This document describes a proposed study to compare the effectiveness of interleaved versus progressive simulation training scenarios on the long-term retention of pediatric resuscitation skills among nursing staff. The study would involve two cohorts of pediatric nurse teams who receive rapid cycle deliberate practice simulation training, with one cohort receiving interleaved scenarios and the other receiving a single progressive scenario. The primary outcome would be the percentage of team participants who can demonstrate retention of three resuscitation skill bundles at 100% after 12 months. Key steps include receiving feedback on the study design, submitting for IRB approval within two months, and goals to accomplish at the INSPIRE conference.

1. ALERT Presentation: Making simulation
training stick with rapid cycle deliberate practice: Does interleaved
various scenarios versus single progressive scenario improve long
term retention of pediatric resuscitation skills?
Melissa Powell, RN, BSN, MHPE, CHSE
Johns Hopkins All Children’s Hospital
INSPIRE @ IMSH 2017 – Orlando, FL, USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. • Skills decay rapidly after training in as little as 3- 6 months. Recommended low dose high
frequency training, recognizing that bi-annual training is not enough for maintenance of
skills.
• We practice 1-2 times a year.
• “Rapid Cycle Deliberate Practice” (RCDP) is also Simulation Based Mastery Learning
(SBML) in that learners do not end the learning session until they have met the mastery
standard for resuscitation performance. Barsuk (2010) was able to get retention to one year
with SBML.
• Original research by Cepeda, Pashler, Vul, Wixted, & Rohrer in 2006 showed that
interleaving of skills practice increases learning and retention. This simulation research
proposes to study retention rates between 2 cohorts of nursing staff. One cohort will receive
a session using interleaving. Learners will rapidly change between various scenarios
receiving RCDP intra- coaching, stopping and restarting. The second cohort will receive
single progressive scenario simulations using RCDP intra- coaching, stopping and
restarting.
International Network for Simulation-based Pediatric Innovation, Research and Education
Background

3. • Population: Pediatric nurse teams from an academic
medical center. 2 separate cohorts.
• Intervention: RCDP with interleaving of different skills
and different scenarios
• Control/Comparison: RCDP with Progressive
single scenario
• Outcome(s): % of team participants retaining at 100%
of all 3 skill bundles for up to 12 monthsInternational Network for Simulation-based Pediatric Innovation, Research and Education
PICO / Research Question

4. • Longitudinal prospective cohort (team) study. Post-
test and retest study. Skills will be retested at 12
months and compared to post test results to test for
skill retention. Specific skill achievements for
performance assessment of nurses managing a
simulated cardiopulmonary arrest will be by
accurately and safely: (1) initiation of compressions
and ventilations within 1 minute of cardiopulmonary
arrest and (2) defibrillating within 2 min of recognition
of ventricular fibrillation on defibrillator monitor and
(3) administering a dose of epinephrine within 3
minutes of recognition of asystole on defibrillator
monitor.
International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design

5. • ALERT Presentation January 2017
• IRB Submission February 2017
• Begin recruitment / Data Collection April 2017 – April 2018
• Data collection and analysis April 2018 – June 2018
• Abstract Presentation July 2018
• Manuscript Preparation September 2018
International Network for Simulation-based Pediatric Innovation, Research and Education
Timeline

6. 1. I train 4-6 at a time – How do I
describe this type of study? Testing is of
team?
2. Some may participate in additional
mock codes – should they be excluded?
3. What are the issues?
International Network for Simulation-based Pediatric Innovation, Research and Education
3 questions to improve study

7. At INSPIRE @ IMSH 2017:
Receive targeted feedback
In 2 months: Submit for IRB approval.
International Network for Simulation-based Pediatric Innovation, Research and Education
Goals to accomplish

8. Melissa Powell
Johns Hopkins All Children’s Hospital
Mpowel41@jhmi.edu
931-993-6959
International Network for Simulation-based Pediatric Innovation, Research and Education
Contact Information