Rapid Cycle Deliberate Practice in Medical Simulation


Simulation has become a standard educational practice across medical training programs. Traditionally, the scenario is run one time with a subsequent debriefing of the learners by faculty. The post-simulation debrief is a facilitated discussion and reflection where the majority of the learning takes place. Typically, learners are expected to be able to apply the knowledge learned during the debrief to the next real patient scenario that they encounter. However, the timing of the encounter with an actual patient with the same clinical scenario can be unpredictable. Knowledge attrition over time could impact the learner’s ability to apply knowledge learned during the simulation. Traditional post-simulation feedback methods may not be the strongest model for giving the learner a timely opportunity to apply their knowledge.

Rapid Cycle Deliberate Practice (RCDP), on the other hand, is a simulation-based technique that differs from traditional simulation practices. It involves learners repetitiously performing a simulation with micro-debriefs interjected by the faculty. Compared to traditional post-simulation feedback, the provided feedback sessions are more frequent and can be more succinct.[1] Incorporation of this feedback allows for continuous improvement upon each iterative cycle in a dynamic learning process. This timely application of feedback and the repetitive process differs from traditional simulation educational methods and may help combat knowledge attrition.


The purpose of the RCDP technique is to be an effective learning model in simulation-based medical education. In some studies, when compared to traditionally-run simulations, RCDP integrated scenarios have shown to be more effective in improving learning.[2] Other studies have not demonstrated a significant difference.[3] Specifically, RCDP has the potential to teach multiple educational concepts in one session at different time points. However, this also creates more opportunities for variability between instructors of the same session.[1] As a result, to optimize the technique, RCDP has been used for strictly choreographed scenarios. In particular, RCDP has been applied to more algorithmic healthcare practices such as resuscitation. 

Procedural Skills Assessment

RCDP has also demonstrated usefulness for teaching procedural skills. One study compared RCDP to post-simulation feedback in teaching the skill of pediatric intubations to pediatric residents.[2] A simulation training with and without the technique took place, followed by a videotaped assessment based on a checklist. Scores improved more significantly in the RCDP group.

Medical Decision Making and Leadership Development

Critically ill patients are among the most vulnerable subset of patients in the hospital — effective education in resuscitation where seconds to minutes matter can make a significant difference. In one study, learners who had undergone a modified Basic Life Support course taught with RCDP demonstrated the performance of higher quality cardiopulmonary resuscitation techniques in areas such as chest compression fraction and optimization and initiation of compressions.[4] RCDP has also had applications in teaching neonatal and pediatric resuscitation curricula.[1][5][6][7] Resuscitation of pediatric patients are often infrequent but high stakes, and simulation with RCDP allows for mastery learning and better preparedness for those scenarios.

Clinical Significance

Rapid Cycle Deliberate Practice has the potential to revolutionize simulation-based healthcare education. The broad impact of effective training models, such as RCDP, is significant. Through effective training of multiple levels of medical professionals, patients may ultimately receive higher quality medical care. Also, simulation allows learners to make mistakes in a controlled setting; this creates a safer clinical environment. The resuscitation and procedural skills are shown to be beneficial with teaching by RCDP are a vital piece of any medical professional's skillset. 

RCDP represents an integration of several key educational principles. Mastery learning is a concept whereby the emphasis on comprehensive learning is on the individual. This concept involves an iterative process until the learner achieves mastery. An individual may take as long as they need to fulfill the prescribed mastery learning objectives. Unlike traditional learning methods, in which the time devoted to learning is more proscribed, time becomes the independent variable in mastery learning. RCDP adopts a similar approach with more time-variable learning.

Additionally, RCDP is also influenced by the concept of deliberate practice. Deliberate practice involves focusing on a specific area of weakness. Through this intentional approach, the learners can address particular areas of weakness, and learning of the overall skill is improved. RCDP repetitively applies deliberate practice. Repetitive learning has shown to be valuable in improving muscle memory and long-term memory development.[1] The repetition of the scenario in RCDP has been performed variably in the literature. Often, learners will rewind 10 to 30 seconds after a micro-debrief or repeat the entire simulation. Increasing difficulty with each repeating scenario has also been a means for variation. Using RCDP, learners will attain mastery through deliberate, repetitive practice.[8]

Overall, RCDP has been well-received by learners. In one study, qualitative statements reflected that learners "gained more confidence" as the exercise went on and improved teamwork. This method of teaching did meet with some criticism in the same study, however. Some participants commented upon their challenges with the exercise, including feeling "overwhelmed" with the numerous pauses.[1] These challenges may be mitigated by standardizing RCDP training of the instructors and focusing the micro-debriefs. For one study, instructors received a guide for teaching points, and mini-review sessions took place for instructors before teaching.[1]

A pre-briefing is another opportunity to normalize the change in simulation format for learners. Because there are often prescribed learning points, learners can expect stops and feedback, regardless of their performance; this alleviates the pressure for them to perform perfectly and allows them to make errors. Learners then have a unique opportunity to fix the errors as the simulation is re-performed and have a chance to apply instructor feedback immediately to the scenario. Thus, in the RCDP model, the faculty enters a role more similar to a coach than an instructor. These compound to potentially create a more psychologically safe environment for the learner.[8]

Pearls and Other Issues

RCDP is a technique integrating the concepts of deliberate practice and derived from the principles of mastery learning. The process differs from traditional simulation teaching. In RCDP, micro-debriefs take place in interrupted segments in a repetitious fashion allowing the learner to apply learned skills immediately.  

Enhancing Healthcare Team Outcomes

Simulation is an integral educational strategy endorsed to teach undergraduate and graduate medical students. RCDP is a valuable tool for simulation-based education. RCDP has been applied to teaching and improving team-based resuscitation to enhance team performance and procedural skills.[5][2] Besides, multiple levels of medical professionals have demonstrated the benefits of RCDP, including nursing students, staff, and residents.[9][10][7] Increasing numbers of published studies are using this technique every year.[8] Further investigation will be necessary to determine other applications for this technique.



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Gross IT, Abrahan DG, Kumar A, Noether J, Shilkofski NA, Pell P, Bahar-Posey L. Rapid Cycle Deliberate Practice (RCDP) as a Method to Improve Airway Management Skills - A Randomized Controlled Simulation Study. Cureus. 2019 Sep 1:11(9):e5546. doi: 10.7759/cureus.5546. Epub 2019 Sep 1     [PubMed PMID: 31523589]

Level 1 (high-level) evidence


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Hunt EA, Duval-Arnould JM, Chime NO, Jones K, Rosen M, Hollingsworth M, Aksamit D, Twilley M, Camacho C, Nogee DP, Jung J, Nelson-McMillan K, Shilkofski N, Perretta JS. Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study. Resuscitation. 2017 May:114():127-132. doi: 10.1016/j.resuscitation.2017.03.014. Epub 2017 Mar 18     [PubMed PMID: 28323084]

Level 1 (high-level) evidence


Gupta R, Fitzgibbons C, Ramsay C, Vanderheiden L, Toppozini C, Lobos AT. Development and pilot of an interprofessional pediatric resuscitation program for non-acute care inpatient providers. Medical education online. 2019 Dec:24(1):1581521. doi: 10.1080/10872981.2019.1581521. Epub     [PubMed PMID: 30811308]

Level 3 (low-level) evidence


Cory MJ, Colman N, McCracken CE, Hebbar KB. Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2019 May:20(5):481-489. doi: 10.1097/PCC.0000000000001891. Epub     [PubMed PMID: 30707211]


Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH, Diener-West M, Perretta JS, Shilkofski NA. Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training. Resuscitation. 2014 Jul:85(7):945-51. doi: 10.1016/j.resuscitation.2014.02.025. Epub 2014 Mar 4     [PubMed PMID: 24607871]


Taras J, Everett T. Rapid Cycle Deliberate Practice in Medical Education - a Systematic Review. Cureus. 2017 Apr 19:9(4):e1180. doi: 10.7759/cureus.1180. Epub 2017 Apr 19     [PubMed PMID: 28540142]

Level 1 (high-level) evidence


Powers S, Claus N, Jones AR, Lovelace MR, Weaver K, Watts P. Improving Transition to Practice: Integration of Advanced Cardiac Life Support Into a Baccalaureate Nursing Program. The Journal of nursing education. 2019 Mar 1:58(3):182-184. doi: 10.3928/01484834-20190221-11. Epub     [PubMed PMID: 30835808]


Kutzin JM, Janicke P. Incorporating Rapid Cycle Deliberate Practice Into Nursing Staff Continuing Professional Development. Journal of continuing education in nursing. 2015 Jul:46(7):299-301. doi: 10.3928/00220124-20150619-14. Epub     [PubMed PMID: 26154670]