Necessity of Pretests in Central Venous Catheter Insertion Simulation-Based Mastery Learning: A Randomized Controlled...

Area of Science:

• Medical Education
• Surgical Skills Training
• Competency-Based Education

Background:

• Simulation-based mastery learning (SBML) is a rigorous educational framework.
• SBML mandates pretest, deliberate practice, and posttest assessments to achieve a minimum passing standard (MPS).
• The necessity of the pretest component in SBML curricula is under investigation.

Purpose of the Study:

• To evaluate the effectiveness of a modified SBML curriculum lacking a pretest assessment compared to a standard SBML curriculum.
• To determine if eliminating the pretest impacts resident performance on central venous catheter insertion.
• To assess the impact of pretest inclusion on overall training time.

Main Methods:

• A randomized controlled trial was conducted with internal medicine residents.
• Participants were assigned to either a standard SBML curriculum with a pretest or a modified SBML curriculum without a pretest.
• Outcomes measured included initial posttest performance and total training duration.

Main Results:

• No statistically significant difference was observed in median initial posttest scores between the pretest and no-pretest groups.
• A higher proportion of residents in the pretest group achieved the MPS on the initial posttest (100%) compared to the no-pretest group (89%).
• The pretest group required 16.5 hours more faculty and learner time than the no-pretest group.

Conclusions:

• While a pretest may slightly increase the likelihood of immediate posttest success, its inclusion in this SBML curriculum did not offer clear performance benefits.
• Eliminating the pretest component of the SBML curriculum for central venous catheter insertion significantly reduced training time.
• Modified SBML curricula without pretests may offer a more time-efficient approach to competency-based medical education.