Deliberate Practice Simulation: Striving for Skills Mastery and Clinical Reasoning

Background:  Deliberate practice is an educational intervention that helps students to master the performance of a skill within a context that facilitates enhanced critical thinking. The underpinnings of deliberate practice are based upon the framework of the Expert-Performance Approach.  It is conceptualized as a concentrated individualized effort to improve performance of a specific skill (Ericsson et al., 2009).  Deliberate practice has been purported to be an appropriate educational intervention for use in the education of medical professionals but remains to be validated specifically in nursing education (Chee, 2014).  We hypothesize that deliberate practice will help facilitate the gap between didactic knowledge and clinical application by providing students additional opportunities to apply theoretical knowledge to client situations involving technical skills and utilizing clinical reasoning in a controlled environment.

Purpose: The purpose of this study was to describe how we  incorporated deliberate practice sessions into the curriculum to improve student clinical reasoning.  Specific aims of the study were to determine feasibility and effectiveness of deliberate practice in one clinical nursing course.

Methods:  This descriptive study evaluated the feasibility and perceived effectiveness of deliberate practice. Ninety-nine undergraduate nursing students participated in one skills review session and two deliberate practice exercises outside of class and clinical time during either their second or third semester of nursing school as a requirement in their Medical-Surgical nursing course.   Two clinical instructors were primary designers of the sessions.  At each session, one of the clinical instructors observed the students, facilitated the debriefing session, and provided feedback.   An anonymous online survey with 13 Likert scale items and a place for free text comments was used to collect data.   

Results:  At the end of the second session in both semesters, students reported feeling more confident in performing nursing skills (92.5%  and 100%).  Additionally, most of the students who participated felt that the deliberate practice exercise was a valuable experience.  The majority of students also reported that they would like to see more deliberate practice exercises in future courses.  Common open ended comments included enjoying the opportunity to practice independently, learning from making mistakes in a safe environment, and desiring additional practice time in the skills laboratory.    

Discussion:  The deliberate practice sessions received an overwhelmingly positive response from the students.  Incorporation of deliberate practice sessions is feasible and desired within the undergraduate curriculum.    Future explorations of student confidence during deliberate practice should include the incorporation of standardized measures of confidence and critical thinking/ reasoning in pre and post-test administration.