Mastery Learning: The New Gold Standard for Teaching Bedside Procedures?

By Michael A. Gisondi (@MikeGisondi)

What is Mastery Learning?

Mastery Learning is an instructional method designed to train well-prepared learners to perform complex tasks to predetermined standards. The technique – made popular by Benjamin Bloom – has been around for many decades and was initially used in primary and secondary schools.

It wasn’t until the late 2000s that mastery learning took off in medical education, following a landmark article by Barsuk et al. His team at Northwestern University Feinberg School of Medicine demonstrated reduced bloodstream infections and less complications from central venous catheterization in a medical intensive care unit when performed by providers trained using simulation-based mastery learning.

Today, mastery learning is commonly used to teach bedside procedures such as paracentesis or to train providers to have difficult conversations such as breaking bad news. A quick PubMed search for simulation-based mastery learning yields many studies demonstrating its utility for teaching a wide range of procedures including tube thoracostomy, distal radius fracture reduction, transesophageal echocardiography, temporary transvenous cardiac pacing… to name just a few. It’s clear that simulation-based mastery learning has been embraced by medical educators across most specialties that perform procedures.

A central premise of mastery learning is that most students will be able to meet a minimum passing standard if they have enough time to learn and practice a task. Generally, this is in the form of a procedure checklist that requires near perfect completion of each step. Most learners succeed in a time-unlimited instructional model that uses deliberate practice with expert feedback. This contrasts with time-limited instructional sessions that generally result in a normal distribution of learner performance based on student aptitude. Therefore, most trainees pass the test when taught using mastery learning, and they do so uniformly and to a high predetermined standard.

Comparison of normal distribution of student aptitude in time-limited instruction vs. the high rate of student achievement observed in a time-unlimited model

An Average Mastery Learning Session Looks Something Like This:

  1. Pre-session assignment such as watching a procedure video or reading prep materials
  2. Initial test to confirm completion of preparatory work (if the learner fails, they reread the study materials and repeat the test when prepared)
  3. Demonstration of a procedure by an expert
  4. Deliberate practice of that procedure by the trainee with expert feedback
  5. No time limit for practice
  6. Once ready, the trainee attempts to complete each step of the procedure checklist (if they fail, they practice more until they are ready to challenge the test again)
  7. The session concludes once the minimum passing score is achieved

It should be noted that mastery learning doesn’t make you a master at procedures. A bit of poor word choice in my humble opinion. I like to think of a spectrum of skill acquisition from novice learner, to a student prepared to ‘mastery’ in a simulated environment (i.e., as good as it is going to get in a sim lab), to a student who achieves competence for a task after practice in a clinical setting, to an eventual expert performer. In many institutions that use mastery learning, trainees must complete the session and meet the minimum passing standard before they are allowed to attempt supervised procedures at the bedside.

Is Mastery Learning the New Gold Standard?

A ‘gold standard’ is a benchmark, something that serves as a standard by which other things can be compared, judged, or measured. From my practice as an educator, I think simulation-based mastery learning should become the gold standard for teaching bedside procedures. I have preferentially used it for over a decade to train students, residents, and faculty members to do various procedures to high performance. It is a standardized approach with clear predetermined goals, and it results in near uniform practice. In my experience, it is quite effective at achieving these outcomes in a timely fashion when compared to historically variable teaching methods employed by variably skilled instructors.

However, while there are many published studies describing the effectiveness of simulation-based mastery learning, I don’t think the technique is regarded as a true gold standard in the literature just yet. We aren’t seeing trials of other teaching methods compared to mastery learning as if it was a benchmark. Most mastery learning studies describe how checklists were derived, how minimum passing standards were determined, and how well learners performed – and all that is very important. We need rigorously designed checklists and standard settings. But medical education researchers now need to pivot their study designs to compare mastery learning to other instructional methods before it can serve as a benchmark.


If mastery learning is new to you, I encourage you to read more about it and to give it a try when you next find yourself teaching bedside procedures. As mentioned, there are hundreds of published studies that use mastery learning in various medical education contexts – and it is likely that a study of mastery learning has been published in your field. There are also a number of good texts describing mastery learning, but perhaps the most relevant to medical education is Comprehensive Healthcare Simulation: Mastery Learning in Health Professions Education by the folks at Northwestern University. They also offer a multi-day course called Designing and Implementing Simulation Based Mastery Learning Curricula. We have sent several of our faculty members and education fellows to the course over the last several years and the quality of our procedure training has improved. (I have no disclosures to report here, I just admire their work.) Whether you choose to use these resources or others, take time to familiarize yourself with the methodology, seek out rigorously designed and published procedure checklists to use, and collect performance data before and after your teaching sessions. Then ask yourself: is mastery learning now solid gold?


About the Author: Michael A. Gisondi, MD is a medical education researcher and emergency physician living in Palo Alto, California. He is currently Associate Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford School of Medicine. Twitter: @MikeGisondi

The views and opinions expressed in this post are those of the author(s) and do not necessarily reflect the official policy or position of The Royal College of Physicians and Surgeons of Canada. For more details on our site disclaimers, please see our ‘About’ page

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