Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training*

Abstract

Objectives: Rapid cycle deliberate practice is a simulation training method that cycles between deliberate practice and directed feedback to create perfect practice; in contrast to reflective debriefing where learners are asked to reflect on their performance to create change. The aim of this study is to compare the impact of rapid cycle deliberate practice versus reflective debriefing training on resident application and retention of the pediatric sepsis algorithm. Design: Prospective, randomized-control study. Setting: A tertiary care university children’s hospital simulation room, featuring a high-fidelity pediatric patient simulator. Subjects: Forty-six upper-level pediatric residents. Interventions: Simulation training using rapid cycle deliberate practice or reflective debriefing. Measurements and Main Results: Knowledge was assessed with a quiz on core sepsis management topics. The application of knowledge was assessed with a sepsis management checklist during the simulated scenario. The residents were assessed before and after the intervention and again at a follow-up session, 3–4 months later, to evaluate retention. Both groups had similar pre-intervention scores. Post-intervention, the rapid cycle deliberate practice group had higher checklist scores (rapid cycle deliberate practice 18 points [interquartile range, 18–19] vs reflective debriefing 17 points [interquartile range, 15–18]; p < 0.001). Both groups had improved quiz scores. At follow-up, both groups continued to have higher scores compared with the pre-intervention evaluation, with the rapid cycle deliberate practice group having a greater change in checklist score from pre-intervention to follow-up (rapid cycle deliberate practice 5 points [interquartile range, 3.5–7] vs reflective debriefing 3 points [interquartile range, 1.5–4.5]; p = 0.019). Both groups reported improved confidence in diagnosing and managing septic shock. Conclusions: Both rapid cycle deliberate practice and reflective debriefing are effective in training pediatric residents to apply the sepsis algorithm and in improving their confidence in the management of septic shock. The rapid cycle deliberate practice method was superior immediately post-training; however, it is unclear if this advantage is maintained over time. Both methods should be considered for training residents.

Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews

“…18 For specific tasks, we used rapid cycle deliberate practice, which offers the opportunity for participants to repeat a procedure after feedback. 19 Debrief on demand was used when technical procedures needed immediate correction and feedback. 20 Because the groups consisted of experienced providers, peer-led debriefing could be used when appropriate.…”

Early Recognition of Pediatric Sepsis Simulation Checklist - An Exploratory Study

“…Adherence was evaluated on six elements of the guidelines, including giving oxygen and fluid boluses (Kessler et al, 2016). Cory, Colman, McCracken, and Hebbar (2019) compared debriefing practices postsimulation on resident knowledge of pediatric sepsis algorithms. Sepsis management was also evaluated using a validated checklist (Cory et al, 2019).…”

“…Cory, Colman, McCracken, and Hebbar (2019) compared debriefing practices postsimulation on resident knowledge of pediatric sepsis algorithms. Sepsis management was also evaluated using a validated checklist (Cory et al, 2019). Qian et al (2016) carried out interprofessional in situ simulations over a one-year time-period every three months within a hospital Pediatric Intensive Care Unit.…”

“…Gaps. Overall, with practicing professionals, many of the pediatric sepsis SBE studies have focused on severe sepsis (Qian et al, 2016) and/or shock (Cory et al, 2019;Kessler et al, 2016;Qian et al, 2016). The simulated patient has often been an infant (Kessler et al, 2016;Qian et al, 2016) with the participant population frequently medicine, such as pediatric residents (Adler et al, 2007;Cory et al, 2019) and/or interprofessional teams (Kessler et al, 2016;Qian et al, 2016).…”

Recent Advances in Simulation for Pediatric Critical Care Medicine

“…1 Translational simulation framework and applications relevant to PCCM [58][59][60] interprofessional teams and improvement of their approach to critical situations, problem-solving, process improvement, and questioning of cultural norms [18,78]. Code-team simulations are a common focus of PCCM simulation, with several studies showing both technical skills improvement and improvement in team-dynamics [79][80][81][82][83][84][85].…”