Oral Themed Presentation
Long term PALS retention following Rapid cycle deliberate practice (RCDP)
A growing body of evidence supports that pediatric residents’ knowledge and skills learned via traditional pediatric advanced life support (PALS) training deteriorates with time. A modified, competency based method of training pediatric residents in PALS called Rapid Cycle Deliberate Practice (RCDP) was reported by Hunt et al in 2014. RCDP simulation technique involves directive feedback in the form of coaching and redirection. In the short term, there appears to be retention of knowledge when PALS is taught using RCDP. What has not been consistently reported is retention rates long term following RCDP; if the learned behaviors during simulation training are translated into retained clinical behaviors during unannounced simulation events or if training using RCDP impacts actual patient care and outcomes.
Research Question / Educational Goal:
Do the residents who undergo a single RCDP one hour training session demonstrate skill retention of at least 75% at 9 months after training?
A single center prospective study of pediatric residents was performed. All residents received PALS training at the beginning of their academic years. At random times before the 2 year PALS renewal, each resident is tested on a standardized cardiac arrest simulation (Pretest). Following the simulation they are trained on PALS cardiac arrest algorithms using RCDP. Immediately following the RCDP training session, a posttest is performed (Posttest). The residents are followed up at 6 months and 9 months post RCDP training by doing a standardized 7 minute cardiac arrest simulation. Their PALS performance is graded using a validated PALS performance scoring tool which included time to epinephrine, verbalizing pulselessness, identifying underlying rhythm, etc. Retention percentage at a given follow up time is calculated as: [(Current test value – Pretest value) / (Posttest value – pretest value)] x 100.
Results So Far:
Of the 27 residents enrolled so far, 17 residents (63%) have completed their 9 month post-RCDP training follow up. Residents average pretest score was only 52% completion of correct tasks. Their immediate posttest was 92% completion of tasks. 9 month average score was 83%. (P < 0.001). In terms of retention percentage the median at 9 months was 100% (interquartile range 57%-100%). 5 of 17 residents had 100% retention. 4 of 17 had greater than 100% retention (i.e. performed better than their immediate post-test scoring after initial RCDP training).
At 9 months residents are randomized into intervention and non-intervention groups. The intervention group receives a brief re-training at 9 months. We plan to investigate if the brief retraining will improve skill retention at 12 months.