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| GENERAL ARTICLE |
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| Year : 2018 | Volume
: 31
| Issue : 1 | Page : 39-42 |
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A review of mastery learning: The roseman model as an illustrative case
Martin S Lipsky1, Catherine J Cone2
1 Roseman University of Health Sciences, South Jordan, UT 84095, USA
2 Department of Pharmacy Practice, College of Pharmacy, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| Date of Web Publication | 14-Aug-2018 |
Correspondence Address:
Martin S Lipsky
College of Pharmacy, Roseman University of Health Sciences, 10920 S River Front Parkway, South Jordan, Utah 84095
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1357-6283.239045
Background: An educational method gaining acceptance in health profession's training is mastery learning. Mastery learning requires learners to demonstrate essential knowledge and skills measured against rigorously set standards without regard to time. The key elements of mastery learning include focus on a single subject, short curricular blocks, setting specific objectives, using frequent feedback, deliberative practice, and demonstrating mastery before moving onto the next subject. Roseman University of the Health Sciences College of Pharmacy (COP) developed and delivered an accelerated mastery learning curriculum designed to develop knowledge and skills through active learning. Methods: The COP uses a mastery model for its PharmD program. The didactic curriculum is divided into 2-week assessment blocks focusing on a single subject. Students must demonstrate mastery, defined as ≥90% on an assessment, to pass a block. Students failing a block assessment receive feedback and a second opportunity to pass. Students failing their repeat assessment continue onto the next block, but require summer remediation before moving onto the next year. Results: National pass rates for the US pharmacy board examination ranged between 92.6% and 96.9% during the 2010–2015 period, while the COP scores ranged from 93.0% to 99.0% and fell below national pass rates on only one occasion. The attrition rate was 6.5%, below the national rate of 10.8%. Students reported an overall satisfaction with their education of 3.82 (Likert scale 1–5) and 4.04 for the block system. Discussion: Overall, the Roseman University mastery model is successful. Students report high levels of satisfaction and outcomes on examinations and attrition compares favorably to national averages.
Keywords: Competency, deliberative practice, feedback, mastery learning
How to cite this article:
Lipsky MS, Cone CJ. A review of mastery learning: The roseman model as an illustrative case. Educ Health 2018;31:39-42 |
| Background | |  |
Health profession's education affects the health and well-being of both the individuals and populations they serve. Recognizing the critical nature of health care, medical educators seek methods to assure that practitioners are competent to perform the services they provide.[1] One method gaining acceptance for achieving these goals is mastery learning.[2] This article will review the key features of mastery learning and describe the Roseman University of Health Sciences College of Pharmacy's (RUCOP) mastery-based curriculum, the first of its kind.
Mastery learning
Mastery learning as conceptualized by Bloom is based on the idea that given sufficient time and resources, all students can learn and that aptitude is a measure of time needed to master content.[3] Based on this assumption, Bloom proposed that instead of a fixed time-based unit educational model as seen in traditional semester-based curricula, students must demonstrate mastery against a predetermined set of standards before advancing on to the next subject unit.[4] A key feature of this model is the use of frequent formative assessments to provide feedback and to evaluate whether students have mastered an instructional standard.[5] For students failing to attain the criteria set for mastery, the assessment serves as a diagnostic tool for instructors to develop an individualized learning plan for corrective action. Students can then use this plan to address their deficiencies and to retake the test. If students fail the second attempt, instructors give additional opportunities for students to study and to retest until they demonstrate mastery.
Bloom believed that by expecting competency for all and by setting high achievement standards, there would be less learner variation. In traditional educational models, a student's achievement is commonly based on a bell-shaped curve. In contrast, a mastery learning curriculum sets passing at the level of competence needed for proficiency, which requires weaker students to achieve a higher mastery level score (such as 90% compared to the traditional 70%) and would skew the curve to the right.[6] A meta-analysis examining the mastery learning model in multiple settings found positive effects in 93% of 108 studies examined, with the greatest impact found among weaker students.[6] In the setting of health professional education, Cook et al. found that mastery learning was associated with positive effects on skill acquisition and moderate effects on patient outcomes.[7]
Mastery learning and competency
[Table 1] summarizes the key elements of the mastery model.[8] Aligning these elements assures that students understand what is expected of them, focuses instruction on objectives, provides students with opportunities to practice and engage in activities that reinforce objectives, and points out areas that need improvement. In the health professions, mastery learning emphasizes problem-solving and application of principles and analytic skills.
| Methods | | |
Mastery learning: The Roseman model
Roseman University of Health Sciences (RUHS) is a private, nonprofit health sciences university founded in 1999. RUHS has colleges of nursing, dentistry, pharmacy, and offers an MBA program. In this article, we use pharmacy to illustrate RUHS's application of a mastery learning curriculum. The PharmD program began as a 3-year program with an inaugural class in 2001. Matriculated students have a median grade point average of 3.4 and a median composite Pharmacy College Admission Test score at about the 50th percentile.
Beginning with its first class, the PharmD program based its curriculum on a mastery learning model and a block system. While many schools use elements of mastery learning, the RUCOP is one of the few schools which bases its entire curriculum on a mastery model. The program includes 72 weeks of didactic and skill-based instruction and 14 weeks of introductory pharmacy practice experiences in the first 2 years of the program. The 3rd year consists of a minimum of 36 weeks of advanced pharmacy practice experiences. During the didactic component of the curriculum, students focus on a single subject and must demonstrate mastery, defined as a 90% or better on their assessment, to pass a block. If a student fails to pass the block assessment, they receive feedback and have a second opportunity to pass. Students who fail repeat examinations may continue onto the next block but are required to remediate during a summer session before moving onto the next year. Students may progress until they reach six failures in a year. The block curriculum allows students to focus on a single subject during the 2-week block rather than juggling several classes. Subject blocks range from 2 to 6 weeks in length, but the longer subject blocks are divided into more digestible 2-week units.
For the didactic and skills' portions of the curriculum, students are in session for 6 h each day. The day combines traditional classroom instruction with active learning activities such as group studies and peer tutoring, programmed instructional units, and audiovisual games. Skill-based learning and activities are incorporated into the curriculum to help students integrate their knowledge into the clinical practice setting. Skill-based curriculum occurs 1 day every 2–3 weeks. The extended classroom day is a platform for the active learning activities and formative feedback that help assure that students are appropriately progressing and mastering block content. [Table 2] describes a sample day in the classroom.
Assessments
Students need to achieve a score of 90% or better on their assessments to pass. After finishing their individual assessment, each student joins a small group to retake the same assessment. If the team scores >95% on the team examination, each team member earns an additional 5% points for their own individual assessment score. The team process challenges students to defend their answers to their group providing immediate feedback for students at the peer level, and if answers are disputed, students have the opportunity to present a rationale for their answer and defend it to the group. The team examination fosters teamwork and collaboration by teaching students how to function within a group dynamic since the group is responsible for making a decision. Following the team examination, instructors review the assessment explaining correct answers and providing a rationale for why other responses are incorrect. The practice is interactive, and students can challenge questions and defend responses.
The Roseman model with multiple opportunities for formative feedback corrects misconceptions and reinforces concepts making 90% a high, but realistic mark. If students do not achieve a score of 90% or higher, they must attend a remediation session and take a reassessment. Teachers focus remediation sessions on identified deficiencies. If the material is not mastered after the reassessment, students are then required to remediate during the summer. The summer remediation culminates in a summative assessment that is similar to the previously administered ones during the regular academic year. Further descriptions of the Roseman curriculum are found elsewhere.[9],[10]
| Results | | |
National attrition rates according to the pharmacy accrediting body from 2010 to 2015 averaged 10.8% per class.[11] The RUCOP attrition rate during this same period never exceeded 6.5% per class. National pass rates for students on the pharmacy board examination varied from year to year and ranged from 92.6% to 96.9% during the 2010–2015 period. RUCOP scores during the same period ranged from 93.0% to 99.0% and fell below national pass rates on only one occasion.
[Table 3] summarizes data from the student exit survey about their RUHS educational experience. Of note is an overall satisfaction with RUHS's educational experience rating of 3.82 (using a 1–5 Likert scale) and an even higher rating of satisfaction with the block system of 4.04. There was a slightly lower degree of satisfaction with the remediation process of 3.52. | Table 3: Roseman University College of Pharmacy student graduation exit survey results 2013-2015a
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Stress can be an issue for RUCOP students compared to a traditional program. While students viewed graduating in 3 years positively [Table 3], an accelerated program (3 years instead of the traditional 4 years) may induce significant levels of stress.[9] Hence, although student stress may be related to the mastery learning model, it could also be due to the compressed timeline.
Difficulties encountered
While the mastery model works well, several issues have emerged. Not all faculty members spend enough time on feedback, deliberative practice, and other key components of mastery learning. Most faculty members either taught in or received their training in a traditional model and do not always embrace the mastery model. To be successful, a mastery model requires an investment in training new faculty and reinforcing the model to the existing faculty. Another issue is that the block end assessment reviews sometimes degenerate into students arguing for points rather than as a learning experience. The argumentation may be a consequence of the 90% bar where students scoring near that level may fiercely argue for extra points to avoid remediation. Finally, while some students who pass their first assessment use the following Monday for an enrichment activity such as research, other students use the time as a “free” day to either decompress or to earn extra income by working as a pharmacy intern.
| Discussion | | |
The complexity and uncertainties of the clinical environment make it challenging for both students and teachers to develop clinical competence.[12] The goal of mastery learning is to achieve high standards with minimal learner variation. Studies suggest that mastery learning works and that mastery learning in medical education may be particularly relevant to ensure that all graduates are competent in what they do. The outcome data from RUCOP's program are similar to or better than national averages and provide insight into how a mastery model can be successfully implemented in an accelerated, comprehensive curriculum.
Acknowledgment
The authors would like to acknowledge Dr. Tom Metzger for providing intuitional data for use in this manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | 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;88:1178-86.  |
| 2. | 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:e8-9. |
| 3. | Zimmerman BJ. Mastery learning and assessment: Implications for students and teachers in an era of high-stakes testing. Psych Sch 2008;45:206-21. |
| 4. | Block JH, Burns RB. Mastery learning. Rev Res Educ 1976;4:3-49. |
| 5. | Guskey TR. Closing achievement gaps: Revisiting Benjamin S. Bloom's “Learning for Mastery”. J Adv Acad 2007;19:8-31. |
| 6. | Kulik CC, Kulik JA, Bangert-Drowns RL. Effectiveness of mastery learning programs: A meta-analysis. Rev Educ Res 1990;60:265-99. |
| 7. | Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, et al. Technology-enhanced simulation for health professions education: A systematic review and meta-analysis. JAMA 2011;306:978-88. |
| 8. | Cohen ER, McGaghie WC, Wayne DB, Lineberry M, Yudkowsky R, Barsuk JH, et al. Recommendations for reporting mastery education research in medicine (ReMERM). Acad Med 2015;90:1509-14. |
| 9. | Frick LJ, Frick JL, Coffman RE, Dey S. Student stress in a three-year doctor of pharmacy program using a mastery learning educational model. Am J Pharm Educ 2011;75:64. |
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| 12. | Oldmeadow L. Developing clinical competence: A mastery pathway. Aust J Physiother 1996;42:37-44. |
[Table 1], [Table 2], [Table 3]
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