Simulation-based mastery learning for intrathecal baclofen pump management in physical medicine and rehabilitation: A pilot study

Background: Simulation-based mastery learning (SBML) has demonstrated superiority as a procedural learning method. Implementation of SBML in Physical Medicine and Rehabilitation (PM&R) education has not been described and there is a paucity of literature regarding standardized procedural learning in this specialty. Objective: To evaluate if implementation of intrathecal baclofen pump management SBML affects knowledge, attitudes, and skills in PM&R residents. Design: Pretest–posttest design. Setting: Academic rehabilitation hospital. Participants: Twenty-two PM&R residents. Interventions: Participants engaged in SBML steps: pre-test, demonstration of proper technique, deliberate practice, and a post-test. Main Outcome Measures: Ability to achieve minimum passing score, quiz scores, and survey scores. Pre- and post-test results were compared using Wilcoxon signed-rank tests. Post graduate year (PGY)-3 and PGY-4 resident results were compared using Mann–Whitney U tests. Results: Based on institutional expert consensus, a simulation procedural checklist was created with a minimum passing score set at correctly performing 30 of 31 items. On pre-test, no learners achieved the minimum passing score (22.5, interquartile range [IQR] 17.0–23.0). Initial post-test score for all learners was 30 (IQR 29.8–31.0). Six learners required additional attempts to reach mastery as defined by reaching the minimum passing score. Quiz scores significantly improved from 9 to 11 (pre-test IQR 9–10; post-test IQR 10–11; p <.05). Confidence in procedure significantly improved (pre-test 2.7/5.9, IQR 2.2–3.8; post-test 4.1/5.0, IQR 3.7–4.5; p <.01). Likelihood to perform procedure in future practice did not change (pre-test 2.2, IQR 1.0–3.8; post-test 3.0, IQR 1.0–4.0; p =.89). Conclusion: SBML is an effective tool to improve multiple domains of learning in PM&R residents.