Mastery Learning, Continuing Professional Education, and Maintenance of Certification

  • Clara SchroedlEmail author
  • Graham T. McMahon
  • William C. McGaghie
Part of the Comprehensive Healthcare Simulation book series (CHS)


This chapter addresses mastery learning in health professions education contexts of continuing professional education (CPE) and maintenance of certification (MOC). These are new applications of the mastery learning model, extending lessons learned from their application in undergraduate and graduate medical education. The chapter begins with a section about challenges in current methods of health professions CPE and MOC. It continues with a detailed discussion about CPE and MOC: rationale, evidence of effectiveness, evolution, requirements, how CPE and MOC differ from undergraduate and postgraduate education, driving self-awareness, and lessons learned. A following section covers the relevance, application, and potential of the mastery learning model to CPE and MOC. This section uses a clinical example about education for veno-venous extracorporeal membrane oxygenation (ECMO) among medical intensive care providers. The chapter concludes with a brief discussion about future directions for mastery learning approaches to CPE in the health professions.


Continuing medical education (CME) Continuing professional development (CPD) Continuing professional education (CPE) Maintenance of certification (MOC) Mastery learning 


  1. 1.
    Kohn LT, Corrigan JM, Donaldson MS, (Institute of Medicine). To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.Google Scholar
  2. 2.
    Arthur W Jr, Bennett W Jr, Stanush PL, McNelly TL. Factors that influence skill decay and retention: a quantitative review and analysis. Hum Perform. 1998;11(1):57–101.CrossRefGoogle Scholar
  3. 3.
    National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. Washington, DC: The National Academies Press; 2015.Google Scholar
  4. 4.
    Meyer AND, Payne VL, Meeks DW, et al. Physicians’ diagnostic accuracy, confidence, and resource requests: a vignette study. JAMA Intern Med. 2013;173(21):1952–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kliegman RM, Bordini BJ, Basel D, Nocton JJ. How doctors think: common diagnostic errors in clinical judgment—lessons from an undiagnosed and rare disease program. Pediatr Clin N Am. 2017;64:1–15.CrossRefGoogle Scholar
  6. 6.
    Singh H, Schiff GD, Graber ML, et al. The global burden of diagnostic errors in primary care. BMJ Qual Saf. 2017;26:484–94.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mokros A, Habermeyer E, Küchenhoff H. The uncertainty of psychological and psychiatric diagnoses. Psychol Assess. 2018;30(4):556–60.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Davis DA, McMahon GT. Translating evidence into practice: lessons for CPD. Med Teach. 2018;40(9):892–5.CrossRefGoogle Scholar
  9. 9.
    Laufer S, Cohen ER, Kwan C, et al. Sensor technology in assessments of clinical skill. N Engl J Med. 2015;372:784–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Laufer S, D’Angelo A-LD, Kwan C, et al. Rescuing the clinical breast examination: advances in classifying technique and assessing physician competency. Ann Surg. 2017;266:1069–74.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Pugh CM, Arafat FO, Kwan C, Cohen ER, Kurashima Y, Vassiliou MC, Fried GM. Development and evaluation of a simulation-based continuing medical education course: beyond lectures and credit hours. Am J Surg. 2015;210:603–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Weinger MB, Banerjee A, Burden AR, et al. Simulation-based assessment of the management of critical events by board-certified anesthesiologists. Anesthesiology. 2017;127:475–89.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Barsuk JH, Cohen ER, Nguyen D, et al. Attending physician adherence to a 29-component central venous catheter bundle checklist during simulated procedures. Crit Care Med. 2016;44:1871–81.CrossRefGoogle Scholar
  14. 14.
    Barsuk JH, Seburn S, Cohen ER, et al. Simulation-based mastery learning improves central line maintenance skills of ICU nurses. J Nurs Adm. 2015;45(10):511–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hafford ML, Van Sickle KR, Willis RE, et al. Ensuring competency: are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel? Surg Endosc. 2013;27:118–26.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Birkmeyer JD, Finks JF, O’Reilly A, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369:1434–42.CrossRefGoogle Scholar
  17. 17.
    Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–73.CrossRefGoogle Scholar
  18. 18.
    McMahon GT. Inspiring curiosity and restoring humility: the evolution of competency-based continuing medical education. Acad Med. 2018;93:1757–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    McGaghie WC. Evaluation apprehension and impression management in medical education. Acad Med. 2018;93(5):685–6.CrossRefGoogle Scholar
  20. 20.
    Leape LL. The preventability of medical injury. In: Bogner MS, editor. Human error in medicine. Hillsdale: Lawrence Erlbaum Associates; 1994. p. 13–25.Google Scholar
  21. 21.
    McMahon GT. What do I need to learn today? The evolution of CME. N Engl J Med. 2016;374(15):1403–6.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    McMahon GT. Advancing continuing medical education. JAMA. 2015;314(6):561–2.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cervero RM. Lifespan professional development through practice-based education: implications for the health professions. In: Neimeyer GJ, Taylor JM, editors. Continuing professional development and lifelong learning: issues, impacts, and outcomes. New York: Nova Science Publishers; 2011. p. 265–76.Google Scholar
  24. 24.
    McGaghie WC. Medical education research as translational science. Sci Transl Med. 2010;2:19cm8.CrossRefGoogle Scholar
  25. 25.
    McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D. Evaluating the impact of simulation on translational patient outcomes. Simul Healthc. 2011;6(7, Suppl):S42–7.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Translational educational research: a necessity for effective health-care improvement. Chest. 2012;142(5):1097–103.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ. 2014;48:373–85.Google Scholar
  28. 28.
    Houle CO. Continuing learning in the professions. San Francisco: Jossey-Bass; 1980.Google Scholar
  29. 29.
    Cervero RM. Effective continuing education for professionals. San Francisco: Jossey-Bass; 1988.Google Scholar
  30. 30.
    American Board of Medical Specialties. Board certification and maintenance of certification. Available at:
  31. 31.
    American Board of Medical Specialties. Steps toward initial certification and MOC. Available at:
  32. 32.
    American Board of Medical Specialties. Value of board certification to health care. Available at:
  33. 33.
    Teirstein PS. Boarded to death—why maintenance of certification is bad for doctors and patients. N Engl J Med. 2015;372(2):106–8.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    McMahon GT. The leadership case for investing in continuing professional development. Acad Med. 2017;92(8):1075–7.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Institute of Medicine. Redesigning continuing education in the health professions. Washington, DC: The National Academies Press; 2010.Google Scholar
  36. 36.
    Fletcher SW. Chairman’s summary of the conference. In: Hager M, editor. Continuing education in the health professions: improving healthcare throughout lifelong learning. New York: Josiah Macy, Jr. Foundation; 2007.Google Scholar
  37. 37.
    Rifai N, Rose T, McMahon GT, Saxberg B, Christensen UJ. Learning in the 21st century: concepts and tools. Clin Chem. 2018;64(10):1423–9.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    McMahon GT, Skochelak SE. Evolution of continuing medical education: promoting innovation through regulatory alignment. JAMA. 2018;319(6):545–6.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    McMahon GT, Aboulsoud S, Gordon J, et al. Evolving alignment in international continuing professional development accreditation. J Contin Educ Health Prof. 2016;36(Suppl. 1):S22–6.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77(6):1121–34.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Dunning D, Heath C, Suls JM. Flawed self-assessment: implications for health, education, and the workplace. Psychol Sci Public Interest. 2004;5(3):69–106.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    McMahon GT. Managing the most precious resource in medicine. N Engl J Med. 2018;378(16):1552–4.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    AAMC. Medical simulation in medical education: results of an AAMC survey. Available at:
  44. 44.
    SACME. Academic CME/CPD in the United States and Canada: the 2015A AMC/SACME Harrison Survey. Available at:
  45. 45.
    Cook DA, Blachman MJ, Price DW, West CP, Berger RA, Wittich CM. Professional development perceptions and practices among U.S. physicians: a cross-specialty national survey. Acad Med. 2017;92(9):1335–45.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102.CrossRefGoogle Scholar
  47. 47.
    Clark EG, Paparello JJ, Wayne DB, et al. Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study. Can J Kidney Health Dis. 2014;1:25.Google Scholar
  48. 48.
    Tsoi STA, de Boer A, Croiset G, Koster AS, Kusurkar RA. Factors influencing participation in continuing professional development: a focus on motivation among pharmacists. J Contin Educ Health Prof. 2016;36(3):144–50.CrossRefGoogle Scholar
  49. 49.
    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.CrossRefGoogle Scholar
  50. 50.
    Society for Human Resource Management. Developing and sustaining high performance work teams. Available at:
  51. 51.
    Prenner SB, Wayne DB, Sweis RN, Cohen ER, Feinglass JM, Schimmel DR. Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography. Catheter Cardiovasc Interv. 2018;91(6):1054–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Frank JR, Snell L, Englander R, Holmboe ES, ICBME Collaborators. Implementing competency-based medical education: moving forward. Med Teach. 2017;39(6):568–73.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Holmboe ES, Sherbino J, Englander R, Snell L, Frank JR, ICBME Collaborators. A call to action: the controversy and rationale for competency-based medical education. Med Teach. 2017;39(6):574–81.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Clara Schroedl
    • 1
    Email author
  • Graham T. McMahon
    • 2
    • 3
  • William C. McGaghie
    • 4
  1. 1.Northwestern University Feinberg School of Medicine, Departments of Medicine and Medical EducationChicagoUSA
  2. 2.Accreditation Council for Continuing Medical EducationPresident and CEOChicagoUSA
  3. 3.Northwestern University Feinberg School of MedicineAdjunct Professor, Departments of Medical Education and MedicineChicagoUSA
  4. 4.Northwestern University Feinberg School of Medicine, Departments of Medical Education and Preventive MedicineChicagoUSA

Personalised recommendations