Strides in Development of Medical Education

Document Type : Review


Department of Medical-Surgical Nursing, Iran University of Medical Sciences, Tehran, Iran


Context Effective clinical skills training of medical students can guarantee a higher quality of care, diagnosis, and treatment for patients. Therefore, selection of appropriate methods of clinical education is of great significance. Mastery learning is one of the learning models in which educational progress is not dependent on time, but rather performance. In this model, the learner is constantly assessed until achieving mastery. All students can achieve the same level of learning, although the amount of time required for mastery is variable. Objectives The purpose of the present study was to review the literature on the effects of mastery learning on the clinical education of medical students. Data Sources This systematic review was conducted in English and Persian databases to evaluate articles on mastery learning in clinical education, published from 1990 to 2016. In the primary search, 503 articles were retrieved using Persian and English keywords, including “clinical teaching” and “mastery learning”. After reviewing the abstracts, 50 relevant articles were selected, and, finally, 26 articles were reviewed. Results Based on the findings, mastery learning can improve skill mastery among students, reduce the complications of medical interventions, increase the students’ self-confidence, reduce the required time for skill acquisition, increase the students’ knowledge, and improve their communication skills. Also, this method of learning has been effectively applied in medicine, nursing, and occupational therapy for students and hospital staff. Conclusions Mastery learning is a suitable method for teaching clinical skills to students. Considering the advantages of this method, it can be used effectively to train students from different medical disciplines.


  1. Dorri S, Hakimi H. The effect of mastery learning model for suction and oxygen therapy skills in nursing students. Res Med Educ.2018;9(4):19–0. doi: 10.29252/rme.9.4.19.
  2. Kashani Z, Damavandi M, Karami Gazafi A. [The effects of mastery learning on attitude, performanceand intrinsic motivation of secondaryschool students in chemistry]. J Innovat Educ. 2010;6(2):155–72.Persian.
  3. Cook DA, Brydges R, Zendejas B, Hamstra SJ, Hatala R. Mastery learning for health professionals using technology-enhanced simulation:A systematic review and meta-analysis. Acad Med. 2013;88(8):1178–86. doi: 10.1097/ACM.0b013e31829a365d. [PubMed: 23807104].
  4. Eppich WJ, Hunt EA, Duval-Arnould JM, Siddall VJ, Cheng A. Structuring feedback and debriefing to achieve mastery learning goals. Acad Med. 2015;90(11):1501–8. doi: 10.1097/ACM.0000000000000934.

[PubMed: 26375272].

  1. Rahmani A, Fathiazar E, Roshangar F. [The effect of adapted model of mastery learning on cognitive and practical learning of nursing students]. Iran J Med Educ. 2008;7(2):277–67. Persian.
  2. Haghani F, Masoomi R. [Overview of learning theories and its applications in medical education]. Iran J Med Educ. 2011;10(5):1188–97. Persian.
  3. Nowroozi HM, Mohsenizadeh SM, Jafari SH, Ebrahimzadeh S. [The effect of teaching uning a blend of collaborative and mastery of learning models, on learning of vital signs: An experiment on nursing and

operation room students of Mashhad University of Medical Sciences]. Iran J Med Educ. 2011;11(5):541–53. Persian.

  1. Barsuk JH, McGaghie WC, Cohen ER, Balachandran JS, Wayne DB. Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit. J Hosp Med. 2009;4(7):397–403. doi: 10.1002/jhm.468. [PubMed: 19753568].
  2. Wayne DB, Barsuk JH, O’Leary KJ, Fudala MJ, McGaghie WC. Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. J Hosp Med. 2008; 3(1):48–54. doi: 10.1002/jhm.268. [PubMed: 18257046].
  3. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Wade LD, Feinglass J, et al. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med. 2006;21(3):251–6. doi:10.1111/j.1525-1497.2006.00341.x. [PubMed:16637824]. [PubMed Central: PMC1828088].
  4. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations. Acad Med. 2011;86(11):e8–9. doi: 10.1097/ACM.0b013e3182308d37. [PubMed:22030671].
  5. Barsuk JH, Cohen ER, Caprio T, McGaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology. 2012;79(2):132–7. doi:10.1212/WNL.0b013e31825dd39d. [PubMed: 22675080]. [PubMed Central: PMC3390539].
  6. Barsuk JH, Cohen ER, Vozenilek JA, O’Connor LM, McGaghie WC, Wayne DB. Simulation-based education with mastery learning improves paracentesis skills. J Grad Med Educ. 2012;4(1):23–7. doi:10.4300/JGME-D-11-00161.1. [PubMed: 23451302]. [PubMed Central:PMC3312528].
  7. Colquitt J, Parish D, Trammell A, McCullough J, Swadener-Culpepper L. Mastery learning of ACLS among internal medicine residents. Anal Resuscitation Curr Res. 2013;1(S1). doi: 10.4172/2324-903x.s1-007.
  8. Hosseiny N, Karimi Z, Malek Zadeh J. [The situation of clinical education based on nursing students’ opinion in Yasuj nursing and midwifery school]. Iran J Med Educ. 2005;5(2):171–5. Persian.
  9. Guskey TR. Mastery learning. In: Seel NM, editor. Encyclopedia of the sciences of learning. New York: Springer; 2012.
  10. Parandeh A, Haji Amini Z. [Practice-based learning and its outcomes in nursing students’ education]. JEduc Ethics Nurs. 2013;2(3):1–8. Persian.
  11. Roha YS, Lima EJ, Issenberg SB. Effects of an integrated simulationbased resuscitation skills training with clinical practicum on mastery learning and self-efficacy in nursing students.Collegian. 2016; 23(1): 53–9. [PubMed: 27188040].
  12. Barsuk JH, Cohen ER, Williams MV, Scher J, Feinglass J, McGaghie WC, et al. The effect of simulation-based mastery learning on thoracentesis referral patterns. J Hosp Med. 2016;11(11):792–5. doi:10.1002/jhm.2623. [PubMed: 27273066].
  13. Reed T, Pirotte M, McHugh M, Oh L, Lovett S, Hoyt AE, et al. Simulationbased mastery learning improves medical student performance and retention of core clinical skills. Simul Healthc. 2016; 11(3): 173–80. doi:10.1097/SIH.0000000000000154. [PubMed: 27093509].
  14. Barsuk JH, Cohen ER, Mikolajczak A, Seburn S, Slade M, Wayne DB. Simulation-based mastery learning improves central line maintenance skills of ICU nurses. J Nurs Adm. 2015;45(10):511–7. doi:10.1097/NNA.0000000000000243. [PubMed: 26425976].
  15. Cason ML, Gilbert GE, Schmoll HH, Dolinar SM, Anderson J, Nickles BM, et al. Cooperative learning using simulation to achieve mastery of nasogastric tube insertion. J Nurs Educ. 2015;54(3 Suppl):S47–51. doi:10.3928/01484834-20150218-09. [PubMed: 25692824].
  16. Barsuk JH, Cohen ER, Potts S, Demo H, Gupta S, Feinglass J, et al. Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ

Qual Saf. 2014;23(9):749–56. doi: 10.1136/bmjqs-2013-002665. [PubMed:24632995].

  1. Cohen ER, Barsuk JH, Moazed F, Caprio T, Didwania A, McGaghie WC, et al. Making July safer: Simulation-based mastery learning during intern boot camp. Acad Med. 2013;88(2):233–9. doi:10.1097/ACM.0b013e31827bfc0a. [PubMed: 23269294].
  2. Kessler DO, Arteaga G, Ching K, Haubner L, Kamdar G, Krantz A, et al. Interns’ success with clinical procedures in infants after simulation training. Pediatrics. 2013;131(3):e811–20. doi:10.1542/peds.2012-0607. [PubMed: 23439901].
  3. Scholtz AK, Monachino AM, Nishisaki A, Nadkarni VM, Lengetti E. Central venous catheter dress rehearsals: Translating simulation training to patient care and outcomes. Simul Healthc. 2013;8(5):341–9. doi:10.1097/SIH.0b013e3182974462. [PubMed: 24061335].
  4. Tang WE, Dong L. Applying mastery learning in a clinical skills training program for primary care nurses. J Contin Educ Nurs. 2013;44(12):535–41. quiz 542-3. doi: 10.3928/00220124-20131015-13.

[PubMed: 24143886].

  1. Ahya SN, Barsuk JH, Cohen ER, Tuazon J, McGaghie WC, Wayne DB. Clinical performance and skill retention after simulation-based education for nephrology fellows. Semin Dial. 2012;25(4):470–3. doi:10.1111/j.1525-139X.2011.01018.x. [PubMed: 22309946].
  2. Zendejas B, Cook DA, Hernandez-Irizarry R, Huebner M, Farley DR. Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair. J Surg Educ. 2012;69(2):208–14. doi:10.1016/j.jsurg.2011.08.008. [PubMed: 22365867].
  3. Baghaei R, Mohammadpour Y, Habibzade H, Rasouli D, Khalilzadeh H, Jafarizadeh H. [Competency- based mastery learning: A planned clinical experience for nursing students]. J Urmia Nurs Midwifery Fac.

2011;9(4):230–6. Persian.

  1. Zendejas B, Cook DA, Bingener J, Huebner M, Dunn WF, Sarr MG, et al. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: A randomized controlled trial. Ann Surg. 2011;254(3):502–9. discussion 509-11. doi:10.1097/SLA.0b013e31822c6994. [PubMed: 21865947].
  2. Butter J, McGaghie WC, Cohen ER, Kaye M, Wayne DB. Simulationbased mastery learning improves cardiac auscultation skills in medical students. J Gen Intern Med. 2010;25(8):780–5. doi:10.1007/s11606-010-1309-x. [PubMed: 20339952]. [PubMed Central: PMC2896602].
  3. Cohen ER, Feinglass J, Barsuk JH, Barnard C, O’Donnell A, McGaghie WC, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simul Healthc. 2010;5(2):98–102. doi:10.1097/SIH.0b013e3181bc8304. [PubMed: 20389233].
  4. Barsuk JH, McGaghie WC, Cohen ER, O’Leary KJ, Wayne DB. Simulationbased mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med.2009;37(10):2697–701. [PubMed: 19885989].
  5. Barsuk JH, Ahya SN, Cohen ER, McGaghie WC, Wayne DB. Mastery learning of temporary hemodialysis catheter insertion by nephrology fellows using simulation technology and deliberate practice. Am J Kidney Dis. 2009;54(1):70–6. doi: 10.1053/j.ajkd.2008.12.041. [PubMed:19376620].
  6. Wise M, Iris V. Using mastery learning to develop patient handling skills in occupational therapy students. Int J Ther Rehabil. 2005;12(7):287–93. doi: 10.12968/ijtr.2005.12.7.19542.
  7. Damavandi ME, Shekari Kashani Z. Effect of mastery learning method on performance, attitude of the weak students in chemistry. Soc Behav Sci. 2010;5:1574–9. doi: 10.1016/j.sbspro.2010.07.327.
  8. Anbari Z, Ramezani M. [The obstacles of clinical education and strategies for the improvement of quality of education at Arak University of Medical Sciences in 2008]. Arak Med Univ J. 2010;13(2):110–8. Persian.
  9. Shahmoradi MK, Khavaninzadeh M, Mousavi Kani K. [Catheter related complications and survival among Iranian ESRD patients treated in Hasheminejad Hospital 2010-2011]. Razi J Med Sci. 2013; 19(105): 21–7.Persian.