Mastery Learning in Medical Education: We Must Push for Reality

medicine puzzleBy: Neel Sharma, National University Hospital, Singapore

McGaghie and colleagues highlight the value of mastery learning with deliberate practice in medical education in their recent AM Last Page. Mastery learning, they argue, “expects excellence for all” with high achievement standards and minimal learner variation. Using a schematic, the authors demonstrate the mastery learning system in practice—pre-testing, a curriculum intervention, post-testing, advancement if successful or a review of the curriculum followed by repeat post-testing if not. They conclude that this approach can translate into improved patient care and safety outcomes, and I would personally agree.

Rote learning medical facts for exam day should now be a thing of the past. Evidence-based medical information is readily available, and learners must focus more on processing and assimilating information than on simply “binging and purging.” My only concern with implementing a mastery learning system is that making it a global reality will be far from easy.

In the UK, two new learning assessments have come into play—the situational judgment test (SJT) and the prescribing safety assessment (PSA). However, certain characteristics of these assessments currently hinder their use in practice. First, The Foundation Programme has emphasized that “Specific feedback about how candidates do on each item [on an SJT] cannot be provided as this would require providing information about items which may be used again in future years.” Second, in reference to the PSA, the Medical Schools Council will provide only an overall score, and they have noted that “the question bank has a limited number of questions and so every question made public is in need of replacement. The development of new questions is a complex process requiring considerable time and expertise.” Thus, despite the existence of these assessments, the concept of mastery learning does not yet exist in practice. So, we must try to overcome these barriers because feedback provides benefits not only to students but ultimately to their patients.

I congratulate the authors on their timely input to this important discussion.

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