A Pilot Study of a Simulation-Based Mastery Learning Procedural Curriculum for Pediatric Emergency Medicine Fellows

Pediatric emergency medicine (PEM) fellows are expected to perform high-risk procedures across a wide range of patient age, size, and physiology including procedures that are no longer required during pediatric residency training. Examples include central venous catheter (CVC) placement, endotracheal intubation of children and adolescents, and tube thoracostomy placement. Simulation-based mastery learning has demonstrated decreased patient morbidity. In this study, we describe implementation of a simulation-based mastery learning (SBML) procedural curriculum for PEM fellows.

Our PEM fellows underwent an SBML procedural curriculum for lumbar puncture (LP), CVC placement, endotracheal intubation, and tube thoracostomy placement. These procedures are mandatory for fellows to learn, have known association with potential iatrogenic injury, and are widely available commercial task trainers. Fellows underwent baseline assessments, group demonstration, deliberate practice, and then postassessments. For both pre- and postassessments, we used internally developed checklists with minimum passing scores (MPSs) calculated by the Mastery-Angoff technique.

Nineteen pediatrics residency-trained PEM fellows underwent this curriculum over a 2-year period. Six fellows (31.58%) achieved the MPS on all four procedures during their first posttest attempt. All fellows achieved the MPS on all four procedures by the second posttest attempt. Most fellows (17/19 or 89.47%) did not achieve the MPS on baseline LP assessments, despite inclusion of this procedure as an Accreditation Council of Graduate Medical Education (ACGME) requirement during their pediatric residency training.

All participating PEM fellows demonstrated competency after training on four procedures associated with iatrogenic injuries. Using an SBML framework is a feasible method to teach procedural skills to PEM fellows, allowing them to demonstrate objective measures of competency in the simulation laboratory.