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‘Live Die Repeat’ simulation for medical students
  1. Victoria Brazil1,
  2. Shaghayegh Shaghaghi2,
  3. Nemat Alsaba1
  1. 1 Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
  2. 2 Hôpital Maisonneuve-Rosemont (CIUSS-EMTL), University of Montreal, Montreal, Quebec, Canada
  1. Correspondence to Dr Victoria Brazil, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia; victoria.brazil{at}

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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.


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. …

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  • Contributors VB, SS and NA all made substantial contributions to study concept and design. VB and NA performed data collection. VB performed data analysis and manuscript drafting, and NA and SS undertook critical review of the manuscript. All authors are accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethical approval was granted by the Bond University Human Research Ethics Committee (Application number 16134).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Data are available on reasonable request.

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