Rapid cycle deliberate practice: a complement to clinical exposure in critical care education

Rapid cycle deliberate practice (RCDP) is an emerging simulation technique that differs from traditional simulation by providing opportunities for shorter and more frequent cycles of practice and feedback.

To explore whether RCDP-based weekly simulations during a 4-week Intensive Care Unit (ICU) rotation helped at least 80% of residents and medical students rotating in the intensive care unit achieve a minimum of 80% of key clinical tasks expected from physicians initially caring for acutely deteriorating inpatients.

This prospective, observational study consisted of delivering 3 weekly RCDP-based small-group simulation sessions, followed by one individual formative simulation-based assessment, repeated monthly. Learner performance during the formative assessment was measured with a checklist containing 22 key clinical tasks previously practiced during the RCDP-based simulations. The primary outcome was learner performance score expressed as the proportion of successfully completed clinical tasks during the assessment simulation. Secondary outcomes included attendance, RCDP acceptability, and perceived psychological safety.

The average attendance to the RCDP sessions was 77% among available learners (residents and medical students). Ten out of the 23 learners (43%; 95% CI, 23-64) assessed at the end of the rotation performed more than 80% of the clinical behaviors. The overall mean performance score of all learners was 77% (95% CI, 73-80). Most of the learners perceived RCPD as educationally valuable and psychologically safe.

Although the targeted performance outcome was not achieved, learners who participated in RCDP-based simulations demonstrated, during their assessment, important skills not consistently practiced during short ICU clinical rotations at the study institution. RCDP-based simulations identified areas for curriculum improvements and were also perceived as valuable and safe educational tools by learners.