Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy
Introduction: Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency. There is no current mastery learning curr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2020-08-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/75z8g2kt |
| _version_ | 1818405115468447744 |
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| author | Danielle T. Miller Hashim Q. Zaidi Priyanka Sista Sarah S. Dhake Matthew J. Pirotte Abra L. Fant David H. Salzman |
| author_facet | Danielle T. Miller Hashim Q. Zaidi Priyanka Sista Sarah S. Dhake Matthew J. Pirotte Abra L. Fant David H. Salzman |
| author_sort | Danielle T. Miller |
| collection | DOAJ |
| description | Introduction: Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency. There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT. Methods: We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests. Results: Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001). Conclusion: This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure. |
| first_indexed | 2024-12-14T08:50:55Z |
| format | Article |
| id | doaj.art-4b2c20809ae544c7bab4f8f5a78709f3 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-12-14T08:50:55Z |
| publishDate | 2020-08-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-4b2c20809ae544c7bab4f8f5a78709f32022-12-21T23:09:03ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182020-08-0121510.5811/westjem.2020.5.46207wjem-21-1258Creation and Implementation of a Mastery Learning Curriculum for Emergency Department ThoracotomyDanielle T. Miller0Hashim Q. Zaidi1Priyanka Sista2Sarah S. Dhake3Matthew J. Pirotte4Abra L. Fant5David H. Salzman6Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, CaliforniaUniversity of Chicago School of Medicine, Department of Emergency Medicine, Chicago, IllinoisVanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TennesseeNorthShore University Health System, Department of Emergency Medicine, Chicago, IllinoisVanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TennesseeNorthwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, IllinoisNorthwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, IllinoisIntroduction: Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency. There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT. Methods: We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests. Results: Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001). Conclusion: This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure.https://escholarship.org/uc/item/75z8g2kt |
| spellingShingle | Danielle T. Miller Hashim Q. Zaidi Priyanka Sista Sarah S. Dhake Matthew J. Pirotte Abra L. Fant David H. Salzman Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy Western Journal of Emergency Medicine |
| title | Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy |
| title_full | Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy |
| title_fullStr | Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy |
| title_full_unstemmed | Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy |
| title_short | Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy |
| title_sort | creation and implementation of a mastery learning curriculum for emergency department thoracotomy |
| url | https://escholarship.org/uc/item/75z8g2kt |
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