Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice.
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.


METHODS
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.


METHODS
Forty-one PGY-2 internal medicine residents in a university-affiliated program.


METHODS
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.
Wayne
Diane B
DB
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. dwayne@northwestern.edu
Butter
John
J
Siddall
Viva J
VJ
Fudala
Monica J
MJ
Wade
Leonard D
LD
Feinglass
Joe
J
McGaghie
William C
WC
D000328:Adult; D000368:Aged; D002641:Chicago; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D007858:Learning; D008020:Life Support Care / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010564:Personnel, Hospital; D013663:Teaching / Q000379:methods