Journal of Surgical Simulation 2017; 4: A: 4 - 4

Published: 19 January 2017


Oral presentation

Special Issue: Improving leadership and non-technical skills with modified rapid cycle deliberate practice simulation

Christopher Taylor, Rebecca Preedy, Rebecca Young and Gomy Kandasamy
Corresponding author: Christopher Taylor, Whipps Cross University Hospital, Leytonstone, London E11 1NR, UK. Email:


Background and aims

850,000 patients in the NHS suffer an adverse event that will cause harm each year. Up to 80% of these healthcare errors are due to breakdowns in non-technical skills. Such skills include communication and leadership alongside cognitive skills such as situational awareness and task management. Deliberate practice improves skill levels via task repetition interspersed with direct feedback enabling the learner to progress from novice to master. Deliberate practice simulation has positive outcomes in technical skill-based training such as resuscitation. We aim to improve doctors’ non-technical skills using a modified version of deliberate practice in a simulation day concentrating on ‘human factors’ by removing the focus from technical skills.

Materials and methods

This project involves one-day simulation available to hospital doctors of any grade from FY1 to Consultant and nursing staff.  All participants have valid Advanced Life Support (ALS) certification. Each day has 5-10 candidates to maximise learning. Simulation is preceded by short interactive lectures based upon core concepts of leadership and non-technical skills. Candidates then experience five simulation scenarios based upon the same ALS algorithm in cardiac arrest. During the five scenarios, the technical elements of the resuscitation remain the same. Initially, one candidate manages this cardiac arrest scenario with other resuscitation team members role played by Sim faculty. This eases candidates into the environment of simulation for the day and establishes the set of technical skills required during the simulation. Candidates are then debriefed by course faculty (and each other) in order to stimulate discussion points and learning.

The subsequent simulation cycles use the exact same medical emergency, but the scenario is complicated by increasingly difficult non-technical challenges. This gradually increases the cognitive load placed on the candidates in the simulation to maximise learning without exceeding their ‘cognitive bandwidth’. Each scenario is followed by a structured debrief with faculty and fellow candidates concentrating on non-technical skills only. Using the same technical elements in every scenario allows candidates to focus on using non-technical skills to manage these simulated crises. It also reduces performance anxiety as technical skills are an area doctors’ feel they are judged on by their peers in this environment.

Results and conclusions

Pre-course questionnaires suggest that many candidates associate simulation with significant technical skill performance anxiety. Modified rapid cycle deliberate practice is an effective educational modality for non-technical skills training and is achieved by keeping the required technical skills the same throughout. The concept of increasing cognitive load for each cycle of simulation is also associated with positive progressive learning. Post-course questionnaires highlight that candidates find this method of education highly valuable for developing leadership and non-technical skills.


healthcare simulation; rapid cycle deliberate practice; medical education; non-technical skills; leadership

Additional Information

This presentation was given at the 6th Annual Homerton Simulation Conference: Safety Engineering and Simulation in Healthcare, Homerton University Hospital, London, UK, on 1 December 2016.

Conflicts of interest: none declared.