Validation of a Rapid Cycle Deliberate Practice Approach
AUTHORS
William C. Meschial, RN, PhD1; Grasiele F. Busnello, RN, PhD1; Lucineia Ferraz, RN, MS1; Alice M. Nespollo, RN, PhD2; Jouhanna C. Menegaz, RN, PhD1; Denise A. A. Zocche, RN, PhD1; Luciene M. S. Andrade, RN, PhD2
1Universidade do Estado de Santa Catarina, Chapecó, SC, Brazil
2Universidade Federal de Mato Grosso, Sinop, MT, Brazil
Corresponding Author: William Campo Meschial, williameschial@yahoo.com.br
Conflict of interest statement: The authors have no conflicts of interest to declare.
Appendix A: Final version of the validated scenario. Link: https://docs.google.com/document/d/1cpRXzi-H0hbbFlb2oQ43GfiyBMNgp1iF/edit?usp=sharing&ouid=105749295989435703169&rtpof=true&sd=true
Please cite this article as: Meschial, W. C., Busnello, G. F., Ferraz, L., Nespollo, A. M., Menegaz, J. C., Zocche, D. A. A., & Andrade, L. M. S. (2026). Simulation scenario for nursing teleconsultation in well-child care: Validation of a rapid cycle deliberate practice approach. Simulation Technology & Operations Resource Magazine, 5(1), 22-29. ISSN: 3070-3506.
SUMMARY
Introduction: Teleconsultation has solidified its role as an essential pillar in contemporary nursing, especially in well-child care, and demands effective training. However, the inherent complexity of teleconsultation competencies can hinder students' initial mastery when using traditional simulation scenarios.
Methods: This methodological study constructed and validated a Rapid Cycle Deliberate Practice (RCDP) scenario for simulation-based education in pediatric nursing teleconsultation. The RCDP was designed with three progressively complex scenarios, involving a professional actress and a realistic infant mannequin. Content validation was conducted by nine expert nurses following International Nursing Association for Clinical and Simulation Learning (INACSL) guidelines and analyzed using the Content Validity Index (CVI).
Results: Analysis of the RCDP scenario yielded an overall CVI of 0.98, with six out of seven sections achieving a CVI greater than 0.90. The specialists' expertise (88.88% with master's degrees, 100% with publication/research experience) corroborated the suitability of the content and the sequential approach. Incorporated suggestions and a pilot test further evaluated its applicability and initial effectiveness.
Conclusions: The design and content validation of this RCDP scenario offer an innovative and effective method for the gradual development of complex teleconsultation skills. This study suggests fragmenting training into progressively complex cycles optimizes competency acquisition and enhances the preparedness of future professionals for remote care.
INTRODUCTION
Telehealth has played a significant role in transforming both access to and quality of healthcare services worldwide. The exponential acceleration of Information and Communication Technologies (ICTs) has not only enabled remote care but also facilitated its integration into routine healthcare practices in countries with diverse socioeconomic contexts, such as the United States, Canada, and Saudi Arabia (Arnaert et al., 2022; Baalharith et al., 2022; Belber et al., 2021; Groom et al., 2021; Paloski et al., 2020). In Brazil, this evolution has been accompanied by fundamental regulatory advancements, notably the promulgation of Law No. 14,510/2022, which authorizes and regulates telehealth practice for all healthcare professionals, and Ministry of Health Ordinance No. 3,232/2024, which establishes the SUS Digital Program. These initiatives not only legitimize the expansion of telehealth but also point to a structural redefinition in the provision of care within the Unified Health System (SUS).
In this landscape, nursing teleconsultation plays a strategic role. Nurses, based on established protocols, can conduct remote consultations aimed at providing quality care, encompassing everything from initial assessment to telemonitoring and prevention (Lima et al., 2022). Child healthcare, which requires continuous monitoring of growth and development, has particularly benefited from teleconsultation. By overcoming barriers to in-person visits, telehealth offers a promising way to reduce infant morbidity and mortality and improve adherence to scheduled consultations (Zluhlan et al., 2023).
The increasing integration of teleconsultation into clinical practice makes it imperative for educational institutions to train nurses who can engage in this modality. Simulation-based education has become a consolidated pedagogical tool for developing clinical and non-clinical skills, preparing students for real-world practice in a safe environment (Pereira et al., 2021; Teles et al., 2020). Its application enhances communication, clinical reasoning, and decision-making (Escudero et al., 2022; Nadler et al., 2022).
However, simulation scenarios addressing teleconsultation, especially in complex areas like child healthcare, often require students to simultaneously manage multiple problems and make real-time decisions. This complexity can be excessively challenging for novice learners, compromising the effectiveness of the teaching-learning process (Escudero et al., 2022).
To optimize the learning of complex skills, Rapid Cycle Deliberate Practice (RCDP) emerges as a promising pedagogical approach. RCDP involves the repetition of tasks in short cycles, with immediate feedback and micro-debriefings, allowing learners to correct errors and progressively consolidate learning (Hunt et al., 2014; Peng & Schertzer, 2023). Recent scoping and systematic reviews associate RCDP with improved performance, knowledge retention, and self-confidence in simulation, particularly in life support training and clinical judgment development (Abelairas-Gómez et al., 2024; Assalin et al., 2023; De Souza et al., 2023; Ingalsbe et al., 2024).
Despite the growing number of publications on RCDP, most studies are conducted in hospital settings, especially resuscitation and invasive procedures, in high-income countries, and predominantly with physicians. There is a clear gap regarding the applicability of the approach in primary care contexts, in middle-income countries like Brazil, and with nursing students (Abelairas-Gómez et al., 2024; Assalin et al., 2023). The insufficient research on rapid cycle simulation for non-procedural situations, such as nursing teleconsultation in child healthcare, reinforces the relevance and originality of the present study.
This study aims to fill this gap by detailing the construction and content validation of an RCDP scenario for simulation-based education in pediatric nursing teleconsultation, with the goal of offering a rigorous and effective pedagogical tool that optimizes the acquisition of competencies by future nurses in this constantly evolving field.
METHODS
This study employs a methodological approach for the construction and validation of a scenario for simulation-based education in pediatric nursing teleconsultation, utilizing the framework of Rapid Cycle Deliberate Practice (RCDP). Methodological studies are crucial in nursing as they involve the development, validation, and evaluation of instruments and methods that ensure reliable and applicable results (Polit & Beck, 2018).
Study Protocol
The study was conducted in two phases: 1) the development of the scenario in RCDP format and its assessment instruments; and 2) the content validation of this scenario by experts.
Phase 1: Development of the Rapid Cycle Deliberate Practice Scenario
The scenario's conception was based on an analysis of documents from the Brazilian Ministry of Health (Basic Care Notebook – Child Health, Child Health Card, Nursing Teleconsultation Guidance Guide) and an extensive review of the scientific literature on teleconsultation in child healthcare.
The central focus of this phase was the transition from a traditional simulation scenario to the RCDP format. Although the original scenario demonstrated robustness in initial validation, expert feedback highlighted the complexity of a single comprehensive scenario for novice learners. This insight guided the restructuring towards RCDP, an ideal strategy for segmenting the learning of complex skills into short, focused repetitions with immediate feedback (Hunt et al., 2014).
The RCDP scenario was designed to include three cycles of increasing complexity, addressing specific competencies of nursing teleconsultation in child healthcare:
· Cycle 1: Focus on fundamental communication, rapport building, and obtaining consent.
· Cycle 2: Directed collection of medical history, identification of main complaints, and development of an initial assessment.
· Cycle 3: Incorporation of complex aspects, such as detailed guidance on eating habits and sleep, identification of warning signs (e.g., dental caries), and the need for interdisciplinary referrals (e.g., nutritionist, dentist).
Teleconsultation Scenario
A detailed clinical case of a 2-year-old patient, Enzo Andrey (fictitious name), accompanied by his mother, was used. To ensure high fidelity, a professional actress played the mother, and a reborn baby doll represented the child. To operationalize the pilot test, a pediatrics professor from another institution played the role of the mother in a simulated home environment, with the 'reborn baby' representing the child. The student participant engaged in the teleconsultation from an isolated computer cabin, mimicking a clinical telehealth environment. Microsoft Teams served as the communication platform.
After the briefing, the student operated independently in the cabin, while peers observed remotely from a separate classroom. The supervising instructor monitored the simulated encounter on Teams, providing feedback with the camera off, activating it solely for interventions. The debriefing occurred in the classroom with the student, the instructor, and the observing peer students, and the professor-actress joined remotely. This scenario was organized into sections based on INACSL recommendations: Preparation, Briefing, Overview, Scenario, Scenario Design/Progression, Debriefing, and Evaluation.
Learning objectives for each RCDP cycle were formulated based on Bloom's Taxonomy and the SMART (Specific, Measurable, Achievable, Relevant, Time-bound) criteria. A performance assessment instrument, in the form of a checklist, was developed to accompany the scenario, enabling observers to track participants’ expected actions in each cycle.
Phase 2: Content Validation of the Rapid Cycle Deliberate Practice Scenario
To evaluate the content validity of this scenario, we sought out specialists in child healthcare, simulation-based education, and/or telehealth. Following literature recommendations, we aimed to recruit between 6 and 20 specialists (Carreiro et al., 2021). Potential experts were identified using the advisors' contact network, complemented by the Snowball Technique. To be eligible, participants were required to be nurses who scored a minimum of 5 points on Lattes curricula, according to adapted Fehring criteria (Fehring, 1987), and completed the evaluation within the designated deadline.
Eligible specialists were contacted via email with a formal invitation to participate. Participants completed a sociodemographic and professional characterization instrument and questions related to the adapted Fehring criteria. After providing electronic informed consent, specialists evaluated the RCDP scenario (PDF). The research is part of a project approved by the university's Research Ethics Committee Involving Human Beings. All participants provided free and informed consent, electronically signed.
Content validity of the scenario and each of its seven sections was evaluated using a four-point Likert scale for each item, where: (1) Item not relevant/representative; (2) Item needs major revision; (3) Item needs minor revision; (4) Item relevant/representative. Justifications and suggestions were optional.
Data Analysis
Quantitative data were organized in Microsoft Excel and statistically processed in SPSS, version 28.0. Content validity was assessed using the Content Validity Index (CVI), calculated as the proportion of specialists who assigned a score of 3 or 4 to each item, section, and the global CVI. A CVI ≥ 0.80 was considered acceptable, with a preference for values above 0.90 in high complexity (Polit et al., 2007). Qualitative comments were analyzed individually for the incorporation of suggestions.
Pilot Testing
Following expert evaluation of content validity and incorporation of changes, a pilot test of the RCDP scenario was conducted with nursing students as described above. The main objective of this test was to evaluate the practical applicability of the scenario in the educational environment and its initial effectiveness in promoting the development of skills in child healthcare teleconsultation.
RESULTS
The scenario was meticulously developed with three cycles of increasing complexity, aiming for progressive improvement of students' skills. The final version of the validated scenario, with its detailed sections, learning objectives for each cycle, and the performance checklist, is available (Appendix A).
Characterization of Specialists
The content validity of the scenario was evaluated by nine nurse specialists, rigorously selected using adapted Fehring criteria. The scores of these specialists, ranging from 7 to 14 points (mean 9.4 ± 3.84), attested to their extensive experience. Of the nine specialists, eight held a master's degree, and two held a doctorate (one with an additional post-doctorate). Five master’s theses and one doctoral dissertation focused on telehealth, child health, or simulation. Importantly, 100% of the specialists had already published or conducted research in these areas, with 55.56% having experience in more than one of the three disciplines. All specialists had at least one year of experience in the relevant areas.
Regarding sociodemographic characteristics, the majority (77.78%) were female, with an average age of 36.9 years. The average time since graduation was 13.89 years (±7.67), and the average time of experience in the study areas was 6.0 years (±3.81). The most prevalent area of experience was simulation (88.89%), followed by child health (44.44%). These data reinforce the qualification and appropriate profile of the expert panel.
Content Validity of the RCDP Scenario
The global CVI of the scenario reached a remarkable 0.98, indicating excellent content validity. Similarly, six of the seven individual sections obtained a CVI greater than 0.90. The only section with a slightly lower, but still high, CVI was the Debriefing section, with 0.89. These scores demonstrate strong expert consensus on the relevance and appropriateness of the RCDP scenario components for the proposed training.
The qualitative suggestions from the specialists were carefully analyzed, resulting in significant adjustments to enhance the final version of the RCDP scenario. Notable accepted suggestions include:
· Estimated Time: The total duration of the simulation was revised, being reduced from two hours to one hour, a crucial adjustment to ensure pedagogical feasibility and engagement.
· Professional Competencies: Inclusion of "time management," recognizing its importance in teleconsultation.
· Clinical Case: Addition of information about the patient being an only child, contextualizing the family interaction.
· Performance Checklist: Inclusion of an item on "guidance on screen time use for age," relevant in contemporary child health.
· Debriefing: The recommendation to specify a debriefing methodology, such as GIBBS, was incorporated, providing greater methodological rigor.
Some expert suggestions were not incorporated to preserve the scenario's clarity and fidelity. These included adding excessive objectives to the Overview section and substantially reducing information in the actress's script, both of which could have compromised the scenario's effectiveness for novice learners. The final validated version of the RCDP scenario reflects this iterative refinement process, balancing expert feedback with pedagogical considerations.
Pilot Test
Initial observations from pilot testing with nursing students supported the scenario's practical applicability. The Microsoft Teams platform proved stable, enabling fluid communication. Minor adaptations enhanced interaction fidelity and replicability, like explicit guidance for 'reborn baby' camera positioning.
Students reported high satisfaction with the progressively complex virtual scenarios and debriefing. However, students perceived the real-time RCDP corrections delivered online as disruptive to their thought processes and line of reasoning. They suggested delivering coaching interventions as feedback at the end of each cycle, alongside a comprehensive final debriefing to integrate all learning points.
DISCUSSION
The validation of simulation-based education scenarios is a crucial step to ensure pedagogical effectiveness and clinical relevance. This study achieved a global CVI of 0.98 for a Rapid Cycle Deliberate Practice (RCDP) scenario focused on nursing teleconsultation in child healthcare. With six of seven scenario sections obtaining a CVI greater than 0.90, these results support the content validity and methodological rigor of the scenario’s construction. This aligns with the premise that simulation effectiveness is linked to its organization and quality of design (Santana et al., 2021).
The RCDP approach stands out by incorporating principles of progressive mastery and repetition guided by immediate feedback—characteristics reported as superior in several recent studies when compared to traditional simulation (De Souza et al., 2023; Peng & Schertzer, 2023). International scoping and systematic reviews reinforce its potential for significant gains in the learning of communication skills, clinical judgment, leadership, and procedures, in addition to positively impacting student confidence and safety (Abelairas-Gómez et al., 2024; Assalin et al., 2023; Ingalsbe et al., 2024). Key differentiators include scenario fragmentation, micro-focused instructor intervention, a low-risk environment for errors, and immediate application of feedback. All these elements favor mastery of complex competencies, reducing cognitive overload (Peng & Schertzer, 2023).
However, most investigations focus on hospital settings, BLS/ALS training, and physician education (Abelairas-Gómez et al., 2024; Assalin et al., 2023), with limited exploration in primary care nursing practices and health promotion, such as teleconsultation in child healthcare. Our study addresses this gap by developing and establishing content validity for an RCDP scenario in this underexplored domain, responding to calls for expanding the contexts of rapid cycle simulation.
The qualified expert panel and the iterative refinement methodology contribute to the validity and replicability potential of the scenario (Nascimento et al., 2021). Successive adjustments, such as detailing the debriefing method, including time management, and adapting competencies to the Brazilian reality, make the instrument more robust for both national and international contexts.
This study addresses an identified gap by developing and establishing content validity for an RCDP scenario tailored to teleconsultation in child healthcare. The Brazilian context – characterized by geographic barriers, healthcare access disparities, and the need for innovative training approaches – suggests this model may have applicability in other middle-income countries facing similar challenges.
Limitations
This study has several limitations. Longitudinal research is needed to evaluate the sustained effects of RCDP on clinical competence, particularly in domains where mastery depends on complex reasoning and digital health communication skills (Abelairas-Gómez et al., 2024). Future studies should compare RCDP effectiveness across different learner profiles and institutional contexts, as intensive scenario fragmentation may not benefit all learners equally (Peng & Schertzer, 2023). Additionally, research is needed to assess RCDP's impact on actual clinical practice using objective measures, to test adapted versions of the method, and to explore integration of technologies such as virtual reality to enhance remote care training (Abelairas-Gómez et al., 2024; De Souza et al., 2023). In addition, student insights on how to improve the delivery of feedback as part of the RCDP will inform a subsequent study evaluating the scenario's practical impact on student satisfaction, self-confidence, and competencies.
CONCLUSION
This study addresses a significant gap in the literature by constructing and validating a Rapid Cycle Deliberate Practice scenario for pediatric nursing teleconsultation training. Expert validation yielded a global Content Validity Index of 0.98, supporting the scenario’s content validity and appropriateness for educational use. This scenario provides a structured, progressive approach to developing teleconsultation skills and may contribute to preparing nurses for the increasing demand for remote pediatric care.
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