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Advanced Curriculum Development:Developing a Mastery Learning Curriculum

David H. Salzman, MD, MEdAssociate Professor - Departments of Medical Education & Emergency MedicineJeffrey H. Barsuk, MD, MSProfessor – Departments of Medical Education & Medicine

Disclosures

David H. Salzman, MD, MEd Nothing to disclose

Jeffrey H. Barsuk, MD, MS Has received research support from Simulab, Co.

Objectives

By the end of the session participants will be able to:1. Identify the seven essential elements of Mastery Learning2. Analyze how integration of mastery learning impacts the six steps of

curriculum development 3. Apply the concepts of curriculum design and mastery learning to modify

an existing curriculum.

Previous Experiences with Mastery Learning

Curriculum Development 1. Problem Identification and General Needs AssessmentWhat is the healthcare problem that needs to be solved?

What are the current vs. ideal approaches?

2. Needs Assessment of Targeted Learners

What do your students need?What does your school or local environment need?

3. Goals and ObjectivesWhat are the overarching

goals and specific measurable objectives?

4. Educational StrategiesWhat teaching and assessment methods

are best suited to your objectives?

5. ImplementationWhat resources are necessary to

deliver this curriculum?

6. Evaluation and FeedbackDid it work?

Individual learners and Program

Traditional Training

Why does this happen in the traditional model of curriculum design for medical education?

Mastery Learning Approach

• Assumes normal distribution of performance is artificial• Assumes all participants can master performance goal

When Traditional Approaches Fail To Meet Expectations

Simulation-Based Mastery Learning:A Better Approach

Pretest

Lecture, video, demonstration and deliberate practice

Posttest

Additional Practice PASS

McGaghie, William C.; Barsuk, Jeffrey H.; Wayne, Diane B. Mastery Learning With Deliberate Practice in Medical Education Academic Medicine. 90(11):1575, November 2015.

SBML: A Better Approach

Components of Mastery Learning

1. Baseline, or diagnostic testing2. Clear learning objectives, sequenced as units in increasing difficulty3. Engagement in educational activities (eg, skills practice, data interpretation,

reading, focused on reaching objectives)4. A set minimum passing standard (eg, test score) for each educational unit5. Formative and/or summative testing to gauge unit completion at a present

minimum passing standard for mastery6. Advancement to the next educational unit given measured achievement at or

above the mastery standard.7. Continued practice or study on an educational unit until the mastery standard is

reached.

Mastery Learning1: Baseline, or diagnostic testing

Mastery Learning2: Clear learning objectives, sequenced as units in increasing difficulty

Mastery Learning3: Engagement in educational activities

Mastery Learning4: A set minimum passing standard for each educational unit

Actual cumulative % of students

Final Passing Score (%) 54%

Minimum and Maximum FAIL RATE

Minimum and Maximum PASS SCORE

Mastery Learning5: Formative and/or summative testing to gauge unit completion at a present minimum passing standard for mastery

Mastery Learning6: Advancement to the next unit given measured achievement at or above the mastery standard.

Mastery Learning

If at first you don’t succeed…..

………..Try, try again

Until meeting or exceeding the standard

7: Continued practice or study until the mastery standard is reached


1. Baseline, or diagnostic testing2. Clear learning objectives, sequenced as units in increasing difficulty3. Engagement in educational activities (eg, skills practice, data interpretation,

reading, focused on reaching objectives)4. A set minimum passing standard (eg, test score) for each educational unit5. Formative and/or summative testing to gauge unit completion at a present

minimum passing standard for mastery6. Advancement to the next educational unit given measured achievement at or

above the mastery standard.7. Continued practice or study on an educational unit until the mastery standard is

reached.

Combining SBML with 6 Steps of Curriculum Design

Combining SBML with 6 Steps of Curriculum Design

Pretest


Posttest


1. Problem Identification and General Needs Assessment

What is the healthcare problem that needs to be solved?

What are the current vs. ideal approaches?2. Needs Assessment of

Targeted Learners

What do your students need?

What does your school or local environment need?

3. Goals and Objectives

What are the overarching goals and specific measurable

objectives?

4. Educational Strategies

What teaching and assessment methods are best suited to your objectives?

5. Implementation

What resources are necessary to deliver this curriculum?

6. Evaluation and Feedback

Did it work?


Convergence of ML and 6 Steps1. Problem Identification and General Needs AssessmentWhat is the healthcare problem that needs to be solved?


2. Needs Assessment of Targeted LearnersWhat do your students need?


3. Goals and ObjectivesWhat are the overarching goals and specific measurable objectives?

4. Educational StrategiesWhat teaching and assessment methods are best suited to your objectives?

5. ImplementationWhat resources are necessary to deliver this curriculum?



Similar Approach

Mastery Learning Model impacts these steps










Similar Approach

Curriculum Development

• Who does the problem affect?

• What does it affect?

Step 1: Problem Identification










Similar Approach


• Determination of the learners• What is known about the learners and their needs

Step 2: Needs Assessment of Targeted Learners

Design a Simulation-Based-Mastery Learning Course










2: Clear learning objectives, sequenced as units in increasing difficulty

Objectives

Objectives:

What should your students be able to do upon completion of the session that they were unable to do prior

Who will do how much (how well) of what, by when?

This is influenced by the Minimum Passing Score

Objectives

• Levels of objectives -

ObjectivesWrite Learning Objectives

Create and Submit Objectives

http://bit.ly/SBML19LO


CAPS IMPORTANT

Create and Submit Objectives


Sharing Objectives










Engagement in educational activities

Baseline, or diagnostic testing

Advancement to the next unit given measured achievement at or above the mastery standard.


Many different types of educational strategiesStep 4: Educational Strategies


• Key to ensure that the methods of instruction are congruent with the goals and objectives

• Use multiple educational methods• Choose educational methods that are feasible in terms of resources

Step 4: Educational Strategies

How these components interact with 6 steps

• How is material going to be delivered?• How will students practice? / how to create engagement in educational activities• Assessment strategies



• Modalities to be considered: lectures, videos, simulations, debriefing, flipped classrooms

• Ensure engagement in educational activities: deliberate practice, data interpretation, reading, focused on the objectives


Design curriculum and set standards

(passing score)

Training: mastery learning with

deliberate practice

passPre-

intervention assessment on simulator fail

Post-intervention assessment on simulator

Figure 2. Standard SBML curriculum.

additional

practice


Deliberate Practice

Step 4: Educational Strategies - Deliberate Practice

A. Ericsson 2007

Deliberate Practice (DP)

• Identify well-defined task• Focused, repetitive practice• Informative feedback• Opportunity to correct errors• Goal: skill improvement

Ericsson, Academic Medicine, 2004

Design Educational Strategies

Describe and Submit Educational Strategies

http://bit.ly/SBML19ES

Sharing Educational Strategies


• Resources• Support• Administrative mechanisms

to support• Barriers• Plan for introduction

Step 5: Implementation


• How the amount of time impacts… (not everyone will need the same amount of time)

Step 5: Implementation

Implementation Science DomainsConsolidated Framework for Implementation Research (CFIR)

1. Intervention

2. Outer setting (e.g., the medical education enterprise)

3. Inner Setting (e.g., culture of a hospital)

4. Individuals involved

5. Process of Implementation (planning, engaging, executing, and evaluating)

Damschroder et al. Implementation science 2009;4:50McGaghie et al. Acad Med 2015;90(11)1487-94

Implementation Planning

Implementation Planning

http://bit.ly/SBML19IP

Sharing Implementation










Actual cumulative % of students

Final Passing Score (%) 54%

Minimum and Maximum FAIL RATE

Minimum and Maximum PASS SCORE

A set minimum passing standard for each educational unit

Diagnostic testing


• Individual level, determination if a learner has met the objectives – Assessment• Determine of success of the program – Evaluation

Step 6: Evaluation and Feedback


• Additional concepts in evaluation and feedback that won’t be covered here:- Checklists

• Creation of Checklists• Reliability and validity of checklists

- Data collection- Data analysis & statistical methods- Ethical considerations with delivery of content

Step 6: Evaluation and Feedback


• Need to establish MPS• Cannot advance to next unit unless meets MPS• Curriculum effectiveness – Translational Outcomes T1-T4

Step 6: Assessment and Feedback

Learner Assessment & Program Evaluation

http://bit.ly/SBML19AE

Sharing Learner Assessment


1. Highly motivated learners with good concentration;2. Engagement with a well-defined learning objective or task; at an3. Appropriate level of difficulty; with 4. Focused, repetitive practice; that leads to5. Rigorous, precise measurements; that yield6. Informative feedback from educational sources (e.g., simulators,

teachers); and where7. Trainees also monitor their learning experiences and correct

strategies, errors, and levels of understanding, engage in more DP; and continue with

8. Evaluation to reach a mastery standard; and then9. Advance to another task or unit10. Goal: constant improvement

Step 4: Educational Strategies - Deliberate Practice

Simulation-Based Mastery Learning:A Better Approach - Questions

Pretest


Posttest




1. Baseline, or diagnostic testing2. Clear learning objectives, sequenced as units in increasing difficulty3. Engagement in educational activities (eg, skills practice, data interpretation, reading,

focused on reaching objectives)4. A set minimum passing standard (eg, test score) for each educational unit5. Formative testing to gauge unit completion at a present minimum passing standard for

mastery6. Advancement to the next educational unit given measured achievement at or above the

mastery standard.7. Continued practice or study on an educational unit until the mastery standard is reached.

Apply to Your Own Curriculum1. Problem Identification and General Needs AssessmentWhat is the healthcare problem that needs to be solved?









Similar Approach

Mastery Learning Model impacts these steps

Additional Questions:

David Salzman, MD, [email protected]

Jeffrey Barsuk, MD, [email protected]

mailto:[email protected]

mailto:[email protected]

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