Simulation-Based Mastery Learning Improves Medical Student Performance and Retention of Core Clinical Skills.

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: (a) ultrasound-guided peripheral intravenous placement, (b) basic skin laceration repair, (c) chest compressions, (d) bag-valve mask ventilation, (e) defibrillator management, and (f) code leadership. METHODS: Seven emergency medicine (EM) faculty members developed curricula, created checklists, and set minimum passing standards (MPSs) to test mastery of the 6 skills. One hundred thirty-five students on an EM clerkship were pretested on all 6 skills, viewed online videos asynchronously followed by a multiple choice computer-based skill-related quiz, received one-on-one hands-on skill training using deliberate practice with feedback, and were posttested until MPS was met. We compared pretest and posttest performance. We also retested, unannounced, a convenience sample (36%) of students from 1 to 9 months postintervention to assess skill retention. RESULTS: All students passed each quiz. The percentage of students who reached each MPS increased significantly (P < 0.001) from pretest to posttest for all 6 clinical skills. Ninety-eight percent of the students scored at or above the MPS when retested 1 to 9 months later. There was no significant decrease in mean score for any of the 6 skills between posttest and retention testing. CONCLUSIONS: Simulation-based mastery learning using a substantial asynchronous component is an effective way for senior medical students to learn and retain EM clinical skills. This method can be adapted to other skill training necessary for residency readiness.

A Vertically Integrated Online Radiology Curriculum Developed as a Cognitive Apprenticeship: Impact on Student Performance and Learning.

RATIONALE AND OBJECTIVES: The principles of Collins' cognitive apprenticeship model were used to design a radiology curriculum in which medical students practice radiological skills using online case-based modules. The modules are embedded within clinical third-year clerkships, and students are provided with personalized feedback from the instructors. We describe the development of the vertical online radiology curriculum and evaluate its impact on student achievement and learning process using a mixed method approach. MATERIALS AND METHODS: The curriculum was developed over a 2-year period. Student participation was voluntary in the first year and mandatory in the second year. For quantitative curriculum evaluation, student metrics for voluntary versus mandatory groups were assessed using independent sample t tests and variable entry method regression analysis. For qualitative analysis, responses from a survey of students about the value of the curriculum were organized into defined themes using consensus coding. RESULTS: Mandatory participation significantly improved (p = .001) the mean radiology examination score (82 %) compared to the voluntary group (73%), suggesting that mandatory participation had a beneficial effect on student performance. Potential preexisting differences in underlying general academic performance were accounted for by including mean basic science grades as the first variable in the regression model. The significant increase in R(2) from .16 to .28 when number of radiology cases completed was added to the original model, and the greater value of the standardized beta for this variable, suggest that the curriculum made a significant contribution to students' radiology examination scores beyond their baseline academic performance. Five dominant themes about curricular characteristics that enhanced student learning and beneficial outcomes emerged from consensus coding. These themes were (1) self-paced design, (2) receiving feedback from faculty, (3) clinical relevance of cases, (4) gaining confidence in interpreting radiological images, and (5) transfer of conceptual knowledge to actual practice. CONCLUSIONS: The vertically integrated online radiology curriculum can positively impact student performance and learning process in the context of the cognitive apprenticeship model.

Associations between formative practice quizzes and summative examination outcomes in a medical anatomy course.

Formative practice quizzes have become common resources for self-evaluation and focused reviews of course content in the medical curriculum. We conducted two separate studies to (1) compare the effects of a single or multiple voluntary practice quizzes on subsequent summative examinations and (2) examine when students are most likely to use practice quizzes relative to the summative examinations. In the first study, providing a single on-line practice quiz followed by instructor feedback had no effect on examination average grades compared to the previous year or student performances on similar questions. However, there were significant correlations between student performance on each practice quiz and each summative examination (r = 0.42 and r = 0.24). When students were provided multiple practice quizzes with feedback (second study), there were weak correlations between the frequency of use and performance on each summative examination (r = 0.17 and r = 0.07). The frequency with which students accessed the practice quizzes was greatest the day before each examination. In both studies, there was a decline in the level of student utilization of practice quizzes over time. We conclude that practice quizzes provide some predictive value for performances on summative examinations. Second, making practice quizzes available for longer periods prior to summative examinations does not promote the use of the quizzes as a study strategy because students appear to use them mostly to assess knowledge one to two days prior to examinations.