William C Mcgaghie

• Northwestern University

Simulation‐based mastery learning (SBML) is a powerful method of competency‐based medical education that leads to improved skill acquisition and better patient outcomes for a variety of procedures within the emergency medicine scope of practice. This Educator's Blueprint discusses the concept of mastery learning and shares practical advice for deve...

Statement This Workbook and its Action Plans and Notes aim to equip health professions educators with the information and guidance needed to develop and implement a simulation-based mastery learning curriculum. The Workbook begins with an introductory statement about mastery learning curriculum developers and teachers and also about expected behavi...

Introduction The 2 aims of this observational study are (a) to describe the implementation and feasibility of a bed mobility skills simulation-based mastery learning (SBML) curricular module for physical therapist students and (b) to measure learning outcomes and student perceptions of this module. Review of Literature Simulation-based mastery lea...

Simulation-based mastery learning is a powerful educational paradigm that leads to high levels of performance through a combination of strict standards, deliberate practice, formative feedback, and rigorous assessment. Successful mastery learning curricula often require well-designed checklists that produce reliable data that contribute to valid de...

Introduction: Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven res...

Visual learning is an important part of echocardiographic training. Our aim is to describe and evaluate a visual teaching tool, tomographic plane visualization (ToPlaV) as an adjunct to skills training in pediatric echocardiography image acquisition. This tool incorporates learning theory by applying psychomotor skills that closely emulate the skil...

This chapter discusses the principles of deliberate practice (DP) and mastery learning (ML) in today's powerful medical education context. It presents four examples that illustrates the use of these technologies for medical education and for education of patients and their caregivers. The chapter talks about a deliberate practice and mastery learni...

Purpose: There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial tested efficacy of the Uncertainty Communication Education Module, a simulation-based mastery learning curriculum designed to establish competency in communicating diagnostic uncertainty. M...

Transesophageal echocardiography (TEE) education is part of pediatric cardiology fellow training. Simulation-based mastery learning (SBML) is an efficient and valuable education experience. The aim of this project was to equip trainees with the basic knowledge and skill required to perform a pediatric TEE. The secondary aim was to assess the utilit...

Background and study aims Practicing endoscopists have variable polypectomy skills during colonoscopy and limited training opportunities for improvement. Simulation-based training enhances procedural skill, but its impact on polypectomy is unclear. We developed a simulation-based polypectomy intervention to improve polypectomy competency. Methods A...

Psychological safety is valued in other high-risk industries as an essential element to ensure safety. Yet, in healthcare, psychological safety is not mandatorily measured, quantified, or reported as an independent measure of safety. All members of the healthcare team’s voice and safety are important. Calls for personal, physical or patient safety...

Introduction: Resident physicians are expected to acquire competence at central venous catheter (CVC) insertion to a mastery standard. Valid competence decisions about resident physicians' CVC performance rely on reliable data and rigorous achievement standards. This study used data from 3 CVC simulation-based mastery learning studies involving in...

Background Medical procedures are traditionally taught informally at patients' bedside through observation and practice using the adage “see one, do one, teach one.” This lack of formalized training can cause trainees to be unprepared to perform procedures independently. Simulation based education (SBE) increases competence, reduces complications,...

Background The US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores are often used to inform a variety of secondary medical career decisions, such as residency selection, despite the lack of validity evidence supporting their use in these contexts. Objective We compared USMLE scores between non–chief residents (non-CRs) and chief resi...

This concluding chapter of Mastery Learning in Health Professions Education addresses two mastery learning centers of interest—opportunities and challenges. Six opportunities are discussed: (a) expand mastery learning curricula to include a broader range of skills training in medicine, nursing, and other health professions; (b) spread mastery learn...

This opening chapter is an indictment of traditional clinical education in the health professions. Traditional clinical education in the health professions is not effective to achieve goals of skill acquisition, use, and maintenance by individuals or teams. The chapter argues from evidence that the time honored “see one, do one, teach one” approach...

Mastery learning is grounded in the principle of “excellence for all.” This chapter sets forth the conceptual framework and key ideas that shape and govern mastery learning programs in health professions education. The chapter starts by presenting the origins of mastery learning in the early and mid-twentieth century and its foundation in three psy...

Competency-based medical education (CBME) has developed strong roots in many professional education systems worldwide. The CBME movement is driven by concern and evidence of significant challenges in the quality and safety of healthcare. Medical education can be viewed as a translational science intervention because the competencies acquired by lea...

Instructional design and delivery to reach mastery learning goals in the health professions is a key responsibility of education leaders. This work requires thoughtful planning and execution, focus on learner improvement, and development and use of assessment programs that permit formative and summative decisions about learner achievement. This cha...

This chapter addresses the key education policy consequences that derive from implementation and management of mastery learning programs in the health professions. The chapter begins with framing statements about mastery learning policy consequences taken from two scholarly reports. It proceeds to discuss the benefits and challenges of mastery lear...

Teamwork and leadership skill training are critically important aspects of medical education. This chapter describes the evolution of education curricula for health professions team-based skill development leading to the potential application of simulation-based (SB) mastery learning. The chapter starts with our interview of Apollo 13 commander Cap...

The purpose of assessment in mastery learning is to promote learner improvement. Assessment is a key and indispensable feature of the mastery learning bundle. Mastery learning approaches are linked to the ability to make accurate decisions. Accurate decisions depend on reliable data that have been collected using instruments and methods linked to c...

This chapter addresses mastery learning in health professions education contexts of continuing professional education (CPE) and maintenance of certification (MOC). These are new applications of the mastery learning model, extending lessons learned from their application in undergraduate and graduate medical education. The chapter begins with a sect...

Mastery learning contributes to translational science (TS) in the health professions not only when learning outcomes are measured in educational settings (T1) but also when outcomes are measured as “downstream” results including patient care practices (T2), patient outcomes (T3), and collateral effects (T4). This chapter describes a simulation-base...

Background: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and conce...

Purpose: It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine sub-internship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). Method: Al...

Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the au...

Background Historically, medically trained experts have served as judges to establish a minimum passing standard (MPS) for mastery learning. As mastery learning expands from procedure-based skills to patient-centered domains, such as communication, there is an opportunity to incorporate patients as judges in setting the MPS. Objective We described...

This book presents the parameters of Mastery Learning (ML), an especially stringent variety of competency-based education that guides students to acquire essential knowledge and skill, measured rigorously against a minimum passing standard (MPS). As both a scholarly resource and a teaching tool, this is a “how to” book that serves as a resource for...

This chapter addresses writing for publication from eight perspectives: (a) motivation to write, (b) types of publications, (c) International Committee on Medical Journal Editors (ICMJE) recommendations, (d) study design and reporting conventions, (e) peer review, (f) words of wisdom, and (g) the craft of writing. Writing for professional publicati...

Problem: Thirteen measurable Entrustable Professional Activities (EPAs) have been proposed by the Association of American Medical Colleges as a means to operationalize medical school graduates' patient care qualifications. Mastery learning is an effective method for boosting clinical skills, but its applicability to the EPAs remains to be studied....

Introduction: Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculu...

Introduction Inpatient telemetry monitoring is a commonly used technology designed to detect and monitor life-threatening arrhythmias. However, residents are rarely educated in the proper use and interpretation of telemetry monitoring. Methods We developed a training module containing an educational video, PowerPoint presentation, and hands-on int...

Background : Mastery learning in health professions education requires learners to learn and undergo assessment until they demonstrate a high level of competence. Setting defensible standards is key to accurately assessing educational outcomes in mastery learning. The Mastery Angoff method was proposed recently to set a minimum passing standard (M...

Background: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. Objective: To develop and demonstrate the efficacy of online training. Design: Randomized educational trial. Participants: Primary care providers (PCPs). Intervention: Mastery learning course with v...

Purpose: Defensible minimum passing standards (MPSs) must be used to evaluate learner performance outcomes in health professions education. In this study, the authors compared the results of traditional Angoff and Hofstee standard-setting exercises with the Mastery Angoff and Patient-Safety approaches for central venous catheter (CVC) insertion sk...

Background Studies show that medical residents do not feel comfortable and lack the skills and confidence to perform common bedside procedures. Regulatory bodies often require a set number of procedures to determine resident competence, yet medical providers' knowledge of competency guidelines are less well known. This study aimed to qualitatively...

This article describes the development, implementation, and modification of an institutional process to evaluate and fund graduate medical education simulation curricula. The goals of this activity were to (a) establish a standardized mechanism for proposal submission and evaluation, (b) identify simulation-based medical education (SBME) curricula...

Purpose: Physicians-in-training often perform bedside thoracenteses in academic medical centers, and complications are more common among less experienced clinicians. Simulation-based mastery learning (SBML) is one potential solution to this problem. This study evaluated the effects of a randomized trial of thoracentesis SBML on patient complicatio...

The work of Draycott et al. using simulators to train professionals on obstetric emergencies clearly shows that rigorous simulation-based education improves perinatal outcomes, safety attitudes, and teamwork climate (1). We read "The cost of local, multi-professional obstetric emergencies training" (2) with great interest. In their study, the autho...

William C McGaghie, Jeffrey H Barsuk, Diane B Wayne Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USAWe read the analytical review by Drs. Siddaiah-Subramanya, Smith, and Lonie titled, “Mastery learning: how is it helpful?” that appeared recently in Advances in Medical Education and Practice, wit...

Background Many medical certifying bodies require that a minimum number of clinical procedures be completed during residency training to obtain board eligibility. However, little is known about the relationship between the number of procedures residents perform and clinical competence. Objective This study evaluated associations between residents'...

The current healthcare environment demands optimization of patient outcomes in addition to maximal cost efficiency. Restrictions on resident work hours have placed limitations on the amount of time that trainee physicians can spend on patient care. For the surgery resident, the consequence is less time spent in the operating room under the supervis...

A 3-day simulation-based capstone course was developed and pilot tested for a cohort of graduating medical students to assess their readiness for residency. The intervention taught and assessed individual performance on specific components of the 13 core entrustable professional activities (EPAs) that all medical school graduates should perform ind...

Objective: Develop new performance evaluation standards for the clinical breast examination (CBE). Summary background data: There are several, technical aspects of a proper CBE. Our recent work discovered a significant, linear relationship between palpation force and CBE accuracy. This article investigates the relationship between other technica...

Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional rol...

Objectives: Central venous catheter insertions may lead to preventable adverse events. Attending physicians' central venous catheter insertion skills are not assessed routinely. We aimed to compare attending physicians' simulated central venous catheterinsertion performance to published competency standards. Design: Prospective cohort study of a...

A 3-day simulation-based capstone course was developed and pilot tested for a cohort of graduating medical students to assess their readiness for residency. The intervention taught and assessed individual performance on specific components of the 13 core entrustable professional activities (EPAs) that all medical school graduates should perform ind...

Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills an...

Introduction: Simulation-based mastery learning (SBML) improves procedural skills among medical trainees. We employed an SBML method that includes an asynchronous knowledge acquisition portion and a hands-on skill acquisition portion with simulation to assess senior medical student performance and retention of the following 6 core clinical skills:...

Three-dimensional (3D) printing is a process where a physical object is created from a three-dimensional computer model through successive material layering. 3D printing is used in many industries to design and manufacture new products. Creation of training models for use in medical education is now possible via adoption of medical 3D printing. Thi...

Purpose: Translational educational outcomes have been defined as starting in simulation laboratories (T1) and moving downstream to improved patient care practices (T2), patient outcomes (T3), and cost or other value outcomes (T4). The authors conducted a realist synthesis review of the literature to evaluate the translational effect of simulation-...

Statement: Curriculum development in medical education should follow a planned, systematic approach fitted to the needs and conditions of a local institutional environment and its learners. This article describes the development and maintenance of a simulation-based medical education curriculum on advanced cardiac life support skills and its trans...

Clinical medical education in the 21st century is grounded in a 19th-century model that relies on longitudinal exposure to patients as the curriculum focus. The assumption is that medical students and postgraduate residents will learn from experience, that vicarious or direct involvement in patient care is the best teacher. The weight of evidence s...

Guidelines for reporting several types of medical studies have been described in the literature. However, there are no current guidelines to report studies on mastery learning curriculum development and trainee evaluation in medical education. Such guidelines will be important because medical education is moving toward a competency-based model. The...

Dissemination of a medical education innovation, such as mastery learning, from a setting where it has been used successfully to a new and different medical education environment is not easy. This article describes the uneven yet successful dissemination of a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) inser...

Sullenberger's skill and leadership from the safe water landing of US Airways Flight 1549 are now legendary. This chapter uses Captain Sullenberger's flying expertise as an example and for inspiration. It amplifies the US Airways Flight 1549 story by addressing the history of education for clinical skill acquisition in medicine, and the definition...

Context: Feedback is considered important in medical education. The literature is not clear about the mechanisms that contribute to its effects, which are often small to moderate and at times contradictory. A variety of variables seem to influence the impact of feedback on learning. The aim of this study was to determine which variables influence...

Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm f...

To the Editor: Clinical-skills assessments provide motivation and direction for learning.1,2 Adoption of simulation-based education methods has introduced a wide variety of options for clinical-performance assessment.3,4 To explore the potential value added by integrating sensor technology with a skills assessment, this study investigated whether s...

Effective team communication is critical in complex settings like hospital intensive care units. A social network analysis study was conducted in a burn intensive care unit, assuming physicians and key members of the nursing and clinical staff would occupy the core of a robust communication network. Clinical team members reported the frequency (0 t...

Integrative scholarship involves the aggregation of data and evidence in a way that allows the research community to comprehend and value the connections and perspectives that unite isolated facts and research studies. Integrative scholarship summarizes data, enlightens and informs readers broadly, and sets the stage for subsequent research. This a...

Introduction: Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of proce...

Background: Skilled performance of cesarean deliveries is essential in obstetrics and gynecology residency. A computer-enhanced visual learning module (CEVL Cesarean) was developed to teach cesarean deliveries. Methods: An online module presented cesarean deliveries as a series of components using text, audio, video and animation. First-year reside...

Introduction: Training for obstetrics and gynecology residents in second-trimester dilation and evacuation (D&E) procedures is extremely limited despite the Accreditation Council for Graduate Medical Education mandating all residents to receive abortion training. Simulation-based training improves surgical competence, but no second-trimester uteri...

Background Cardiac physical examination skills are often deficient in trainees and faculty members. Although recommended, the impact of cardiac physical examination faculty development on “downstream” trainee skills is unknown. Aim This study aims to evaluate the effectiveness of cardiac physical examination education for faculty and its impact...

To the Editor In a recent report, Dr Curtis and colleagues1 found that simulation-based education did not improve patient-reported quality of communication. We disagree with the authors’ conclusion that “these findings raise questions about skills transfer from simulation training to actual patient care and the adequacy of communication skills asse...

Objectives This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Seco...

Approximately 41 000 central line-associated bloodstream infections (CLABSI) occur annually in US hospitals. We previously developed a simulation-based mastery learning (SBML) curriculum in central venous catheter (CVC) insertion that significantly reduced CLABSI rates. In this study, we evaluated the effect of dissemination of the SBML curriculum...

Background: Medical students are increasingly documenting their patient notes in electronic health records (EHRs). Documentation short-cuts, such as copy-paste and templates, have raised concern among clinician-educators because they may perpetuate redundant, inaccurate, or even plagiarized notes. Little is known about medical students' experience...

Medical school graduates are expected to possess a broad array of clinical skills. However, concerns have been raised regarding the preparation of medical students to enter graduate medical education. We designed a simulation-based "boot camp" experience for students entering internal medicine residency and compared medical student performance with...

Introduction: Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may lead to less favorable outcomes. Incomplete execution of this standard of care may be due to ineffective provider education. Simulation has consistently proven a valuable educational tool in...

Effective communication during patient care transitions is essential for high-quality patient care. The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill. We stu...

Whether cognitive and patient care skills attained during simulation-based mastery learning (SBML) are retained is largely unknown. We studied retention of intensive care unit (ICU) clinical skills after an SBML boot camp experience. Forty-seven postgraduate year (PGY)-1 residents completed SBML intervention designed to increase procedural, communi...

Importance Lack of training hampers melanoma recognition by physicians. Objective To evaluate a melanoma simulation model to teach visual assessment and counseling skills. Design and Setting Simulation model study in an academic research setting. Participants A convenience sample of third-year medical students was randomly assigned to receive the i...

Background: Increasingly, paracentesis procedures are performed in interventional radiology (IR) rather than at the bedside. No guidelines exist to aid decision-making about the best location, and patient outcomes are unknown. Our aims were to develop a prediction model for which location (bedside vs IR) clinicians select for inpatient paracentesi...

Background: How often passing standards for clinical skills examinations should be reexamined is unknown. Purpose: The goal is to determine if improved resident performance affects the passing standard imposed by expert judges. Method: In 2006, we set a passing standard for a central venous catheter insertion clinical skills examination using...

Purpose: Patient care quality worsens during academic year turnover. Incoming interns' uneven clinical skills likely contribute to this phenomenon, known as the "July effect." The aim of this study was to evaluate the impact of a simulation-based mastery learning (SBML) boot camp on internal medicine interns' clinical skills. Method: This was a...

Introduction: Previous research shows that gaps exist in internal medicine residents' critical care knowledge and skills. The purpose of this study was to compare the bedside critical care competency of first-year residents who received a simulation-based educational intervention plus clinical training with third-year residents who received clinic...