title: Setting mastery learning standards.
abstract: Mastery learning is an instructional approach in which educational progress is based on demonstrated performance, not curricular time. Learners practice and retest repeatedly until they reach a designated mastery level; the final level of achievement is the same for all, although time to mastery may vary. Given the unique properties of mastery learning assessments, a thoughtful approach to establishing the performance levels and metrics that determine when a learner has demonstrated mastery is essential.Standard-setting procedures require modification when used for mastery learning settings in health care, particularly regarding the use of evidence-based performance data, the determination of appropriate benchmark or comparison groups, and consideration of patient safety consequences. Information about learner outcomes and past performance data of learners successful at the subsequent level of training can be more helpful than traditional information about test performance of past examinees. The marginally competent "borderline student" or "borderline group" referenced in traditional item-based and examinee-based procedures will generally need to be redefined in mastery settings. Patient safety considerations support conjunctive standards for key knowledge and skill subdomains and for items that have an impact on clinical outcomes. Finally, traditional psychometric indices used to evaluate the quality of standards do not necessarily reflect critical measurement properties of mastery assessments. Mastery learning and testing are essential to the achievement and assessment of entrustable professional activities and residency milestones. With careful attention, sound mastery standard-setting procedures can provide an essential step toward improving the effectiveness of health professions education, patient safety, and patient care.
authors.affiliation: R. Yudkowsky is associate professor, Department of Medical Education, and director, Dr. Allan L. and Mary L. Graham Clinical Performance Center, University of Illinois at Chicago College of Medicine, Chicago, Illinois. Y.S. Park is assistant professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois. M. Lineberry is assistant professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois. A. Knox is a resident in plastic and reconstructive surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. E.M. Ritter is associate professor, vice chairman for education, and program director for the general surgery residency, Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine/Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Yudkowsky
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Matthew
authors.initials: M
authors.lastname: Lineberry
authors.forename: Aaron
authors.initials: A
authors.lastname: Knox
authors.forename: E Matthew
authors.initials: EM
authors.lastname: Ritter
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D004501:Education, Medical / Q000592:standards*; D004521:Educational Measurement; D019317:Evidence-Based Medicine; D006801:Humans; D007858:Learning; D017145:Models, Educational