Preparation for Future Learning of Procedural Skills

Abstract

Background: Competence in clinical practice involves effective application of previously-acquired knowledge and the ability to use knowledge adaptively for innovation across diverse clinical contexts. In the learning context, this adaptability is termed Preparation for Future Learning (PFL) and looks at the capacity of trainees to use knowledge and strategies to learn and solve new problems. We compared how three instructional designs impacted procedural skill acquisition and PFL, through assessment of transfer to learning a novel procedural skill. Methods: We randomized 60 medical students to practice infant lumbar puncture (ILP) according to a Simulation-based Discovery Learning intervention (i.e. guided invention before expert instruction), a Simulation-based Mastery Learning condition (i.e., a stringent form of competency-based education), or a control sequence. In a second session, we assessed how well learners transferred strategies developed in the first session to learn a novel task – knee arthrocentesis (KA). We compared trainees’ post-test ILP performance and PFL ability via a KA performance test. Results: There was a significant effect of group on ILP checklist score after controlling for pre-test score, F(2,56) = 3.202, p<0.05. Post-intervention ILP checklist scores were statistically greater in the mastery group (93.03% ±2.02) compared to the control group (85.94% ±1.93). There was no significant effect of group on ILP global rating score. Though reliability of ratings was low, there was no significant effect of group on KA performance. Conclusion: This work supports a benefit of mastery learning compared with non-mastery simulation-based instruction for procedural skill acquisition, but did not demonstrate a benefit for mastery learning over invention followed by direct instruction. Most participants in all groups were not competent to perform KA and no intervention showed clear benefit for PFL. Future work is required to guide development of learning interventions which support PFL given the expectation for trainees to problem solve and innovate.