individual aspects of the procedure, and (5) final assessment. If a minimum passing score was not achieved, additional coaching and deliberate practice occurred until the learner was able to achieve a minimum passing score.ResultsAfter piloting the course with a cohort of seven PGY 2 emergency medicine residents, we successfully trained 24 additional PGY 2 residents in the subsequent two classes. Combining all three cohorts (N = 31), there was a statistically significant increase in learners’ modified TUBE-iCOMPT scores (pretest M = 61.2, SD = 10.0; posttest M = 75.5, SD = 2.9; p < .001). Learners’ confidence in their ability to correctly place a chest tube increased, rated on a 10-point Likert scale (1 = not very confident, 10 = very confident; precourse M = 5.6, SD = 1.8; postcourse M = 8.3, SD = 1.1; p < .001).DiscussionThis simulation-based course was well received by learners. Our assessment demonstrated that learners improved directly observed procedural skills in simulation and confidence in tube thoracostomy placement.

Evidence-based assessment of acupuncture skills using a newly developed simulation-based test

ObjectiveAcupuncture is an efficient treatment modality for many different training, but the technique can be challenging to master. Identification of the different acupuncture points can now be practiced in a standardized and patient-safe simulation-based environment. We aim to gather additional evidence regarding simulation-based training of acupuncture skills and hope that the simulation-based test developed and will be used for simulation-based mastery learning in future develop. MethodsThe aim of this study was to develop a test of acupuncture skills using the TCM (Traditional Chinese Medicine) Meridians & Acupoints Anatomy Teaching Platform and gather validity evidence using Messick's framework. Novice medical students without prior experience in acupuncture (n = 43), intermediate medical students who had finished the mandatory acupuncture course (n = 24), and skilled acupuncture doctors (n = 17) were included in the study. One-hundred and seven acupuncture points were presented to the participants in identical randomized order and they were asked to identify each point by touching the correct anatomical location on the simulator. The simulator automatically registered the accuracy of participants’ answers. ResultsThe reliability of the final test (66 acupuncture points) was at a high level with a Cronbach's alpha of 0.98 and only 16 acupuncture points were needed to ensure a reliability of 0.90. The test could discriminate significantly between all three groups and a credible pass/fail-score of 34 points was determined which resulted in eight out of 43 (19%) novices passing the test and only two out of 17 (12%) experienced failing the test. These consequences were statistically significant (P < 0.001). ConclusionBased on Messick's framework we demonstrated strong validity evidence for a newly developed simulation-based test of acupuncture points localization skills. The test can be used as an aid to decide when trainees are ready to progress to more advanced training and clinical practice. Compared with the traditional point-point test, the point-point evaluation of the simulator can be more objective and reduce the effort of teachers.

The OSSE: Development and validation of an "Objective Structured Supervision Evaluation".

BackgroundTrainee supervision and teaching are distinct skills that both require faculty physician competence to ensure patient safety. No standard approach exists to teach physician supervisory competence, resulting in variable trainee oversight and safety threats. The Objective Structured Teaching Evaluation (OSTE) does not adequately incorporate the specific skills required for effective supervision. To address this continuing medical education gap, the authors aimed to develop and identify validity evidence for an “Objective Structured Supervision Evaluation” (OSSE) for attending physicians, conceptually modeled on the historic OSTE.MethodsAn expert panel used an iterative process to create an OSSE instrument, which was a checklist of key supervision items to be evaluated during a simulated endotracheal intubation scenario. Three trained “standardized residents” scored faculty participants' performance using the instrument. Validity testing modeled a contemporary approach using Kane's framework. Participants underwent simulation‐based mastery learning (SBML) with deliberate practice until meeting a minimum passing standard (MPS).ResultsThe final instrument contained 19 items, including three global rating measures. Testing domains included supervision climate, participant control of patient care, trainee evaluation, instructional skills, case‐specific measures, and overall supervisor rating. Reliability of the assessment tool was excellent (ICC range 0.84–0.89). The assessment tool had good internal consistency (Cronbach's α = 0.813). Out of 24 faculty participants, 17 (70.8%) met the MPS on initial assessment. All met the MPS after SBML and average score increased by 19.5% (95% CI of the difference 10.3%–28.8%, p = 0.002).ConclusionsThe OSSE is a promising tool to assess faculty supervision performance. Further study should evaluate the effect of OSSE training on supervision in the clinical environment, which may have measurable changes in patient‐centered outcomes and resident teaching.

Simulation Based Mastery Learning of Transesophageal Echocardiography.

Transesophageal echocardiography (TEE) education is part of pediatric cardiology fellow training. Simulation-based mastery learning (SBML) is an efficient and valuable education experience. The aim of this project was to equip trainees with the basic knowledge and skill required to perform a pediatric TEE. The secondary aim was to assess the utility of using SBML for pediatric TEE training. The target group is trainees from pediatric cardiology and cardiac anesthesia who participated in a TEE bootcamp. A baseline knowledge pretest was obtained. The knowledge session consisted of preparation via reading material, viewing recorded lectures and completing an iterative multiple-choice examination, which was repeated until a minimum passing score of 90% was achieved. The skills session involved a review of TEE probe manipulation and image acquisition, followed by rapid cycle deliberate practice using simulation to acquire TEE skills at 3 levels, advancing in complexity from level 1 to level 3. Eight individuals (7 pediatric cardiology fellows at varying training levels and one anesthesia attending) participated in the TEE bootcamp. All reached a minimum knowledge post test score of at least 90% before the skills session. All subjects reached mastery in TEE probe manipulation. All reached mastery in image acquisition for the skill level that they attempted (level 1-8/8, level 2-8/8, level 3-4/4, with 4 participants not attempting level 3). ATEE bootcamp using SBML is a powerful medical education strategy. SBML is a rigorous approach that can be used to achieve high and uniform TEE learning outcomes among trainees of different training levels and backgrounds.

Simulation-Based Mastery Learning to Facilitate Transition to Nursing Practice.

Simulation-based mastery learning (SBML) was developed and implemented to facilitate nursing students' transition to clinical practice. To evaluate nursing students' perspectives on the impact of SBML on their transition to clinical practice. A descriptive qualitative study using focus group discussions was conducted with final-year nursing students who had completed their clinical practicum and SBML. Three themes emerged: authenticity of simulations, whereby students were able to draw some parallels between their simulations and clinical experiences; self-efficacy in clinical practice, which was gained through deliberate practice; and application of cognitive tools, which provided mental frameworks to guide clinical performances. This study highlights the need to ensure the fidelity of the simulations to achieve authentic experiences, provide deliberate practice to develop self-efficacy, and use cognitive tools for mental model formation to create a high-quality SBML program to foster better transfer of simulation learning to real-life setting.

Clinical Experience Is Not a Proxy for Competence: Comparing Fellow and Medical Student Performance in a Breaking Bad News Simulation-Based Mastery Learning Curriculum.

It is unknown whether traditional medical education ensures competence among fellows in the key skill of breaking bad news (BBN). While simulation-based mastery learning (SBML) has been used to train fourth-year medical students (M4s) in BBN, it is unclear if it adds similar value for fellows. We examined the effect of traditional medical training on BBN skills by comparing baseline fellow and M4 skills and confidence and assessed the impact of a BBN SBML curriculum for fellows. Fellows training in six programs at Northwestern University from November 2018 to May 2019 were eligible for inclusion. Fellows completed a BBN SBML curriculum including a pretest, individualized feedback using a previously published assessment tool, and ongoing deliberate practice until all achieved a minimum passing standard (MPS). The primary outcomes were checklist and scaled item scores on the assessment tool. Fellow performance was compared to a historical M4 cohort. Twenty-eight of 38 eligible fellows completed the curriculum and were included for analysis. Fellows reported significantly more experience and confidence in BBN compared to M4s, yet their pre-training performance was significantly worse on checklist (57.1% vs 65.0%, P = .02) and scaled items; only 4% reached the MPS. After training, fellow performance significantly improved on checklist (57.1% to 92.6%, SD = 5.2%, P < .001) and scaled items; all reached the MPS. Despite higher confidence and BBN clinical experience, fellows performed worse than untrained M4s, confirming that experience is not a proxy for skill. Programs must develop competency-based assessments to ensure entrustment of communication skills.

Simulation-Based Mastery Learning Improves the Performance of Donning and Doffing of Personal Protective Equipment by Medical Students.

IntroductionMedical students lack adequate training on how to correctly don and doff personal protective equipment (PPE). Simulation-based mastery learning (SBML) is an effective technique for procedural education. The aim of this study was to determine whether SBML improves proper PPE donning and doffing by medical students.MethodsThis was a prospective, pre-test/post-test study of 155 medical students on demonstration of correct PPE use before and after a SBML intervention. Subjects completed standard hospital training by viewing a US Centers for Disease Control and Prevention training video on proper PPE use prior to the intervention. They then participated in a SBML training session that included baseline testing, deliberate practice with expert feedback, and post-testing until mastery was achieved. Students were assessed using a previously developed 21-item checklist on donning and doffing PPE with a minimum passing standard (MPS) of 21/21 items. We analyzed differences between pre-test and post-test scores using paired t-tests. Students at preclinical and clinical levels of training were compared with an independent t-test.ResultsTwo participants (1.3%) met the MPS on pre-test. Of the remaining 153 subjects who participated in the intervention, 151 (98.7%) reached mastery. Comparison of mean scores from pre-test to final post-test significantly improved from an average raw score of 12.55/21 (standard deviation [SD] = 2.86), to 21/21(SD = 0), t(150) = 36.3, P <0.001. There was no difference between pre-test scores of pre-clinical and clinical students.ConclusionSimulation-based mastery learning improves medical student performance in PPE donning and doffing in a simulated environment. This approach standardizes PPE training for students in advance of clinical experiences.

National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients

BackgroundTransurethral resection of bladder tumours (TURBT) is the initial diagnostic treatment for patients with bladder cancer. TURBT is not an easy procedure to master and simulator training may play a role in improving the learning curve. ObjectiveTo implement a national training programme for simulation-based mastery learning in TURBT and explore operating theatre performance after training. Design, setting, and participantsFrom June 2019 to March 2021, 31 doctors at urology departments in Denmark performed two pretraining TURBT procedures on patients, followed by proficiency-based mastery learning on a virtual reality simulator and then two post-training TURBTs on patients. Outcome measurements and statistical analysesOperating theatre performances were video-recorded and assessed by two independent, blinded raters using the Objective Structured Assessment for Transurethral Resection of Bladder Tumours Skills (OSATURBS) assessment tool. Paired-sample t tests were used to compare pretraining and post-training analyses and independent t tests for between-group comparisons. This trial is registered at ClinicalTrials.gov as NCT03864302. Results and limitationsBefore training, novices had significantly lower performance scores in comparison to those with intermediate experience (p = 0.017) and experienced doctors (p < 0.001). After training, novices significantly improved their clinical performance score (from 11.4 to 17.1; p = 0.049, n = 10). Those with intermediate experience and experienced doctors did not benefit significantly from simulator training (p = 0.9 and p = 0.8, respectively). ConclusionsNovices improved their TURBT performance in the operating theatre after completing a proficiency-based training programme on a virtual reality simulator. Patient summaryWe trained surgeons in an operation to remove bladder tumours using a virtual reality simulator. Novice doctors improved their performance significantly after the training, but the training effects for more experienced doctors were minimal. Therefore, we suggest the introduction of mandatory simulator training in the residency programme for urologists.