Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice

Diane B. Wayne*, Jeffrey H. Barsuk, Kevin J. O'Leary, Monica J. Fudala, William C. McGaghie

*Corresponding author for this work

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Background: Thoracentesis has been identified as a core competency for hospitalists. Residency training may not provide adequate preparation to perform this procedure. Objective: Our aim was to use a thoracentesis simulation to assess graduating residents' proficiency in thoracentesis procedural skills and to evaluate the impact of an educational intervention on skill development to mastery standards. Design: This was a pretest-posttest mastery learning design without a control group. Setting: Participants were 40 third-year internal medicine residents in a university-affiliated program. Intervention: Using an observational checklist, each resident underwent baseline assessment of thoracentesis skill using a standardized clinical history, radiograph, and thoracentesis simulation. After baseline testing, residents received two 2-hour education sessions featuring a videotaped presentation and deliberate practice with the thoracentesis simulator. Measurements: Residents were retested after the intervention. Skill mastery was defined as meeting or exceeding the minimum passing score (MPS) set by an expert panel at thoracentesis posttest. Those who did not achieve the MPS had additional deliberate practice and were retested until the MPS was reached. Results: Performance improved 71% from pretest to posttest on the clinical skills examination. All residents met or exceeded the mastery standard. The amount of practice time needed to reach the MPS was the only predictor (negative) of posttest performance. The education program was rated highly. Conclusions: A curriculum featuring deliberate practice dramatically increased the skills of residents in thoracentesis. Residents enjoy training and receiving evaluation and feedback in a simulated clinical environment. This mastery program illustrates a feasible and reliable mechanism to achieve procedural competency.

Original languageEnglish (US)
Pages (from-to)48-54
Number of pages7
JournalJournal of hospital medicine
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Internal Medicine
Learning
Technology
Hospitalists
Education
Clinical Competence
Thoracentesis
Internship and Residency
Checklist
Curriculum
Control Groups

Keywords

  • Mastery learning
  • Residency education
  • Simulation-based education
  • Thoracentesis

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

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title = "Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice",
abstract = "Background: Thoracentesis has been identified as a core competency for hospitalists. Residency training may not provide adequate preparation to perform this procedure. Objective: Our aim was to use a thoracentesis simulation to assess graduating residents' proficiency in thoracentesis procedural skills and to evaluate the impact of an educational intervention on skill development to mastery standards. Design: This was a pretest-posttest mastery learning design without a control group. Setting: Participants were 40 third-year internal medicine residents in a university-affiliated program. Intervention: Using an observational checklist, each resident underwent baseline assessment of thoracentesis skill using a standardized clinical history, radiograph, and thoracentesis simulation. After baseline testing, residents received two 2-hour education sessions featuring a videotaped presentation and deliberate practice with the thoracentesis simulator. Measurements: Residents were retested after the intervention. Skill mastery was defined as meeting or exceeding the minimum passing score (MPS) set by an expert panel at thoracentesis posttest. Those who did not achieve the MPS had additional deliberate practice and were retested until the MPS was reached. Results: Performance improved 71{\%} from pretest to posttest on the clinical skills examination. All residents met or exceeded the mastery standard. The amount of practice time needed to reach the MPS was the only predictor (negative) of posttest performance. The education program was rated highly. Conclusions: A curriculum featuring deliberate practice dramatically increased the skills of residents in thoracentesis. Residents enjoy training and receiving evaluation and feedback in a simulated clinical environment. This mastery program illustrates a feasible and reliable mechanism to achieve procedural competency.",
keywords = "Mastery learning, Residency education, Simulation-based education, Thoracentesis",
author = "Wayne, {Diane B.} and Barsuk, {Jeffrey H.} and O'Leary, {Kevin J.} and Fudala, {Monica J.} and McGaghie, {William C.}",
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AU - McGaghie, William C.

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AB - Background: Thoracentesis has been identified as a core competency for hospitalists. Residency training may not provide adequate preparation to perform this procedure. Objective: Our aim was to use a thoracentesis simulation to assess graduating residents' proficiency in thoracentesis procedural skills and to evaluate the impact of an educational intervention on skill development to mastery standards. Design: This was a pretest-posttest mastery learning design without a control group. Setting: Participants were 40 third-year internal medicine residents in a university-affiliated program. Intervention: Using an observational checklist, each resident underwent baseline assessment of thoracentesis skill using a standardized clinical history, radiograph, and thoracentesis simulation. After baseline testing, residents received two 2-hour education sessions featuring a videotaped presentation and deliberate practice with the thoracentesis simulator. Measurements: Residents were retested after the intervention. Skill mastery was defined as meeting or exceeding the minimum passing score (MPS) set by an expert panel at thoracentesis posttest. Those who did not achieve the MPS had additional deliberate practice and were retested until the MPS was reached. Results: Performance improved 71% from pretest to posttest on the clinical skills examination. All residents met or exceeded the mastery standard. The amount of practice time needed to reach the MPS was the only predictor (negative) of posttest performance. The education program was rated highly. Conclusions: A curriculum featuring deliberate practice dramatically increased the skills of residents in thoracentesis. Residents enjoy training and receiving evaluation and feedback in a simulated clinical environment. This mastery program illustrates a feasible and reliable mechanism to achieve procedural competency.

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