Simulation-Based Mastery Learning for Cranial Nerve Physical Exam Skill Acquisition

Concern among medical educators about graduate variability in core clinical skills has existed for decades. Simulation-based mastery learning (SBML) is an alternative method of clinical instruction that ensures proficiency from every learner. This article reports a novel application of SBML in physician assistant (PA) education for instruction and assessment of cranial nerve physical examination skills and compares SBML with traditional training.

The rigorous SBML education intervention included (1) a pretest, (2) clearly defined learning objectives, (3) deliberate practice with instructor feedback, (4) lecture, video, and peer feedback, (5) post-test, (6) continued training and retesting as needed to meet a minimum passing standard (MPS), and (7) retention testing. Student self-efficacy (S-E) was measured before and after the SBML intervention.

At pretest, 0/34 (0%) (mean = 54.55; standard deviation [SD] = 18.30) PA students in the SBML cohort met the MPS. Post intervention, 33/34 (97.1%) PA students passed the initial post-test. All (100%) students finally met the MPS with a mean score of 97.13% (SD = 3.33%). Retention testing was performed at 6 weeks; 31/34 (91%) PA students retained mastery-level skills. The SBML cohort significantly outperformed the historical cohort when their performance was evaluated against the MPS (96.15% vs. 75.54%; P < .001; Cohen's d = 2.20). Student S-E improved with SBML.

Students trained via SBML on the cranial nerve exam achieved high competence and confidence with minimal skill deterioration over time. Their scores exceeded those of students trained traditionally. Simulation-based mastery learning is an effective method of training clinical skills due to its high standard of proficiency, durable retention, and learner satisfaction.