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

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Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Related collections

Most cited references 45

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Deliberate practice and acquisition of expert performance: a general overview.

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Traditionally, professional expertise has been judged by length of experience, reputation, and perceived mastery of knowledge and skill. Unfortunately, recent research demonstrates only a weak relationship between these indicators of expertise and actual, observed performance. In fact, observed performance does not necessarily correlate with greater professional experience. Expert performance can, however, be traced to active engagement in deliberate practice (DP), where training (often designed and arranged by their teachers and coaches) is focused on improving particular tasks. DP also involves the provision of immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behavior. In this article, we draw upon the principles of DP established in other domains, such as chess, music, typing, and sports to provide insight into developing expert performance in medicine.

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A critical review of simulation-based mastery learning with translational outcomes.

William C. McGaghie, Saul Issenberg, Jeffrey H Barsuk … (2014)

This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care.

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Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit.

Jeffrey H Barsuk, Diane B Wayne, Jennifer O'Leary … (2009)

To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period. Observational cohort study of an educational intervention. Tertiary-care urban teaching hospital. One hundred three internal medicine and emergency medicine residents. Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Simulator-trained residents reported fewer needle passes (p < .0005), arterial punctures (p < .0005), catheter adjustments (p = .002), and higher success rates (p = .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, SD = 23.4%; mean (subclavian) = 48.4%, SD = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at posttest: mean (internal jugular) = 93.9%, SD = 10.2; mean (subclavian) = 91.5%, SD = 17.1 (p < .0005). Written examination performance improved from mean = 70.3%, SD = 7.7%, to 84.8%, SD = 4.8% (p < .0005). A simulation-based mastery learning program increased residents' skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care.

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Author and article information

Journal

Journal ID (nlm-ta): ATS Sch

Journal ID (iso-abbrev): ATS Sch

Journal ID (publisher-id): ats-scholar

Title: ATS Scholar

Publisher: American Thoracic Society

ISSN (Electronic): 2690-7097

Publication date (Electronic, pub): 23 January 2023

Publication date (Electronic, collection): March 2023

Publication date PMC-release: 23 January 2023

Volume: 4

Issue: 1

Pages: 48-60

Affiliations

[ ¹ ]Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois and

[ ² ]Northwestern Medical Group, Northwestern Memorial Hospital, Chicago, Illinois

Author notes

Correspondence and requests for reprints should be addressed to Kaitlyn M. Vitale, M.D., Department of Medicine, Northwestern University Feinberg School of Medicine, 303 E. Superior Street, SQ 5-523, Chicago, IL 60611. E-mail: kaitlyn.vitale@ 123456northwestern.edu .