Are two heads better than one? Comparing dyad and self-regulated learning in simulation training

Abstract

CONTEXT The optimal learner to simulator ratio for procedural skills training is not known. Research in motor learning suggests observational training in pairs, termed 'dyad training', may be as effective as directed selfregulated learning (DSRL).OBJECTIVES This study was conducted to compare the relative effectiveness and efficiency of dyad versus DSRL training of simulation-based lumbar puncture (LP). METHODSWe conducted a two-group randomised equivalence trial. First-year internal medicine residents (n = 50) were randomly assigned to learn LP either in dyads or as individual learners on a simulator, using a directed self-regulated approach (i.e. the learning sequence was defined for them, but they defined the pace of learning). Participants were videotaped performing a simulated LP on a pre-test, an immediate post-test, and a 6-week delayed retention test. In duplicate, blinded raters independently evaluated all trainee performances using a previously validated 5-point global rating scale (GRS) and 35-item checklist.RESULTS Our analyses showed no significant differences (p = 0.69) on pre-test, post-test or retention test GRS scores between the dyad (mean AE standard deviation [SD] scores by test: 2.39 AE 0.57, 3.48 AE 0.62, 3.12 AE 0.85, respectively) and DSRL (mean AE SD scores by test: 2.67 AE 0.50, 3.34 AE 0.77, 3.21 AE 0.79, respectively) groups. Both groups improved significantly from pre-test to post-test (p < 0.001) and retained that performance following the 6-week delay. Dyad participants experienced significantly greater pre-test to post-test gains than DSRL participants (p = 0.02). There was no significant difference in total practice time between the groups (20.94 minutes for individuals and 24.20 minutes for dyads; p = 0.175).CONCLUSIONS Our results indicate that learning in pairs is as effective as independent DSRL. Dyad training permits the more efficient use of simulators as two learners use the same resources as an individual.

The effect of dyad versus individual simulation‐based ultrasound training on skills transfer

“…As cognitive load decreases with increasing levels of skills automaticity,10, 24 the benefits of dyad practice may be reduced and this reduction may occur independently of skill complexity. Interestingly, the time allocated to dyad practice during simulation‐based training in the study by Shanks et al 16. (24 minutes), the present study (2 hours), and the study by Räder et al 17.…”

“…found no differences in pre‐, post‐ and retention test performances between students who practised alone and those who worked in dyads. However, the dyad group displayed greater pre‐ to post‐test gains than the single‐practice group without using additional practice time 16. Finally, a recent study involving virtual reality coronary angiography training did not demonstrate any significant differences in retention test performances between students who were allocated to individual or dyad practice 17.…”

“…(3.5 hours) seems to be inversely related to the immediate gains in learning of the dyad participants. In the study by Shanks et al .,16 the dyad group demonstrated significantly greater pre‐ to post‐test gains than the single‐practice group, whereas there were no differences between groups in the present study and slightly worse performances in the dyad group in the study by Räder et al 17. The trade‐off between gains from dyad practice in terms of peer observation and shared information processing against the reduction in hands‐on experience may help to explain the reduced effects of dyad practice beyond initial training.…”

“…Finally, we examined only the immediate effects of dyad practice on skills transfer and did not attempt to evaluate effects on skills retention. This has, however, been examined in several recent studies, in which no significant differences were found between dyad and single practice in the simulated setting after delays of 2–3 weeks 15, 16, 17, 36…”

Efeitos de um workshop de simulação sobre a competência em punção arterial de estudantes de enfermagem

“…(8,11,16,17) However, effective simulation-based training can be resource-intensive and this may pose a threat to its implementation in faculties with a limited budget. (12,17,18) In these cases, video demonstration, modelling examples, dyad learning and intermittent feedback have demonstrated that, when used in conjunction with self-directed simulated practice, can be beneficial for the acquisition of competence in procedural skills whilst limiting the amount of resources needed. (8,(18)(19)(20)(21)(22)(23) In spite of this, our literature review showed that there is a dearth of published studies aiming to develop, implement and evaluate the effects of educational interventions that facilitate the acquisition of competence in arterial puncture amongst healthcare professionals in general and nursing students in particular.…”