Table 5.

GPeds did not learn procedures through methods consistent with a mastery learning model: The number (N) and percentage (%) of 51 GPeds who reported that they did not experience components of mastery learning when learning procedures. Representative quotes provide explanation for their lack of experience

Sawyer’s Model Component	Description of Component	Theme	N (%)	Quotations
Learn (Cognitive Phase)	Learn about the procedure via readings, videos, and online training. Cognitive tests may be included	GPeds Did Not Learn or Teach Back Procedures Prior to ‘Doing’	25 (49.0)	‘I don’t ever recall being given dedicated lectures to procedures.’ ‘I don’t recall having any textbooks or online resources. I think we did a verbal review with the attending or fellowbefore performing the procedure.’
See (Cognitive Phase)	Demonstration of the skill to a learner with both nonverbal and verbal instruction. Learners are asked to ‘teach back’ to solidify concepts.	GPeds Did Not Learn or Teach Back Procedures Prior to ‘Doing’	25 (49.0)	‘Because of the kind of randomness of when it was your turn to do a procedure, it was often in the moment. It’s like, here it is, jump into the pool and so I didn’t know many resources for education, especially like the Just-in-Time kind of education.’ ‘I was never asked to describe how to do a procedure before doing it on a real person.’
Practice (Psychomotor Phase)	Formative assessment, which usually entails in-vitro or simulated settings. This phase incorporates deliberate practice.	GPeds Did Not Engage in Deliberate Practice	18 (35.2)	‘Residency was a big contrast to my nursing training where you would have lectures, labs, and practice before doing a procedure. In nursing, there were multiple dummy trials before you can do it in real life. But as a resident, attendings would say, “You just need to do this”. And if you said “I don’t even know how,” Tthey would say: “Well look it up and do it.”’ ‘No, we did not have any practice or simulation labs. Sometimes at night in the ER we would get out splinting material and splint each other just for practice but it was nothing formal and was not supervised.’
Prove (Psychomotor Phase)	Summative assessment that demonstrate competency and eventually mastery learning. These assessments are typically done in in-vitro or simulated settings.	GPeds Did Not Prove Competence in Training	22 (43.1)	‘Sure, we were expected to keep a procedure log but no one ever did. So, at the very end, people just fabricated up scenarios.’ ‘You had to log your procedures and you had a minimum quota of logging. But it didn’t even say they had to be observed. You literally could make them up if you wanted to, but I’m obviously not comfortable doing that. But there was definitely not somebody who watched you do it or signed off on you.’
Do (Psychomotor Phase)	Performance of skill on a human being with direct observation, performance-based assessment and feedback.	GPeds Did Not Participate in Graduated Supervision	51 (100)	‘Well, mostly you saw somebody do one, and then you did one under supervision. Sometimes you didn’t even see somebody do one first. It was just like, an attending is telling you and making marks of where it goes and [then doing] the procedure.’ ‘It really was like watching a couple and then doing a couple with the senior resident.’
Maintain	Skill is maintained not only through clinical practice but also supplemented through simulation, procedures logs, individual quality improvement and/or maintenance of certification.	GPeds Do Not Desire Formal Skill Maintenance	29 (56.9)	“Because the scope of practice of different pediatricians is so different, the requirements which you need to be good at are different and you may not be in a setting where you really need to be great at IV placement or laceration repairs. So, I don’t think there is a real need to continue to maintain those skills because medicine is getting pretty compartmentalized. ‘My initial thought is no, [procedural maintenance] should not be required for [MOC] as we already have enough stuff to keep track of, and it’s too burdensome.’