‘Live Die Repeat’ simulation for medical students

The ‘Live.Die.Repeat’ (LDR) format for simulation-based education (SBE) involves repetition of scenario segments until adequate learner performance is achieved and emphasises repetitive practice over prolonged postscenario reflective debriefing.1 We incorporated the LDR format into our medical student simulations and suggest that it can be a useful element in a programmatic simulation curriculum, with appropriate preparation for learners and faculty.

Background
Simulation-based education (SBE) has been widely adopted as a learning method for health professional education and may also be enhanced by the integration of educational games - ‘an instructional method requiring the learner to participate in a competitive activity with preset rules’.2 In their ‘Live.Die.Repeat’ (LDR) study, Sunga et al designed a simulation scenario that incorporated gameplay to teach the management of emergent pulmonary conditions to postgraduate emergency medicine trainees.1 The design was based on recursive objective-based gameplay—‘a serious-game scheme in which participants are allowed infinite lives so that they can achieve predetermined criteria for progression through multiple levels of increasing difficulty’.1

The LDR format has parallels with rapid cycle deliberate practice (RCDP)3 simulation, a team-based simulation method, emphasising repetitive practice over reflective debriefing, with progressively more challenging rounds, frequent starts and stops and direct coaching. RCDP is well described for ‘algorithmic’ tasks like resuscitation, and the Sunga study was also undertaken with critical care postgraduate trainees in high acuity scenarios. We hypothesised that the format would also be effective for the lower acuity and less technical context of medical student education.