Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios

Department of Anesthesia, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 08/2009; 103(4):531-7. DOI: 10.1093/bja/aep222
Source: PubMed


Research into adverse events in hospitalized patients suggests that a significant number are preventable. The purpose of this randomized, controlled study was to determine if simulation-based debriefing improved performance of practicing anaesthetists managing high-fidelity simulation scenarios.
The anaesthetists were randomly allocated to Group A: simulation debriefing; Group B: home study; and Group C: no intervention and secondary randomization to one of two scenarios. Six to nine months later, subjects returned to manage the alternate scenario. Facilitators blinded to study group allocation completed the performance checklists (dichotomously scored checklist, DSC) and Global Rating Scale of Performance (GRS). Two non-expert raters were trained, and assessed all videotaped performances.
Interim analysis indicated no difference between Groups B and C which were merged into one group. Seventy-four subjects were recruited, with 58 complete data sets available. There was no significant effect of group on pre-test scores. A significant improvement was seen between pre- and post-tests on the DSC in debriefed subjects (pre-test 66.8%, post-test 70.3%; F(1,57)=4.18, P=0.046). Both groups showed significant improvement in the GRS over time (F(1,57)=5.94, P=0.018), but no significant difference between the groups.
We found a modest improvement in performance on a DSC in the debriefed group and overall improvement in both control and debriefed groups using a GRS. Whether this improvement translates into clinical practice has yet to be determined.

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Available from: Jodi Herold, Oct 07, 2015
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    • "Medical simulation has also been shown to improve technical skills such as lumbar puncture in medical residents [18] and enhance PGY1 surgical resident skills to the level of a PGY2 resident [19]. Observer ratings of team skills have been shown to correlate with team performance during a simulated task [20], and debriefing modestly enhances performance [21]. Medical simulation has not yet been used as a training method for response to acute events in the EMU. "
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    ABSTRACT: Patient safety is critical for epilepsy monitoring units (EMUs). Effective training is important for educating all personnel, including residents and nurses who frequently cover these units. We performed a needs assessment and developed a simulation-based team training curriculum employing actual EMU sentinel events to train neurology resident-nurse interprofessional teams to maximize effective responses to high-acuity events. A mixed-methods design was used. This included the development of a safe-practice checklist to assess team response to acute events in the EMU using expert review with consensus (a modified Delphi process). All nineteen incoming first-year neurology residents and 2 nurses completed a questionnaire assessing baseline knowledge and attitudes regarding seizure management prior to and following a team training program employing simulation and postscenario debriefing. Four resident-nurse teams were recorded while participating in two simulated scenarios. Employing retrospective video review, four trained raters used the newly developed safe-practice checklist to assess team performance. We calculated the interobserver reliability of the checklist for consistency among the raters. We attempted to ascertain whether the training led to improvement in performance in the actual EMU by comparing 10 videos of resident-nurse team responses to seizures 4-8months into the academic year preceding the curricular training to 10 that included those who received the training within 4-8months of the captured video. Knowledge in seizure management was significantly improved following the program, but confidence in seizure management was not. Interrater agreement was moderate to high for consistency of raters for the majority of individual checklist items. We were unable to demonstrate that the training led to sustainable improvement in performance in the actual EMU by the method we used. A simulated team training curriculum using a safe-practice checklist to improve the management of acute events in an EMU may be an effective method of training neurology residents. However, translating the results into sustainable benefits and confidence in management in the EMU requires further study. Copyright © 2015 Elsevier Inc. All rights reserved.
    Epilepsy & Behavior 03/2015; 45. DOI:10.1016/j.yebeh.2015.01.018 · 2.26 Impact Factor
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    • "The quality of debriefi ng plays a crucial role for the effi cacy of simulation learning. If the debriefi ng is missed, learners most likely do not signifi cantly improve their skills (Morgan et al. 2009 ; Savoldelli et al. 2006 ). The positive effect of debriefi ng arises from two different causes. "
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    ABSTRACT: An overview is presented of the strengths and limitations of simulation learning, with a particular focus on simulation learning in medicine and health care. We present what simulation learning is about and what the main components of simulations are. The most important theoretical approaches are reviewed which were developed in order to explain why simulation learning is effective. The most prominent best-practice examples of simulation learning applications are presented, and a short overview on research fi ndings concerning simulation learning is given.
    International Handbook of Research in Professional and Practice-based Learning, Edited by S. Billett, C. Harteis, H. Gruber, 01/2014: chapter Simulation learning: pages 673-98; Springer, Heidelberg., ISBN: 978-94-017-8901-1
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    • "It has been identified as the most important step of simulation (Dieckmann, Molin Friis, Lippert, & Ostergaard, 2009; Dreifuerst, 2009; Grant, Moss, Epps, & Watts, 2010; Mayville, 2011; Shinnick, Woo, Horwich, & Steadman, 2011). Expert opinion abounds about how a debriefing should be facilitated, particularly in the areas of medical simulation, anesthesia crisis resource management , and crew resource management (Fanning & Gaba, 2007; Gaba, Howard, Fish, Smith, & Sowb, 2001; Morgan et al, 2009; Rudolph, Simon, Rivard, Dufresne, & Raemer, 2007). Simulation experts in nursing generally model debriefing practices held for medical simulation, such as discussing performance gaps and examining mental frameworks (Arafeh, Hansen, & Nichols, 2010). "
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    ABSTRACT: Background Debriefing as part of the simulation experience is regarded as essential for learning. Evidence concerning best debriefing practices from the standpoint of a student nurse participant is minimal, particularly when comparing debriefing types. This study evaluated the differences in the student experience between two debriefing types: debriefing with video and debriefing without video (debriefing alone). Method Nursing students participating in an intensive care simulation were randomized into one of the two debriefing types: debriefing with video (n = 32) and debriefing alone (n = 32) following simulation completion. After debriefing was completed, students were asked to complete a debriefing experience scale, designed to evaluate the nursing student experience during debriefing. Results Statistically significant differences were found in only 3 of 20 items on the Debriefing Experience Scale. Debriefing with video had higher means with two items, “Debriefing helped me to make connections between theory and real-life situations” (p = .007) and “I had enough time to debrief thoroughly” (p = .039). Debriefing alone had a higher mean on one item ‘‘The debriefing session facilitator was an expert in the content area’’ (p = .006). Conclusion Students identified learning as part of their experience with both debriefing types. Although a few differences exist, nursing students reported overall that their experiences were minimally different between debriefing with video and debriefing alone.
    Clinical Simulation in Nursing 12/2013; 9(12):e585–e591. DOI:10.1016/j.ecns.2013.05.007
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