Simulation-Based Mastery Learning Improves Emergency Medicine Residents' Ability to Perform Emergency Cricothyrotomy

Emergency cricothyrotomy (EC) is a critical procedure for Emergency Medicine (EM) physicians to master. Simulation-based mastery learning (SBML), a form of competency-based education with deliberate practice, has been shown to prepare residents to perform numerous procedures. The objectives of this study were to create a SBML curriculum to teach EM residents EC, to compare pre- and post-training scores for EM residents performing EC, and to assess retention of mastery at 5 months.

EM residents completed baseline testing, training, post-testing, and retention testing using a commercially available task trainer and completed a post-curriculum satisfaction survey. An expert panel of EM physicians and trauma surgeons reviewed a previously developed 27-item checklist and set a minimum passing standard (MPS) using a Mastery Angoff approach. "Mastery" was defined as a checklist score meeting or exceeding the MPS.

The MPS was set at 26 correctly performed items (96.3%). A cohort of 56 EM residents completed the curriculum. No resident achieved mastery on baseline testing; 33 residents (59.0%) achieved mastery on initial post-testing. Checklist scores significantly improved from baseline to post-testing. All residents that did not initially achieve mastery successfully did after an additional 30-Min of deliberate practice. At 5 months, 40 residents retained mastery (71.4%). Retention performance of various checklist items decayed more than others. Retention performance did not significantly vary based on PGY level or if additional practice was required to achieve mastery. Post-curriculum survey data showed high resident satisfaction and significantly higher confidence in performing emergency cricothyrotomy.

A SBML curriculum improved EM residents' ability to perform EC in a simulated environment. Baseline testing highlighted the gap that traditional training approaches have in teaching this critical skill to a mastery standard. Retention results can inform a timeline for additional deliberate practice to ensure continual mastery.