New Mastery Learning Course for ICU Procedures

Second-year internal medicine resident Chen Lin, MD, fully gowned and capped in surgical blue, congenially addressed a rather quiet patient on his table on a grey afternoon in early March.

“Mr. Smith, I’m Dr. Lin,” he intoned. “Today I’m going to be putting in a central line, like a big IV, to get you the medication you need.”

He patiently explained the risks and benefits of a central line insertion, and asked Mr. Smith if he consented to performance of the procedure

Smith was actually a medical simulator with the voice of Jeffrey Barsuk, MD, professor in the Division of Hospital Medicine and Director of Simulation and Patient Safety at Northwestern Simulation. Barsuk helps oversee the Northwestern mastery learning program. The program is special endeavor, changing the way medical learners around the country are taught to care for patients and improving outcomes for all involved.

Feinberg is a leader in the field of mastery learning, an educational approach that emphasizes skill, knowledge, and professional competencies. What primarily sets mastery learning apart is that it allows students to perfect essential techniques at their own pace with depth and rigor.

“Instead of thinking of it as a series of parts, it’s important for residents to understand the whole procedure,” Barsuk said. “It has to make sense to [Lin] as he does it.”

Mastery learning research began in elementary school education in the late 1960s, according to Vice Dean for Education Diane B. Wayne, MD, Dr. John Sherman Appleman Professor of Medicine and Medical Education in the Division of General Internal Medicine and Geriatrics. William C McGaghie, PhD, professor of Medical Education, and Wayne pioneered the use of mastery learning in health professions education at Northwestern University in 2004.

“Instead of time being fixed, outcomes are fixed,” said Wayne. “In the real world this means you finish second grade when you master the competencies that are required, not in June because the school year ends.”

The problem with time-based curricula, she said, is that outcomes and skills vary from student to student. Educators can reduce outcome variability by focusing on mastering the skill at hand rather than promoting students at a set time.

Simulation is a key component of mastery learning at Feinberg.

“It’s better to practice on mannequins than patients,” Wayne said. “For example, residents must document they can perform a procedure to the minimum standard in a simulated setting before performing the procedure on an actual patient. There’s no penalty for taking extra time – it’s not a negative.”

Pass/fail grading is common among health profession schools, according to Barsuk. Feinberg’s research, he said, demonstrates that mastery learning and simulation, taught in concert, ultimately improve patient care and reduce complications.

“The response from students has been overwhelmingly positive,” Barsuk said. “They leave feeling confident about their skills. Hands-on training is fun and more realistic.”

Mastery learning has been implemented in a range of specialties at Northwestern, including cardiology, nephrology, surgery and pediatrics. Internal medicine residents can choose from an exhaustive list of special courses and projects, such as central venous catheter insertion, thoracentesis, lumbar puncture and even end-of-life discussions. 

“It’s really spread,” said Wayne. “Northwestern has become one of the most impactful research groups in the world in the area of mastery learning in health professions – and we are especially known for translating our education program into actual patient outcomes.”

A number of the techniques and procedures practiced in mastery learning are not taught in medical school, according to Lin. Prior to studying in the simulation lab, he reports his success rate around 30 percent.

“The stakes for these procedures are high,” Lin said. “They require a lot of experience. This is a safe learning environment where it’s ok to mess up. Mastery learning taught me how to troubleshoot and the sessions reduced my anxiety significantly.”

Lin performed two central venous catheterizations that day on Smith: an internal jugular and a subclavian. He passed both.

“That’s the great thing about mastery learning,” Barsuk proclaimed, smiling. “Everyone succeeds!”