Acquiring and Maintaining Technical Skills Using Simulation: Initial, Maintenance, Booster, and Refresher Training

Anne Sullivan, Summer Elshenawy, Anne Ades, Taylor Sawyer, Anne Sullivan, Summer Elshenawy, Anne Ades, Taylor Sawyer

Abstract

Simulation-based education has been shown to be an effective tool to mitigate skill decay. However, many of the strategies reported in the literature have overlapping terminology with little consensus on the timing of the strategy to prevent skill decay. In this review, we propose and provide a standardized nomenclature and framework for simulation strategies used to obtain, maintain, or regain skills that are decaying. This framework delineates four types of training: initial, maintenance, booster, and refresher. The framework differentiates these training types based on the learner competency at the time of the training, as well as the frequency and intensity of the training. Initial training is aimed at "novice" learners with the goal to achieve competency. Once competency is achieved, maintenance training prevents skill deterioration through low-dose high-frequency (LDHF) training. Booster training is used when the learner is still proficient, but competency begins to wane. Booster training occurs less frequently than maintenance training but with greater intensity to overcome the skill decay that occurs over time. Refresher training is aimed at re-establishing skill levels after competency has reached unsatisfactory levels. Refresher training is higher intensity than booster and maintenance training. We describe simulation-based strategies reported in the literature that can be used for each type of training. We conclude that there should be an increased emphasis in medical education towards maintenance and booster training in order to preserve skills before competency is lost.

Keywords: booster training; competency-based medical education; medical education; refresher training; simulation; simulation based medical education; skill maintenance; skills training.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2019, Sullivan et al.

Figures

Figure 1. Maintenance, booster, and refreshers.
Figure 1. Maintenance, booster, and refreshers.
This schematic demonstrates maintenance, booster, and refresher training with respect to skill decay over time. Maintenance involves high-frequency, but low-dose training sessions provided on an ongoing basis to maintain proficiency without losing competency. Booster training is used when proficiency has started to wane due to lack of use. The frequency of booster training is less than that of maintenance but with higher intensity, as is reflected in the greater amplitude of the curve. Refresher training becomes relevant when competency has diminished to unsatisfactory levels. This type of training requires a higher intensity than either maintenance or booster training.

References

    1. Counteracting skill decay: four refresher interventions and their effect on skill and knowledge retention in a simulated process control task. Kluge A, Frank B. Ergonomics. 2014;57:175–190.
    1. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Issenberg SB, McGaghie WC, Petrusa ER, et al. Med Teach. 2005;27:10–28.
    1. “Rolling Refreshers”: a novel approach to maintain CPR psychomotor skill competence. Niles D, Sutton RM, Donoghue A, et al. Resuscitation. 2009;80:909–912.
    1. Low-dose high-frequency CPR training improves skill retention of in-hospital pediatric providers. Sutton RM, Niles D, Meaney PA, et al. Pediatrics. 2011;128:0–151.
    1. Retention of pediatric resuscitation performance after a simulation-based mastery learning session: a multicenter randomized trial. Braun L, Sawyer T, Smith K, et al. Pediatr Crit Care Med. 2015;16:131–138.
    1. Proficiency and retention of neonatal resuscitation skills by pediatric residents. Patel J, Posencheg M, Ades A. Pediatrics. 2012;130:515–521.
    1. Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Kaczorowski J, Levitt C, Hammond M, et al. . Fam Med. 1998;30:705–711.
    1. Transforming medical education: is competency-based medical education the right approach? Whitcomb ME. Acad Med. 2016;91:618–620.
    1. Does simulation booster impact retention of resuscitation procedural skills and teamwork? Bender J, Kennally K, Shields R, et al. J Perinatology. 2014;34:664–668.
    1. The role of deliberate practice in the acquisition of expert performance. Ericsson KAK, Krampe RRT, Tesch-Romer C, et al. Psychol Rev. 1993;100:363–406.
    1. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Ericsson KA. Acad Med. 2004;79:70–81.
    1. Deliberate practice and acquisition of expert performance: a general overview. Ericsson KA. Acad Emerg Med. 2008;15:988–994.
    1. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial. Wayne DB, Butter J, Siddall VJ, et al. Teach Learn Med. 2005;17:202–208.
    1. Deliberate practice using simulation improves neonatal resuscitation performance. Sawyer T, Sierocka-Castaneda A, Chan D, et al. Simul Healthc. 2011;6:327–336.
    1. Retention of critical care skills after simulation-based mastery learning. Moazed F, Cohen ER, Furiasse N, et al. J Grad Med Educ. 2013;5:458–463.
    1. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills. Wayne DB, Siddall VJ, Butter J, et al. Acad Med. 2006;8:9–12.
    1. Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial. Cheng A, Brown LL, Duff JP, et al. JAMA Pediatr. 2014;169:137–144.
    1. The correlation of workplace simulation-based assessments with interns’ infant lumbar puncture success: a prospective, multicenter, observational study. Auerbach M, Fein DM, Chang TP, et al. Simul Healthc. 2016;11:126–133.
    1. Effect of just-in-time simulation training on tracheal intubation procedure safety in the pediatric intensive care unit. Nishisaki A, Donoghue AJ, Colborn S, et al. Anesthesiology. 2010;113:214–223.
    1. Frequent brief on-site simulation training and reduction in 24-h neonatal mortality - an educational intervention study. Mduma E, Ersdal H, Svensen E, et al. Resuscitation. 2015;93:1–7.
    1. Dreyfus SE, Dreyfus HL. Oper Res. Vol. 1980. Berkeley, CA: California Univ Berkeley Operations Research Center; 1980. A five-stage model of the mental activities involved in directed skill acquisition; pp. 1–18.
    1. Retention curves for pediatric and neonatal intubation skills after simulation-based training. Andreatta PB, Dooley-Hash SL, Klotz JJ, et al. Pediatr Emerg Care. 2016;32:71–76.
    1. Learning curves in health professions education. Pusic M V, Boutis K, Hatala R, et al. Acad Med. 2015;90:1034–1042.

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