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

TL;DR

A simulation-based training program significantly improved emergency medicine residents' ability to perform emergency cricothyrotomy and maintain that skill over time.

Contribution

This study introduces a simulation-based mastery learning curriculum for emergency cricothyrotomy with measurable improvements and retention.

Findings

59% of residents achieved mastery after initial training, and all non-masters did so after additional practice.

71.4% of residents retained mastery at 5 months.

Residents reported high satisfaction and increased confidence after the curriculum.

Abstract

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.

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