Lemke Daniel S, Fielder Elaine K, Hsu Deborah C, Doughty Cara B
From the Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX.
Pediatr Emerg Care. 2019 Jul;35(7):480-486. doi: 10.1097/PEC.0000000000000940.
Simulation-based medical education (SBME) improves medical knowledge compared with no intervention. In traditional SBME, more time is spent debriefing than practicing skills. Rapid cycle deliberate practice (RCDP) simulation allows learners to practice skills repetitively, receive brief interspersed feedback, and has been shown to improve individual performance of resuscitation skills in simulation; it has not been compared with traditional simulation methods.
The aim of the study was to compare traditional and RCDP SBME.
Four pediatric resuscitation cases (3 for teaching and 1 for testing) were developed. For the RCDP arm, traditional cases were deconstructed into sequences of progressively difficult rounds. The last RCDP round served as the traditional arm scenario.Learners received 1 type of instruction on 2 separate days. Pretest and posttest performance during simulation were video recorded and scored using the Simulation Team Assessment Tool; satisfaction surveys were collected.
Pretest team performance was similar in both groups. Simulation Team Assessment Tool score improvement for RCDP was 7.2% (95% confidence interval, 3.4% to 11%) and traditional was 0.8% (95% confidence interval, -11% to 13%). The difference in improvement of the human factors subscore was statistically significant; RCDP improved 10.2% and traditional improved 1.7% (P = 0.013). The RCDP technique was well received by learners but caused fatigue.
This pilot study showed a trend toward greater improvement in team performance and significantly greater improvement for human factors with RCDP compared with traditional simulation. Future studies comparing RCDP with other methods are needed to identify best practices and applications of RCDP, including which learners and learning objectives are best suited to RCDP.
与无干预相比，基于模拟的医学教育（SBME）可提高医学知识水平。在传统的SBME中，用于总结回顾的时间比练习技能的时间更多。快速循环刻意练习（RCDP）模拟使学习者能够反复练习技能，获得简短的穿插式反馈，并且已被证明可提高模拟中复苏技能的个人表现；但尚未与传统模拟方法进行比较。
本研究的目的是比较传统SBME和RCDP SBME。
开发了四个儿科复苏病例（3个用于教学，1个用于测试）。对于RCDP组，将传统病例解构为难度逐渐增加的轮次序列。最后一轮RCDP用作传统组的场景。学习者在两个不同的日子接受一种类型的指导。模拟期间的预测试和后测试表现通过视频记录，并使用模拟团队评估工具进行评分；收集满意度调查。
两组的预测试团队表现相似。RCDP的模拟团队评估工具分数提高了7.2%（95%置信区间，3.4%至11%），传统组提高了0.8%（95%置信区间，-11%至13%）。人为因素子分数的提高差异具有统计学意义；RCDP提高了10.2%，传统组提高了1.7%（P = 0.013）。RCDP技术受到学习者的好评，但会导致疲劳。
这项初步研究表明，与传统模拟相比，RCDP在团队表现方面有更大改善的趋势，在人为因素方面有显著更大的改善。需要未来的研究将RCDP与其他方法进行比较，以确定RCDP的最佳实践和应用，包括哪些学习者和学习目标最适合RCDP。
