Rapid Cycle Deliberate Practice Compared With Traditional Simulation Debriefing for Resuscitation Skills Training in Pediatric Residents.

backgroundRapid cycle deliberate practice (RCDP) is a form of simulation debriefing that incorporates repeated cycles of hands-on practice, characterized by within-simulation directed feedback and repeated practice with the goal of mastering a skill. RCDP debriefing has been shown to improve immediate performance; however, evidence of improved retention and superiority to traditional styles of debriefing is lacking.

objectivesTo compare RCDP and traditional debriefing for knowledge and skills acquisition and retention as part of a longitudinal residency simulation curriculum.

designParticipants were first-year pediatrics residents who underwent two simulation scenarios, focusing on basic airway and cardiac arrest management, at the beginning of their intern year. Participants were block randomized to either the RCDP or the traditional debriefing arm. Knowledge was assessed in a pre-post format at time 0 and at 12 months using a multiple-choice quiz. All interns received a repeat simulation teaching session at three, six, nine, or 12 months, remaining in their RCDP or traditional debriefing arm. Skills were assessed via a video-recorded simulated scenario prior to an initial simulation session (RCDP vs. traditional debriefing) at time 0 and three, six, nine, and 12 months, and before and after their repeat simulation teaching session. Videos were scored by two pediatric emergency medicine physicians using a resuscitation skills assessment tool.

resultsThere was no statistical difference in overall knowledge (via paired t-test) or skills acquisition (via linear mixed effects model) between residents who received traditional debriefing and those who received RCDP debriefing. The RCDP group showed significant improvement in skills when compared with the traditional group for those who received repeat education at three months; however, there was no difference in the other time groups. There was no difference between groups in skills retention at three months after the repeat teaching session, as assessed via the ANOVA analysis.

conclusionOverall, we demonstrated similar knowledge and skills gain and retention in traditional debriefing and RCDP groups, with the exception of those residents who received repeat teaching at the three-month time point. This may indicate that a three-month time interval could be the most appropriate timing for repeated RCDP resuscitation teaching. Higher power randomized controlled trials comparing RCDP to traditional simulation and/or qualitative studies assessing the efficacy of RCDP would add to current evidence.