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Comparison of Rapid Cycle Deliberate Practice Simulation to Traditional Simulation in a Resource-Limited Setting


Abstract

Background: High-fidelity simulation-based education has shown improved resident knowledge and performance1,2,3. While there is evidence that learning is not dependent on simulator fidelity4, there is little research on low-fidelity simulation to teach complex scenarios, particularly in pediatrics.  Rapid Cycle Deliberate Practice is a simulation technique allowing for rapid feedback and mastery of skills with graded difficulty levels5. It focuses on initial assessment and initial stabilization steps, which are most likely to be life-saving in a low-resource setting, while traditional debriefing focuses more on advanced skills occurring later in the scenario. We sought to develop a year-long simulation-based curriculum for pediatric residents in Rwanda utilizing instruction with either RCDP or traditional debriefing.

Research Questions:  Will a simulation-based curriculum for pediatric residents in Rwanda utilizing instruction with Rapid Cycle Deliberate Practice lead to greater improvement on simulation-based performance when compared with instruction utilizing Traditional Debriefing?

Methodology:  Research was approved by the Kigali University Teaching Hospital (KUTH) IRB as well as by the Boston Children’s Hospital and Texas Children’s Hospital IRBs. Pediatric residents rotating at the Kigali University Teaching Hospital (KUTH) were randomly assigned to one of two simulation curriculum groups (RCDP or traditional simulation) and completed a six month-long simulation-based curriculum designed to improve pediatric resuscitation skills. Cases addressed management of shock, respiratory failure, and cardiac arrest.

Basic demographic data and data regarding previous training were collected. Residents were tested on their performance on a simulation-based based pediatric resuscitation before and after the curriculum. Pre- and post- simulation tests were videotaped and reviewed by 2 of the investigators using a modified version of the Simulation Team Assessment Tool with the blinded investigator’s scores used for data analysis, and the non-blinded investigator’s scores used to calculate the intraclass correlation coefficient (ICC).

Results: There were no significant differences in the demographic factors between the groups randomized to RCDP and traditional. Pre-test scores on the simulated resuscitation for the overall group, RCDP group, and traditional group were 45%, 44% and 47% respectively. Post-test scores for the overall group, RCDP group, and traditional group were 67%, 66%, and 68%, demonstrating a statistically significant mean improvement of 21% in each group (p<0.001). There was no statistically significant difference between the RCDP and traditional groups in overall performance, or on sub-analysis comparing performance on early lifesaving skills or leadership skills. The ICC for video review was 0.95 (95% CI 0.90-0.98; p<0.001)

Discussion/Conclusions: Completion of a six month simulation-based curriculum for pediatric residents in Rwanda led to statistically significant improvement in performance in a simulated resuscitation. Residents randomized to receive instruction utilizing RCDP vs traditional debriefing demonstrated similar improvement. RCDP and traditional simulation-based instruction may both be valuable tools to improve resuscitation skills in pediatric residents in limited-resource settings.

 

 

Poster
non-peer-reviewed

Comparison of Rapid Cycle Deliberate Practice Simulation to Traditional Simulation in a Resource-Limited Setting


Author Information

Samantha Rosman Corresponding Author

Division of Emergency Medicine, Boston Children's Hospital

Rosine Nyirasafari

Pediatrics, University of Rwanda

Hippolyte Bwiza Muhire

Pediatrics, University of Rwanda

Christian Umuhoza

Pediatrics, University of Rwanda

Elizabeth A. Camp

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

Marideth C. Rus

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital


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  • Author Information
    Samantha Rosman Corresponding Author

    Division of Emergency Medicine, Boston Children's Hospital

    Rosine Nyirasafari

    Pediatrics, University of Rwanda

    Hippolyte Bwiza Muhire

    Pediatrics, University of Rwanda

    Christian Umuhoza

    Pediatrics, University of Rwanda

    Elizabeth A. Camp

    Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

    Marideth C. Rus

    Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

    Poster Information
    Publication history

    Received by Cureus: May 31, 2017
    Published: June 01, 2017

    License

    This is an open access poster distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: High-fidelity simulation-based education has shown improved resident knowledge and performance1,2,3. While there is evidence that learning is not dependent on simulator fidelity4, there is little research on low-fidelity simulation to teach complex scenarios, particularly in pediatrics.  Rapid Cycle Deliberate Practice is a simulation technique allowing for rapid feedback and mastery of skills with graded difficulty levels5. It focuses on initial assessment and initial stabilization steps, which are most likely to be life-saving in a low-resource setting, while traditional debriefing focuses more on advanced skills occurring later in the scenario. We sought to develop a year-long simulation-based curriculum for pediatric residents in Rwanda utilizing instruction with either RCDP or traditional debriefing.

Research Questions:  Will a simulation-based curriculum for pediatric residents in Rwanda utilizing instruction with Rapid Cycle Deliberate Practice lead to greater improvement on simulation-based performance when compared with instruction utilizing Traditional Debriefing?

Methodology:  Research was approved by the Kigali University Teaching Hospital (KUTH) IRB as well as by the Boston Children’s Hospital and Texas Children’s Hospital IRBs. Pediatric residents rotating at the Kigali University Teaching Hospital (KUTH) were randomly assigned to one of two simulation curriculum groups (RCDP or traditional simulation) and completed a six month-long simulation-based curriculum designed to improve pediatric resuscitation skills. Cases addressed management of shock, respiratory failure, and cardiac arrest.

Basic demographic data and data regarding previous training were collected. Residents were tested on their performance on a simulation-based based pediatric resuscitation before and after the curriculum. Pre- and post- simulation tests were videotaped and reviewed by 2 of the investigators using a modified version of the Simulation Team Assessment Tool with the blinded investigator’s scores used for data analysis, and the non-blinded investigator’s scores used to calculate the intraclass correlation coefficient (ICC).

Results: There were no significant differences in the demographic factors between the groups randomized to RCDP and traditional. Pre-test scores on the simulated resuscitation for the overall group, RCDP group, and traditional group were 45%, 44% and 47% respectively. Post-test scores for the overall group, RCDP group, and traditional group were 67%, 66%, and 68%, demonstrating a statistically significant mean improvement of 21% in each group (p<0.001). There was no statistically significant difference between the RCDP and traditional groups in overall performance, or on sub-analysis comparing performance on early lifesaving skills or leadership skills. The ICC for video review was 0.95 (95% CI 0.90-0.98; p<0.001)

Discussion/Conclusions: Completion of a six month simulation-based curriculum for pediatric residents in Rwanda led to statistically significant improvement in performance in a simulated resuscitation. Residents randomized to receive instruction utilizing RCDP vs traditional debriefing demonstrated similar improvement. RCDP and traditional simulation-based instruction may both be valuable tools to improve resuscitation skills in pediatric residents in limited-resource settings.

 

 

Samantha Rosman

Division of Emergency Medicine, Boston Children's Hospital

For correspondence:
samantha.rosman@gmail.com

Rosine Nyirasafari

Pediatrics, University of Rwanda

Hippolyte Bwiza Muhire

Pediatrics, University of Rwanda

Christian Umuhoza

Pediatrics, University of Rwanda

Elizabeth A. Camp

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

Marideth C. Rus

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

Samantha Rosman

Division of Emergency Medicine, Boston Children's Hospital

For correspondence:
samantha.rosman@gmail.com

Rosine Nyirasafari

Pediatrics, University of Rwanda

Hippolyte Bwiza Muhire

Pediatrics, University of Rwanda

Christian Umuhoza

Pediatrics, University of Rwanda

Elizabeth A. Camp

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

Marideth C. Rus

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

Samantha Rosman

Division of Emergency Medicine, Boston Children's Hospital

For correspondence:
samantha.rosman@gmail.com

Rosine Nyirasafari

Pediatrics, University of Rwanda

Hippolyte Bwiza Muhire

Pediatrics, University of Rwanda

Christian Umuhoza

Pediatrics, University of Rwanda

Elizabeth A. Camp

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

Marideth C. Rus

Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital

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