O3290: Comparison of Rapid Cycle Deliberate Practice and Traditional Simulation on Pediatric Resident Resuscitation Skills

Background: Since its introduction by Hunt et al. in 2014, rapid cycle deliberate practice (RCDP) has been shown to enhance learner performance in simulation-based training. RCDP provides targeted feedback at key task points, allowing participants multiple attempts until mastery is achieved. In contrast, traditional simulation involves a continuous scenario followed by a structured debriefing.

RCDP was initially developed to address the decline in Pediatric Advanced Life Support (PALS) skills post-course, particularly in pediatric cardiac arrest scenarios. While RCDP has demonstrated improvements in critical skills like trauma surveys, teamwork, and intubation, studies comparing RCDP to traditional simulation remain inconclusive, especially regarding long-term skill retention.

This study aims to evaluate whether RCDP or traditional simulation leads to improved retention of PALS skills in pediatric residents, measured by time to defibrillation in pediatric cardiac arrest scenarios. Secondary outcomes include time to pulse check, verbalization of pulselessness, chest compression initiation, and verbalization of rhythm. To our knowledge, this is the first randomized trial conducted over multiple sessions in an academic year comparing RCDP and traditional simulation in a fixed group of pediatric residents.

Methods: Pediatric residents were randomly assigned to four cohorts, with two using traditional simulation and two using RCDP for three longitudinal sessions during the academic year. Performance was evaluated using a validated tool measuring task completion times, with data captured via audio-visual recordings.

Results: Preliminary data indicates that RCDP groups showed overall improvement (mean scores increased from 12 to 13), whereas traditional simulation groups declined (mean scores dropped from 12.3 to 10.5). RCDP participants improved in 7 of 10 assessed categories, consistently scoring higher in time to defibrillator pad placement, time to first defibrillation, and time to call for first epinephrine. Traditional simulation groups scored higher in time to initiate chest compressions.

In the first round, data from 3 RCDP groups and 2 traditional simulation groups were not captured due to technical difficulties. In the second round, all four sessions from one traditional simulation cohort were not captured.

Conclusion: Preliminary findings suggest RCDP improves resuscitation efficiency, particularly in time-sensitive tasks critical to pediatric cardiac arrest management. The decline in traditional simulation group performance raises concerns about skill retention and highlights potential benefits of repetitious learning in RCDP. The exclusion of one traditional simulation group from the second round may have impacted results; however, with one session remaining, data from all cohorts will provide further insights.

These findings contribute to the growing literature on simulation-based training and offer guidance for optimizing curricula to enhance pediatric resuscitation skills. As PALS competency is vital for all pediatricians, these results have broad implications for residency training. Further analysis will provide a more comprehensive evaluation of these trends and their impact on pediatric simulation education.