ArticleLiterature Review

Research Regarding Debriefing as Part of the Learning Process

Authors:
  • Alberta Children's Hospital, University of Calgary
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Abstract

Debriefing is a process involving the active participation of learners, guided by a facilitator or instructor whose primary goal is to identify and close gaps in knowledge and skills. A review of existing research and a process for identifying future opportunities was undertaken. A selective critical review of the literature on debriefing in simulation-based education was done. An iterative process of analysis, gathering input from audience participants, and consensus-based synthesis was conducted. Research is sparse and limited in presentation for all important topic areas where debriefing is a primary variable. The importance of a format for reporting data on debriefing in a research context was realized and a "who, when, where, what, why" approach was proposed. Also, a graphical representation of the characteristics of debriefing studies was developed (Sim-PICO) to help guide simulation researchers in appropriate experimental design and reporting. A few areas of debriefing practice where obvious gaps that deserve study were identified, such as comparing debriefing techniques, comparing trained versus untrained debriefers, and comparing the effect of different debriefing venues and times. A model for publication of research data was developed and presented which should help researchers clarify methodology in future work.

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... The evidence to guide decisions about the use of simulation in health care education and practice is growing. However, the literature documents uncertainties regarding a lack of standardized reporting and rigor in simulation-based research publications (Cook, Levinson, & Garside, 2011, 2013 Kardong-Edgren, Adamson, & Fitzgerald, 2010;Laschinger et al., 2008;Raemer et al., 2011). Consequently, new recommendations (Fey, Gloe, & Mariani, 2015) for simulation-based research reporting have been developed as an extension to the Consolidated Standards of Reporting Trials reporting guidelines (Cheng et al., 2016). ...
... The Simulation Research Rubric (SRR), originally published by Fey et al. (2015), was informed by existing research reporting guidelines (e.g., Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology, and Transparent Reporting of Evaluations with Nonrandomized Designs). Because of the unique characteristics of simulation-based research, elements of the Sim-PICO (Population, Intervention, Comparator, Outcome) framework (Raemer et al., 2011) were included in the SRR. The aim of the original project was to develop a rubric to evaluate the quality of published simulation research articles. ...
... in the design, implementation, and reporting of simulation research that may perpetuate poor-quality studies and hinder the advancement of the science (Cook et al., 2011(Cook et al., , 2013Kardong-Edgren et al., 2010;Laschinger et al., 2008;Raemer et al., 2011). Consequently, the SRR is meant to be a guide for the design and reporting of simulation research studies. ...
Article
Background Rigorous simulation-based research is essential to advance the science of nursing education. This article outlines the use of the updated Simulation Research Rubric (SRR) to assess the quality of published simulation research articles. Methods The SRR was used to rate 73 published articles in the Clinical Simulation in Nursing from 2015 to 2017. All articles were reviewed and rated by two reviewers. Results Of the 73 articles reviewed, 15 (20.5%) received a rating of excellent (76%-100%), 39 (53.4%) were rated as good (51%-75%), and 19 (26%) were rated as fair (26%-50%). Inter-rater reliability was 0.92, with a content validity index of 0.95 for the SRR. Conclusions The strengths and weaknesses of two years of published simulation-based research reports were identified. Although the SRR was not intended to be used to evaluate research itself, the rubric can be used as a framework to develop a thorough research proposal, for rating grant proposals, and for teaching students how to critique written research reports.
... Multiple qualitative methods were also used as a part of the convergence approach to provide greater construct validity, descriptive validity, and internal reliability to the study (Cresswell & Clark, 2017;Eisenhart, 2006;Maxwell, 2002). These methods consisted of Case Research (Fraser & al Sayah, 2011;Wang et al., 2017), and recorded reflection activities (Raemer et al., 2011;Raminoscy, 2007). An audio recorder was used to record the reflection activities which were later transcribed, photographs were taken of the created art of the participants. ...
... An Action Reflection Learning approach (Rimanoczy, 2007) was taken in order to ensure that participants were able to guide their own learning. No formal questions were developed for the evening reflection with each participant having time to share individual outcomes with the group prior to an unstructured group debrief of the day (Raemer et al., 2011). This approach allowed participants to provide authentic learning without an overt emphasis on the study goals, providing greater validity to the genuineness of responses (Cresswell & Gutterman, 2018;Raemer et al., 2011). ...
... No formal questions were developed for the evening reflection with each participant having time to share individual outcomes with the group prior to an unstructured group debrief of the day (Raemer et al., 2011). This approach allowed participants to provide authentic learning without an overt emphasis on the study goals, providing greater validity to the genuineness of responses (Cresswell & Gutterman, 2018;Raemer et al., 2011). These responses were coded and analyzed using field observations with results compared to data transformed using the LIWC2015 (Pennbaker et al, 2015. ...
Thesis
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Conformity to western socialized norms of masculinity has been associated with negative mental health outcomes and is considered to be a factor in negative social, political, and environmental impacts. Encouraging men to engage in help-seeking behaviors is a frequently noted solution, however, there has been limited prior research identifying methods to achieve this. To fill this research gap, this study consists of two phases; 1). The development and initial validation of the Anchored Interdependent Masculinity Scale (AIMS), 2). Exploring whether a nature-based intervention may prove effective in engaging masculine-identified individuals in help-seeking behaviors. Phase 1 of this project involved testing the AIMS with two studies distributed via Facebook advertising to recruit a geographically representative sample (n1= 186; n2=155) across the United States. Initial analysis found that the AIMS was an effective metric to gauge individual association with masculinity norms compared to current psychometric scales. The second phase involved an initial feasibility study that engaged five participants in a week-long nature-based mindfulness retreat. The second phase used a mixed methods case study assessing a nature-based retreat for teen boys. Findings suggested that a nature-based intervention may; 1.) Shift participant anchoring of masculinity to one of interdependence, 2.) Reduce symptoms of depression anxiety and stress, and 3.) Enhance connectedness to nature. Though initial results are promising, future research is required to further understand the relationship between interdependent masculinity, nature-connectedness, and positive mental health outcomes.
... Homework activities seem to have been designed to provide children with the opportunity to develop further the supported self-management skills and healthcare behaviours they had just learnt [334]. Evidence suggests that reinforcement strategies are important components of effective education [334,335]. Research is sparse with regard to the importance of debriefing [334,335]. ...
... Evidence suggests that reinforcement strategies are important components of effective education [334,335]. Research is sparse with regard to the importance of debriefing [334,335]. ...
Thesis
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Chronic condition self-management is well defined for adult populations as the completion of a range of health-enhancing behaviours that a person with chronic condition/s completes autonomously. As a precursor to autonomous chronic condition self-management, for children and young people, supported self-management involves a shared responsibility for the self-management tasks between children and young people and their caregivers that changes over time. There is clear delineation from family management (i.e. in infancy and early childhood) to supported self-management by the child/young person (i.e. in middle childhood, early adolescence and older adolescence) to ideally autonomous chronic condition self-management (i.e. at the point of transfer to adult healthcare services at approximately 18–20 years of age). However, there is currently little evidence available to guide caregivers, clinicians (of various disciplines) and healthcare policy makers in how to best deliver self-management teaching and support approaches to children and young people. Across the world, including Australia, more than one in 10 children and young people (0–20 years) live with a chronic medical condition/s. This thesis presents new self-management teaching and support approaches specifically designed to fit with the changing needs of children and young people with a chronic condition as they develop and mature (that reflect changing abilities). More specifically, the research investigated three main areas – (1) the role children and young people have in managing their own chronic conditions at various developmental stages; (2) how children and young people undertake shared responsibility for supported self-management with their caregivers; and (3) the teaching and support approaches that clinicians can use to promote growth in supported self-management skills and healthcare behaviours. This thesis is predominately exploratory and theoretical, reflecting the limited research on supported self-management for children and young people with chronic conditions done to date. Three focus conditions were used to illustrate supported self-management – i.e. asthma, cystic fibrosis (CF) and type 1 diabetes mellitus (T1DM). Furthermore, so that the research findings can be applied more broadly across paediatric health care settings an interdisciplinary lens was applied. A pragmatic research philosophy using a mixed-methods approach was chosen and four studies were completed. Specific methods used for the studies included: • Two systematic reviews o A systematic review of current guidelines for promoting developmentally appropriate supported self-management in children and young people with asthma, CF and T1DM (Published, Saxby et al. Chronic Illn., 2020) [8] o A systematic review of supported self-management education interventions with children young people with asthma, CF and T1DM (Published Saxby et al., Patient Educ. Couns., 2019) [7] • A concept analysis for supported self-management for children and young people with chronic conditions (manuscript in preparation for publication 2020) • A Delphi consensus of developmentally appropriate supported self-management for children and young people (published, Saxby et al., Patient Educ. Couns., 2020) [9] A rigorous new interdisciplinary method of concept analysis was also developed for the purposes of this thesis (two manuscripts in preparation for publication 2020). Together, the outputs of this research program (i.e. the three peer reviewed journal articles [7-9], the three journal articles in preparation for publication, and the two versions of a printed book [5, 6]) form an interdisciplinary framework for supported self-Management for children and young people with chronic. Several key differences between supported self-management for children/young people and chronic condition self-management for adults were identified. Supported self-management was found to be a layered and multidimensional process – which supports the complexity and interrelatedness of the attributes, antecedents and consequences of the concept. Moreover, this research found that the presence of the developmental trajectory throughout childhood and adolescence requires a child-centred and individualised, triadic, and an adjustable and responsive approach. Through the encouragement of children’s and young people’s lifelong active participation in supported self-management, which begins at the time of diagnosis, the research findings have the potential to influence the quality of life of children and young people. The research findings may also assist in improving interdisciplinary paediatric healthcare practices; in turn, leading to improved transition processes from paediatric to adult healthcare services.
... The impact of IPE can be optimized when concerted efforts are made to level traditional hierarchies between professions and ensure different perspectives and expertise are freely shared (Van Schaik et al., 2015). Sharing of knowledge and insight occurs during the scenarios themselves, but the underlying motivations and frames can be deliberately explored by facilitators during debriefing that follows scenarios (Fanning & Gaba, 2007;Raemer et al., 2011). In interprofessional simulation debriefing, practices vary, with some programs using co-facilitators from different professions. ...
... Another critical and modifiable element of interprofessional simulation training is facilitator behavior. The simulation literature suggests that facilitator behavior is critical to the overall success of debriefing by many measures (Fanning & Gaba, 2007;Raemer et al., 2011). The finding that more oral contribution by the nurse facilitator (but not the physician facilitator) was correlated with lower overall average learner engagement score, but not with average nurse learner engagement score is interesting to consider. ...
Article
Simulation offers a high fidelity modality to deliver and study team-based interprofessional education. Debriefing the following simulated scenarios is a critical component of this training. Little data exist to inform best practices to optimize interprofessional engagement during debriefing. This pilot study analyzed interprofessional debriefing events following 20 pediatric simulation-based team trainings to identify associations between modifiable factors and learner engagement. Reviewers observed a total of 236 learners, using a previously published tool to assess learner engagement. Data related to the scenario, debriefing, learners, and facilitators were collected. Spearman’s correlation was used to analyze the association between factors of interest and average learner engagement scores for each debriefing event. Mean engagement did not differ between physicians and nurses, but was lower for other professionals. Average learner engagement was inversely related to learner group size, but not to the proportion of learners in each profession. Oral participation differed significantly between professions for both learners and co-facilitators, with physicians speaking more in both groups. Students of all professions had lower engagement and spoke less frequently. This study identifies several modifiable factors, including total group size, learner level, and facilitator behavior that were associated with interprofessional engagement during debriefing following simulation-based team training.
... 42 It plays a central role in experiential learning environments, such as medical simulation, with debriefing frameworks that have been designed and adapted for clinical environments. 30,[43][44][45][46] It has also been used as a vehicle to identify systems gaps and improve patient safety and quality. 16 There are at least 2 reasons why debriefing critical events may have important benefits to the health care system. ...
... Debriefing is a reflective conversation about performance and may include processed select performance data (ie, feedback). 30,31 Finally, performance refers to both taskwork and teamwork. 32 Taskwork represents what the team does, such as adhering to a resuscitation algorithm, but also includes psychomotor skills, such as performing CPR or defibrillation; teamwork reflects how team members perform taskwork with each other. ...
Article
Debriefing after perioperative crises (eg, cardiac arrest, massive hemorrhage) is a well-described practice that can provide benefits to individuals, teams, and health systems. Debriefing has also been embraced by high-stakes industries outside of health care. Yet, in studies of actual clinical practice, there are many critical events that do not get debriefed. This article explores the gap that exists between principle and reality and the factors and strategies to offer opportunities to reflect on actual critical events, when indicated, across the increasing scope of environments where anesthesia care is provided.
... In this research, the focus group and semi-structured interviews were conducted using a standard debrief format incorporating discussion and analysis of the experience, and evaluation of lessons learned. The focus group explores lessons learned through a consensusbased synthesis in a group environment (Gardner, 2013;Raemer et al., 2011). Typically used after an emergency, the debrief process asks participants to explore what worked well, what could be improved and to identify gaps (Kitzinger, 1994;MacKinnon & Gough, 2014). ...
... Two focus groups and 13 semi-structured interviews were conducted using a standard debrief format incorporating discussion and analysis of the experience, and evaluation of lessons learned through a consensus-based synthesis in a group environment (Gardner, 2013;Raemer et al., 2011) (Appendix 1). Typically used after an emergency, the process asks participants to explore what worked well, what could be improved and to identify gaps (Kitzinger, 1994;MacKinnon & Gough, 2014). ...
Thesis
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Multiagency collaboration is fundamental to effective emergency management, yet little is known about what impacts collaboration between stakeholders in the human-animal interface in emergencies. This doctoral research sought to address this gap by investigating the issues impacting multiagency collaboration in animal welfare emergency management (AWEM) and by considering if New Zealand’s AWEM framework is fit-for-purpose. An action research and qualitative methods approach was used, incorporating focus groups, semi-structured interviews and document reviews related to three events (2017 Port Hills fire, 2017 Eastern Bay of Plenty floods and 2019 Pigeon Valley fire). Participants included 73 responders from 19 organisations. Data was analysed using thematic analysis. The data analysis has led to identifying four interrelated themes describing key factors influencing interagency collaboration during emergency response: 1) emergency management context, 2) behaviour in emergencies, 3) the knowledge base of responders and 4) connection, the latter being critical to improving collaboration in AWEM. The findings highlight how professional silos and a failure to understand the importance of human-animal-environment (h-a-e) interdependencies has resulted in AWEM being largely disconnected from emergency management overall. This thesis proposes the adoption of a One Welfare (OW) framework to develop a transdisciplinary approach to emergency management in which all stakeholders acknowledge the importance of h-a-e interdependencies and work to implement a framework to support this. This thesis offers five strategies, tested and refined in the local context, to address One Welfare implementation challenges and to ensure that animals are truly integrated into emergency management: legislation and policy changes, including human-animal-environment interface interactions as business as usual, improving knowledge through interprofessional education and training, incorporating OW champions, and recognising the role of animals as vital conduits into communities. This is the first known examination of the effectiveness of multiagency collaboration within the New Zealand AWEM framework and the first proposal for OW as a mechanism to integrate animals in all components of the emergency management framework. An ‘Aotearoa One Welfare’ approach will support a shift from a focus on individual emergency management domains towards a transdisciplinary approach that acknowledges the interdependencies of the h-a-e interface, a range of knowledge systems (including indigenous knowledge) and, ultimately, optimises outcomes for AWEM in New Zealand.
... The most important components of healthcare simulation are feedback and debriefing [1][2][3][4]. The terms "feedback" and "debriefing" are often used interchangeably; however, there are important distinctions between the two. ...
Chapter
Feedback and debriefing are the most important components of healthcare simulation. Feedback is the one-way conveyance of information to a learner on the gap between their performance and a standard, with suggestions on how the gap might be bridged. Debriefing is a bi-directional, interactive, and reflective discussion. In this chapter, we explore debriefing for extracorporeal membranous oxygenation (ECMO) simulations. We begin by examining debriefing timing and facilitation methods including the post-event debriefing and within-event debriefing. We then review two different conversational structures used in debriefing: (1) reaction, analysis, summary; and (2) gather, analyze, summarize. Next, we explore debriefing process elements including essential elements of debriefing, conversational techniques, educational strategies, and debriefing adjuncts. We then provide an analysis of special considerations for debriefing ECMO simulations. Finally, we conclude with a brief discussion of debriefing training and assessment. The goal of this chapter is to provide a general overview of debriefing techniques and strategies that simulation educators can use when debriefing ECMO simulations.
... Similar methods have been applied in the training and education of emergency department staff, whereby in situ simulations can be transitioned to virtual platforms (Hanel et al., 2020). In this instance, a method worth giving consideration is the inclusion of a "facilitated debrief, " an aspect of online learning which may not always be included (Raemer et al., 2011;Esposito and Sullivan, 2020). Other strategies that have been used in facilitating the application of theoretical knowledge have been referenced, such as problembased online tutorial meeting using tools such as Google Meet, Skype, or Zoom (Prata-Linhares et al., 2020). ...
Article
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Since the first case of the novel coronavirus emerged in late 2019 (COVID-19), it quickly spread beyond China, with reported cases in nearly all countries and territories. As these unprecedented times have resulted in significant social and economic disruption, educational institutions have been forced to implement alternative teaching and learning approaches, including a total transition to online learning. Given the dependence of undergraduate science units and degrees on practical and laboratory activities, students and academics are faced with significant hurdles regarding delivery, learning, and assessment. Therefore, this article considers the impact of COVID-19 and the approaches being utilized to facilitate undergraduate science learning during the evolving pandemic.
... Similarly, sharing safety messages following incidents in daily team meetings will increase staff awareness and help them become more vigilant. Although used effectively in HROs, learning tools, such as debriefing and simulation, have been used inconsistently in healthcare, with several disparities reported around conducting debriefing sessions following surgery [27,66,67,87]. Staff workload, staff shortages and lack of time and resources were all viewed as major barriers in using these tools [23,66,88]. ...
Article
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Background A high reliability organization is an organization that has sustained almost error-free performance, despite operating in hazardous conditions where the consequences of errors could be catastrophic. A number of tools and initiatives have been used within High Reliability Organizations to learn from safety incidents, some of which have the potential to be adapted and used in health care. We conducted a systematic review to identify any learning tools deemed to be effective that could be adapted and used by multidisciplinary teams in healthcare following a patient safety incident. Methods This review followed the PRISMA-P reporting guidelines and was registered with the PROSPERO (CRD42017071528). A search of databases was carried out in January 2021, from the date of their commencement. Electronic databases include Web of Science, Science Direct, MEDLINE in Process Jan 1950-present, EMBASE Jan 1974-present, CINAHL 1982-present, PsycINFO 1967-present, Scopus and Google Scholar. We also searched the grey literature including reports from government agencies, relevant doctoral dissertations and conference proceedings. A customised data extraction form was used to capture pertinent information from included studies and Critical Appraisal Skills Programme tool to appraise on their quality. Results A total of 5,921 articles were identified, with 964 duplicate articles removed and 4932 excluded at the title (4055), abstract (510) and full text (367) stages. Twenty-five articles were included in the review. Learning tools identified included debriefing, simulation, Crew Resource Management and reporting systems to disseminate safety messages. Debriefing involved deconstructing incidents using reflective questions, whilst simulation training involved asking staff to relive the event again by performing the task(s) in a role-play scenario. Crew resource management is a set of training procedures that focus on communication, leadership, and decision making. Sophisticated Incident reporting systems provide valuable information on hazards and were widely recommended as a way of disseminating key safety messages following safety incidents. These learning tools were found to have a positive impact on learning if conducted soon after the incident with efficient facilitation. Conclusion Healthcare organizations should find ways to adapt the learning tools or initiatives used in high reliability organizations following safety incidents. It is challenging to recommend any specific one as all learning tools have shown considerable promise. However, the way these tools or initiatives are implemented is critical and so further work is needed to explore how to successfully embed them into health care organizations so that everyone at every level of the organization embraces them.
... The INACSL Standards of Best Practice: Simulation Debriefing outline overarching principles for conducting a debrief with any type of simulation-based learning experience ( INACSL, 2016 ); however, nurse educators require practical guidance related to debriefing virtual simulations. In 2011, gaps in the simulation debriefing literature in general included comparing debriefing techniques, comparing trained versus untrained debriefers, and comparing the effect of different debriefing venues and times ( Raemer et al., 2011 ), which are also gaps in the literature related to debriefing virtual simulations. Results of our review provide preliminary evidence related to debriefing formats that are both feasible and effective for use with virtual simulations. ...
Article
Background Debriefing has been widely explored; however, there has been little focus on debriefing virtual simulations. Objective This systematic review examined efficacy of debriefing methods for virtual simulation related to healthcare learner outcomes including satisfaction, knowledge, attitudes, and skills. Methods Seven papers were reviewed using Joanna Briggs Institute (JBI) methodology. Results Options to debrief virtual simulations included face-to-face, synchronous virtual debrief, asynchronous debrief, computer debrief or self-debrief. Conclusions All debriefing methods demonstrated some benefits, and debriefer experience was found to be important. Additional research is needed to determine methods that are most effective in supporting different levels of learners.
... Secondly, students who participated in a simulation scenario, directly prior to the debriefing, might not have the emotional absorption capacity for the debriefing input, leading to cognitive overload and resulting in a declining learning process [44]. Certainly, the post simulation debriefing is a crucial component to promote the actual learning process during SBME [12,46,47]. Nevertheless, in order to foster active learning and accelerate learning from experience by promoting reflection during SBME, some concepts and factual knowledge have to be reviewed beyond the boundary of formal class time with selfdirected instructional activities [45,48]. ...
Article
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Background Many efforts of the past years aimed to build a safer health care system and hereby, non-technical skills (NTS) have been recognised to be responsible for over 70 % of preventable medical mishaps. In order to counteract those mishaps, several simulation-based trainings have been implemented in health care education to convey NTS. Still, the best and effective way to foster NTS in simulation-based training is not known. Due to the importance of NTS, this gap in knowledge needs to be filled. A possible approach to convey NTS effectively during simulation-based medical education (SBME), might be the use of the flipped learning approach. The benefits of flipped learning regarding the improvement of human factors (NTS), have not been investigated yet. Therefore, the authors introduced flipped learning as an experimental intervention into their SBME emergency trainings and aimed to analyse, whether flipped learning improved students´ NTS performance compared to lecture-based learning (LBL). Methods In a randomized controlled trial, 3rd year medical students participated in a SBME training and then received either a further SBME training with integrated flipped learning on NTS (intervention), or a further SBME training and an accompanying lecture on NTS (control). NTS performance was assessed on three skill dimensions with a validated behavioural marker system. Results The authors analysed NTS performance of 102 students, prior and after their allocation to each teaching method. The baseline NTS performance of both groups did not differ, whereas the intervention group enhanced significantly on all three skill dimensions ( t (44) = 5.63, p < .001; t (44) = 4.47, p < .001; t (44) = 4.94, p < .001). Conclusion The integration of flipped learning into SBME yields a significant improvement of NTS performance and therefore medical educators should consider the application of flipped learning to convey complex human factors and skills.
... In Keene et al., [72] the debriefing session is one example of support that an organization can provide as part of a multifaceted approach in support for its staff [72]. In addition, the use of debriefing sessions is an essential method to reflect through experiential learning [73,74]. However, individual nurses and teams are also exposed to personal matters related to work-life balance. ...
Article
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Background: Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is currently no comprehensive overview of what competencies this requires. Objectives: To identify what competencies are required from BNs/MNs in facilitating the development of an effective workplace culture in nursing homes. Methods and design: We conducted an integrative review (IR) using Whittemore and Knafl’s method. We searched the PubMed, CINAHL, and PsycINFO databases for studies published between January 2010 and December 2021 in English. Two independent reviewers determined whether studies met inclusion: bachelor- or master-educated nurse; nursing home; professional competencies; and mixed methods or qualitative and qualitative studies. We applied the CASP appraisal tool and analyzed the data by applying content analysis. Results: Sixteen articles were included. Five themes were identified representing required competencies for BNs/MNs facilitating: (1) learning cultures in nursing practice; (2) effective work relationships within teams; (3) leadership capability within teams; (4) implementation of guidelines, standards, and protocols; (5) a work environment acknowledging grief and loss of residents within teams. Conclusions: It shows that the BN/MN applies five competencies associated with a facilitator role to promote the development of an effective workplace culture to achieve a safe, high-level quality of care, satisfaction, and well-being. An overarching leadership as a change champion will support teams to achieve a quality that should guide the transformation in nursing care
... Un reflexión facilitada permite un aprendizaje significativo. El debriefing es el paso obligatorio después de un escenario de simulación 9 . ...
Article
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Resumen Uno de los retos actuales en la formación de personal para la salud es la seguridad del paciente. La enseñanza mediante la simulación nos permite tener aprendizajes significativos por medio de la práctica segura, la comunicación efectiva. La experiencia simulada en ambientes controlados es fundamental, el debriefing se ha convertido en una de las herramientas fundamentales para el logro de estos propósitos, toda vez que implica reflexión guiada que se realiza posterior a un esce-nario de simulación donde se analiza y se da sentido a la experiencia vivida, en este modelo la reflexión es la base nece-saria para la enseñanza. El debriefing representa además en el área clínica un fundamento pedagógico de aprendizaje basado en la experiencia. La calidad educativa depende en buena parte de la preparación de los docentes, un profesor capacitado es crucial para mejorar los procesos y la formación de los estudiantes. Su competencia en debriefing dentro del aprendizaje por simulación es fundamental para que el alumno adquiera un aprendizaje significativo. La capacitación y evaluación del docente en debriefing mejora está técnica dentro de su práctica, les permite estandarizar el lenguaje y la metodología aplicada en la docencia con simulación. Abstract One of the current leftovers in health personnel training is patient safety. Teaching through simulation allows us to have meaningful learning through safe practice, effective communication. The simulated experience in controlled environments is essential, debriefing has become one of the fundamental tools for achieving these purposes, since it involves guided reflection that takes place after a simulation scenario where it is analyzed and meaning is given to the lived experience, in this model reflection is the necessary basis for teaching. The debriefing also represents in the clinical area a pedagogical foundation for learning based on experience. Educational quality depends largely on the preparation of teachers, a trained teacher is crucial to improve the processes and training of students. Their competence in debriefing within simulation learning is essential for the student to acquire meaningful learning. The training and evaluation of the teacher in debriefing improves this technique within their practice, allows them to standardize the language and the methodology applied in teaching with simulation.
... Debriefing is a reflective conversation about performance and may include processed select performance data (ie, feedback). 119,120 Finally, performance refers to both taskwork and teamwork. 121 Taskwork represents what the team does, such as adhering to a resuscitation algorithm, but also includes psychomotor skills, such as performing CPR or defibrillation; teamwork reflects how team members perform taskwork with each other. ...
... Otherwise, it would have been very difficult to control for differences in the use of these adjuncts. Each scenario was immediately followed by a non-scripted, video-assisted, operator-led debriefing (30 min) in the debriefing room with all participants, including the observing nurses [14]. Formative feedback was provided, not only on the ABCDE assessment, but also on other aspects, such as skill performance, clinical reasoning, differential diagnosis, and crew resource management principles. ...
Article
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Background The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses. This study assessed the adherence to the ABCDE algorithm and whether this was affected by the instruction method used to teach this approach. Methods Randomized controlled trial in which simulation was used as investigational method. Between June 2017 and January 2018, neonatal healthcare providers routinely participated in simulated neonatal advanced life support (NALS) scenarios, using a high-fidelity manikin. They were randomly assigned to a video-based instruction (intervention group) or a conventional lecture (control group) as the method of instruction. One blinded researcher evaluated the adherence to the ABCDE approach on video with an assessment tool specifically designed and tested for this study. The primary outcomes were: 1) the overall adherence and 2) the between-group difference in individual adherence to the ABCDE approach, both expressed as a percentage score. Secondary outcomes were: 1) the scores of each profession category (nurses, neonatal ward clinicians, fellows/neonatologists) and 2) the scores for the separate domains (A, B, C, D, and E) of the algorithm. Results Seventy-two participants were assessed. Overall mean (SD) percentage score (i.e. overall adherence) was 31.5% (19.0). The video-based instruction group (28 participants) adhered better to the ABCDE approach than the lecture group (44 participants), with mean (SD) scores of 38.8% (18.7) and 27.8% (18.2), respectively ( p = 0.026). The difference in adherence between both groups could mainly be attributed to differences in the adherence to domain B ( p = 0.023) and C ( p = 0.007). Neonatal ward clinicians (39.9% (18.2)) showed better adherence than nurses (25.0% (15.2)), independent of the study group ( p = 0.010). Conclusions Overall adherence to the ABCDE algorithm was rather low. Video-based instruction resulted in better adherence to the ABCDE approach during NALS training than lecturing. Trial registration ISRCTN registry, trial ID ISRCTN95998973 , retrospectively registered on October 13th, 2020.
... Il s'agit de proposer un temps d'analyse structurée de la mise en situation, afin de comprendre les liens entre les actions, pensées et sentiments ressentis, ainsi que les performances observées (Kolbe et al., 2015). Une discussion réflexive est alors engagée afin d'identifier les écarts entre les performances des apprenant·e·s et les objectifs pédagogiques ayant guidés la conception du scénario (Oriot & Alinier, 2019;Raemer et al., 2011). Bien que la littérature s'accorde sur la nécessité d'animer un débriefing, il n'existe pas de consensus sur la manière de guider un débriefing. ...
Thesis
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La communication ouverte est un comportement de partage d’informations non-sollicitées visant à améliorer une situation menaçante. Bien que ce comportement soit bénéfique pour les performances techniques des équipes soignantes, une tendance au silence est fréquemment observée. L’objectif de cette thèse de psychologie sociale appliquée est d’examiner les attitudes et comportements de communication ouverte parmi une population d’étudiant·e·s en soins infirmiers (ESI). Deux études portent sur la construction et la validation d’un questionnaire d’attitudes relatives à la communication ouverte auprès d’un échantillon d’ESI et d’étudiant·e·s en médecine. Une structure en trois dimensions est observée : la perception de sécurité, le climat de communication ouverte au sein de l’équipe, et l’efficacité perçue. Trois études évaluent la validité prédictive de cet outil sur les probabilités de communication ouverte autorapportées. Une dernière étude présente une intervention en simulation, permettant l’observation des comportements d’ESI face à des opportunités de communication ouverte. Les résultats mettent en évidence une tendance au silence et l’utilisation de stratégies peu assertives. Le statut d’étudiant·e, la présence d’un·e patient·e et l’appréhension des répercussions sont les barrières à la communication ouverte les plus fréquemment évoquées. Les implications de ces résultats sont discutées dans le cadre de la formation initiale et continue des professionnel·le·s de santé.
... This promotes specific interventions, targeted towards the actual issues and needs of the team e.g. excessive radiation doses [29]. Currently in the Academic Medical Centre in Amsterdam, a black box is being used to analyse laparoscopic surgical procedures and organize debriefing sessions, led by an objective facilitator (TOPPER Trial) [30]. ...
Article
Purpose In laparoscopy, the Operating Room Black Box® (ORBB) provides insights into operative performance to improve patient safety. This technology may also enhance endovascular surgical practice; however, the use of a C-arm and X-rays pose important challenges, hindering transferability to an endovascular context. We describe the first implementation of ORBB technology in a hybrid angiosuite and illustrate its value in evaluating surgeons’ radiation safety, technical and non-technical performance. Methods Team members (surgeons, nurses, anaesthesiologists) and stakeholders were informed during several information sessions. Together with teams from Surgical Safety Technologies (Toronto, Canada), an implementation plan was developed, and video-evaluation frameworks were chosen. Radiation safety was assessed using dose measurements and video-evaluation of safety-related behaviours. Technical performance was assessed using ‘global’ (GRS) and ‘procedure-specific’ (PRS) rating scales and the ‘EndoVascular Aortic Repair Assessment of Technical Expertise’ (EVARATE) framework. Surgeons’ non-technical skills were assessed with the NOTSS framework. Results The system captures Audio-visual data from four ceiling-mounted cameras, three ceiling-array microphones, the fluoroscopy screen and anaesthesia monitor. After patient and team consent, an elective endovascular aneurysm repair was successfully analysed. Dose-Area-Product and Air Kerma were 71094 mGy.cm² and 270 mGy, respectively. Behavioural analysis revealed deficiencies in stepping back and radiation safety communication. Technical skill assessment was feasible: GRS: 29/40; ‘PRS’: 27/35; EVARATE: 29/35. Non-technical analysis highlighted surgeons’ leadership qualities. Conclusion An innovative data capture platform has been successfully installed to evaluate overall performance during endovascular procedures. This technology may facilitate identification of (radiation) safety-related errors and instigate educational interventions based on real-world issues.
... It is suggested that academic programs should reevaluate their curriculum to encourage students to acquire self-regulatory and meta-cognitive skills explicitly [15]. actions and thought processes, promote reflective learning, and identify strategies to improve future performance [8,36,37]. The debriefing evaluates a real or simulated event in which participants analyze their actions and reflect on their mental processes, psychomotor skills, and emotional states to improve or maintain an efficient and effective performance in the future [4]. ...
Article
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Self-regulation is a fundamental competency that physicians develop in their professional training and preparation for patient care. It is well known that health professionals need to maintain high performance in general competencies. Train�ing with clinical simulation is a teaching tool that helps develop clinical competencies in physicians-in-training; combining this with debriefing and self-regulation techniques can improve learning. Debriefing is a methodology that a teacher can use to assess the thoughts, feelings, knowledge, and mental schemata of a student in a simulated environment and pro�duce a significant change in the learning of the student. This technique can improve the acquisition of knowledge, skills, and competencies in students. The objective of this investigation was to know if the students in a School of Medicine in Mexico could improve their academic performance with the use of simulators when combined with the techniques of debriefing and self-regulation. The obtained results show that clinical simulation with debriefing and explicit self�regulation techniques does improve academic performance in medical students.
... Además de las habilidades adquiridas, estas se transfieren al entorno del trabajo lo que se traduce en una mejoría de los resultados clínicos. (25,26,27) En anestesiología una adecuada planificación de los procedimientos que se realizarán son determinantes para asegurar el cumplimiento de los objetivos. El uso de debriefing en anestesiología se compara con la planificación de un vuelo, ya que los participantes se reúnen al inicio y al final de cada procedimiento con el objetivo de poner en comunión los pormenores de las actividades a desarrollar, la distribución de las funciones, el repaso de los procedimientos de emergencias, entre otros elementos. ...
... In this study, the focus is more on the impact of debriefing in online learning. Perhaps the most reliable definition of debriefing as related to this topic is that by Raemer et al. (2011), who acknowledged that debriefing is a procedure which includes effective student involvement, and is led by a mediator or instructor, whose major aim is to recognize and close any gaps in the knowledge and skills. Lederman (1984), a prominent writer on the subject, described debriefing as a post-experience analytical process in which the students and the teacher engage actively in oral discussion intended to steer the students through a reflective process on the basis of their own learning. ...
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We are very happy to publish this issue of the International Journal of Learning, Teaching and Educational Research. The International Journal of Learning, Teaching and Educational Research is a peer-reviewed open-access journal committed to publishing high-quality articles in the field of education. Submissions may include full-length articles, case studies and innovative solutions to problems faced by students, educators and directors of educational organisations. To learn more about this journal, please visit the website http://www.ijlter.org. We are grateful to the editor-in-chief, members of the Editorial Board and the reviewers for accepting only high quality articles in this issue. We seize this opportunity to thank them for their great collaboration. The Editorial Board is composed of renowned people from across the world. Each paper is reviewed by at least two blind reviewers. We will endeavour to ensure the reputation and quality of this journal with this issue.
... Levine debriefing for meaningful learning (DML) as defined in Table 1. [8,[10][11][12][13][14][15]23]. With the publication of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework by Eppich and Cheng in 2015, scripted debriefing by healthcare educators can be applied for a variety of goals ranging from teaching the "right thing", to understanding team dynamics and cultural assumptions, with an eye towards both education and patient safety [12,[16][17][18]. ...
Article
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Purpose of review: This review highlights the emerging fields of simulation research by tying innovation into principles of learning and process improvement. Recent findings: Advances have been made in both educational simulation and simulation for quality improvement, allowing this versatile modality to be more broadly applied to healthcare and systems. Summary: Simulation in pediatric critical care medicine continues to evolve. Although the majority of simulation is focused on learner education, emerging research has broadened to focus on patient- and system-centered outcomes, leading to improvement in the quality of care delivered in the ICU.
... This allowed learners to attend in pairs, rather than small groups, so that they received more individualised attention. Future iterations of the project could seek to compare the efficacy of debriefings led by senior versus junior educators, as identified by Raemer et al. 14 ...
Article
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Aims and method To investigate whether a psychiatry-specific virtual on-call training programme improved confidence of junior trainees in key areas of psychiatry practice. The programme comprised one 90 min lecture and a 2 h simulated on-call shift where participants were bleeped to complete a series of common on-call tasks, delivered via Microsoft Teams. Results Thirty-eight trainees attended the lecture, with a significant improvement in confidence in performing seclusion reviews ( P = 0.001), prescribing psychiatric medications for acute presentations ( P < 0.001), working in section 136 suites (places of safety) ( P = 0.001) and feeling prepared for psychiatric on-call shifts ( P = 0.002). Respondents reported that a virtual on-call practical session would be useful for their training (median score of 7, interquartile range 5–7.75). Eighteen participants completed the virtual on-call session, with significant improvement in 9 out of the 10 tested domains ( P < 0.001). Clinical implications The programme can be conducted virtually, with low resource requirements. We believe it can improve trainee well-being, patient safety, the delivery of training and induction of rotating junior doctors during the COVID-19 pandemic and it supports the development and delivery of practical training in psychiatry.
... Providing adult learners with meaningful feedback is likely to be an important contributor to improved future performance [1][2][3]. Debriefing following simulation-based medical education (SBME) events is a key step in allowing participants to identify performance gaps and sustain good practice [3][4][5]. To achieve this goal, it is acknowledged that effective debriefing is important [6,7]. ...
Article
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Background Debriefing is an essential skill for simulation educators and feedback for debriefers is recognised as important in progression to mastery. Existing assessment tools, such as the Debriefing Assessment for Simulation in Healthcare (DASH), may assist in rating performance but their utility is limited by subjectivity and complexity. Use of quantitative data measurements for feedback has been shown to improve performance of clinicians but has not been studied as a focus for debriefer feedback. Methods A multi-centre sample of interdisciplinary debriefings was observed. Total debriefing time, length of individual contributions and demographics were recorded. DASH scores from simulation participants, debriefers and supervising faculty were collected after each event. Conversational diagrams were drawn in real-time by supervising faculty using an approach described by Dieckmann. For each debriefing, the data points listed above were compiled on a single page and then used as a focus for feedback to the debriefer. Results Twelve debriefings were included (µ = 6.5 simulation participants per event). Debriefers receiving feedback from supervising faculty were physicians or nurses with a range of experience ( n = 7). In 9/12 cases the ratio of debriefer to simulation participant contribution length was ≧ 1:1. The diagrams for these debriefings typically resembled a fan-shape. Debriefings ( n = 3) with a ratio < 1:1 received higher DASH ratings compared with the ≧ 1:1 group ( p = 0.038). These debriefings generated star-shaped diagrams. Debriefer self-rated DASH scores (µ = 5.08/7.0) were lower than simulation participant scores (µ = 6.50/7.0). The differences reached statistical significance for all 6 DASH elements. Debriefers evaluated the ‘usefulness’ of feedback and rated it ‘highly’ (µ= 4.6/5). Conclusion Basic quantitative data measures collected during debriefings may represent a useful focus for immediate debriefer feedback in a healthcare simulation setting.
... Although various PRD tools exist, a lack of standardized data reporting has made comparison between methods impossible and there is scant research directly comparing debriefing methods. This presents a significant barrier to the widespread adoption of PRD; even if a group is interested and motivated to adopt a formalized PRD framework, the lack of comparative study between methods makes it impossible to make an informed, evidence-based decision on which framework to implement [13,14]. An additional challenge of the existing PRD literature is the variety of environments in which it has been created, described, and studied, ranging from simulation, to clinical environments, to guidelines, as well as within the realm of medical education and assessment. ...
Article
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Background Post-resuscitation debriefing (PRD) is the process of facilitated, reflective discussion, enabling team-based interpersonal feedback and identification of systems-level barriers to patient care. The importance and benefits of PRD are well recognized; however, numerous barriers exist, preventing its practical implementation. Use of a debriefing tool can aid with facilitating debriefing, creating realistic objectives, and providing feedback. Objectives To assess utility of two PRD tools, Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) and Post-Code Pause (PCP), through user preference. Secondary aims included evaluating differences in quality, subject matter, and types of feedback between tools and implications on quality improvement and patient safety. Methods Prospective, crossover study over a 12-month period from February 2019 to January 2020. Two PDR tools were implemented in 8 week-long blocks in acute care settings at a tertiary care children’s hospital. Debriefings were triggered for any intubation, resuscitation, serious/unanticipated patient outcome, or by request for distressing situations. Post-debriefing, team members completed survey evaluations of the PDR tool used. Descriptive statistics were used to analyze survey responses. A thematic analysis was conducted to identify themes that emerged from qualitative responses. Results A total of 114 debriefings took place, representing 655 total survey responses, 327 (49.9%) using PCP and 328 (50.1%) using DISCERN. 65.2% of participants found that PCP provided emotional support while only 50% of respondents reported emotional support from DISCERN. PCP was found to more strongly support clinical education (61.2% vs 56.7%). There were no significant differences in ease of use, support of the debrief process, number of newly identified improvement opportunities, or comfort in making comments or raising questions during debriefs between tools. Thematic analysis revealed six key themes: communication, quality of care, team function & dynamics, resource allocation, preparation and response, and support. Conclusion Both tools provide teams with an opportunity to reflect on critical events. PCP provided a more organized approach to debriefing, guided the conversation to key areas, and discussed team member wellbeing. When implementing a PRD tool, environmental constraints, desired level of emotional support, and the extent to which open ended data is deemed valuable should be considered.
... Feedback and debriefing are two of the methods utilized to enhance learning and reflection. In medical training, they are employed increasingly to enhance clinical performance [6]. For example, the National Health Service in England has added debriefings to their National Safety Standards for Invasive Procedures [7]. ...
Article
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Introduction Debriefing is increasingly used to enhance learning and reflection in clinical practice. Nevertheless, barriers to implementing debriefings in the operating room (OR) include lack of time, the availability of trained facilitators, and difficulty gathering the full team after surgery. Spending five minutes on a debriefing during skin closure or between procedures may enhance learning and reflection on practice, generating to improve patient safety. The aim of this study was to explore characteristics, feasibility and content of short debriefings in the OR. Methods This was a mixed-method study of short debriefings, analyzing audio-recordings, field notes and relevance ratings from multi-professional teams, that conducted short debriefings in the OR at two University Hospitals in Denmark. Results A total of 135 debriefings were conducted, with a median duration of five minutes (range 1:19 min–12:05 min). A total of 477 team members participated in the debriefings. The teams’ median rating of relevance was 6 (range 1–10). The rating was higher following challenging events and in debriefings where the surgeon actively participated in the conversation. The teams discussed non-technical skills in all the debriefings and verbalized reflections on practice in 75 percent of the debriefings. Conclusion It was feasible to conduct short debriefings in a production-focused, complex work environment. In all the debriefings, the teams discussed various non-technical skills (NTS) and reflected on practice. The majority of team members rated the debriefings as relevant for their task management.
Article
Abstract Background Combined with traditional placement, simulation has been used as an experiential learning opportunity to integrate theory and practice in maternal-child nursing. Method van Manen’s phenomenology of practice uncovered the lived experience of new graduate nurses adopting maternal-child simulation in their practice. Narrative methods included a three-phased approach to phenomenological interviews to capture the new graduate's entry into practice. Results Thematic analysis revealed four main themes: acting like a nurse, forming a clinical imagination, embodying the role of the novice nurse, and embracing in-situ simulation. Discussion The essence of being a nurse required immersion into the ethics of caring and creation of an optimal simulation debriefing using a skilled and thoughtful approach to trigger imaginative thinking. While an inventory of simulation in nursing education was deemed necessary to understand the current blend of traditional placement and simulation in practice education, the new graduate nurses in the study looked for specialty training, and exposure to advanced roles in the simulation experiences. Conclusion An integrated traditional placement with the use of simulation fostered clinical imagination where the new graduate nurse visualized and embodied the role of the novice nurse. Future research is required to describe the impact of simulation on practice readiness.
Article
Background: COVID-19 has led to increased use of screen-based simulation. However, the importance of including a robust debriefing as a component of these simulations is often neglected. Problem: Failing to include debriefing with screen-based simulation could negatively impact student learning outcomes. Approach: Debriefing, including recollection, discussion to reveal understanding, feedback and reflection, is a process of helping learners make sense of learned content and knowledge as it is applied to the patient care experience. Debriefing for Meaningful Learning (DML) is an evidence-based method derived from theory, which can be easily incorporated into screen-based simulation to augment the clinical learning experience. Conclusion: By guiding learners to consistently engage in DML, clinical decisions and actions taken during virtual simulations can be uncovered, discussed, challenged, corrected, and explored. Including a synchronous, structured debriefing like DML ensures that screen-based simulation results in meaningful learning in addition to performance feedback to foster safe and quality patient care.
Article
Since 1987, the Neonatal Resuscitation Program (NRP) course has taught the cognitive, technical, and behavioral skills required to effectively resuscitate newborns. To remain relevant and effective, the NRP course needs to continually evolve and embrace evidence-based educational strategies proven to improve outcomes from resuscitation. In this Educational Perspectives article, 6 educational strategies that can be applied to neonatal resuscitation education are reviewed. These educational strategies include mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, and innovative educational strategies Then knowledge translation and implementation of these educational strategies through passive and active knowledge translation, change theory, design thinking, performance measurement, deadoption strategies, continuous quality improvement, incentive and penalties, and psychological marketing are explored. Finally, ways to optimize faculty development of NRP instructors, including both initial instructor training and ongoing instructor development, are examined. The goal of this review is to help NRP program developers and instructors use evidence-based educational strategies to improve neonatal resuscitation outcomes.
Article
Introduction A great deal of literature has recently discussed the evaluation and management of the coronavirus disease of 2019 (COVID-19) patient in the emergency department (ED) setting, but there remains a dearth of literature providing guidance on cardiac arrest management in this population. Objective This narrative review outlines the underlying pathophysiology of patients with COVID-19 and discusses approaches to cardiac arrest management in the ED based on the current literature as well as extrapolations from experience with other pathogens. Discussion Patients with COVID-19 may experience cardiovascular manifestations that place them at risk for acute myocardial injury, arrhythmias, and cardiac arrest. The mortality for these critically ill patients is high and increases with age and comorbidities. While providing resuscitative interventions to and performing procedures on these patients, healthcare providers must adhere to strict infection control measures and prioritize their own safety through the appropriate use of personal protective equipment. A novel approach must be implemented in combination with national guidelines. The changes in these guidelines emphasize early placement of an advanced airway to limit nosocomial viral transmission and encourage healthcare providers to determine the effectiveness of their efforts prior to placing staff at risk for exposure. Conclusions While treatment priorities and goals are identical to pre-pandemic approaches, the management of COVID-19 patients in cardiac arrest has distinct differences from cardiac arrest patients without COVID-19. We provide a review of the current literature on the changes in cardiac arrest management as well as details outlining team composition.
Chapter
This chapter describes the use of simulation technology and how it can be applied to a sedation-analgesia program. This chapter gives an educational background of simulation in the medical field, describes the types of simulators with respective functionalities, and discusses preventable complications with the goal of improving quality and safety in sedation-analgesia. We will further describe the application of simulation for different domains (clinical, administrative, education-assessment, and team dynamics) as it pertains to sedation-analgesia program. A variety of simulation scenarios are mentioned at the end of this chapter for the readers.
Article
Resumen Introducción La pandemia actual de SARS-CoV-2 ha supuesto la mayor crisis sociosanitaria mundial experimentada en el último siglo. Cada centro asistencial se ha visto impelido a adecuar las guías de tratamiento establecidas por las distintas sociedades científicas. Objetivos Analizar el impacto de la metodología basada en la simulación como herramienta de mejora de nuestra práctica clínica: dinámica de trabajo, efectividad y seguridad de todos los facultativos implicados en el manejo del parto en gestantes COVID y su utilidad para facilitar la adecuación de los protocolos a un contexto clínico específico. Método Estudio observacional descriptivo que incluye las cesáreas y partos de gestante COVID realizados en nuestro hospital. Se analizaron de manera multidisciplinar las actuaciones ejecutadas utilizando las herramientas de la simulación briefing y debriefing, antes y después de cada caso. Resultados Se analizaron un total de 5 casos clínicos. Se encontraron dificultades en la ejecución de los protocolos establecidos para la atención de la gestante COVID a nivel organizativo, estructural, de recursos materiales y de factores humanos. Conclusiones Este modelo de análisis ha resultado una herramienta de gran valor en tres aspectos: la mejora del trabajo en equipo, la realización de protocolos de actuación consensuados y el establecimiento de propuestas efectivas para la adecuación de los protocolos.
Article
Contexte : Au sein de la Haute École de santé de Fribourg (HEdS-FR), composante de la Haute École de Suisse occidentale, il n’est souvent pas possible former les formateurs novices en simulation dans les deux premières années suivant leur engagement. Le niveau de formation et d’expérience des nouveaux formateurs en soins infirmiers pour animer un débriefing post-simulation est très variable. L’enjeu est pourtant important, le débriefing post-simulation étant unanimement reconnu comme le moment où les apprentissages se réalisent et où se prépare leur transfert dans la pratique professionnelle/stage. But : Procéder à une étude exploratoire des besoins de formation des formateurs novices en simulation, en sollicitant leur sentiment de compétence, à partir d’une analyse de l’écart perçu entre leurs performances lors de la pratique du débriefing post-simulation en l’absence de formation spécifique et les performances souhaitées au regard des recommandations de bonnes pratiques en simulation en santé. Méthodes : Étude qualitative par entretiens individuels semi-dirigés de formateurs novices engagés à la HEdS-FR entre 2019 et 2020. Résultats : Cinq entretiens ont été réalisés. La comparaison des pratiques verbalisées lors des entretiens avec la grille Debriefing Assessment for Simulation in Healthcare (DASH) met en évidence des écarts au niveau du briefing, de l’analyse des performances des étudiants et des techniques d’animation et de questionnement. Les participants ont exprimé le désir d’être accompagné par des personnes expérimentées en débriefing et de disposer d’outils pour structurer le débriefing. Les critères qu’ils utilisent pour évaluer leurs débriefings et estimer leur sentiment de compétence sont proches de ceux de la grille DASH. Conclusion : La réponse aux besoins de formation des formateurs novices pourrait être un accompagnement spécifique par des experts, avec la grille DASH comme outil de référence pour les échanges, en plus d’être un outil d’autoévaluation.
Chapter
High-Fidelity Human Simulation (HFHS) is used in many disciplines, including nursing, as an innovative teaching pedagogy that offers an active learning process. The simulation process involves a number of stages with the most critical stage identified as debriefing. The main focus of debriefing is to stimulate reflection and encourage communication while exploring the emotions of the participants. These emotions assist in framing the experience that aids in enhancement of learning for the student. This quantitative, quasi-experimental study explored the comparison of two debriefing processes, video-assisted and oral, by assessing the students' opinion of the debriefing experience and the students' rating of the importance of the debriefing experience. Participants were first semester baccalaureate nursing students. The overall finding and the four subscales for both dependent variables showed no statistical significance. This article provides further evidence to guide educators to a preferred method of debriefing students after a simulated experience.
Article
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Aim To evaluate neonatal and paediatric life support training practices across Europe. Methods We conducted a descriptive study. Paediatric residents, general paediatricians, and subspecialists were surveyed to assess how paediatric basic and advanced life support (PBLS/PALS) and neonatal life support (NLS) are practically arranged and utilised throughout Europe. A mini-Delphi approach was used for survey development. Eligible professionals in general and university hospitals received a web link to the survey. Results 498 respondents from 16 countries were included. A large majority of responses came from the Netherlands (n = 393) and Belgium (n = 42). Therefore, analysis was based on these responses. PBLS was more frequently offered than PALS and NLS, though not to all professionals caring for children. For PBLS, PALS, and NLS, official recertification varied between 35–75%. Approximately 80–90% had read the latest guidelines, at least partially. Sixty to seventy percent felt capable of instant PALS, 75–90% considered themselves able to perform PBLS and NLS instantly. Not reading the guidelines and less confidence about instant resuscitation seemed to occur more often in the lower and higher age/experience groups compared to the intermediate age/experience groups. A quarter of the respondents <30 years did not feel prepared for instant PALS. General paediatricians appeared to feel most capable of instant resuscitation. General and university hospitals had rather similar training practices and facilities. Manikins were predominantly low-fidelity, especially in general hospitals. Barriers to course participation were high costs, lack of time, the non-compulsory status, remote location, and unavailability of courses. Conclusion Although most paediatric professionals receive life support training, guideline reading, recertification, training utilisation, and resuscitation preparedness require improvement. Barriers to course participation should be addressed.
Article
Ongoing shifts in the healthcare system require practitioners who possess metacognitive skills to evaluate their decisions and the thinking and rationale guiding those decisions. In an effort to design learning activities that support metacognition in nursing education, undergraduate and graduate faculty, are embracing simulation-based education (SBE) as an effective teaching and learning strategy. SBE includes prebriefing, the simulation scenario, and debriefing, all of which are supported by psychological safety. Prebriefing precedes the entire learning process and is integral to engagement in the simulation and to the effectiveness of the debriefing. Debriefing provides educators with the opportunity to explore and develop those metacognitive skills with learners. In this chapter on evidence-based debriefing, the authors will explore the evidence and theories surrounding best practices in SBE, specifically the prebriefing and debriefing components of the learning experience. The chapter explores the theoretical foundation of SBE and theory-based debriefing; educational best practices of prebriefing as an integral part of an effective debriefing; theory-based debriefing models; research evidence of debriefing outcomes; evaluation of the prebriefing and debriefing process; and finally, provides recommendations on the priorities for further research in debriefing. Within this chapter, the term educator is inclusive of undergraduate, graduate, and professional development nurse educators and reflects the educator role in SBE.
Thesis
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Face à des injonctions éthiques et sociales, la formation des professionnels santé est devenue un défi en particulier dans la gestion des risques en situation critique. La simulation interprofessionnelle (SIP) est un dispositif de formation incontournable dans la formation des professionnels de santé. Cependant, le dispositif de SIP favorise les effets induits par l’asymétrie sociale (peur du jugement, conflits de pouvoir, rôles hiérarchiques) perturbant la régulation des conflits sociocognitifs à la base du processus d’apprentissage. Nous avons proposé une évolution du dispositif standard vers un dispositif de SIP avec un débriefing combiné (entretien individuel avant le débriefing collectif - CODIS). Une méthodologie de recherche mixte a été menée avec comme intention de « connaître pour objectiver » les effets du dispositif et de « connaître pour expliquer » les effets observés ou mesurés. L’hypothèse principale était que le dispositif CODIS était plus efficace que la SIP standard pour le développement des compétences des équipes de soins aigus dans la gestion de situation critique. Une approche multidimensionnelle a permis de conclure que CODIS était plus efficace dans la régulation des émotions, a amélioré les interactions sociales au moment du débriefing collectif et a diminué les tensions hiérarchiques avec comme résultante l’amélioration de la performance des équipes de soins aigus dans la gestion d’une situation critique en particulier dans les comportements liés au leadership. Une réflexion épistémologique nous a conduit à nous questionner sur les modèles d’évaluation des dispositifs de formation par simulation dans le domaine de la santé. Nous proposons une approche méthodologique différente suite à ce travail de recherche afin d’explorer les effets internes et externes du dispositif. De nouvelles recherches devront être menées dans une visée transformative.
Chapter
This chapter provides an overview of key healthcare simulation concepts with particular attention to the various spectrum, modalities and key terms used. The key principles and uses of healthcare simulation within the domains of education, research and systems improvement are outlined.
Article
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Introduction: Training Basic Life Support saves lives. However, current BLS training approaches are time-consuming and costly. Alternative cost-efficient and effective training methods are highly needed. The present study evaluated whether a video-feedback supported peer-guided Basic Life Support training approach achieves similar practical performance as a standard instructor-guided training in laypersons. Methods: In a randomized controlled non-inferiority trial, 288 first-year medical students were randomized to two study arms with different Basic Life Support training methods: 1) Standard Instructor Feedback (SIF) or 2) a Peer Video Feedback (PVF). Outcome parameters were objective data for Basic Life Support performance (compression depth and rate) from a resuscitation manikin with recording software as well as overall Basic Life Support performance and subjective confidence. Non-inferiority margins (Δ) for these outcome parameters and sample size calculation were based on previous studies with Standard Instructor Feedback. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority. Results: Results confirmed non-inferiority of Peer Video Feedback to Standard Instructor Feedback for compression depth (proportion difference PVF-SIF = 2.9%; 95% CI: -8.2% to 14.1%; Δ = -19%), overall Basic Life Support performance (proportion difference PVF-SIF = 6.7%; 95% CI: 0.0% to 14.3%; Δ = -27%) and subjective confidence for CPR performance (proportion difference PVF-SIF = -0.01; 95% CI: -0.18-0.17; Δ = -0.5) and emergency situations (proportion difference PVF-SIF = -0.02; 95% CI: -0.21-0.18; Δ = -0.5). Results for compression rate were inconclusive. Discussion: Peer Video Feedback achieves comparable results as standard instructor-based training methods. It is an easy-to-apply and cost-efficient alternative to standard Basic Life Support training methods. To improve performance with respect to compression rate, additional implementation of a metronome is recommended.
Article
The value of simulation-based education can be lost without a structured and purposeful guided debrief where nursing students and health care professionals are able to think critically and reflect on the experiential learning. Debriefing enhances peer-to-peer learning and aids the nursing student in formulating best practice for the next time when this encounter may occur in the clinical setting. Debriefing should be led by a trained facilitator using evidence-based methods to ensure a safe learning environment for nursing students. Debriefing is an essential learning tool that should be considered for application in the classroom, clinical, and laboratory settings.
Article
Résumé Cette étude s’intéresse au processus de professionnalisation d’étudiants en soins infirmiers. Elle vise plus précisément à comprendre comment chaque étape d’un apprentissage par simulation favorise l’acquisition de compétences chez des étudiants en soins infirmiers. Au total, quarante-sept étudiants ont participé à cette étude. Ils étaient inscrits en première année de formation et répondaient de façon anonyme, aux quatre temps de la démarche de recherche, à un questionnaire composé de six questions permettant de mesurer leur opinion quant à l’acquisition de compétences au cours d’un apprentissage par simulation. Chaque question était construite autour de l’un des six savoirs définis par Le Boterf, 1997, Le Boterf, 2007, Le Boterf, 2011 dans son modèle théorique de la compétence. Les résultats obtenus mettent en évidence que chaque étape de la formation par simulation modifie significativement l’opinion que les étudiants ont de leurs différents savoirs. Et, le débriefing, qui constitue un élément essentiel de l’apprentissage par simulation, s’avère être l’étape la plus complexe étant donné les multiples processus psycho-cognitifs et émotionnels qui y sont en jeu.
Article
Contexte : Le débriefing dans le secteur de la santé est souvent considéré comme un processus de réflexion centré sur l’apprenant nécessaire pour la construction des connaissances, où le formateur joue un rôle de facilitateur. Cependant, diverses études soulignent l’importance que le débriefing soit explicite pour les apprenants novices. Cet article examine l’efficacité de différents types de débriefing, simulation, pour des apprenants expérimentés qui travaillent dans des équipes d’urgence. Objectif : Cette étude vise à vérifier si le débriefing explicite est aussi efficace pour les professionnels expérimentés qu’il l’a été pour les apprenants novices. Méthodes : Cette étude prospective randomisée monocentrique a été réalisée dans le cadre d’un programme de simulation basé sur des interventions d’urgence lors d’un arrêt cardiaque. Les connaissances déclarées de chaque participant, leur auto-efficacité et l’efficacité de l’équipe ont été mesurées avant et après la formation par simulation. Résultats : Les résultats montrent un effet bénéfique sur les connaissances et l’auto-efficacité pour les deux types de débriefing. Les soins apportés aux patients ont aussi été optimisés pour les deux types de débriefing. Conclusion : Les deux types de débriefing post-simulation sont efficaces pour les équipes d’urgence expérimentées.
Article
In this study, we examined the professional development of preservice teachers (PTs) in the framework of simulation-based learning (SBL) during pedagogical courses. The study’s goal was to examine the reflective discourse patterns by focusing mainly on the linguistic behaviour of the SBL’s participants, to describe their experiences that tended to contribute to the professional development. To this end, two SBL workshops were studied using three data collection tools: (a) workshop transcripts, which were analysed using positioning theory and the systemic functional linguistic method; (b) interviews conducted with the main SBL participant in each workshop; and (c) observations collected by two simulation instructors who viewed the videotaped simulation of the two workshop scenarios. Thus, we obtained a broad picture of PTs’ perceptions of the SBL experiences. The data analysis revealed distinctive patterns of behaviour during the participants’ discursive interactions, pointing at three directions of PTs’ learning process. The findings show that SBL, as perceived by PTs, is a unique and novel tool that contributes to the enrichment of their professional training as well as benefits their professional development. The study contributes to the field by suggesting the connection between SBL experiences of the participants and the professional development process they undergo.
Article
Background: A common recommendation to develop skillful practice is to playback videos during debriefing; however, no study has addressed the advantages of such a technique. Objectives: The present study aimed to compare the pedagogical effectiveness of video-assisted debriefing and oral debriefing in simulation-based training. By comparing video-assisted debriefing and traditional oral debriefing, it was hypothesized that video-assisted debriefing would improve medical students' decision-making skills and professional attitudes. Methods: This quasi-experimental study used a pretest-posttest design. The study encompassed 76 medical students in the fourth year of their seven-year training program. The participants were selected using a census and were then randomly divided into intervention (video-assisted debriefing, n = 36) and control (oral debriefing, n = 40) groups. The required data were collected using a demographic information questionnaire, the Penn State College of Medicine Professionalism Questionnaire, and Lauri and Salantera’s (2002) Clinical Decision-making Questionnaire. Descriptive statistics such as mean and standard deviation were used to describe the participants’ characteristics. Paired t-test and independent t-test were run to compare the medical students’ clinical decision-making and professional attitude scores before and after the intervention within and between the groups. Results: There was no significant difference in the medical students’ clinical decision-making skills between the two groups before the intervention (P = 0.09); however, significant differences were observed in both groups after the intervention (P < 0.001). Moreover, there was no significant difference in the professional attitude of medical students between the two groups before the intervention (P = 0.03); however, there were significant differences in both groups after the intervention (P < 0.001). Conclusions: The findings revealed that simulation-based training with video-assisted debriefing was more effective in developing the undergraduate medical students' decision-making skills and promoting their professional attitudes.
Article
Background Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants’ reflection in debriefings. Methods In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants’ verbalisation of a mental model as a particular form of reflection. Results The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers’ observation to debriefers’ opinion (z=9.85, p<0.001), from opinion to debriefers’ open-ended question (z=9.52, p<0.001) and from open-ended question to participants’ mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. Conclusion When debriefers pair their observations and opinions with open-ended questions, paraphrase participants’ statements and ask specific questions, they help participants reflect during debriefings.
Article
Self-directed learning is associated with several benefits in simulation-based clinical skill training and can be complemented by feedback in the form of post-event debriefing. In this study, final-year veterinary medicine students ( n = 111) were allocated into one of three groups and practiced four clinical skills from the domain of production animal reproductive medicine in a clinical skills laboratory. Group 1 completed an instructor-led practice session (I), group 2 completed a self-directed practice session with post-event debriefing (D), and group 3 completed a self-directed practice session without debriefing (control, C). Each practice session included two clinical skills categorized as being directly patient-related ( patient) and two clinical skills involving laboratory diagnostics or assembling equipment ( technical). Students evaluated the practice session using Likert-type scales. Two days after practice, 93 students took part in an objective structured clinical examination (OSCE). Student performance was analyzed for each learning station individually. The percentage of students who passed the OSCE did not differ significantly between the three groups at any learning station. While the examiner had an effect on absolute OSCE scores (%) at one learning station, the percentage of students who passed the OSCE did not differ between examiners. Patient learning stations were more popular with students than technical learning stations, and the percentage of students who passed the OSCE was significantly larger among students who enjoyed practicing at the respective station (90.9%) than among those who did not (77.8%).
Chapter
Debriefing is the analytical process used to reflect on the actions performed during the scenario. The purpose of the debriefing is to engage participants in a reflective discussion about their performance in relation to the learning objectives on which the simulation experience was designed, enriched by other important points or events that may have occurred. Although not standardized, debriefing is commonly divided into a series of phases to ensure that the conversation proceeds in a structured and orderly manner from start to finish. Many debriefing techniques run through three main phases or more and contain common elements, such as the initial attention to reactions and emotions, descriptions of events, analysis and understanding of performance, synthesis, and take-home message(s).The reaction phase is intended to give participants time to address reactions and emotions in order to allow the discussion to proceed with a lighter emotional load. The descriptive phase allows for a description of the events that unfolded, providing a summary of simulation events and the establishment of a shared mental model.The analysis phase is devoted to learner-centered reflection: the focus is on what happened during the simulation and why the participants behaved the way they did.The synthesis phase focuses on reflecting on what was learned, codifying the insights gained during the analysis phase.KeywordsSimulationDebriefingDebriefing techniquesMedical simulationSimulation scenario
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Background & purpose: Debriefing facilitates team learning but currently is not consistently performed in operating rooms. Barriers exist to consistent, effective operative team debriefing. The purpose of this study was to identify these barriers and their potential solutions as articulated by front-line staff in the operating room. Methods: We interviewed staff in the operating theatre of a children's hospital and undertook reflexive thematic analysis with a critical realist theoretical framework. Results: Interviews were analysed from 40 operating room staff: 14 nurses, 7 anaesthetists, 7 anaesthetic technicians, and 12 surgeons; 25 (62%) were female. The key themes were: one of the most valuable things - teamwork and audit; it's a safe space - psychological safety is a pre-requisite of, and is enhanced by, debriefing; natural born leader - constructs around leadership; space-time - finding time to debrief, routinely and after critical events; and doing the basics well - structure without over-complication. Conclusion: Psychological safety is both a prerequisite for and a product of debriefing. Leadership, if viewed as a collective responsibility, could help break down power structures. Given the results of this study and evidence in the literature, it is likely that routine debriefing, if well done, will improve psychological safety, facilitate team learning, reduce errors, and improve patient safety.
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Ceviri kitap. Fikti Mulkiyet Hakki Society Simulation for Healthcare aittir
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Background: This pilot study evaluated the effect of videotape-facilitated human patient simulator (HPS) practice and guidance on clinical performance indicators. Method: Nursing and nurse anesthetist students in the treatment group (n = 20) participated in HPS practice and guidance using videotape-facilitated debriefing, and the control group (n = 20) participated in HPS practice and guidance using oral debriefing alone. Results: Students in the intervention group were significantly more likely to demonstrate desirable behaviors concerning patient identification, team communication, and vital signs. The role students played in the simulation significantly impacted their performance. When scores of both the intervention and control groups were combined, team leaders, airway managers, and nurse anesthetists had higher mean total performance scores than crash cart managers, recorders, or medication nurses. Conclusion: Video-facilitated simulation feedback is potentially a useful tool in increasing desirable clinical behaviors in a simulated environment. © 2010 International Nursing Association for Clinical Simulation and Learning.
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Health care professionals experience grief when caring for children with life-threatening conditions. Harriet Lane Compassionate Care, the pediatric palliative care program of the Johns Hopkins Children's Center, created an action plan to support health care professionals; one intervention-- the bereavement debriefing session - was specifically aimed at providing emotional support and increasing one's ability to manage grief. A structured format for conducting bereavement debriefing sessions was developed, and 113 sessions were held in a three-year period; data were collected to capture themes discussed. Bereavement debriefing sessions were conducted most frequently after unexpected deaths or deaths of long-term patients. Though attendance included all disciplines, nurses attended the sessions most often. Self-report evaluation forms revealed that health care professionals found the sessions helpful. Bereavement debriefing sessions can be one aspect of an effective approach to supporting health care professionals in managing their grief in caring for children with life-threatening conditions.
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Research on medical education is translational science when rigorous studies on trainee clinical skill and knowledge acquisition address key health care problems and measure outcomes in controlled laboratory settings (T1 translational research); when these outcomes transfer to clinics, wards, and offices where better health care is delivered (T2); and when patient or public health improves as a result of educational practices (T3). This Commentary covers features of medical education interventions and environments that contribute to translational outcomes, reviews selected research studies that advance translational science in medical education at all three levels, and presents pathways to improve medical education translational science.
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Describing what simulation centre leaders see as the ideal debriefing for different simulator courses (medical vs. crisis resource management (CRM)-oriented). Describing the practice of debriefing based on interactions between instructors and training participants. Study 1 - Electronic questionnaire on the relevance of different roles of the medical teacher for debriefing (facilitator, role model, information provider, assessor, planner, resource developer) sent to simulation centre leaders. Study 2 - Observation study using a paper-and-pencil tool to code interactions during debriefings in simulation courses for CRM for content (medical vs. CRM-oriented) and type (question vs. utterance). Study 1 - The different roles were seen as equally important for both course types with the exception of 'information provider' which was seen as more relevant for medical courses. Study 2 - There were different interaction patterns during debriefings: line - involving mostly the instructor and one course participant, triangle - instructor and two participants, fan - instructor and all participants in a dyadic form and net - all participants and the instructor with cross references. What simulation centre heads think is important for the role mix of simulation instructors is (at least partly) not reflected in debriefing practice.
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This manual is a practical guide to help airline instructors effectively facilitate debriefings of Line Oriented Simulations (LOS). It is based on a recently completed study of Line Oriented Flight Training (LOFT) debriefings at several U.S. airlines. This manual presents specific facilitation tools instructors can use to achieve debriefing objectives. The approach of the manual is to be flexible so it can be tailored to the individual needs of each airline. Part One clarifies the purpose and objectives of facilitation in the LOS setting. Part Two provides recommendations for clarifying roles and expectations and presents a model for organizing discussion. Part Tree suggests techniques for eliciting active crew participation and in-depth analysis and evaluation. Finally, in Part Four, these techniques are organized according to the facilitation model. Examples of how to effectively use the techniques are provided throughout, including strategies to try when the debriefing objectives are not being fully achieved.
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Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independent observers viewing videotapes of simulated crises. Raters scored the videotapes of 14 different teams that were managing two scenarios: malignant hyperthermia (MH) and cardiac arrest. Technical performance and crisis management behaviors were rated. Technical ratings could range from 0.0 to 1.0 based on scenario-specific checklists of appropriate actions. Ratings of 12 crisis management behaviors were made using a five-point ordinal scale. Several statistical assessments of interrater variability were applied. Technical ratings were high for most teams in both scenarios (0.78 +/- 0.08 for MH, 0.83 +/- 0.06 for cardiac arrest). Ratings of crisis management behavior varied, with some teams rated as minimally acceptable or poor (28% for MH, 14% for cardiac arrest). The agreement between raters was fair to excellent, depending on the item rated and the statistical test used. Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be useful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.
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1969 to 2003, 34 years. Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. HEADLINE RESULTS: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.
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Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning. To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs. Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure." Residents were then block-randomized to a technical/knowledge debriefing covering the medical subject matter or a CDR debriefing covering vertical line failure. They then completed a written survey and were interviewed by an ethnographer. Four investigators blinded to group assignment reviewed the interview transcripts and coded the comments. The comments were qualitatively analyzed and those upon which three out of four raters agreed were quantified. A random sample of 84 comments was assessed for interrater reliability using a kappa statistic. Sixty-two residents from two EM residencies participated. Survey results were compared by technical (group A, n = 32) or cognitive (group B, n = 30) debriefing. There were 255 group A and 176 group B comments quantified. The kappa statistic for coding the interview comments was 0.42. The CDR debriefing group made more, and qualitatively richer, comments regarding CDR concepts. The technical debriefing group made more comments on the medical subjects of cases. Both groups showed an appreciation for the risk of diagnostic error. Survey data indicate that technical debriefing was better received than cognitive debriefing. The authors theorize that an understanding of CDRs can be facilitated through simulation training based on the analysis of interview comments.
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Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.
Book
Making Minds is a controversial critique of our education systems. The author is a school leader 'at the forefront of scientific and technological advancement in schools' who, as an American, 'felt comfortable taking on the British establishment' (The Times Educational Supplement). Making Minds is written for general readers- especially parents- as well as educational professionals. The book examines the underlying limitations that have been accepted in education over the past two thousand years. The author challenges common assumptions about education through evidence-based, political, ethical, and emotional arguments, as well as examining case studies such as university admissions and the autism 'epidemic'. Making Minds describes a more productive scientific approach to learning, drawing on recent research findings, particularly in the US and UK. The author illustrates how new research methods, new technologies, and very recent discoveries in neuroscience that will, in the end, allow us to make minds.
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The bridges between medicine and simulation are many and varied. This introductory article presents some of the topics covered in this symposium on simulation in medicine and healthcare. The importance of the theme is noted, and some of the recurring topics are discussed briefly, such as debriefing, design, technology, hands-on training, and modeling.
Article
Experiential learning in the educational context incorporates real-life-based processes into the educational setting in order for them to be used and scrutinized The heart of these sorts of learning experiences is the postexperience analytic process, generally referred to as the debriefing session. This essay focuses on the debriefing process as it accompanies one form of experiential learning, simulations and games. It provides a review of the existent literature on debriefing, an analysis of the debriefing process, and effective strategies for its use. It provides an analysis of the process, identifies its components and essential phases, and presents a systematic approach to the assessment of the conduct of debriefing sessions.
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Programs educating advanced practice nurses (APNs), including acute care nurse practitioners (ACNPs) and clinical nurse specialists (CNSs) may struggle with the degree to which technical and cognitive skills necessary and unique to the care of critically ill patients should be incorporated within training programs, and the best ways these skills can be synthesized and retained for clinical practice. This article describes the critical care technical skills training mechanisms and use of a High-Fidelity Human Simulation (HFHS) Laboratory in the ACNP and CNS programs at the University of Pittsburgh School of Nursing. The mechanisms for teaching invasive procedures are reviewed including an abbreviated course syllabus and documentation tools. The use of HFHS is discussed as a measure to provide students with technical and cognitive preparation to manage critical incidents. The HFHS Laboratory, scenario development and implementation, and the debriefing process are discussed. Critical care technical skills training and the use of simulation in the curriculum have had a favorable response from students and preceptors at the University of Pittsburgh School of Nursing, and have enhanced faculty's ability to prepare APNs.
Article
Background: This education-focused research project evaluated the benefit of a structured debriefing session on students' learning after the students completed three pediatric-based clinical simulations. Method: Eleven students participated in this study, in which their performance was videotaped during each simulation. They received a verbal debriefing at the conclusion of each clinical simulation and then received a structured debriefing session involving a review of the videotape during a qualitative focus group interview. Results and Conclusions: Descriptive findings from the discussion of the debriefing session suggest that students have a strong need for debriefing immediately following the conclusion of each simulation to help them decompress and integrate the experience into their knowledge base. © 2008 International Nursing Association for Clinical Simulation and Learning.
Article
Robustly tested instruments for quantifying clinical performance during pediatric resuscitation are lacking. Examining Pediatric Resuscitation Education through Simulation and Scripting Collaborative was established to conduct multicenter trials of simulation education in pediatric resuscitation, evaluating performance with multiple instruments, one of which is the Clinical Performance Tool (CPT). We hypothesize that the CPT will measure clinical performance during simulated pediatric resuscitation in a reliable and valid manner. Using a pediatric resuscitation scenario as a basis, a scoring system was designed based on Pediatric Advanced Life Support algorithms comprising 21 tasks. Each task was scored as follows: task not performed (0 points); task performed partially, incorrectly, or late (1 point); and task performed completely, correctly, and within the recommended time frame (2 points). Study teams at 14 children's hospitals went through the scenario twice (PRE and POST) with an interposed 20-minute debriefing. Both scenarios for each of eight study teams were scored by multiple raters. A generalizability study, based on the PRE scores, was conducted to investigate the sources of measurement error in the CPT total scores. Inter-rater reliability was estimated based on the variance components. Validity was assessed by repeated measures analysis of variance comparing PRE and POST scores. Sixteen resuscitation scenarios were reviewed and scored by seven raters. Inter-rater reliability for the overall CPT score was 0.63. POST scores were found to be significantly improved compared with PRE scores when controlled for within-subject covariance (F1,15 = 4.64, P < 0.05). The variance component ascribable to rater was 2.4%. Reliable and valid measures of performance in simulated pediatric resuscitation can be obtained from the CPT. Future studies should examine the applicability of trichotomous scoring instruments to other clinical scenarios, as well as performance during actual resuscitations.
Article
Over the past decade, medical simulation has evolved into an essential component of pediatric resuscitation education and team training. Evidence to support its value as an adjunct to traditional methods of education is expanding; however, large multicenter studies are very rare. Simulation-based researchers currently face many challenges related to small sample sizes, poor generalizability, and paucity of clinically proven and relevant outcome measures. The Examining Pediatric Resuscitation Education Using Simulation and Scripting (EXPRESS) pediatric simulation research collaborative was formed in an attempt to directly address and overcome these challenges. The primary mission of the EXPRESS collaborative is to improve the delivery of medical care to critically ill children by answering important research questions pertaining to pediatric resuscitation and education and is focused on using simulation either as a key intervention of interest or as the outcome measurement tool. Going forward, the collaborative aims to expand its membership internationally and collectively identify pediatric resuscitation and simulation-based research priorities and use these to guide future projects. Ultimately, we hope that with innovative and high-quality research, the EXPRESS pediatric simulation research collaborative will help to build momentum for simulation-based research on an international level.
Article
The topic of debriefing has received little attention in the simulation literature. In simulation, knowing how to debrief the learner's experiences is as essential as creating scenarios and selecting the correct manikin. The purpose of this article will be to discuss debriefing as it relates to simulation-based learning. Aspects of simulation-based learning, including briefing (preparing learners for simulation) and the simulation (scenario), will be reviewed because they have particular relevance to debriefing. Guidelines and strategies for debriefing will be discussed to facilitate the learner's ability to reflect on their performance. Debriefing will be reviewed following 3 occasions: a critical patient event, an in situ drill, and a simulation at a simulation center. Since debriefing may be different in each of these instances, customizing debriefing to fit the learning environment will be examined. Finally, because of the significance of debriefing on learning, evaluation of the debriefer will be addressed to ensure optimal performance.
Article
This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969-2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003-2009. The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record. Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.
The aim of this paper is to critically review what is felt to be important about the role of debriefing in the field of simulation-based learning, how it has come about and developed over time, and the different styles or approaches that are used and how effective the process is. A recent systematic review of high fidelity simulation literature identified feedback (including debriefing) as the most important feature of simulation-based medical education. 1 Despite this, there are surprisingly few papers in the peer-reviewed literature to illustrate how to debrief, how to teach or learn to debrief, what methods of debriefing exist and how effective they are at achieving learning objectives and goals. This review is by no means a systematic review of all the literature available on debriefing, and contains information from both peer and nonpeer reviewed sources such as meeting abstracts and presentations from within the medical field and other disciplines versed in the practice of debriefing such as military, psychology, and business. It also contains many examples of what expert facilitators have learned over years of practice in the area. We feel this would be of interest to novices in the field as an introduction to debriefing, and to experts to illustrate the gaps that currently exist, which might be addressed in further research within the medical simulation community and in collaborative ventures between other disciplines experienced in the art of debriefing.
We report on our experience with an approach to debriefing that emphasizes disclosing instructors' judgments and eliciting trainees' assumptions about the situation and their reasons for acting as they did. To highlight the importance of instructors disclosing their judgment skillfully, we call the approach "debriefing with good judgment." The approach draws on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through "reflective practice." This approach specifies a rigorous self-reflection process that helps trainees recognize and resolve pressing clinical and behavioral dilemmas raised by the simulation and the judgment of the instructor. The "debriefing with good judgment" approach is comprised of three elements. The first element is a conceptual model drawn from cognitive science. It stipulates that the trainees' "frames"--comprised of such things as knowledge, assumptions, and feelings--drive their actions. The actions, in turn, produce clinical results in a scenario. By uncovering the trainee's internal frame, the instructor can help the learner reframe internal assumptions and feelings and take action to achieve better results in the future. The second element is a stance of genuine curiosity about the trainee's frames. Presuming that the trainee's actions are an inevitable result of their frames, the instructor's job is that of a "cognitive detective" who tries to discover, through inquiry, what those frames are. The instructor establishes a "stance of curiosity" in which the trainees' mistakes are puzzles to be solved rather than simply erroneous. Finally, the approach includes a conversational technique designed to bring the judgment of the instructor and the frames of the trainee to light. The technique pairs advocacy and inquiry. Advocacy is a type of speech that includes an objective observation about and subjective judgment of the trainees' actions. Inquiry is a genuinely curious question that attempts to illuminate the trainee's frame in relation to the action described in the instructor's advocacy. We find that the approach helps instructors manage the apparent tension between sharing critical, evaluative judgments while maintaining a trusting relationship with trainees.
Article
The use of high-fidelity human patient simulators (HPS) have been embraced by nursing education programs in the development of immersive clinical simulations despite the lack of research into a pedagogy or educational philosophy appropriate to guide this technology-based learning tool. In this article, we explore this approach to clinical teaching through a critical examination of the application of behaviorist and constructivist pedagogy to high-fidelity scenario-based simulation sessions. Practical guidelines for developing simulation-based learning sessions that reflect both philosophical paradigms are provided. Consideration is also given to societal trends such as the digital revolution and the incoming millennial generation who represent the aptitude of the modern nursing student to utilize high-fidelity realistic and immersive simulation. Depending on the desired goal of simulator utilization, the nurse educator may want to draw on constructivism or behaviorism or a blend of both educational philosophies to best meet the needs of the adult learner.
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The authors present a four-step model of debriefing as formative assessment that blends evidence and theory from education research, the social and cognitive sciences, experience drawn from conducting over 3,000 debriefings, and teaching debriefing to approximately 1,000 clinicians worldwide. The steps are to: 1) note salient performance gaps related to predetermined objectives, 2) provide feedback describing the gap, 3) investigate the basis for the gap by exploring the frames and emotions contributing to the current performance level, and 4) help close the performance gap through discussion or targeted instruction about principles and skills relevant to performance. The authors propose that the model, designed for postsimulation debriefings, can also be applied to bedside teaching in the emergency department (ED) and other clinical settings.
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Aspects of teaching and learning at senior house officer level in South East Thames region were investigated by analysis of the responses of consultants, senior registrars, registrars, and senior house officers to a postal questionnaire. Responses to sections about who teaches senior house officers, how senior house officers learn, and the relation between the service and training elements of these posts varied significantly, according to the status of the respondents; certain grades commonly overestimated their own contribution when compared with the estimates of the other grades. Although the replies of senior house officers showed that they were taught by various grades, 47% of this group did not regard the consultant as their main teacher. Senior registrars and registrars rather than consultants were regarded by senior house officers as best at teaching (63% v 48% respectively). Consultants and registrars were considered to require more commitment to training, personal educational training, and to be more approachable. Inquiry about teaching methods used most by senior house officers showed absence of a systematic approach to training. Only about half of senior house officers cited ward rounds with consultants. Views on the relation between training and service were significantly different among grades, but there was general dissatisfaction. Overall, the findings disclosed the ineffectiveness of senior house officer training posts. This arises from lack of a clear distinction between training and service elements, of educational training for teachers, of a clear contractual obligation to teach im the consultant grade, and of allotted time for training and study for the teachers and senior house officers respectively. Reversal of these current trends is needed for senior house officer posts to fulfil their main training function.
Article
The aim of this study was to examine the performance of anaesthetists while managing simulated anaesthetic crises and to see whether their performance was improved by reviewing their own performances recorded on videotape. Thirty-two subjects from four hospitals were allocated randomly to one of two groups, with each subject completing five simulations in a single session. Individuals in the first group completed five simulations with only a short discussion between each simulation. Those in the second group were allowed to review their own performance on videotape between each of the simulations. Performance was measured by both 'time to solve the problem' and mental workload, using anaesthetic chart error as a secondary task. Those trainees exposed to videotape feedback had a shorter median 'time to solve' and a smaller decrease in chart error when compared to those not exposed to video feedback. However, the differences were not statistically significant, confirming the difficulties encountered by other groups in designing valid tests of the performance of anaesthetists.
Article
Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies. A prospective, randomized, controlled trial was conducted of primary care practices (pediatric, family practice, and health departments) that were recruited from an existing database of North Carolina practices. Practices that agreed to participate were randomly assigned to either the intervention or the control group. Unannounced mock codes were conducted in the intervention practices by 2 emergency medicine clinicians (medical doctor and/or registered nurse). Practices were expected to respond to the mock code using their own staff, equipment, and local emergency medical system. After the exercise, the emergency medicine clinicians and the local emergency medical system team led a structured debriefing session providing constructive feedback to the staff on their performance, a review of the office's equipment, and a resource manual designed for the project. The primary outcome measures were obtained by survey 3 to 6 months postintervention and included 1) purchase of new pediatric emergency equipment and medications, 2) receipt or updating of basic life support/pediatric advanced life support/advanced life support training by staff members, and 3) development of written emergency pediatric protocols. The control practices received no interventions during the trial and completed a similar outcome survey. Thirty-nine practices (20 intervention, 19 control) completed the trial. There were no significant differences in practice characteristics between the 2 groups. Intervention practices were more likely to develop written office protocols (60% vs 21%); more staff in the intervention practices received additional basic life support/pediatric advanced life support/advanced life support training 3 to 6 months after the intervention (118 vs 54). There were no significant differences in the purchase of new equipment or medications. Ninety percent of the intervention practices rated the intervention as useful for their practice, and 95% believed that the program should be continued. The findings suggest that the intervention was well received and motivated practices to take concrete actions to prepare for pediatric emergencies.
Article
Programs educating advanced practice nurses (APNs), including acute care nurse practitioners (ACNPs) and clinical nurse specialists (CNSs) may struggle with the degree to which technical and cognitive skills necessary and unique to the care of critically ill patients should be incorporated within training programs, and the best ways these skills can be synthesized and retained for clinical practice. This article describes the critical care technical skills training mechanisms and use of a High-Fidelity Human Simulation (HFHS) Laboratory in the ACNP and CNS programs at the University of Pittsburgh School of Nursing. The mechanisms for teaching invasive procedures are reviewed including an abbreviated course syllabus and documentation tools. The use of HFHS is discussed as a measure to provide students with technical and cognitive preparation to manage critical incidents. The HFHS Laboratory, scenario development and implementation, and the debriefing process are discussed. Critical care technical skills training and the use of simulation in the curriculum have had a favorable response from students and preceptors at the University of Pittsburgh School of Nursing, and have enhanced faculty's ability to prepare APNs.
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Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.
Article
Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. Forty-one PGY-2 internal medicine residents in a university-affiliated program. Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.