Rapid cycle deliberate practice vs. traditional simulation in a resource-limited setting

• Published in: BMC medical education Vol. 19; no. 1; p. 314
• Main Authors: Rosman, Samantha L, Nyirasafari, Rosine, Bwiza, Hippolyte Muhire, Umuhoza, Christian, Camp, Elizabeth A, Weiner, Debra L, Rus, Marideth C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.08.2019; BioMed Central; BMC
• Subjects: Administrative Organization; Attrition (Research Studies); Cardiopulmonary Resuscitation - education; Cardiopulmonary Resuscitation - standards; Clinical Competence; Curricula; Curriculum; Data collection; Design; Education; Educational Measurement; Experimental Groups; Feedback; Fidelity; First Aid; Health Resources; Hospitals; Humans; Internship and Residency; Likert Scales; Low-fidelity; Medical education; Mortality; Participation; Pediatricians; Pediatrics; Pediatrics - education; Rapid cycle deliberate practice; Residents (Medicine); Resource-limited; Resuscitation; Rwanda; Simulation; Simulation Training; Skills; Statistical Analysis; Studies; Teaching; Teaching Methods; Training; Training Methods; Transfer of Training; Rwanda; Rapid cycle deliberate practice; Resident education; Low-fidelity; Pediatrics; Simulation; Resource-limited; Africa; Curriculum; Resuscitation
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/s12909-019-1742-4

We sought to develop a low-fidelity simulation-based curriculum for pediatric residents in Rwanda utilizing either rapid cycle deliberate practice (RCDP) or traditional debriefing, and to determine whether RCDP leads to greater improvement in simulation-based performance and in resident confidence compared with traditional debriefing. Pediatric residents at the Centre Hospitalier Universitaire de Kigali (CHUK) were randomly assigned to RCDP or traditional simulation and completed a 6 month-long simulation-based curriculum designed to improve pediatric resuscitation skills. Pre- and post- performance was assessed using a modified version of the Simulation Team Assessment Tool (STAT). Each video-taped simulation was reviewed by two investigators and inter-rater reliability was assessed. Self-confidence in resuscitation, pre- and post-simulation, was assessed by Likert scale survey. Analyses were conducted using parametric and non-parametric testing, ANCOVA and intra-class correlation coefficients (ICC). There was a 21% increase in pre- to post-test performance in both groups (p < 0.001), but no difference between groups (mean difference - 0.003%; p 0.94). Inter-rater reliability was exceptional with both pre and post ICCs ≥0.95 (p < 0.001). Overall, self-confidence scores improved from pre to post (24.0 vs. 30.0 respectively, p < 0.001), however, the there was no difference between the RCDP and traditional groups. Completion of a six-month low-fidelity simulation-based curriculum for pediatric residents in Rwanda led to statistically significant improvement in performance on a simulated resuscitation. RCDP and traditional low-fidelity simulation-based instruction may both be valuable tools to improve resuscitation skills in pediatric residents in resource-limited settings.