Rapid Cycle Deliberate Practice Research Articles

Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study

ObjectiveThe objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS). DesignThis study is a prospective, randomized, controlled curriculum evaluation. SettingJohns Hopkins Medicine Simulation Center. SubjectsOne hundred twenty-two first year medical students were divided into fifty-nine teams. InterventionHospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP). MeasurementsThe primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation. Main resultsOut-of-hospital cardiac arrestHospBLS teams had larger CCF: [69% (65–74) vs. 58% (53–62), p<0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9s (7–12) vs. 22s (17.5–30.5), p<0.001].In-hospital cardiac arrestHospBLS teams had larger CCF: [73% (68–75) vs. 50% (43–54), p<0.001] and were faster to initiate compressions: [10s (6–11) vs. 36s (27–63), p<0.001]. All teams utilized the hospital AED to defibrillate within 180s per AHA guidelines [HospBLS: 122s (103–149) vs. TradBLS: 139s (117–172), p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p<0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001]. ConclusionA hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.

Rapid Cycle Deliberate Practice: Application to Neonatal Resuscitation.

This curriculum includes two simulation cases for neonatal resuscitation training using the rapid cycle deliberate practice (RCDP) technique. RCDP is a simulation-based curriculum that presents participants with rounds of increasing difficulty in rapid repetition, interspersing brief, direct feedback within the simulation. In contrast, traditional debriefing focuses on learning after the scenario is complete. Traditional debriefing usually utilizes advocacy-inquiry debriefing but allows less opportunity for practice. Each case provides a neonatal resuscitation scenario (respiratory failure secondary to perinatal compromise and cardiac arrest secondary to placental abruption) for a term newborn in the delivery room. The curriculum utilizes high-fidelity neonatal mannequins with learner teams of three to six multidisciplinary teammates who participate in scenarios of increasing difficulty to revive a neonate. Learners can include a spectrum from beginning to advanced neonatal resuscitation providers. Learners are expected to perform the appropriate steps per the neonatal resuscitation program algorithm in addition to exhibiting effective crisis resource management skills. Immediate assessment of learner performance and feedback within the RCDP model is more directive, which allows for rapid resumption of practice. The instructor may also choose to pause and back up or to pause and restart, depending on the correction needed. Neonatal resuscitation program teaching utilizes a neonatal resuscitation performance evaluation, which may be used to guide opportunities for feedback within RCDP.

Improving leadership and non-technical skills with modified rapid cycle deliberate practice simulation

Improving leadership and non-technical skills with modified rapid cycle deliberate practice simulation

Incorporating Rapid Cycle Deliberate Practice Into Nursing Staff Continuing Professional Development.

Rapid Cycle Deliberate Practice (RCDP) is an innovative concept used to teach a sequence of predetermined skills to learners in a short period of time. When implemented correctly, learners build on their actions (deliberate practice) repeatedly, over a short period of time (rapid cycle). Incorporating RCDP into a nursing mandatory education program has improved both the satisfaction of the staff attending a mandatory education day and improved their response to patients in cardiac arrest.

Rapid Cycle Deliberate Practice Pediatric Simulation Scenarios

Abstract Introduction Rapid cycle deliberate practice (RCDP) provides progressively more challenging simulation rounds in rapid repetition, with brief, usually directive expert feedback intersperse...

Ebola Virus Hemorrhagic Fever: A Simulation-Based Clinical Education Experience Designed for Senior Undergraduate Nursing Students

In light of the recent Ebola virus disease outbreak, the nursing faculty at Memorial University of Newfoundland, School of Nursing recognized the need to reassess and reinforce undergraduate nursing students’ knowledge and skills related to infection prevention and control precautions and the use of personal protective equipment (PPE). Senior nursing students may have a very limited role in the identification of an Ebola case, depending on clinical placement settings, but teaching them about the expanded precautions used in the care of Ebola cases can serve to reinforce understanding of principles, stimulate interest in infection control, and enhance technical skills that are transferable to other patients with infections. A simulation-based clinical education experience designed for senior students in their final year of studies in the Bachelor of Nursing (Collaborative) Program was developed using a step-wise approach and following the deteriorating patient scenario (DPS) method. The simulation has four implementation frames that are linked to the four key learning objectives, which include the following: (1) recognize Ebola virus disease compatible symptoms, (2) implement the guidelines for expanded isolation precautions to prevent the transmission of the Ebola virus, (3) demonstrate the proper sequence for donning and doffing personal protective equipment (PPE), and (4) remove risk for exposure to the Ebola virus through decontamination. The simulation experience concludes with a video-based debriefing that followed a modified rapid cycle deliberate practice method.

Pediatric resident resuscitation skills improve after “Rapid Cycle Deliberate Practice” training

IntroductionPrevious studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e. “Milestones”. We developed a simulation-based teaching approach “Rapid Cycle Deliberate Practice” (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e. “first-five minutes” (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to “try again” over lengthy debriefing. ParticipantsPediatric residents from an academic medical center. MethodsProspective pre-post interventional study of residents managing a simulated cardiopulmonary arrest. Main outcome measures include: (1) interval between onset of pulseless ventricular tachycardia to initiation of compressions and (2) defibrillation. ResultsSeventy pediatric residents participated in the pre-intervention and fifty-one in the post-intervention period. Baseline characteristics were similar. The RCDP-FFM intervention was associated with a decrease in: no-flow fraction: [pre: 74% (5–100%) vs. post: 34% (26–53%); p<0.001)], no-blow fraction: [pre: 39% (22–64%) median (IQR) vs. post: 30% (22–41%); p=0.01], and pre-shock pause: [pre: 84s (26–162) vs. post: 8s (4–18); p<0.001]. Survival analysis revealed RCDP-FFM was associated with starting compressions within 1min of loss of pulse: [Adjusted Hazard Ratio (HR): 3.8 (95% CI: 2.0–7.2)] and defibrillating within 2min: [HR: 1.7 (95% CI: 1.03–2.65)]. Third year residents were significantly more likely than first years to defibrillate within 2min: [HR: 2.8 (95% CI: 1.5–5.1)]. ConclusionsImplementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency.

4.5 Determining the effects of visual and self-motioninputs on intersegmental postural responses

The objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS).This study is a prospective, randomized, controlled curriculum evaluation.Johns Hopkins Medicine Simulation Center.One hundred twenty-two first year medical students were divided into fifty-nine teams.HospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP).The primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation.Out-of-hospital cardiac arrestHospBLS teams had larger CCF: [69% (65–74) vs. 58% (53–62), p < 0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9 s (7–12) vs. 22 s (17.5–30.5), p < 0.001].In-hospital cardiac arrestHospBLS teams had larger CCF: [73% (68–75) vs. 50% (43–54), p < 0.001] and were faster to initiate compressions: [10 s (6–11) vs. 36 s (27–63), p < 0.001]. All teams utilized the hospital AED to defibrillate within 180 s per AHA guidelines [HospBLS: 122 s (103–149) vs. TradBLS: 139 s (117–172), p = 0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p = 0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p < 0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p < 0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p < 0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p < 0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p < 0.001].A hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.