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Simul Healthc. 2015 Aug;10(4):202-9. doi: 10.1097/SIH.0000000000000095.

An Equivalence Trial Comparing Instructor-Regulated With Directed Self-Regulated Mastery Learning of Advanced Cardiac Life Support Skills.

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From the Departments of Medicine (L.A.D., R.B., R.B.C.) and Family and Community Medicine (V.P.), University of Toronto; Departments of Medicine (L.A.D.), Mount Sinai Hospital, University Health Network, ON, Canada; Department of Educational Development and Research (J.D.), FHML, Maastricht University, Maastricht, Netherlands; The Wilson Centre (R.B.), University of Toronto; SimSinai (V.P.); Ho Ping Kong Center for Excellence in Education and Practice (R.B.C.), University Health Network, Toronto, ON, Canada; Miller School of Medicine (S.B.I.), University of Miami; and Gordon Center for Research in Medical Education (S.B.I.), Miami, FL.



Instructor-led simulation-based mastery learning of advanced cardiac life support (ACLS) skills is an effective and focused approach to competency-based education. Directed self-regulated learning (DSRL) may be an effective and less resource-intensive way to teach ACLS skills.


Forty first-year internal medicine residents were randomized to either simulation-based DSRL or simulation-based instructor-regulated learning (IRL) of ACLS skills using a mastery learning model. Residents in each intervention completed pretest, posttest, and retention test of their performance in leading an ACLS response to a simulated scenario. Performance tests were assessed using a standardized checklist. Residents in the DSRL intervention were provided assessment instruments, a debriefing guide, and scenario-specific teaching points, and they were permitted to access relevant online resources. Residents in the IRL intervention had access to the same materials; however, the teaching and debriefing were instructor led.


Skills of both the IRL and DSRL interventions showed significant improvement after the intervention, with an average improvement on the posttest of 21.7%. After controlling for pretest score, there was no difference between intervention arms on the posttest [F(1,37) = 0.02, P = 0.94] and retention tests [F(1,17) = 1.43, P = 0.25]. Cost savings were realized in the DSRL intervention after the fourth group (16 residents) had completed each intervention, with an ongoing savings of $80 per resident.


Using a simulation-based mastery learning model, we observed equivalence in learning of ACLS skills for the DSRL and IRL conditions, whereas DSRL was more cost effective.

[Indexed for MEDLINE]

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