Simulation-based Mastery Learning Improves Critical Care Skills of Advanced Practice Providers

Area of Science:

• Critical Care Medicine
• Medical Simulation
• Advanced Practice Provider Education

Background:

• Advanced practice providers (APPs) are crucial in intensive care units (ICUs) and require procedural competence.
• Established criteria for independent APP procedural performance are lacking.
• Simulation-based mastery learning (SBML) is effective for critical care skills but not yet applied to practicing ICU APPs.

Purpose of the Study:

• To assess the efficacy of an SBML curriculum in enhancing ICU APPs' critical care skills.
• To evaluate the impact of SBML on ICU APPs' procedural self-confidence.

Main Methods:

• A pretest-posttest study design was employed for central venous catheter (CVC) insertion, thoracentesis, and mechanical ventilation (MV) management.
• ICU APPs underwent baseline simulations, followed by didactic sessions, deliberate practice, and feedback.
• Participants aimed to meet minimum passing standards (MPS) on posttests within two weeks, with remediation for those who did not.

Main Results:

• All 12 participating APPs achieved mastery standards across all trained skills (CVC insertion, MV management).
• Significant improvements were observed in checklist scores for internal jugular CVC (67.2% to 97.1%), subclavian CVC (29.2% to 93.1%), thoracentesis (63.9% to 99.2%), and MV management (54.8% to 92.3%).
• APP procedural confidence increased significantly for all assessed skills post-intervention.

Conclusions:

• SBML is a highly effective strategy for training APPs in essential ICU procedures.
• Traditional educational methods may not sufficiently prepare APPs for complex critical care skills.
• SBML ensures APPs meet defined competency standards before independent practice.