Open AccessMastery Learning of Advanced Cardiac Life Support Skills by Internal Medicine Residents Using Simulation Technology and Deliberate Practice
Author(s) -
Wayne Diane B.,
Butter John,
Siddall Viva J.,
Fudala Monica J.,
Wade Leonard D.,
Feinglass Joe,
McGaghie William C.
Publication year - 2006
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2006.00341.x
Subject(s) - medicine , curriculum , certification , medical education , advanced cardiac life support , inter rater reliability , educational measurement , observational study , mastery learning , family medicine , emergency medicine , psychology , cardiopulmonary resuscitation , rating scale , pedagogy , developmental psychology , resuscitation , political science , law
BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY‐2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest‐posttest design without control group. After baseline evaluation, residents received 4, 2‐hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research‐derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty‐one PGY‐2 internal medicine residents in a university‐affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency‐based efforts illustrate outcome‐based medical education that is now prominent in accreditation reform of residency education.