Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

Abstract

Introduction. Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. Innovation. An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS. Outcomes. A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD ¼ 12.09% vs mean 88.67%, SD ¼ 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing. Comments. We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes.

Use of a simulation‐based mastery learning curriculum to improve ultrasound‐guided vascular access skills of pediatric anesthesiologists

“…Additionally, there are few studies in the simulation-based mastery learning literature that evaluate practicing attending physicians' performance and require them to meet or exceed an minimum passing standard. 18,19 Our study adds to the growing body of literature that already demonstrates simulation-based mastery learning has the potential to improve clinical skills [7][8][9][10][11][12] and patient outcomes, 9,20 as well as providing a positive return on investment. 21,21,22,22,23 In contrast with previous studies, 7,10,24 we showed modest correlations between simulated test performance and the number of procedures performed in practice and self-confidence.…”

“…Despite this, a significant amount of research has already shown that simulation-based mastery learning improves physicians' skills and patient care outcomes. [7][8][9][10][11][12] The control for the study was each participants' pretest score and therefore, each individual served as their own control (quasi experimental design). A formal controlled trial was not performed because every anesthesiologist needed to be trained quickly to evaluate the clinical effects of the study.…”

“…Those who do not meet this standard participate in further training until they can be retested and reach the minimum passing standard. Simulation‐based mastery learning has been shown to increase physicians’ skills in Advanced Cardiac Life Support, central venous catheter insertion, thoracentesis, paracentesis, lumbar puncture, and communication skills 7‐12 . To our knowledge, there are no published simulation‐based mastery learning training programs in pediatric anesthesiology.…”

Non-technical skills progression during anesthesiology residency in Portugal: the impact of a National Pedagogical Plan

“…As the residency progresses, students understand that asking for help is a basic component of the general clinical practice and specifically of anesthesiology. Communication skills are fundamental and impact numerous health outcomes, including trust in clinicians, satisfaction, and even patient and family quality of life [ 18 – 20 ]. Therefore, training in communication skills is crucial to improve them [ 21 ].…”

Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

“…There is a large and growing body of evidence supporting the use of SBML as an educational modality for acquiring technical and procedural skills [27][28][29][30][31][32]. However, SBML has less frequently been used for acquisition of communication and interpersonal skills [33,34]. SBML is time and resource intensive, as one of the main means by which trainees acquire mastery is through repeated deliberate practice.…”