Necessity of Pretests in Central Venous Catheter Insertion Simulation-Based Mastery Learning: A Randomized Controlled Trial

Purpose: Simulation-based mastery learning (SBML) is a rigorous form of competency-based learning. Components of SBML include a pretest, deliberate practice, and a posttest; all learners must meet or exceed a minimum passing standard (MPS) on the posttest before completing training. The authors aimed to explore whether a modified SBML curriculum (without a pretest assessment) was as effective as the standard SBML curriculum (with a pretest assessment). Method: The authors performed a randomized controlled trial of internal medicine residents who participated in an internal jugular central venous catheter insertion SBML curriculum at a tertiary care academic medical center in Chicago, Illinois, from December 2018 through December 2021. Residents were randomly assigned to complete the usual SBML intervention (pretest group) or to complete a modified SBML intervention without a pretest (no pretest group). The authors compared initial posttest performance and training time between groups. Results: Eighty-nine of 120 eligible residents (74.1%) completed the study: 43 in the pretest group and 46 in the no pretest group. Median (IQR) initial posttest scores were not statistically different between the pretest group (96.6 [93.1-100]) and the no pretest group (96.6 [92.4-100]). However, all 43 residents (100%) in the pretest group reached the MPS at the initial posttest compared with 41 of the 46 (89%) in the no pretest group (P =.06). Residents in the pretest group required 16.5 hours more faculty and learning time than the no pretest group. Conclusions: More residents who completed a pretest reached the MPS at initial posttest. However, incorporating a pretest during the internal jugular central venous catheter SBML curriculum required substantially more learner and faculty time without clear performance benefits.