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Background/objectives: To develop and evaluate a post-acute care simulation-based mastery learning (SBML) continuing medical education (CME)/maintenance of certification (MOC) procedure course., Design: Pretest-posttest study of the SBML intervention., Setting: A 2-day post-acute care procedures course., Participants: Sixteen practicing clinicians (5 physicians,11 advanced practice providers). Participants engaged in a skills pretest on knee aspiration/injection, gastrostomy tube removal/replacement, tracheostomy tube exchange, and basic suturing using a checklist created for each procedure. Participants received a didactic on each procedure followed by deliberate practice with feedback. Using the same checklists, participants completed a skills posttest and were required to meet a minimum passing standard (MPS) to obtain CME/MOC credit., Measurements: The MPS for each skills checklist was determined by a multidisciplinary panel of 11 experts. Participants completed surveys on procedure self-confidence and a course evaluation., Results: There was statistically significant improvement between pre- and posttests for all four procedures ( p < .001). All participants were able to meet or exceed the MPS for each skill during the 2-day course. Participants' self-confidence regarding each procedure improved significantly ( p < .001)., Conclusion: An SBML training course granting CME/MOC credit for post-acute care providers significantly improves performance of knee aspiration/injection, gastrostomy tube removal/replacement, tracheostomy tube exchange, and basic suturing.

Mastery learning is a form of competency-based education in which learning time varies but outcomes are uniform. Trainees must meet a minimum passing standard (MPS) before completing a mastery learning curriculum. The objective of this study was to establish a curriculum for fall risk and gait assessment for medical students, determine an MPS for a fall risk and gait assessment clinical skills examination (CSE), and apply the MPS to a sample of medical students completing a fall risk and gait assessment CSE. Medical students completed an interactive session about fall risk and gait assessment including the Timed Up and Go (TUG) test and completed deliberate practice with 3 patients. Skills were evaluated using an 18-item skills checklist. A panel of clinical experts set the MPS at 82%. Eighty-seven medical students participated. The average score on the checklist was 14.7 of 18 (81.4%.) Although almost all performed the TUG correctly, only 61% met the MPS for the checklist. Our results suggest that a mastery learning approach may better prepare the 39% of students that did not meet MPS to complete a fall risk and gait assessment.

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. The authors designed this study to evaluate a mastery learning intervention to teach and assess components of 3 of the 13 EPAs in a 4th-year capstone course., Intervention: The course featured mastery learning principles and addressed three EPA-based skills: (a) obtain informed consent, (b) develop a differential diagnosis and write admission orders, and (c) write discharge prescriptions. All students underwent a baseline skills assessment, received feedback, engaged in deliberate practice with actionable feedback, and completed a similar skills-based posttest assessment. Students continued with practice and testing until the minimum passing standards (MPSs) were reached for each posttest., Context: All medical students at a single medical school (Northwestern University, Feinberg School of Medicine) who matriculated in 2012 and graduated with the class of 2016 participated in a required transition to residency course immediately prior to graduation., Outcome: There were 134 students eligible to participate, and 130 (97.0%) completed all curricular requirements and assessments. All 130 medical students who completed the course met or exceeded the MPS for each of the three EPA-based clinical skills. Reliability coefficients for outcome data were uniformly high. Measures for each of the three clinical skills showed statistically significant improvement., Lessons Learned: The capstone course was an effective approach to teach and assess components of three EPA-based clinical skills to mastery learning standards in a 4th-year capstone course. We learned that this approach for implementation is feasible and results in significant improvement in components of EPA skill performance. Next steps will include developing assessments incorporating the mastery model into components of additional EPAs, identifying the best location within the curriculum to insert this content, and expanding the number of assessments as part of a larger assessment system.

Phenomenon: Teaching patient-centered care (PCC) is a key component of undergraduate medical curricula. Prior frameworks of PCC describe multiple domains of patient-centeredness, ranging from interpersonal encounters to systems-level issues. Medical students' perceptions of PCC are thought to erode as they progress through school, but little is known about how students view PCC toward the beginning of training. This study explores the perceptions of PCC among 1st-year medical students to inform curricular development and evaluation. Approach: Medical students participated in semistructured, in-person interviews within 4 months of starting medical school as part of a longitudinal study. Transcripts were analyzed using a grounded theory approach and the constant comparative method to describe responses and characterize emergent themes. Transcripts were reviewed to compare codes and compile a final codebook. Findings: Thirty-eight students completed interviews. Students provided heterogeneous definitions of PCC, including perceptions that PCC is implicit and obvious. Many students were unable to provide a concrete definition of PCC, juxtaposing PCC with other priorities such as profit- or physician-centered care, whereas others thought the term was jargon. Some participants defined PCC as upholding patient values using hypothetical examples centered around physician behavior. Insights: Although students appeared to enter medical school with a range of perceptions about PCC, many of their descriptions were limited and only scratch the surface of existing frameworks. Rather than their perceptions of PCC eroding during medical school, students may never fully develop a foundational understanding of PCC. Our findings reinforce the need for authentic, clinically experiential learning opportunities that promote PCC from the earliest stages of medical education.

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 an expert panel. From 2007 to 2010, trainee scores improved steadily. In 2010, a new expert panel provided judgments for the examination using 4 consecutive years of resident performance data. Interrater reliabilities and test-retest reliability (stability) were calculated. Passing standards from 2006 and 2010 were compared., Results: Judgments provided were reliable and stable. The new passing standard was 88% for internal jugular and 87% for subclavian central venous catheter insertion compared to 79% for both sites in 2006., Conclusions: Cumulative performance data influenced experts to set a more stringent minimum passing standard. Standards should be regularly reviewed to ensure they are fair and appropriately rigorous.

Background: Resident education in Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) is required but underemphasized., Purposes: The objectives are to identify SBP and PBLI knowledge and skills with the most relevance to our graduates' practices and to determine how well they were prepared during residency training to address these issues., Methods: A survey was drafted based on Accreditation Council for Graduate Medical Education competency definitions and published literature on SBP and PBLI. Respondents indicated the extent to which each item is relevant to their practice and the adequacy of instruction received on a 5-point Likert scale., Results: All topics had high perceived relevance to practice with most topics rated low for adequacy of training. Topics of practice management and health care economics contained the largest gaps between mean ratings of relevance and adequacy of training (p < .001). Few differences in ratings were seen based on graduate demographics., Conclusions: This survey has allowed us to prioritize SBP and PBLI curricula to meet the needs of our graduates.

Background: Internal medicine residents must be competent in Advanced Cardiac Life Support (ACLS) for board certification., Purpose: The purpose was to use a medical simulator to assess baseline proficiency in ACLS and determine the impact of an intervention on skill development., Method: This was a randomized trial with wait-list controls. After baseline evaluation in all residents, the intervention group received 4 education sessions using a medical simulator. All residents were then retested. After crossover, the wait-list group received the intervention, and residents were tested again. Performance was assessed by comparison to American Heart Association guidelines for treatment of ACLS conditions with interrater and internal consistency reliability estimates., Results: Performance improved significantly after simulator training. No improvement was detected as a function of clinical experience alone. The educational program was rated highly.

Background: Residency programs are required to teach and evaluate trainees in the area of professionalism and medical ethics. Prior to developing a curriculum in this area, residents and fellows were surveyed to assess learning needs., Description: A case-based survey was developed based on published curricula. Residents and fellows were asked to describe their comfort level in 11 clinical scenarios on a Likert-type scale ranging from 1 (not at all comfortable) to 10 (extremely comfortable)., Evaluation: 151 surveys were returned for an overall response rate of 73%. Comfort levels ranged from a low of 3.1 to a high of 8.5 on the 10-point scale. Despite additional years of clinical training, fellows only reported an increased comfort level in 1 case., Conclusion: Learning needs exist in residents and fellows in the area of medical ethics. Use of a needs assessment was instrumental in planning and designing an ethics curriculum.