Yudkowsky Rachel, Park Yoon Soo, Lineberry Matthew, Knox Aaron, Ritter E Matthew
R. Yudkowsky is associate professor, Department of Medical Education, and director, Dr. Allan L. and Mary L. Graham Clinical Performance Center, University of Illinois at Chicago College of Medicine, Chicago, Illinois. Y.S. Park is assistant professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois. M. Lineberry is assistant professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois. A. Knox is a resident in plastic and reconstructive surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. E.M. Ritter is associate professor, vice chairman for education, and program director for the general surgery residency, Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine/Walter Reed National Military Medical Center, Bethesda, Maryland.
Acad Med. 2015 Nov;90(11):1495-500. doi: 10.1097/ACM.0000000000000887.
Mastery learning is an instructional approach in which educational progress is based on demonstrated performance, not curricular time. Learners practice and retest repeatedly until they reach a designated mastery level; the final level of achievement is the same for all, although time to mastery may vary. Given the unique properties of mastery learning assessments, a thoughtful approach to establishing the performance levels and metrics that determine when a learner has demonstrated mastery is essential.Standard-setting procedures require modification when used for mastery learning settings in health care, particularly regarding the use of evidence-based performance data, the determination of appropriate benchmark or comparison groups, and consideration of patient safety consequences. Information about learner outcomes and past performance data of learners successful at the subsequent level of training can be more helpful than traditional information about test performance of past examinees. The marginally competent "borderline student" or "borderline group" referenced in traditional item-based and examinee-based procedures will generally need to be redefined in mastery settings. Patient safety considerations support conjunctive standards for key knowledge and skill subdomains and for items that have an impact on clinical outcomes. Finally, traditional psychometric indices used to evaluate the quality of standards do not necessarily reflect critical measurement properties of mastery assessments. Mastery learning and testing are essential to the achievement and assessment of entrustable professional activities and residency milestones. With careful attention, sound mastery standard-setting procedures can provide an essential step toward improving the effectiveness of health professions education, patient safety, and patient care.
掌握式学习是一种教学方法，其教育进展基于已证明的表现，而非课程时间。学习者反复练习和重新测试，直到达到指定的掌握水平；尽管达到掌握水平的时间可能不同，但最终的成就水平对所有人来说都是相同的。鉴于掌握式学习评估的独特性质，采用深思熟虑的方法来确定表现水平和衡量标准（以判定学习者何时展现出掌握程度）至关重要。
当用于医疗保健领域的掌握式学习环境时，标准设定程序需要进行调整，特别是在基于证据的表现数据的使用、适当基准或比较组的确定以及对患者安全后果的考量方面。有关学习者结果以及在后续培训水平上取得成功的学习者的过往表现数据，可能比关于过去考生考试表现的传统信息更有帮助。在基于掌握式学习的环境中，通常需要重新定义传统基于项目和基于考生的程序中所提及的勉强合格的“边缘学生”或“边缘群体”。患者安全考量支持对关键知识和技能子领域以及对临床结果有影响的项目采用联合标准。最后，用于评估标准质量的传统心理测量指标不一定能反映掌握式评估的关键测量属性。掌握式学习和测试对于可托付专业活动和住院医师培训里程碑的达成与评估至关重要。通过仔细关注，合理的掌握式标准设定程序可以为提高卫生专业教育的有效性、患者安全和患者护理提供关键一步。
