• CJEM · Aug 2023

    Randomized Controlled Trial Multicenter Study

    Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice.

    • Andrew Petrosoniak, Jonathan Sherbino, Thomas Beardsley, James Bonz, Sara Gray, Andrew K Hall, Christopher Hicks, Julie Kim, George Mastoras, Melissa McGowan, Julian Owen, Ambrose H Wong, and Sandra Monteiro.
    • Division of Emergency Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada. petro82@gmail.com.
    • CJEM. 2023 Aug 1; 25 (8): 667675667-675.

    ObjectivesSimulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC).MethodsWe conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test.ResultsImmediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01).ConclusionsThere was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time.© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).

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