The Mastery Learning Medical Education Pathway

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By: William C. McGaghie, PhD, professor of medical education, Northwestern University Feinberg School of Medicine

In 2004, at Northwestern Memorial Hospital, we began a mastery learning program to train PGY-2 internal medicine residents in advanced cardiac life support (ACLS) team resuscitation skills. There is the perception that American Heart Association (AHA) provider courses–the traditional “gold standard” for ACLS education–are insufficient to prepare residents to respond to actual ACLS events. So we developed our mastery learning program. The sessions involve strong doses of deliberate practice by individuals and teams in a medical simulation laboratory with coaching, assessment, and feedback from engaged instructors. This is hard work. The residents sweat. Most meet or exceed the mastery standard within the usual eight-hour curriculum, but a handful need extra time (never more than one hour). The residents leave these training sessions tired but smiling because they know the experience has made them better doctors. Representative post-training comments from participants include: “Very good training with dedicated teachers. Beats the AHA course by 100%.” and “This was incredibly fantastic. I feel so much more prepared to lead a code. Thank you!” A frequent suggestion is to have refresher sessions throughout the year.

What then is mastery learning in medical education? And how does it work?

Mastery learning is a stringent form of competency-based education. It is designed to promote learner acquisition of knowledge, skill, and professionalism competencies, which are measured rigorously, to achieve high standards, with little or no outcome variation among learners and without limiting learning time to fixed intervals.

I believe mastery learning is important because it facilitates “excellence for all” (especially when coupled with Anders Ericsson’s notion of deliberate practice) to produce powerful educational outcomes among individuals and teams. These outcomes include: an expanded and enriched functional knowledge base; improved invasive and noninvasive clinical skills; better communication with patients, families, and staff; and professional self-efficacy among medical learners. Mastery learning in medical education also dovetails with new priorities related to entrustable professional activities for graduating medical students and ACGME-mandated educational milestones for residents.

The cluster of nine articles that appears in the November 2015 issue of Academic Medicine addresses the winding pathway of mastery learning in contemporary medical education in the United States and worldwide. This scholarship challenges medical educators to consider their work in several new ways: to focus on measureable learning outcomes in undergraduate, graduate, and continuing medical education; to aim for high expectations and achievement for all learners; to abandon “time bound” curriculum management structures; and to pursue an educational focus on deliberate practice by ensuring that learners use new technologies rather than didactic or clinical instruction by teachers. Implementing the mastery learning model in medical education will be neither easy nor swift. However, its promise for an improved medical workforce and greater patient safety will encourage widespread, long-run adoption.

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