Board #237 - Program Innovation Improve Simulation Education Efficiency

Objectives Simulation-based medical education featuring mastery learning (SBML) with deliberate practice (DP) is a form of competency-based education. Learners acquire knowledge and skill to high achievement standards judged by reliable measures without regard to learning time.1 This method involves skill repetition supported by specific feedback resulting in improved knowledge and skill acquisition.2 SBML grants educators flexibility, within practical educational limits, to tailor instruction and assessment to individual learners. Mastery learning is a form of education which involves significant face-to-face time. Asynchronous education (AE) has been successfully used in medical education as a solution to high face-to-face time demands. However, we are unable to find evidence to support AE in SBML with medical students. Several GME studies have used videos or reading, but the material is frequently reintroduced in didactic format and learners are not accountable for knowledge acquisition. We employed SBML with DP to instruct medical students during a 4-week Emergency Medicine Clerkship (EMC). We applied adult learning principles and AE to offset approximately 25% of time needed to reach the minimum passing standard for each skill. Description The four-week rotation involves patient care plus four dedicated educational days that are lecture-free, but include case-based discussions and SBML. We isolated seven skills for mastery learning: simple suturing, ultrasound guided IV insertion, ECG interpretation, chest compressions, bag valve mask, defibrillator, and code leader. The asynchronous part of the SBML curriculum provides students with tools to self-direct knowledge acquisition. An online time management planner is divided by weekly topics to give students an outline and links to required activities. Students review educational content and complete a quiz for each skill. Content is presented via videos, PowerPoint presentations and an internally created e-module for ECG content. Students are required to complete a short quiz for each skill delivered via Moodle. These formative quizzes give students feedback about their content understanding and help to identify deficient areas. Statistical feedback from Moodle helps faculty monitor student progress and performance. Students must complete the asynchronous requirements before participating in hands-on training for skill mastery. One year of data analysis including costs will be complete by December 2014. We will also have skill retention data for approximately 25% of the group. Conclusion Successful implementation of AE within the rigors of SBML should improve education efficiency. Such an approach can be adopted by other institutions with similar goals, not only in UME, but also other educational formats. Our methods addressed the design objective to use asynchronous education for knowledge acquisition prior to faculty face time for material application. This “flipped” classroom model in which students acquire didactic material from asynchronous sources as homework frees-up class time for application and critical thinking. The “flipped” classroom has successfully transformed higher-education learning environments3. Not only did we off-set about 25% of the material, we also held students accountable for the material via quizzes accounting for 10% of student grades. This was a participation grade which did not deduct for learning time or number of quiz attempts. There are several limitations to this study, including the potential for quiz answer sharing, lack of control of clinical experience, and lack of screening for prior skill exposure. In the future, we plan to assess the translation of these skills to the bedside during ED shifts. We also plan to compare residents who went through our training as students to those residents who did not. References 1. McGaghie WC, Miller GE, Sajid A, Telder TV. Competency-Based Curriculum Development in Medical Education. Public Health Papers No. 68. World Health Organization 1978. 2. Issenberg SB, McGaghie WC, Petrusa, ER, Gordon DL, Scalese, RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005;27:10-28. 3. Bergmann, J, Sams A. Flip Your Classroom: Reach Every Student in Class Every Day. Eugene, OR: International Society for Technology in Education; 2012. Disclosures None

Topic: Simulation-Based Education in Healthcare
Subfield: Physiology
Field: Medicine
Domain: Health Sciences