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Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training*

Cory, Melinda J. MD1; Colman, Nora MD1; McCracken, Courtney E. PhD2; Hebbar, Kiran B. MD, FCCM1

Pediatric Critical Care Medicine: May 2019 - Volume 20 - Issue 5 - p 481-489
doi: 10.1097/PCC.0000000000001891

Objectives: Rapid cycle deliberate practice is a simulation training method that cycles between deliberate practice and directed feedback to create perfect practice; in contrast to reflective debriefing where learners are asked to reflect on their performance to create change. The aim of this study is to compare the impact of rapid cycle deliberate practice versus reflective debriefing training on resident application and retention of the pediatric sepsis algorithm.

Design: Prospective, randomized-control study.

Setting: A tertiary care university children’s hospital simulation room, featuring a high-fidelity pediatric patient simulator.

Subjects: Forty-six upper-level pediatric residents.

Interventions: Simulation training using rapid cycle deliberate practice or reflective debriefing.

Measurements and Main Results: Knowledge was assessed with a quiz on core sepsis management topics. The application of knowledge was assessed with a sepsis management checklist during the simulated scenario. The residents were assessed before and after the intervention and again at a follow-up session, 3–4 months later, to evaluate retention. Both groups had similar pre-intervention scores. Post-intervention, the rapid cycle deliberate practice group had higher checklist scores (rapid cycle deliberate practice 18 points [interquartile range, 18–19] vs reflective debriefing 17 points [interquartile range, 15–18]; p < 0.001). Both groups had improved quiz scores. At follow-up, both groups continued to have higher scores compared with the pre-intervention evaluation, with the rapid cycle deliberate practice group having a greater change in checklist score from pre-intervention to follow-up (rapid cycle deliberate practice 5 points [interquartile range, 3.5–7] vs reflective debriefing 3 points [interquartile range, 1.5–4.5]; p = 0.019). Both groups reported improved confidence in diagnosing and managing septic shock.

Conclusions: Both rapid cycle deliberate practice and reflective debriefing are effective in training pediatric residents to apply the sepsis algorithm and in improving their confidence in the management of septic shock. The rapid cycle deliberate practice method was superior immediately post-training; however, it is unclear if this advantage is maintained over time. Both methods should be considered for training residents.

1Division of Critical Care, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.

2Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

*See also p. 497.

The authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Children’s Healthcare of Atlanta, Atlanta, GA.

Address requests for reprints to: Melinda J. Cory, MD, Department of Pediatrics – Critical Care Medicine, Children’s Healthcare of Atlanta at Egleston, 1405 Clifton Rd NE, Atlanta, GA 30322. E-mail:

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies