Academic medicine : journal of the Association of American Medical Colleges
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Mastery learning is a powerful educational strategy in which learners gain knowledge and skills that are rigorously measured against predetermined mastery standards with different learners needing variable time to reach uniform outcomes. Central to mastery learning are repetitive deliberate practice and robust feedback that promote performance improvement. ⋯ Despite the growing body of health care simulation literature documenting the efficacy of mastery learning models, to date insufficient details have been reported on how to design and implement the feedback and debriefing components of deliberate-practice-based educational interventions. Using simulation-based training for adult and pediatric advanced life support as case studies, this article focuses on how to prepare learners for feedback and debriefing by establishing a supportive yet challenging learning environment; how to implement educational interventions that maximize opportunities for deliberate practice with feedback and reflection during debriefing; describing the role of within-event debriefing or "microdebriefing" (i.e., during a pause in the simulation scenario or during ongoing case management without interruption), as a strategy to promote performance improvement; and highlighting directions for future research in feedback and debriefing for mastery learning.
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An emerging priority in medical education is the need to facilitate learners' acquisition of quality improvement (QI) competencies. Accreditation bodies in both Canada and the United States have included QI and patient safety in their core competencies. ⋯ The curriculum will be evaluated using a knowledge assessment and satisfaction tool and postproject resident interviews. Facilitators will focus more on improving faculty develop ment in QI.
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The problem of poor mental health in residency is well established. Burnout, depression, and suicidal ideation are prevalent among resident physicians, and these problems appear to persist into practice. Leaders in graduate medical education such as policy makers at the Accreditation Council for Graduate Medical Education (ACGME) and directors of individual programs and institutions should acknowledge these important issues and take steps to address them. ⋯ The ACGME should also call for and support research in this area. Leaders or directors of individual programs and institutions should consider wellness initiatives that both (1) identify and address suboptimal aspects of the learning environment and (2) train residents in resilience skills. Efforts to improve the residency learning environment could be guided by the work of Maslach and Leiter, who describe six categories of work stress that can contribute to burnout: (1) workload, (2) control, (3) balance between effort and reward, (4) community, (5) fairness, and (6) values.