Comparing the Video-guided Intubation Skills of Competency and Mastery-trained Staff Physicians

INTRODUCTION: Identifying the most effective simulation training approach for maintaining critical skills among staff physicians is essential, as this can affect patient safety and healthcare costs. While competency-based and mastery-based interventions have been studied independently, their effects on skill retention and transfer have not been directly compared. This prospective cohort study compared mastery-based and competency-based training for video laryngoscopy (VL) skill maintenance among staff physicians. METHODS: Each intervention included a presimulation online module and a simulation-based training session differing only in performance standards. The competency group (n=8) followed an instructor-determined standard, while the mastery group (n=8) adhered to a higher Mastery Angoff-established standard. VL skills were assessed pre-, post-, and 6 months later (follow-up) in the mastery group; the competency group was assessed only at follow-up. Follow-up included a retention test (pediatric mannequin) and a transfer test (neonatal task trainer). Performance was evaluated using an 18-item checklist (max score: 36) and procedural time (seconds). RESULTS: The mastery group significantly increased mean VL scores and decreased mean VL time from pretest (score=22.13; time=162.00 s) to post-test (34.38; 71.50 s) [(P<0.001, 95% CI: -17.44, -7.06);(P<0.001, 95% CI: 61.73, 119.27)]. All mastery-trained staff maintained skill mastery (≥32) at follow-up and outperformed the competency group at retention [(score=33.00 vs. 27.00; P<0.001, 95% CI: 3.40, 8.60);(time=60.63 s vs. 91.25s; P>0.05, 95% CI: -70.02,8.78)] and transfer [(score=34.38 vs. 26.13; P<0.001, 95% CI: 6.05, 10.45) (time=30.63s vs. 55.00 s; P>0.05,95% CI: -53.50, 4.75)]. CONCLUSIONS: Simulation-based mastery learning may enhance staff physicians' maintenance of VL skills and procedural efficiency. However, given the absence of baseline data for the competency group, definitive conclusions regarding superiority cannot be drawn.