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

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.