From the Section of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Simul Healthc. 2022 Feb 1;17(1):e20-e27. doi: 10.1097/SIH.0000000000000568.
Rapid cycle deliberate practice (RCDP) for teaching team-based resuscitation is associated with similar improvements in immediate performance as compared with postsimulation debriefing (PSD). Limited studies compare skill retention between these 2 modalities. Our objective was to compare retention of team leader performance in residents trained with RCDP versus PSD.
This was a cluster-randomized trial comparing RCDP and PSD from January 2018 to April 2019. Pediatric and emergency medicine residents participated in simulation-based pediatric resuscitation education, and teams were randomized to undergo either RCDP or PSD. Each participant's team leader performance was assessed 1 to 12 months after training via a simulated cardiac arrest. The primary outcome was time to defibrillation. Secondary outcomes included overall team leader performance and time to chest compressions.
Thirty-two residents (90.6% pediatrics, 9.4% emergency medicine) met inclusion criteria (16 RCDP, 16 PSD). Of the 32 residents, 40% returned in 1 to 3 months, 25% 3 to 6 months, 16% 6 to 9 months, and 19% 10 to 12 months. Participants in RCDP had more than 5 times the odds of achieving defibrillation versus those in the PSD group (odds ratio = 5.57, 95% confidence interval = 1.13-27.52, P = 0.04). The RCDP group had a higher mean Resident Team Leader Evaluation score (0.54 ± 0.19) than the PSD group (0.34 ± 0.16, P < 0.001).
This study shows significant differences in subsequent performance in the team leader trained with RCDP and suggests that RCDP may improve retention of pediatric resuscitation skills compared with PSD. Future studies should focus on best applications for RCDP with attention to knowledge and skill decay.
与模拟后讨论（PSD）相比，快速循环刻意练习（RCDP）用于团队复苏教学与即时表现的类似改善相关。有限的研究比较了这两种方式的技能保留。我们的目的是比较接受 RCDP 与 PSD 培训的住院医师团队负责人表现的保留情况。
这是一项从 2018 年 1 月至 2019 年 4 月的集群随机试验，比较 RCDP 和 PSD。儿科和急诊医学住院医师参加了基于模拟的儿科复苏教育，团队被随机分为接受 RCDP 或 PSD。培训后 1 至 12 个月，通过模拟心脏骤停评估每个参与者的团队负责人表现。主要结果是除颤时间。次要结果包括整体团队负责人表现和按压时间。
32 名住院医师（90.6%儿科，9.4%急诊医学）符合纳入标准（16 名 RCDP，16 名 PSD）。在 32 名住院医师中，40%在 1 至 3 个月内返回，25%在 3 至 6 个月内返回，16%在 6 至 9 个月内返回，19%在 10 至 12 个月内返回。与 PSD 组相比，RCDP 组实现除颤的几率高出 5 倍以上（比值比=5.57，95%置信区间=1.13-27.52，P=0.04）。RCDP 组的住院医师团队负责人评估得分（0.54±0.19）高于 PSD 组（0.34±0.16，P<0.001）。
本研究表明，接受 RCDP 培训的团队负责人在后续表现方面存在显著差异，并表明与 PSD 相比，RCDP 可能会提高儿科复苏技能的保留率。未来的研究应侧重于 RCDP 的最佳应用，并注意知识和技能的衰减。
