Simulation-based Mastery Learning Research Articles

Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

IntroductionPhysician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. InnovationAn SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS. OutcomesA BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing. CommentsWe developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes.

Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion

Background: Several studies have shown the beneficial effects of mastery learning of a simulation-based course, but not all trainees complete it. Objectives: The purpose of this study was to find deciding factors for the completion of a simulation-based mastery learning course with distributive practice in flexible bronchoscopy. Methods: Seventy-seven trainees who signed up for the course were invited to a survey for deciding factors of completing the course. Sixty-two (81%) trainees answered the survey. Results: Male trainees were more likely to complete the course. The most important factor for completion was clinical relevance, and the most important factor for not completing the course was being “too busy.” Conclusion: Several deciding factors for completing the course were identified. Successful simulation-based mastery learning courses should be clinically relevant, and the trainees should be provided protected time to complete the training. The instructional design should also be adapted systematically for male and female trainees to achieve the necessary competencies.

Simulation-based mastery learning in medical students: Skill retention at 1-year follow up

Context: Deficits in basic skill performance and long-term skill retention among medical students and novice doctors are a persistent problem. This controlled study tested whether the addition of a mastery learning component to simulation-based teaching is associated with long-term retention and performance of peripheral venous catheter insertion.Methods: Fourth-year medical students were assigned to receive either the control (simulation without mastery learning, n = 131) or the intervention (simulation + mastery learning, n = 133) instruction in peripheral venous catheter insertion. Performance was assessed at one year post-instruction. Eighty-four students from the control group and 71 from the intervention group participated in the assessment.Results: Students who received the mastery learning instruction achieved higher overall test scores than did controls (median mastery learning score: 20.0, IQR 2.0; median control score 19.0, IQR 3.0; Mann–Whitney U test, p < 0.001, effect size d = 0.82). Pass rates also differed significantly between the groups, with 74.5% (n = 53) of the intervention group passing compared with 33% (n = 28) of the control group (p < 0.001).Conclusions: Mastery learning is an effective means of teaching practical skills to medical students, and is associated with higher scores at a 1-year follow up.

TARGET PRACTICE: SIMULATION-BASED MASTERY LEARNING FOR ULTRASOUND-GUIDED PERIPHERAL IV INSERTION

SESSION TITLE: Education, Research, and Quality Improvement 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Ultrasound use for peripheral IV (PIV) insertion has been shown to improve success rates and decrease overall time to placement [1,2]. Residents are often relied on to obtain venous access in patients with difficult access or an urgent need for intravenous medications; however, few studies have assessed competency-based training methods for internal medicine residents in ultrasound-guided (USG) PIV placement. We evaluated the effectiveness of simulation-based mastery learning of USG-PIV through a “train-the-trainer” approach. METHODS: Data on residents who participated in a simulation-based training on USG-PIV insertion was evaluated retrospectively. Internal medicine residents underwent a 1-hour simulation-based training with the expectation of performing USG-PIV placement to mastery standards on a task trainer. Pre and post-surveys were completed on the day of training. Survey questions regarding self-confidence and skills were rated on a numerical scale of 1-5, with 5 representing high confidence. Skill performance was assessed by an approved trainer using a detailed checklist upon completion of training. RESULTS: Eleven residents completed the training during a 2-week period. 73% (N= 8) were PGY-2 and 27% (N = 3) were PGY-3. Seventy-three percent (N=8) had received general ultrasound training previously, but none had received formal ultrasound training for PIV insertion. Forty-five percent (N=5) of residents had never placed an USG-PIV, and 55% (N=6) had placed less than 5 USG-PIVs. Self-confidence and self-skills assessment improved significantly after training. Average self-confidence in correctly identifying the vein using USG by transverse and longitudinal technique was significantly higher post-simulation (3.0 vs 4.6, p=0.008 and 2.3 vs 4.5, p=0.002, respectively). There was also a significant increase in self-confidence following the needle tip into the target vein using USG transverse and longitudinal technique (2.3 vs 4.5, p=0.001 and 1.9 vs 4.3, p=0.001, respectively). Residents met the mastery standard for skills with a 100% pass rate on the skills-based checklist. CONCLUSIONS: A simulation-based mastery learning model for USG-PIV insertion improves resident self-confidence, self-skill assessment and technical skills in a simulated environment. Deliberate practice with a mastery learning model ensures that each learner has achieved the necessary skill set to place a PIV using USG. CLINICAL IMPLICATIONS: We developed a feasible and time-efficient method for USG-PIV training that relies on developing a group of resident “super-users.” We look to evaluate the effect of this train-the-trainer approach for USGPIV insertion on internal medicine resident skill, behaviors and patient outcomes. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Hailey Gupta, source=Web Response No relevant relationships by Krystle Hernandez, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Daniel Steinberg, source=Web Response

268 A Simulation-Based Mastery Learning Ultrasound Guided IV Insertion Curriculum for Emergency Medicine Trainees

268 A Simulation-Based Mastery Learning Ultrasound Guided IV Insertion Curriculum for Emergency Medicine Trainees

A Better Way to Train Personnel to Be Safe in Emergencies

Offshore petroleum platforms present complex, time-sensitive situations that can make emergency evacuations difficult to manage. Virtual environments (VE) can train safety-critical tasks and help prepare personnel to respond to real-world offshore emergencies. Before industries can adopt VE training, its utility must be established to ensure the technology provides effective training. This paper presents the results of two experiments that investigated the training utility of VE training. The experiments focused particularly on determining the most appropriate method to deliver offshore emergency egress training using a virtual environment. The first experiment used lecture-based teaching (LBT). The second experiment investigated the utility of a simulation-based mastery learning (SBML) pedagogical method from the medical field to address offshore emergency egress training. Both training programs (LBT and SBML) were used to train naïve participants in basic onboard familiarization and emergency evacuation procedures. This paper discusses the training efficacy of the SBML method in this context and compares the results of the SBML experimental study to the results of the LBT training experiment. Efficacy of the training methods is measured by a combination of time spent training and performance achieved by each of the training groups. Results show that the SBML approach to VE training was more time effective and produced better performance in the emergency scenarios. SBML training can help address individual variability in competence. Limitations to the SBML training are discussed and recommendations to improve the delivery of SBML training are presented. Overall, the results indicate that employing SBML training in industry can improve human reliability during emergencies through increased competence and compliance.

A Simulation-Based Mastery Learning Approach to Ventricular Assist Device Self-Management: The SimVAD Study

Background Care of ventricular assist devices (VADs) requires meticulous self-management skills by patients and caregivers to enhance competence and prevent adverse events. Simulation-based mastery learning (SBML) is a clinical educational model that uses mannequins to train healthcare providers to a high standard and has been shown to reduce patient complications. SBML has not been used to train patients or caregivers to mastery on required skills. This abstract describes the multidisciplinary development of an innovative patient-centered, VAD self-management SBML curriculum. Methods We completed multidisciplinary, semi-structured interviews with 11 physicians, 7 VAD coordinators, 16 patients and 12 caregivers to identify important factors in VAD self-management. From these responses, we created a device-specific SBML training curriculum. SBML curricula include pretests followed by deliberate practice (repetitive, focused skills practice with expert feedback) on a mannequin. After practice, participants must meet or exceed a minimum passing standard (MPS) on posttests. To set MPSs on posttests for our SBML curriculum, we convened an expert panel of 6 physicians, 6 VAD coordinators, 6 patients and 6 caregivers and used the Mastery Angoff standard setting method. Results Interviews identified critical factors for inclusion in the curriculum: critical learning content (e.g., medications, controller and dressing changes) and training modalities such as wearable simulators, educational videos, emergency checklists and refresher training sessions. We created educational videos on controller changes, dressing changes, and abnormal driveline sites. Emergency checklists were created to help reinforce knowledge of alarms and VAD-related items needed for travel. We created checklists for controller and dressing changes, and changing power sources for scoring pre and post skills exams. We also developed a post training written exam which included key knowledge components. The MPS, per expert panel, for the skills exams ranged from 94–99% items correct while the written exam was 96% items correct. One, three, and 12-month follow-up skills assessments were subsequently created. Conclusions This is the first patient-centered VAD self-management curriculum to be created utilizing a powerful educational modality (SBML) and multidisciplinary feedback. We are currently engaged in a pilot trial (SimVAD) of the SBML curriculum to assess knowledge, skills acquisition and health related outcomes. Download : Download high-res image (90KB) Download : Download full-size image

Simulation-based mastery learning significantly reduces gender differences on the Fundamentals of Endoscopic Surgery performance exam.

Analysis of the Fundamentals of Endoscopic Surgery (FES) performance exam showed higher scores for men than women. Gender differences have been reduced with task-specific practice. We assessed the effect of simulation-based mastery learning (SBML) on FES performance exam differences by gender. Forty-seven surgical trainees [29 men (m), 18 women (w)] completed a SBML curriculum and were assessed by FES. Fourteen trained on the GI Mentor 2, 18 on the Endoscopy Training System, and 15 using the Surgical Training for Endoscopic Proficiency curriculum. Performance of male and female trainees was compared. On the pre-training assessment, there were large differences between genders in FES pass rates (m 77%, w 15%, p < 0.001), total scores (m 69 ± 11, w 50 ± 12; p < 0.001), and in four of five FES sub-task scores (Navigation, m 73 ± 19, w 55 ± 22, p = 0.02; Loop reduction, m 34 ± 29, w 14 ± 22, p = 0.02; Retroflexion, m 81 ± 17, w 47 ± 27, p < 0.001; Targeting, m 89 ± 10, w 66 ± 23, p = 0.002). No differences were discernible post training (Pass rate, m 100%, w 94%, p = 0.4; Total score, m 77 ± 8, w 72 ± 12, p = 0.2; Navigation, m 91 ± 13, w 80 ± 13, p = 0.009; Loop reduction, m 49 ± 26, w 46 ± 36, p = 0.7; Retroflexion, m 82 ± 18, w 81 ± 15, p = 0.9; Targeting, m 92 ± 15, w 86 ± 12, p = 0.12). Time needed to complete curricula was not discernably different by gender (m 3.8 ± 1.7h, w 5.0 ± 2.6h, p = 0.17). Gender-based differences are nearly eliminated through task-specific SBML training. This lends further evidence to the validity argument for the FES performance exam as a measure of basic endoscopic skills.

A Comparison of Approaches for Mastery Learning Standard Setting.

Defensible minimum passing standards (MPSs) must be used to evaluate learner performance outcomes in health professions education. In this study, the authors compared the results of traditional Angoff and Hofstee standard-setting exercises with the Mastery Angoff and Patient-Safety approaches for central venous catheter (CVC) insertion skills examinations. The authors also evaluated how these standards affected the historical performance of residents who participated in a simulation-based mastery learning (SBML) curriculum for CVC insertion skills. In April and May 2015, 12 physicians with expertise in CVC insertion set MPSs for previously published internal jugular (IJ) and subclavian (SC) CVC insertion checklists using Angoff, Hofstee, Mastery Angoff, and Patient-Safety approaches. The resulting MPSs were compared using historical performance of internal medicine and emergency medicine residents who participated in CVC insertion SBML. The MPSs were set as follows: Angoff: IJ 91% checklist items correct, SC 90%. Hofstee: IJ 88%, SC 90%. Mastery Angoff: IJ 98%, SC 98%. Patient-Safety: IJ 98%, SC 98%. Based on the historical performance of 143 residents assessed on IJ and SC insertion, applying the 98% MPS would result in additional practice and retesting of 55/123 residents (45%) who had previously passed the IJ examination and 36/130 residents (28%) who had passed the SC examination using the Angoff and Hofstee MPSs. The Mastery Angoff and Patient-Safety standard-setting approaches resulted in higher CVC insertion SBML MPSs compared with traditional standard-setting methods. Further study should assess the impact of these more rigorous standards on patient outcomes.

Pretest Scores Uniquely Predict 1-Year-Delayed Performance in a Simulation-Based Mastery Course for Central Line Insertion.

Within simulation-based mastery learning (SBML) courses, there is inconsistent inclusion of learner pretesting, which requires considerable resources and is contrary to popular instructional frameworks. However, it may have several benefits, including its direct benefit as a form of deliberate practice and its facilitation of more learner-specific subsequent deliberate practice. We consider an unexplored potential benefit of pretesting: its ability to predict variable long-term learner performance. Twenty-seven residents completed an SBML course in central line insertion. Residents were tested on simulated central line insertion precourse, immediately postcourse, and after between 64 and 82 weeks. We analyzed pretest scores' prediction of delayed test scores, above and beyond prediction by program year, line insertion experiences in the interim, and immediate posttest scores. Pretest scores related strongly to delayed test scores (r = 0.59, P = 0.01; disattenuated ρ = 0.75). The number of independent central lines inserted also related to year-delayed test scores (r = 0.44, P = 0.02); other predictors did not discernibly relate. In a regression model jointly predicting delayed test scores, pretest was a significant predictor (β = 0.487, P = 0.011); number of independent insertions was not (β = 0.234, P = 0.198). This study suggests that pretests can play a major role in predicting learner variance in learning gains from SBML courses, thus facilitating more targeted refresher training. It also exposes a risk in SBML courses that learners who meet immediate mastery standards may be incorrectly assumed to have equal long-term learning gains.

Learning Theory Foundations of Simulation-Based Mastery Learning

Simulation-based mastery learning (SBML), like all education interventions, has learning theory foundations. Recognition and comprehension of SBML learning theory foundations are essential for thoughtful education program development, research, and scholarship. We begin with a description of SBML followed by a section on the importance of learning theory foundations to shape and direct SBML education and research. We then discuss three principal learning theory conceptual frameworks that are associated with SBML-behavioral, constructivist, social cognitive-and their contributions to SBML thought and practice. We then discuss how the three learning theory frameworks converge in the course of planning, conducting, and evaluating SBML education programs in the health professions. Convergence of these learning theory frameworks is illustrated by a description of an SBML education and research program in advanced cardiac life support. We conclude with a brief coda.

Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial.

Physicians-in-training often perform bedside thoracenteses in academic medical centers, and complications are more common among less experienced clinicians. Simulation-based mastery learning (SBML) is one potential solution to this problem. This study evaluated the effects of a randomized trial of thoracentesis SBML on patient complications: iatrogenic pneumothorax (IP), hemothorax, and reexpansion pulmonary edema (REPE). The authors randomized internal medicine residents to undergo thoracentesis SBML at a tertiary care academic center from December 2012 to May 2016. They subsequently compared thoracentesis complications from procedures performed by SBML-trained residents, traditionally trained residents (no simulation training), and those referred to pulmonary medicine or interventional radiology (IR). During the study period, 917 thoracenteses were performed on 709 patients. IP occurred in 60 (6.5%) procedures, of which 7 (11.6%) were clinically meaningful. SBML-trained residents performed procedures with a trend toward lower combined clinically meaningful complications (IP, hemothorax, REPE) compared with traditionally trained residents (7.9% vs. 0%; P = .06). SBML-trained residents caused fewer clinically meaningful IPs compared with traditionally trained residents, pulmonary, and IR referrals (P = .02). Hemothorax occurred after 4 (0.4%) thoracenteses, and SBML-trained residents had a trend toward lower hemothorax (0) compared with other groups (P = .07). REPE occurred after 3 (0.3%) procedures, with no differences between groups. SBML-trained residents performed procedures with lower combined clinically meaningful complications compared with other groups (P = .008). Residents randomized to an SBML intervention performed thoracenteses with low rates of clinically meaningful complications. Rigorous education represents a successful quality improvement strategy.

Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study.

The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.

The Case for Simulation-Based Mastery Learning Education Courses for Practicing Surgeons.

Pediatric surgeons rely on simulation courses to develop skills for safe minimally invasive repair of complex congenital anomalies. The majority of minimally invasive surgery (MIS) training courses occur during short "exposure courses" at annual conferences. Little data are available to support the benefit of these courses relative to the safe implementation of new skills. The purpose of this article is to determine the impact of an exposure course for advanced neonatal MIS on self-perceived comfort levels with independent performance of advanced MISs. Participants of a 4-hour hands-on course for neonatal MIS were surveyed regarding clinical practices and pre- and post-training perceived "comfort levels" of MIS skills for thoracoscopic esophageal atresia with tracheoesophageal fistula (tTEF) repair, thoracoscopic left upper lobe pulmonary lobectomy (tLobe), and laparoscopic duodenal atresia (lapDA) repair. Descriptive analyses were performed. Seventeen participants completed pre- and postcourse surveys. The majority of participants had no prior experience with tLobe (59%) or lapDA (53%), and 35% had no experience with tTEF repair. Similarly, the majority were "not comfortable" with these procedures. After the short course, the majority of surgeons reported that they were "likely to perform" these operations within 6 months, despite low levels of baseline experience and comfort levels. An exposure training course led to immediate perception of increased skills and confidence. However, these courses typically do not provide basic tenets of expert performance that demands deliberate practice. Future course design should transition to a mastery learning framework wherein regular skill assessments, milestones, and unlimited education time are prioritized before implementation of the new skills.

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

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.

Neonatal resuscitation experience curves: simulation based mastery learning booster sessions and skill decay patterns among pediatric residents.

Background Following neonatal resuscitation program (NRP) training, decay in clinical skills can occur. Simulation-based deliberate practice (SBDP) has been shown to maintain NRP skills to a variable extent. Our study objectives were (a) to determine whether a single 30 min simulation-based intervention that incorporates SBDP and mastery learning (ML) can effectively restore skills and prevent skill decay and (b) to compare different timing options. Methods Following NRP certification, pediatric residents were randomly assigned to receive a video-recorded baseline assessment plus SBDP-ML refresher education at between 6 and 9 months (early) or between 9 and 12 months (late). One year following initial certification, participants had repeat skill retention videotaped evaluations. Participants were scored by blinded NRP instructors using validated criteria scoring tools and assigned a global performance rating score (GRS). Results Twenty-seven participants were included. Residents in both early and late groups showed significant skill decay 7 and 10 months after initial NRP. SBDP-ML booster sessions significantly improved participants' immediate NRP performance scores (p<0.001), which persisted for 2 months, but were again lower 4 months later. Conclusions NRP skills may be boosted to mastery levels after a short SBDP-ML intervention and do not appear to significantly decline after 2 months. Brief booster training could potentially serve as a useful supplement to traditional NRP training for pediatric residents.

Utilizing the Flipped Classroom, Simulation-Based Mastery Learning and Group Learning to Teach and Evaluate Lumbar Puncture Skills

Author(s): Crichlow, Amanda; Parsons, Jessica; Goswami, Varsha; Ponnuru, Srikala; Griswold, Sharon

Preparing for the American Board of Surgery Flexible Endoscopy Curriculum: Development of multi-institutional proficiency-based training standards and pilot testing of a simulation-based mastery learning curriculum for the Endoscopy Training System

BackgroundThe Fundamentals of Endoscopic Surgery (FES) exam is required for American Board of Surgery certification. The purpose of this study was to develop performance standards for a simulation-based mastery learning (SBML) curriculum for the FES performance exam using the Endoscopy Training System (ETS). MethodsExperienced endoscopists from multiple institutions and specialties performed each ETS task (scope manipulation (SM), tool targeting (TT), retroflexion (RF), loop management (LM), and mucosal inspection (MI)) with scores used to develop performance standards for a SBML training curriculum. Trainees completed the curriculum to determine feasibility, and effect on FES performance. ResultsTask specific training standards were determined (SM-121sec, TT-243sec, RF-159sec, LM-261sec, MI-180-480sec, 7 polyps). Trainees required 29.5 ± 3.7 training trials over 2.75 ± 0.5 training sessions to complete the SBML curriculum. Despite high baseline FES performance, scores improved (pre 73.4 ± 7, post 78.1 ± 5.2; effect size = 0.76, p > 0.1), but this was not statistically discernable. ConclusionsThis SBML curriculum was feasible and improved FES scores in a group of high performers. This curriculum should be applied to novice endoscopists to determine effectiveness for FES exam preparation.

Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam.

The fundamentals of endoscopic surgery (FES) program has considerable validity evidence for its use in measuring the knowledge, skills, and abilities required for competency in endoscopy. Beginning in 2018, the American Board of Surgery will require all candidates to have taken and passed the written and performance exams in the FES program. Recent work has shown that the current ACGME/ABS required case volume may not be enough to ensure trainees pass the FES skills exam. The aim of this study was to investigate the feasibility of a simulation-based mastery-learning curriculum delivered on a novel physical simulation platform to prepare trainees to pass the FES manual skills exam. The newly developed endoscopy training system (ETS) was used as the training platform. Seventeen PGY 1 (10) and PGY 2 (7) general surgery residents completed a pre-training assessment consisting of all 5 FES tasks on the GI Mentor II. Subjects then trained to previously determined expert performance benchmarks on each of 5 ETS tasks. Once training benchmarks were reached for all tasks, a post-training assessment was performed with all 5 FES tasks. Two subjects were lost to follow-up and never returned for training or post-training assessment. One additional subject failed to complete any portion of the curriculum, but did return for post-training assessment. The group had minimal endoscopy experience (median 0, range 0-67) and minimal prior simulation experience. Three trainees (17.6%) achieved a passing score on the pre-training FES assessment. Training consisted of an average of 48±26 repetitions on the ETS platform distributed over 5.1±2 training sessions. Seventy-one percent achieved proficiency on all 5 ETS tasks. There was dramatic improvement demonstrated on the mean post-training FES assessment when compared to pre-training (74.0±8 vs. 50.4±16, p<0.0001, effect size=2.4). The number of ETS tasks trained to proficiency correlated moderately with the score on the post-training assessment (r=0.57, p=0.028). Fourteen (100%) subjects who trained to proficiency on at least one ETS task passed the post-training FES manual skills exam. This simulation-based mastery learning curriculum using the ETS is feasible for training novices and allows for the acquisition of the technical skills required to pass the FES manual skills exam. This curriculum should be strongly considered by programs wishing to ensure that trainees are prepared for the FES exam.

Sa1074 A Simulation-Based Mastery Learning Model of Percutaneous Endoscopic Gastrostomy Tube Placement Improves Gastroenterology Fellow Procedural Attitudes

Sa1074 A Simulation-Based Mastery Learning Model of Percutaneous Endoscopic Gastrostomy Tube Placement Improves Gastroenterology Fellow Procedural Attitudes