From the Stanford University, School of Medicine (G.G.T.); Department of Emergency Medicine (M.A.G., S.S.S.-S., W.W.D.), Stanford University, Stanford, CA; Department of Emergency Medicine (N.M.M.), Vanderbilt University, Nashville, TN; and Department of Orthopedic Surgery (R.S.A.), Stanford University, Stanford, CA.
Simul Healthc. 2021 Dec 1;16(6):e176-e180. doi: 10.1097/SIH.0000000000000534.
Distal radius fractures are common orthopedic injuries managed in emergency departments. Simulation-based mastery learning is widely recognized to improve provider competence for bedside procedures but has not been studied to teach fracture management. This study evaluated the effectiveness of a simulation-based mastery learning curriculum to teach distal radius fracture reduction to novice orthopedic surgery and emergency medicine residents.
We created a novel mastery learning checklist using the Mastery Angoff method of standard setting, paired with a new simulation model designed for this project, to teach orthopedic surgery and emergency medicine interns (N = 22) at the study site. Orthopedic surgery and emergency medicine faculty members participated in checklist development, curriculum design, and implementation. Training included just-in-time asynchronous education with a readiness assessment test, in-classroom expert demonstration, and deliberate practice with feedback. Residents completed a pretest/posttest skills examination and a presurvey/postsurvey assessing procedural confidence.
Standard setting resulted in a 41-item checklist with minimum passing score of 37/41 items. All participants met or surpassed the minimum passing score on postexamination. Postsurvey confidence levels were significantly higher than presurvey in all aspects of the distal radius fracture procedure (P < 0.05).
This study demonstrated that a simulation-based mastery learning curriculum improved skills and confidence performing distal radius fracture reductions for orthopedic surgery and emergency medicine interns. Future planned studies include curriculum testing across additional institutions, examination of clinical impact, and application of mastery learning for other orthopedic procedures.
桡骨远端骨折是急诊科常见的骨科损伤。基于模拟的掌握学习被广泛认为可以提高提供者进行床边操作的能力，但尚未研究教授骨折管理。本研究评估了基于模拟的掌握学习课程在教授桡骨远端骨折复位方面对骨科和急诊医学住院医师的有效性。
我们使用掌握安戈夫方法的标准制定了一个新的掌握学习清单，并结合了专为该项目设计的新模拟模型，来教授研究地点的骨科和急诊医学实习医生（N=22）。骨科和急诊医学教师参与了清单的制定、课程设计和实施。培训包括及时的异步教育、带有准备情况评估测试的课堂专家演示以及带有反馈的刻意练习。住院医师完成了技能前测/后测考试以及程序信心评估的预调查/后调查。
标准制定产生了一个 41 项清单，最低通过分数为 37/41 项。所有参与者都达到或超过了后测的最低通过分数。后测的信心水平在桡骨远端骨折程序的所有方面都明显高于前测（P<0.05）。
本研究表明，基于模拟的掌握学习课程提高了骨科和急诊医学住院医师进行桡骨远端骨折复位的技能和信心。未来的计划研究包括在其他机构进行课程测试、检查临床影响以及将掌握学习应用于其他骨科手术。
