To the Editor:
Cohen and colleagues1 share excellent recommendations for reporting mastery education research in medicine. Their list is extensive, yet, in their own opinion, a work-in-progress. We identify an important omission and recommend including comparative effectiveness methodology in future reports of mastery learning and deliberate practice. Current medical education reports often lack proper comparison groups as well as adherence to mastery learning principles.2 A recent review of deliberate practice training in medicine reported overall positive effects on selected skills, even translating to performance in clinical practice.3 However, upon critical review, very few studies included control groups, and many studies did not adhere to principles of deliberate practice (i.e., students lacked repeated practice with coaching).4,5 We recommend that future researchers pay careful attention to research methods and include a testable control group to show comparative effectiveness of their developed curriculum. In a simulated environment, the control group may use self-directed practice with an equal amount of time as students engaged in deliberate practice.6 In order to drive change towards adopting mastery learning for physician competence, we need future research that answers the question, “Is mastery learning the most effective way to achieve competence?”
Ankeet D. Udani, MD, MSEd
Assistant professor, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; [email protected]
Edward R. Mariano, MD, MAS
Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, and chief, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California.
Steven K. Howard, MD
Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, and staff physician, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California.
The ADAPT (Anesthesiology-Directed Advanced Procedural Training) Research Group
1. Cohen ER, McGaghie WC, Wayne DB, Lineberry M, Yudkowsky R, Barsuk JH. Recommendations for reporting mastery education research in medicine (ReMERM). Acad Med. 2015;90:15091514.
2. Udani AD, Kim TE, Howard SK, Mariano ER. Simulation in teaching regional anesthesia: Current perspectives. Local Reg Anesth. 2015;8:3343.
3. Hastings RH, Rickard TC. Deliberate practice for achieving and maintaining expertise in anesthesiology. Anesth Analg. 2015;120:449459.
4. Bruppacher HR, Alam SK, LeBlanc VR, et al. Simulation-based training improves physicians’ performance in patient care in high-stakes clinical setting of cardiac surgery. Anesthesiology. 2010;112:985992.
5. Johnson KB, Syroid ND, Drews FA, et al. Part task and variable priority training in first-year anesthesia resident education: A combined didactic and simulation-based approach to improve management of adverse airway and respiratory events. Anesthesiology. 2008;108:831840.
6. Udani AD, Harrison TK, Mariano ER, et al.; ADAPT (Anesthesiology-Directed Advanced Procedural Training) Research Group. Comparative-effectiveness of simulation-based deliberate practice versus self-guided practice on resident anesthesiologists’ acquisition of ultrasound-guided regional anesthesia skills. Reg Anesth Pain Med. 2016;41:151157.