Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Balancing Deliberate Practice and Reflection

A Randomized Comparison Trial of Instructional Designs for Simulation-Based Training in Cardiopulmonary Resuscitation Skills

Diederich, Emily, MD; Lineberry, Matthew, PhD; Blomquist, Michael, RN; Schott, Vanessa, PhD; Reilly, Chelsi, RN; Murray, Megan, MHSA; Nazaran, Pooneh, RN; Rourk, Meghan, OTD; Werner, Rachel, RN; Broski, Julie, PhD

doi: 10.1097/SIH.0000000000000375
FIRES Articles

Introduction A key question in simulation-based education is how to maximize learning within time and resource limits, including how best to balance hands-on practice versus reflective debriefing. Several instructional design frameworks suggest setting the balance according to the type of learning objective(s); however, broad professional activities such as team-based cardiopulmonary resuscitation include several interrelated component skills. This study experimentally manipulated hands-on practice versus reflective debriefing for cardiopulmonary resuscitation skills, hypothesizing that the former best supports learning taskwork (eg, compression quality), whereas the latter best supports learning teamwork.

Methods The study was a randomized comparison trial with a pretest and posttest. Twenty-six teams of 5 to 6 first-year residents underwent either “drill” practice of key resuscitation phases, designed to maximize deliberate practice opportunities for individual and team skills, or “scrimmage” practice, designed to maximize full-scenario rehearsals and reflective debriefs. Key taskwork and teamwork behaviors were coded, and compression quality was collected and analyzed from an accelerometer.

Results Most performance parameters improved considerably from a pretest to posttest for both taskwork (eg, percent correct compression depth 62%–81%, P = 0.01) and teamwork (eg, role leadership, 47%–70%, P = 0.00). Only 2 parameters improved differently by condition, favoring “drill” training: checking “Do Not Actively Resuscitate” wristband (odds ratio = 14.75, P = 0.03) and use of compression adjuncts (estimated marginal means = 75% versus 67%, P = 0.03).

Conclusions Consistent with the notion that component skills in resuscitation do not clearly and exclusively constitute “taskwork” versus “teamwork,” both instructional designs led to similar improvements despite differences in the balance between hands-on practice versus reflection.

From the Zamierowski Institute for Experiential Learning, a partnership between the University of Kansas Medical Center and The University of Kansas Health System, Kansas City, KS.

Reprints: Emily Diederich, MD, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 (e-mail:

The authors declare no conflict of interest.

E.D. and M.L. contributed equally as primary authors to this study.

Online date: May 21, 2019

© 2019 Society for Simulation in Healthcare