ArticleLiterature Review

The Role of Debriefing in Simulation-Based Learning

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Abstract

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.

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... The debriefing session involves conceptualisation and processing of emotional responses, analysis, and generalising from the simulated scenario to other similar scenarios (Fanning and Gaba 2007). Various models have been developed for running the debriefing session (Dieckmann et al. 2009). ...
... To achieve the desired SBL outcomes is it crucial to plan debriefing sessions aiming at provoking reflective thinking regarding the participants' experience (Decker et al. 2013). Guiding the debriefing stage is a role that requires conceptualisation and processing of emotional responses, as well as the ability to analyse and generalise from the scenario to other situations (Fanning and Gaba 2007). Thus, the guidance provided by the simulation instructor is the crucial factor for obtaining optimal learning outcomes (Lehtinen and Viiri 2017). ...
... Consequently, they are more likely to accept others' criticism, which affords them an optimal learning experience. In fact, the debriefing involves conceptualisation and processing of the emotional reactions that surfaced during the simulation stage (Fanning and Gaba 2007). Considering this observation and the evidence provided by our findings, we recommend that SBL instructors open the debriefing stage by giving the main participant the opportunity to air out emotions and drawing attention to the level of emotional involvement of all the participants during the debriefing. ...
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.
... 10 Debriefing is "facilitated or guided reflection in the cycle of experiential learning. 11 It is the discussion and analysis of scenarios and events with the trainees after the conclusion of the simulation to reflect upon their performance and experience. It helps to identify A. Khan, A. Amerjee, J.M. Dias, et al. areas of improvement with guidance provided by skilled instructors. ...
... Literature supports the use of debriefing in simulation-based team training. 11 Many studies have utilised debriefing in team training and reported about its potential to improve behaviour change and foster effective collaborative health teams. 11,30 Simulation has the advantage of being innovative, and it provides an opportunity for measured practice with experiential and reflective learning. ...
... 11 Many studies have utilised debriefing in team training and reported about its potential to improve behaviour change and foster effective collaborative health teams. 11,30 Simulation has the advantage of being innovative, and it provides an opportunity for measured practice with experiential and reflective learning. However, it also bears certain disadvantages. ...
Article
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Objective: To determine if simulation-based team training improves the management of shoulder dystocia compared to traditionally taught obstetrical emergencies. Methods: The prospective mixed-method study was conducted at the Centre for Innovation in Medical Education at the Aga Khan University, Karachi, from June to August 2018, and comprised doctors and nurses having up to five years of labour and delivery experience. The subjects were divided into two equal groups which were further subdivided into four equal teams. Group 1 was taught to manage shoulder dystocia using traditional lectures and hands-on pelvic models, while group 2 was trained in a simulated environment with a simulated scenario of shoulder dystocia. After two weeks, the performance of both teams were assessed and compared. Data was analysed using SPSS 19. A focus group discussion was subsequently conducted on the quality of the simulation experience. Results: Of the 32 subjects, 16(50%) each were doctors and nurses. They were divided into groups having 16(50%) members each, and each group had 4 teams having 4(25%) subjects. The overall mean age of the sample was 31.9±2.8 years (range: 28-38 years). The mean score for performance on technical and communication task of group 2 was 10.25±1.258 compared to 5.7±2.500 in group 1 (p=0.028). Focus group participants agreed that training in a simulated environment was far superior than being traditionally taught. Conclusions: Simulation-based team training in shoulder dystocia management was associated with better feedback than traditional-style teaching.
... Dans cette approche, c'est l'analyse réflexive et rétrospective de sa propre activité qui permet le développement d'un « sujet capable », doté d'un pouvoir d'agir et de transférer son savoir dans différentes situations (Pastré, 2010). 7 Les mécanismes qui sous-tendent les débriefings sont peu théorisés dans la littérature anglophone (Fanning & Gaba, 2007 ;Pearson & Smith, 1985 ;Sawyer et al., 2016). Tout juste peut-on trouver l'idée d'un écart entre le fait de vivre une situation et celui d'en construire du sens (making sense of it), écart que les différents modèles de débriefing permettraient de combler en se fondant sur un supposé « ordre naturel du traitement humain » consistant à « faire l'expérience d'un événement, réfléchir sur celui-ci, le discuter avec d'autres, apprendre et modifier son comportement sur cette base » (Fanning & Gaba, 2007, p. 117, notre traduction). ...
... Par ailleurs, les chercheurs anglo-saxons mettent l'accent sur les aspects émotionnels des débriefings qui sont très peu pris en compte dans les travaux de didactique professionnelle. Dans leur ensemble, ces chercheurs préconisent que le débriefing donne lieu à une exploration des sentiments des participants (Fanning & Gaba, 2007 ;Pearson & Smith, 1985 ;Sawyer et al., 2016). Ils donnent plusieurs raisons à cela : tout d'abord, il est nécessaire que les participants soient engagés affectivement, et pas seulement cognitivement, dans le processus d'analyse ; ensuite, aussi bien les situations analysées que le processus de débriefing peuvent altérer leur confiance en eux-mêmes ; enfin le débriefing est un outil puissant sur ce versant émotionnel puisqu'il permet de traiter le stress post-traumatique généré par certains vécus. ...
... L'absence de conceptualisation inductive et l'omniprésence de la conceptualisation théorique sont révélatrices de cela : pour constituer de nouvelles chaînes narratives et conceptuelles, ce ne sont pas seulement des vécus et des récits qui sont expériencés, mais aussi d'autres chaînes conceptuelles précédemment constituées. Ceci peut avoir des implications pour la conduite des débriefings : si la plupart des « modèles de débriefing » proposés dans les publications anglo-saxonnes sont séquentiels, en partant de l'évocation d'une situation vécue pour aller vers une réflexion généralisante (Fanning & Gaba, 2007 ;Sawyer et al., 2016), il convient sans doute que le formateur, au fil des échanges avec les participants, soit souple et n'hésite pas à s'écarter de ce schéma linéaire (Pearson & Smith, 1985). Particulièrement, il semble intéressant que relativement tôt au cours d'un débriefing il s'efforce d'identifier et n'hésite pas à susciter l'expression de relations conceptuelles entre des entités et des propriétés par les participants. ...
Article
While reflexivity has become central to the fields of professional training and learning, it has not been a central focus in the research conducted during the course of action program. In studying the experience of debriefing in psychotherapy training, we focused on “reflexive practices” of returning in the present to a past moment of activity. To achieve this, we used the enactive concept of “distinction” and developed the related notions of remanent structures and narrative and conceptual chains. This allowed us to define different types of "remembering", the retrieval in the present of moments of past experience. The results show, during the debriefing, a circulation between the different forms of construction of remanent structures and of remembering, as well as a multi-temporality of the experience which does not reduce it to the temporal horizons of the debriefing and of the analysed situation. These results open up the debriefings to objectives and temporalities broader than those usually assigned to them. Furthermore, the enrichment of the theoretical and analytical framework of the course of action program allows us to address reflexivity, abstraction and conceptualisation, and thus to better identify what brings it closer to or differentiates it from professional didactics.
... Realistic simulation has been an important component of health professionals' training [18][19][20][21]. The caveats of dealing with health in emergent situations do not allow unanticipated mistakes, which would have life-threatening consequences. ...
... Simulation, training and debriefing are the triple foundation of the protocol [18][19][20][21][22][23][24]. The first step of the protocol was the realistic simulation. ...
... Suggestions and corrections we taken into account so that the protocol could be updated and improved over time. Of note, the protocol has a dynamic profile, so it can be reinvented and improved whenever the situation requires it [18][19][20][21][22][23][24]. ...
Article
Background: Endovascular therapeutic hypothermia (ETH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). New available advanced technology allows cooling much faster, but there is paucity of resources for training to avoid delays in door-to-balloon time (DTB) due to ETH and subsequently coronary reperfusion, which would derail the procedure. The aim of the study was to describe the process for the development of a simulation, training & educational protocol for the multidisciplinary team to perform optimized ETH as an adjunctive therapy for STEMI. Methods and results: We developed an optimized simulation protocol using modern mannequins in different realistic scenarios for the treatment of patients undergoing ETH adjunctive to PCI for STEMIs starting from the emergency room, through the CathLab, and to the intensive care unit (ICU) using the Proteus® Endovascular System (Zoll Circulation Inc™, San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB) time. We successfully trained 361 multidisciplinary professionals in realistic simulation using modern mannequins and sham situations in divisions of the hospital where real patients would be treated. The focus of simulation and training was logistical optimization and educational debriefing with strategies to reduce waste of time in patient's transportation from different departments, and avoiding excessive rewarming during transfer. Afterwards, the EHT protocol was successfully validated in a trial randomizing 50 patients for 18 minutes cooling before coronary recanalization at the target temperature of 32 ± 1.0 ∘C or PCI-only. A total of 35 patients underwent ETH (85.7% [30/35] in 90 ± 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; p = 0.509). Conclusions: Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEMI. Clinicaltrials: gov: NCT02664194.
... The authors conclude that more research is needed on the impact that this educational strategy has on simulationbased education. This is important as there are different theories and debriefing styles, and the teachers who use them must be appropriately trained because their inappropriate use can negatively affect the learning of the medical students, thereby lowering their self-esteem, generating stress, and causing the students to reject simulation-based learning and debriefing [5]. ...
... This strategy consists of a conversation between two or more people to review a real or simulated event in which the participants analyze their actions and reflect on their mental processes, psychomotor skills, and emotional states to improve or maintain their performance in the future [4]. However, debriefing is not systematically used, as demonstrated by some scientific research [5] that reviewed debriefing and simulation, making it clear that there are opportunity areas for its advantageous use. ...
... Some authors [8] mention that debriefing should be a fundamental part of clinical simulation. It was found that debriefing is not performed systematically in all activities that use simulators because not all teachers are aware or know the importance of this strategy in the use of educational technologies [5,8]. We think that the use of debriefing promotes the development of self-regulation in students. ...
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.
... Adults have a plethora of previous experiences, they value that the learning of values is relevant and applicable to concrete situations (20), prefer problem solving, and possess internal motivation. The educational theories applicable to simulation are the theories described by Vytgosky, Kolb, Dreyfus and Drefyus, Posner, Schon, Bandura and Ericcson, among others. ...
... Vytgosky describes the concept of "Zone of Proximate Development, " which establishes the progress that a student must have (21). David Kolb describes "Experiential Learning" (20). Dreyfus and Dreyfus describe the existence of skill acquisition levels, from novice to expert (16). ...
... Simulation is an "active" learning methodology, because it involves the participation and observable actions of the student. In the adult student, active participation increases the effectiveness of learning (20). In simulations, the student interacts with basic or complex simulators, or with standardized patients (which simulate pathologies and allow communication or anamnesis), or they can interact with other students or health professionals, allowing teamwork. ...
Article
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In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
... What are your initial reactions?; Ahmed et al., 2012;Eppich & Cheng, 2015;Fanning & Gaba, 2007). Part of the impetus for the inclusion of this phase is to address aspects of healthcare tasks that are emotionally demanding and thus necessitate emotional labor. ...
... The benefits to including an initial reaction phase have been articulated in the ostensive link to psychological safety-the extent to which individuals perceive that their environment offers them the freedom to take interpersonal risks in speaking up without fear of reprisal (Edmondson, 1999;Kahn, 1990;Schein & Bennis, 1965). Specifically, the placement of this phase ahead of the discussion of performance feedback is based on the premise that it provides the foundation for a frank, honest, and open environment that facilitates discussion of mistakes and failures in the prior performance episode (Fanning & Gaba, 2007;Keiser & Arthur, 2021;Pearson & Smith, 1985). ...
... The direction of the effects (AAR with a reaction phase d = 0.74 versus without d = 0.99) is in the expected direction of what was hypothesized and what one would expect based on feedback theory (Kluger & DeNisi, 1996), although the confidence interval comparing these effects overlaps with zero (95% CI [−0.47, 0.05]). Notwithstanding that, the results suggest that AARs are less effective when they include a reaction phase is notable because it is contrary to arguments from the extant literature for the benefits of this phase through the enhancement of psychological safety (Fanning & Gaba, 2007;Keiser & Arthur, 2021;Pearson & Smith, 1985). ...
Article
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This study expands on Keiser and Arthur's (2021) meta-analysis of the after-action review (AAR), or debrief, by examining six additional task and training characteristics that contribute to or attenuate its effectiveness. The findings based on a bare-bones meta-analysis of results from 83 studies (134 ds [955 teams; 4,684 individuals]) indicate that the effectiveness of the AAR (overall d = 0.92) does indeed vary across the pertinent characteristics. The primary impact of this study pertains to the practical implementation of AARs; notably, the findings indicate that the AAR is particularly effective in task environments that are characterized by a combination of high complexity and ambiguity in terms of offering no intrinsic feedback. The types of tasks-often project and decision-making-that more commonly entail these characteristics are frequently used in industries that do not traditionally use the AAR. The results also suggest that more recent variants of the AAR (i.e., a reaction phase, a canned performance review) do not meaningfully add to its effectiveness. These findings are combined with those from prior meta-analyses to derive 11 empirically-based practical guidelines for the use of AARs. In sum, this study highlights the complexity of the AAR that results from the independent and interdependent influence among various components and characteristics, the examination of the effects of novel and ostensibly distinct variants or approaches to AARs, and the extension of AARs to tasks and contexts in which they are less commonly used.
... This process is enhanced by receiving continuous feedback (Van der Kleij et al., 2015). When simulation is paired with feedback, supervision outcomes are often improved (Fanning and Gaba, 2007;McGaghie et al., 2009). Following the completion of a computer-based simulation, best practice suggests that a knowledgeable facilitator should provide students with an opportunity to answer self-reflective and applied questions related to their simulation. ...
... Following the completion of a computer-based simulation, best practice suggests that a knowledgeable facilitator should provide students with an opportunity to answer self-reflective and applied questions related to their simulation. This experience, known as a debrief, supports students in reflecting on how the simulation can apply to real patients and clinical scenarios (Gardner, 2013;Fanning and Gaba, 2007;Dufrene and Young, 2013;Dudding et al., 2019). This component allows students and instructors alike to reflect on the lessons learned during the simulation and establish learning objectives and outcomes obtained through the experience (Mattila et al., 2020). ...
... This result has clinical implications for using computerbased simulators, specifically Simucase, for clinical teaching purposes. The seminal reviews by Fanning and Gaba (2007) sought to critically explore the role of debriefing in simulation-based learning. Debriefing as a teaching tool, sets to make learners active participants in their learning while ensuring that simulation learning objectives are met. ...
Article
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Clinical simulations, in a variety of forms, is a viable educational tool, allowing CSD students to acquire professional competencies and skills. Simucase is a computer-based simulation program designed for this objective. The goal of this study was to determine what elements of simulation engagement predicted success on a student's overall ability to make the correct recommendation for patient care, and what those predictors can tell us about how students navigate computer-based simulations. The data set used for this study comprised 149 graduate students in communication sciences and disorders (CSD) programs who completed a computer-based assessment simulation for a patient with aphasia. To determine which areas of the simulation predicted student success, a logistic regression was performed to determine which of the 12 types of decision points offered predictive data for making the correct final recommendation. The 12 types of decisions used comprised case history, collaborator, assessment, and diagnosis sections with reflective, acceptable, and rejected options in each. Results indicate that student patterns of case engagement can predict overall case success. The overall model was significant and individual predictors were significantly responsible for predicting which students would choose the correct outcome at the end of the case. This study revealed that students who engage in more careful navigation of preliminary assessment steps such as case history and collaborators were more likely to reach the correct recommendation at the end of the case. This finding has implications for the implementation of computer-based simulations for clinical education.
... Much of the research on effective teaching in simulation has centered around debriefing, feedback, and prebriefing. [5][6][7][8][9][10] Research has shown the importance of creating learning environments conducive to constructive debriefing, involving the learners in the codebriefing dialog, [10][11][12] and using specific data to compare objectives and outcomes. 5,9,10,[12][13][14][15] Research has also shown the importance of prebriefing to create an effective learning environment and set up learning goals to be addressed in the debriefing. ...
... [5][6][7][8][9][10] Research has shown the importance of creating learning environments conducive to constructive debriefing, involving the learners in the codebriefing dialog, [10][11][12] and using specific data to compare objectives and outcomes. 5,9,10,[12][13][14][15] Research has also shown the importance of prebriefing to create an effective learning environment and set up learning goals to be addressed in the debriefing. 5,9 Few researchers have investigated student perceptions about the instructor attributes, skills, and knowledge they believe that are needed to create an effective learning experience. ...
... 5,9,10,[12][13][14][15] Research has also shown the importance of prebriefing to create an effective learning environment and set up learning goals to be addressed in the debriefing. 5,9 Few researchers have investigated student perceptions about the instructor attributes, skills, and knowledge they believe that are needed to create an effective learning experience. ...
Article
Summary statement: Twenty-three focus groups were held with 183 first-year medical students to assess student perceptions of effective simulation instructors during preclinical training in a medical school. Qualitative descriptive analysis guided the interpretation of focus group data. Students identified 6 areas of knowledge (schedule, student learning goals, session scenario, tasks and checklists, technique, and session purpose); 5 effective instructor skill categories (setting up the learning environment, teaching at the appropriate level, teaching technique, providing deeper context, and giving effective feedback); and 8 positive instructor attributes (enthusiasm, engaged, prepared, knowledgeable, patient, relational, transparent, and calm) instructors should have. Each category of instructor attributes, skills, and knowledge was also described in detail providing illustrative examples of what effective instruction would look like in practice from the students' perspective. Recommendations for instructor faculty development methods and topics/goals are given.
... The 3 most reported structured debriefing methods used were Promoting Excellence and Reflective Learning in Simulation (PEARLS), 10 advocacy/inquiry, 11 and Plus/Delta. 12 Most programs indicated limited faculty development training in simulation. Whereas 45% (55) reported faculty were trained on how to run a simulation scenario, only 40% (49) said faculty were trained in debriefing. ...
... 11 Plus/Delta is a debriefing technique where learner's actions are placed into columns labeled plus (+) and delta (D), indicating which actions should be continued or changed, respectively. 12 Structured debriefing methods exist beyond those described here and are largely selected by facilitator preference. 15 Novice simulation educators may use scripted and structured debriefing to improve learner's knowledge acquisition while standardizing the debriefing process. ...
Article
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Background: Teaching and learning using simulation-based methods is increasing in health professions education; however, the prevalence of simulation use in respiratory care programs to date has not been explored. Methods: All 412 Commission on Accreditation for Respiratory Care (CoARC)-accredited entry-into-practice respiratory care programs were e-mailed a survey inquiring about simulation use as an educational tool in their programs. Results: Of the initial 412 programs contacted, 124 returned the survey, for a 30% response rate. More than three-quarters of programs reported using simulation including 87% of associate degree programs, 75% of bachelor's degree programs, and 100% of master's degree programs. Simulation modalities differed by course and program as did length of simulation activities and debriefings. Simulation hours may not be substituted for learner's clinical time under CoARC guidelines, and 69% of respondents agreed with this stance; however, 66% of responding programs have mandatory simulation learning activities, and 68% believe the amount of simulation should be increased. The survey also revealed respiratory care faculty have limited training in the use of simulation. Conclusions: Simulation-based teaching and learning is widespread and varied, but there is a lack of faculty development in its use among respiratory care programs.
... During this internalisation, the student moves from a state of cognitive disequilibrium to a state of equilibrium. The movement from inter-psychological to intra-psychological and internalisation is enabled when the facilitator understands what is required for learning to occur (Fanning & Gaba, 2007); that in turn implies knowledge of educational theory, and ability to apply this when conducting debriefing. ...
... Communities provide a safe environment for individuals to engage in learning through observation and interaction with experts and through discussion with colleagues (Grimshaw et al., 2009). This necessitates the need for the facilitator to create a safe learning space, one in which the learners feel non-threatened and one that recognises and accounts for the inherent vulnerability during the learning activity and debriefing (Fanning & Gaba, 2007). This highlights the importance of a functioning supervision system within the clinical environment, in which students are supported. ...
Thesis
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The thesis reports on the role of medical simulation in developing undergraduate acute care clinical skills competencies in South Africa. The study aim was to explore the role, including the limits and possibilities, of medical simulation as a pedagogical method in an undergraduate acute care clinical skills curriculum within a South African tertiary education environment. The study consisted of three phases, during phase one, I conducted a modified Delphi study to identify the acute care clinical skills competencies undergraduate medical students need to acquire to prepare them, in the role as newly qualified clinicians, for managing acute care cases within a South African in-hospital environment. Phase two explored what acute care clinical competencies would lend themselves to a medical simulation modality within a South African tertiary education environment by conducting a qualitative focus group discussion with curriculum experts. Phase three explored the role, including the limits and possibilities, of medical simulation as an educational modality in developing acute care clinical skills curriculum within a South African tertiary education environment through conducting semi-structured interviews with simulation experts within South Africa The findings of the phase one Delphi study contributed to developing a comprehensive list of undergraduate acute care clinical skills competencies required for the South African environment. The findings of the phase two focus group discussion challenged how medical simulation was being implemented in South Africa by proposing a framework within which medical simulation pedagogy can be used to develop competencies under the following themes, namely, foundational competencies, contextually standardised competencies, assessments, and teamwork. The third phase of semi-structured interviews with South African simulation experts sought to explore the role limits and possibilities of simulation within South Africa as a resource-constrained environment. A major finding was the value of conceptualising medical simulation as a pedagogy rather than a technology. The social and cognitive constructivist theories, and key related concepts informing this study, supported this new way of framing medical simulation. A further key finding in this phase was the importance of staff development in simulation pedagogy and less emphasis on the acquisition of expensive equipment in resource constrained environments. The implications of adopting this view have the potential for an earlier introduction and smoother transition of medical students into the clinical environment, which may lead to them being better prepared for clinical practice with resultant reduced morbidity and improved patient safety.
... One of the key elements of this teaching method is the debriefing. Existing research [2,3] provides evidence that the debriefing is the most important component of the learning process of any experience based on simulation [4]. It has to be planned and directed by a facilitator (debriefer) who orients the discussion from reflection, focusing on the learning objectives and on the application of knowledge. ...
... There are many definitions of debriefing, they all agree that it is the sum of feedback plus reflection on an experience [6], carried out through means of analysis of the thought process, guided by action and decision making during the simulation (what was done, why it was done, what could have been done differently) in order to apply the results obtained to future situations [3,5,[7][8][9][10]. When the instructions encourage a high level of commitment from the participants, they have better retention and undergo deeper learning, raising the probabilities that new or reinforced knowledge, abilities and attitudes will be transferred to clinical practice, or better health performance in general [11]. ...
Article
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Clinical simulation as a teaching methodology allows the student to train and learn technical abilities and/or non-technical abilities. One of the key elements of this teaching methodology is the debriefing, which consists of a conversation between several people, in which the participants go over a real or simulated event in order to analyze their actions and reflect on the role that thought processes, psychomotor skills and emotional states can play in maintaining, or improving their performance in the future. The Debriefing Experience Scale allows the experience of students in debriefing to be measured. The objective of this study is to translate the Debriefing Experience Scale (DES) into Spanish and analyze its reliability and validity to measure the experience of nursing students during the debriefing. The study was developed in two phases: One: the adaption of the instrument to Spanish, two: a transversal study carried out in a sample of 290 nursing students. The psychometric properties were analyzed in terms of reliability and construct validity using confirmatory factorial analysis (CFA). Cronbach’s alpha was adequate for all the scales and for each one of the dimensions. The confirmatory factorial analysis showed that the 4-dimensional model is acceptable for both scales (experience and opinion). The Spanish version Debriefing Experience Scale questionnaire is useful, valid and reliable for use to measure the debriefing experience of university students in a simulation activity.
... Dernière phase, le débriefing est bien souvent considéré comme l'élément le plus important dans le processus d'apprentissage en simulation (Bastiani et al., 2017 ;Dieckmann et al., 2009 ;Fanning & Gaba, 2007 ;Gardner, 2013 (Oget & Audran, 2016, p.78) mais il constitue surtout le temps de l'analyse de l'activité. Le temps didactique où la réflexivité est invitée à s'extérioriser et à être mise en débat à partir de l'expression de l'expérience vécue, tout en se décentrant. ...
... Ainsi, il est tout d'abord important d'intégrer l'enseignement par simulation dans le curriculum de formation initiale dès la première année, ce qui permet de favoriser la cohérence dans l'ensemble du cursus d'apprentissage des étudiants (Issenberg et al., 2005). Les apprenants doivent pouvoir s'appuyer sur leurs connaissances antérieures cliniques et/ou en lien avec les sciences fondamentales (Fanning & Gaba, 2007 ;Vanpee & al., 2009 ;Zigmont et al., 2011). La situation proposée devrait correspondre au niveau de connaissance et à l'expérience des participants (Lee et al., 2017). ...
Thesis
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La formation par simulation interprofessionnelle s’est imposée ces dernières années avec pour perspective le développement des compétences relatives à la sécurité des patients. Néanmoins, l’incidence des événements indésirables liés aux soins concerne encore un patient hospitalisé sur dix. Cette thèse contribue à éclairer le rapport travail- formation, plus précisément le rapport entre la configuration didactico-pédagogique et le potentiel d’apprentissage organisationnel. Elle s’appuie sur une méthode mixte intégrée, combinant un ensemble d’analyses qui traite des composantes de l’acte éducatif, de la pluralité des situations professionnelles qui en constitue la référence, de l’évolution des compétences perçues qui en découlent. Le dispositif étudié est caractérisé par un mode transmissif davantage qu’interactif, par un faible partage de la réflexivité de la part des apprenants, et par des débats centrés très largement sur des éléments favorables à un apprentissage simple boucle plutôt que double boucle. Le suivi en quatre temps de l’évolution des compétences perçues montre un développement limité dans le temps de la plupart des domaines de compétences relatives à la sécurité des patients. Exploiter le potentiel d’apprentissage organisationnel en simulation interprofessionnelle et renforcer les compétences relatives à la sécurité des patients par leur ampleur et leur durée, impliquent une consolidation de l’articulation entre le travail et la formation, d’une part en soutenant le positionnement des apprenants à partir de leurs richesses d’expérience, d’autre part en abordant l’environnement de simulation comme un lieu de réflexivité sur l’activité, propice à la transformation des pratiques.
... Post-simulation debriefing is one of the most important components of simulation-based education and is critical to the learning experience [29]. Its objective is to encourage the learners' reflective thinking and provide feedback about performance. ...
... Its objective is to encourage the learners' reflective thinking and provide feedback about performance. Debriefing provides learners the possibility to reformulate the experienced scenario, explain thought processes, discuss and learn from mistakes, and identify unmet needs [29,30,[30][31][32]. The science of debriefing has rapidly evolved over the past decades. ...
Article
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Simulation has traditionally been used in neonatal medicine for educational purposes which include training of novice learners, maintaining competency of health care providers, and training of multidisciplinary teams to handle crisis situations such as neonatal resuscitation. Current guidelines recommend the use of simulation as an education tool in neonatal practice. The place of simulation-based education has gradually expanded, including in limited resource settings, and is starting to show its impact on improving patient outcomes on a global basis. Over the past years, simulation has become a cornerstone in clinical settings with the goal of establishing high quality, safe, reliable systems. The aim of this review is to describe neonatal simulation training as an effective tool to improve quality of care and patient outcomes, and to encourage the use of simulation-based training in the neonatal intensive care unit (NICU) for not only education, but equally for team building, risk management and quality improvement.Conclusion: Simulation is a promising tool to improve patient safety, team performance, and ultimately patient outcomes, but scarcity of data on clinically relevant outcomes makes it difficult to estimate its real impact. The integration of simulation into the clinical reality with a goal of establishing high quality, safe, reliable, and robust systems to improve patient safety and patient outcomes in neonatology must be a priority. What is Known: • Simulation-based education has traditionally focused on procedural and technical skills. • Simulation-based training is effective in teaching non-technical skills such as communication, leadership, and teamwork, and is recommended in neonatal resuscitation. What is New: • There is emerging evidence for the impact of simulation-based training on patient outcomes in neonatal care, but data on clinically relevant outcomes are scarce. • Simulation is a promising tool for establishing high quality, safe, reliable, and robust systems to improve patient safety and patient outcomes.
... The interaction is videotaped, then analyzed, and followed by debriefing. Debriefing provides the participants the opportunity to 'make sense' of the scenario and the experience by analysing it, discussing it, and by reflecting on it in order to improve their future performance as teachers (Fanning & Gaba, 2007;Kolenova & Halakova, 2019). ...
Article
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Empathic competences as they are expressed in interpersonal interaction
... Team composition, training location, didactics and content vary between the studies and complicate the comparability. For example, the debriefing of scenarios is recognized as the most important feature of simulationbased medical education [8] and is not always described methodically. ...
Article
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Purpose Emergency training using simulation is a method to increase patient safety in the delivery room. The effect of individual training concepts is critically discussed and requires evaluation. A possible influence factor of success can be the perceived reality of the participants. The objective of this study was to investigate whether the presence in a simulated emergency caesarean section improves subjective effect of the training and evaluation. Methods In this observation study, professionals took part in simulated emergency caesarean sections to improve workflow and non-technical skills. Presence was measured by means of a validated questionnaire, effects and evaluation by means of a newly created questionnaire directly after the training. Primary outcome was a correlation between presence and assumed effect of training and evaluation. Results 106 participants (70% of course participants) answered the questionnaires. Reliability of the presence scale was good (Cronbach’s alpha 0.72). The presence correlated significantly with all evaluated items of non-technical skills and evaluation of the course. The factor “mutual support” showed a high effect size (0.639), the overall evaluation of the course (0.395) and the willingness to participate again (0.350) a medium effect. There were no differences between the professional groups. Conclusion The presence correlates with the assumed training objectives and evaluation of the course. If training is not successful, it is one factor that needs to be improved.
... Participants' observations during the exercise simulation feed into the discussions and exchanges that take place during the debriefing phase between the participants and the facilitator. Indeed, debriefing is recognized as a crucial phase of learning in an experiential situation (Fanning & Gaba, 2007;Salas et al., 2009). ...
Article
Issu de : Loss Prevention 2022 - 17th EFCE International Symposium on Loss Prevention and Safety Promotion in Process Industries, Prague, République Tchèque, June 5-8 2022
... Doskonalenie przez doświadczenie jest skutecznym podejściem ułatwiającym edukację dorosłych [57]. Symulacje w połączeniu z ustrukturyzowanym podsumowaniem nie tylko zapewniają aktywne przyswajanie pożądanej wiedzy i umiejętności praktycznych, ale mogą zwiększać prawdopodobieństwo, że uczący się będą w stanie zastosować te kompetencje w konfrontacji z rzeczywistymi przypadkami w warunkach klinicznych [58]. ...
Article
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Zaawansowane funkcjonalności narzędzi symulacji medycznej mogą być wykorzystywane w doskonaleniu personelu medycznego. Dotyczy to skomplikowanych sytuacji klinicznych u pacjentów w stanie ciężkim lub z zagrożeniem życia. Trudne i rzadkie przypadki kliniczne mogą służyć do przygotowania scenariuszy symulacyjnych. Praktyczne ich przećwiczenie oraz omówienie w trakcie sesji debriefingowej pozwala na przygotowanie lekarzy do realizacji podobnych procedur w rzeczywistym środowisku pracy. Szczególnie cenna jest metoda nauczania problemowego oraz opartego na przypadkach klinicznych. Pozwala ona aktywnie uczestniczyć w procesie dydaktycznym, skupiając uwagę na zagadnieniu w ujęciu holistycznym. Znajomość zasad postępowania oraz praktyczna umiejętność działania, w tego typu zdarzeniach, niewątpliwie podnosi bezpieczeństwo leczonych pacjentów. Technika doskonalenia symulacyjnego oparta na przypadkach klinicznych może być również wykorzystywana do szkolenia personelu medycznego Sił Zbrojnych RP.
... Whether adoption of many of these practices improves survival outcomes for pediatric IHCA is less clear. Many have been advocated in the resuscitation literature, [15][16][17][18][19][20][21][22][23][24] and all are observational in nature, limiting inferences on causality. Moreover, most have been conducted in hospitals caring for adults with IHCA. ...
Article
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Background Resuscitation practices in pediatric hospitals have not been compared, and whether practices differ between freestanding pediatric only hospitals and combined hospitals (which care for adults and children) is unknown. Methods We surveyed hospitals that submit data on pediatric in-hospital cardiac arrest (IHCA) to Get-With-The Guidelines®-Resuscitation, to elicit information on resuscitation practices. Hospitals were categorized as pediatric only and combined hospitals, and rates of resuscitation practices were compared. Results Thirty-three hospitals with ≥5 IHCA events between 2017–2019 completed the survey, of which 9 (27.3%) were pediatric only and 24 (72.7%) were combined hospitals. Overall, 18 (54.5%) hospitals used a device to measure chest compression quality, 16 (48.5%) had a staff member monitor chest compression quality, 10 (30.3%) used lanyards or hats to designate code leaders during a resuscitation, 16 (48.5%) routinely conducted code debriefings immediately after a resuscitation, and 7 (21.2%) conducted mock codes at least quarterly with 17 (51.5%) reporting no set schedule. Pediatric only hospitals were more likely to employ a device to measure chest compressions (88.9% vs. 41.7%; P = 0.02), conduct code debriefings always or frequently after resuscitations (77.8% vs. 37.5%, P = 0.04), use lanyards or a hat to designate the code team leader during resuscitations (66.7% vs. 16.7%, P = 0.006), and allow nurses to defibrillate using an AED (77.8% vs. 29.2%, P = 0.01). There were no differences in simulation frequency or other resuscitation practices between the two hospital groups. Conclusions Across hospitals caring for children, substantial variation exists in resuscitation practices, with notable differences between pediatric only and combined hospitals.
... As mentioned earlier, especially in high-fidelity interactive training tools like this VR simulation, participants need assistance transferring the VR experience to their work practice. A proper, well-considered, and tested brief-and debrief protocol is widely accepted as essential in simulation-based learning to warrant consistent execution and stimulate reflective thinking and experiential learning (Fanning and Gaba 2007). Finally, there was the tendency to assess the participants' learning outcomes on the total number of stars they collected in the debriefing, although the number of stars does not indicate what they have learned and whether they can apply this knowledge and skills in practice. ...
Article
Virtual Reality (VR) simulation-based training can be a quick and effective way to train healthcare workers (HCWs) during the COVID-19 pandemic by creating lifelike scenarios whilst maintaining safety measures. This study examines the lessons learned from VR simulation training to prepare HCWs to work in COVID-19 departments and use personal protective equipment correctly. A total of 32 participants (N = 32) participated in this study. This study involved two VR scenarios with each two self-evaluation questionnaires and observations during the training. Structured interviews were conducted six weeks after the second scenario. Participants reported experiencing immersiveness after completing the VR training and reported perceiving the training as useful for their professional practice. The scenarios were not always perceived as relevant. The effects of transfer from simulation to professional practice are inconclusive. The potential of VR simulation-based training to train HCWs to work with COVID-19 is considerable but investing more time on the front end of design is recommended. Therefore, we present four lessons about design as guidelines for future work. This study shows the propensity to design solutions instantaneously during a pandemic tempts us to bypass the usual stages of an iterative design process, but that urgency to act should not be a licence to improvise.
... Jeffries [3] described the three phases of simulation as pre-briefing, scenario and debriefing. The final phase of debriefing is the act of reviewing critical actions that unfolded during the course of a simulation scenario [4]. During debriefing, faculty and students can reflect on the simulation experience from a variety of perspectives, exchange feedback and review performance errors [5,6]. ...
Article
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Background The Debriefing Experience Scale (DES) is a tool that is used to explore nursing students’ subjective experiences during a debriefing and to help determine best debriefing practices. A Chinese version of the scale has not been found; its development can enhance learning in simulation activites in Chinese healthcare education programs. Methods A simplified Chinese version of the DES was developed and tested using 34 Chinese undergraduate (second year) nursing students. They participated in six simulation scenarios and debriefings. Eight experts were consulted to determine the content validity of the scale. Critical ratio method, Cronbach’s alpha, intraclass correlation coefficient, correlation coefficient and factor analysis were used in testing the psychometric properties of the scale. Results Analysis of 200 scales showed that the simplified Chinese version of the DES had good potential in discriminatiing Chinese nursing students’ experiences of debriefing. Conclusions The simplified Chinese DES was effective in evaluating the experience of debriefing. A larger sample size and multicenter research is needed to confirm these findings.
... Premièrement, la simulation se réalise dans un environnement sécurisé, où les erreurs et mauvaises prises de décision ne portent pas à conséquence grave [14]. Deuxièmement, la simulation permet un apprentissage actif des intervenants par l'action et la réflexion sur l'action, c'est-à-dire permettant un apprentissage de savoir-faire ne se limitant pas aux savoirs [15,16]. En particulier, la réflexion sur l'action consiste à amener les formés à adopter un point de vue analytique et réflexif sur leur activité. ...
Conference Paper
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Du point de vue des opérateurs, le déclenchement d'une crise accentue le risque de perdre le contrôle de la situation. Pour garder ce contrôle malgré l'incertitude, une gestion efficiente des risques nécessite la mise en place de processus d'adaptation. Se pose dès lors la question suivante : comment les opérateurs répondent-ils aux exigences d'adaptation spécifiques en situation de crise, et ce, dans le but de garder la maitrise de la situation ? Pour apporter des éléments de réponse à cette question, nous nous appuyons sur l'étude de cas d'une crise simulée ayant impliqué la cellule de crise (CDC) d'une entreprise gérant des réseaux de distribution de gaz et d'électricité en Wallonie (Belgique). Sur base de l'observation directe du déroulement de la simulation (y compris le débriefing), nous avons analysé l'activité de gestion des risques mise en place par les membres de cette CDC. Les résultats montrent que cette activité repose surtout sur la construction continue et coûteuse d'un diagnostic exhaustif. Ceci témoigne de défaillances dans les processus d'adaptation qui devraient être mis en oeuvre dans la situation simulée. Sans viser l'exhaustivité, l'identification de ces défaillances nous amène aussi à proposer quelques pistes pour la conception des simulations visant la formation à la gestion des risques en situation de crise.
... The latter is debriefing conducted at the end of the whole scenario management. [25][26][27] The debriefer or facilitator is also like a movie director in that they are meant to guide the discussion to elicit the emotions of the experience, cover the learning objectives, and make it memorable or recallable. [28] There is also the possibility of conducting micro-debriefing, where there will be appropriate stops during the conduct of the scenario, for the faculty to debrief and share certain pointers, before the team proceeds to the next stage of the same scenario. ...
Article
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The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, “Writing Powerful Narratives,” depiction of emotional elements, specific industry-driven developments as well as the “cultural considerations” in both. For medical simulation and simulation-based education, the corresponding stages are as follows: Development Preproduction Production Postproduction and Distribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt from the film-making process in cinematography and storytelling. Both film-making and sim-making can be seen from the artistic perspective as starting with a large piece of blank, white sheet of paper, which will need to be colored by the “artists” and personnel involved; in the former, to come up with the film and for the latter, to engage learners and ensure learning takes place, which is then translated into action for patients in the actual clinical care areas. Both entities have to go through a series of systematic stages. For film-making, the stages are as follows: Identification of problems and needs analysis Setting objectives, based on educational strategies Implementation of the simulation activity Debriefing and evaluation, as well as Fine-tuning for future use and archiving of scenarios/cases.
... El objetivo de esta fase es reflexionar y extraer conclusiones entre todos los participantes que les permita ser conscientes no solo de los contenidos que aprenden (producto), sino también del desarrollo (proceso). En palabras de Fanning y Gaba (2007), esta fase es una reconstrucción cognitiva en grupo de los eventos vivenciados, por eso se dice que la finalidad de esta fase es dotar a la experiencia de significado a través de la puesta en común de las reflexiones personales y los aprendizajes adquiridos. 71 El rol del facilitador en esta fase es clave. ...
... Such efforts aim to ensure that team members from different professional groups "learn about, from and with each other," with the ultimate goal of improving interprofessional collaboration and patient care (WHO, 2010). Learning from simulation is thought to occur primarily during post-simulation debriefing, when participants have the opportunity to learn through reflection and feedback (Fanning & Gaba, 2007;Issenberg et al., 2005;Poore et al., 2019). In the interprofessional team context, communication and feedback between participants from different professions can stimulate learning from and about other professionals. ...
Article
Interprofessional simulation aims to improve teamwork and patient care by bringing participants from multiple professions together to practice simulated patient care scenarios. Yet, power dynamics may influence interprofessional learning during simulation, which typically occurs during the debriefing. This issue has received limited attention to date but may explain why communication breakdowns and conflicts among healthcare teams persist despite widespread adoption of interprofessional simulation. This study explores the role of power during interprofessional simulation debriefings. We collected data through observations of seven interprofessional simulation sessions and debriefings, four focus groups with simulation participants, and four interviews with simulation facilitators. We identified ways in which power dynamics influenced discussions during debriefing and sometimes limited participants’ willingness to share feedback and speak up. We also found that issues related to power that arose during interprofessional simulations often went unacknowledged during the debriefing, leaving healthcare professionals unprepared to navigate power discrepancies with other members of healthcare teams in practice. Given that the goal of interprofessional simulation is to allow professionals to learn together about each other, explicitly addressing power in debriefing after interprofessional simulation may enhance learning.
... The framework consisted of four phases: reaction, description, analysis, and summary. During the initial part of the analysis phase, we used plus-delta, 22 and strived subsequently to use advocacy-inquiry 23 where appropriate. The entire debriefing was conducted openly and allowed for emerging themes from participants. ...
Article
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Introduction Early defibrillation within minutes increases survival after in-hospital cardiac arrest (IHCA). However, early defibrillation is often not achieved even though automated external defibrillators (AEDs) are available. We aimed to investigate how AEDs were used and the barriers and facilitators for successful use. Methods We conducted unannounced, full-scale in-situ simulations of IHCAs in hospital wards with an AED. A debriefing followed the simulations. The simulations and debriefings were video recorded, and the debriefings were transcribed for subsequent qualitative analysis about the AED use. Results We conducted 36 unannounced in-situ simulations, and an AED was used in 98% of simulations. It was decided to collect an AED after a median of 62 (31; 123) seconds, the AED arrived after 99 (82; 146) seconds, were attached after 188 (150; 260) seconds, and the first shock were delivered after 221 (181; 301) seconds from time of cardiac arrest diagnosis. We identified three main domains related to barriers and facilitators of AED use: teamwork, knowledge, and transfer. Frequent reasons for successful use of an AED were recent resuscitation course, previous experience, and leadership. Reasons for unsuccessful use were doubt about responsibility, lack of knowledge, and lack of contextualized training. Conclusion During unannounced simulated IHCAs, time to defibrillation was often > 3 minutes. Most of the delay occurred after the AED was collected. Non-technical skills and contextualized training were among the main perceived barriers to AED usage. Facilitators for successful use included recent training, previous experience, and successful leadership.
... Accordingly, addressing perceived gaps in knowledge, dissemination, team roles, and inter-professional communication is essential [27,28]. In addition to simulation training mentioned previously, other solutions for improved communication include training programs on cultural humility, conflict resolution, reinforcing aligned objectives that attend to skills specific to each discipline, and post-intubation clinical or "hot" debriefs [26,27,[29][30][31]. The lessons learned from this rapidly implemented and high-acuity collaboration will remain pertinent as external personnel continue to play active roles in ED care [32]. ...
Article
Objectives In the early stages of the COVID-19 pandemic, there were significant concerns about the infectious risks of intubation to healthcare providers. In response, a dedicated emergency response intubation team (ERIT) consisting of anesthesiologists and allied health providers was instituted for our emergency department (ED). Given the high-risk nature of intubations and the new interprofessional team dynamics, we sought to assess health-care provider experiences and potential areas of improvement.Methods Surveys were distributed to healthcare providers at the University Health Network, a quaternary healthcare centre in Toronto, Canada, which includes two urban EDs seeing over 128,000 patients per year. Participants included ED physicians and nurses, anesthesiologists, anesthesia assistants, and operating room nurses. The survey included free-text questions. Responses underwent thematic analysis using grounded theory and were independently coded by two authors to generate descriptive themes. Discrepancies were resolved with a third author. Descriptive themes were distilled through an inductive, iterative process until fewer main themes emerged.ResultsA total of 178 surveys were collected (68.2% response rate). Of these, 123 (69%) participated in one or more ERIT activations. Positive aspects included increased numbers of staff to assist, increased intubation expertise, improved safety, and good team dynamics within the ERIT team. Challenges included a loss of scope (primarily ED physicians and nurses) and unfamiliar workflows, perceived delays to ERIT team arrival or patient intubation, role confusion, handover concerns, and communication challenges between ED and ERIT teams. Perceived opportunities for improvement included interprofessional training, developing clear guidelines on activation, inter-team role clarification, and guidelines on handover processes post-intubation.Conclusions Healthcare providers perceived that a novel interprofessional collaboration for intubations of COVID-19 patients presented both benefits and challenges. Opportunities for improvement centred around interprofessional training, shared decision making between teams, and structured handoff processes.
... Résultats des analyses qualitatives concernant la plus-value du débriefing instrumenté par audio vidéo Il est intéressant de croiser les résultats obtenus par le traitement quantitatif des données avec les corpus des apprenants et d'observer s'ils en parlent, d'où ils en parlent, et comment. L'intérêt de travailler ce sujet est réel, car l'état de l'art actuel sur la simulation en santé propose une vision contrastée du bénéfice de l'utilisation du film lors des débriefings (Maubant et al. 2005 ;Fanning & Gaba, 2007 ;Sawyer et al.2012 ;Hill & Hamilton, 2013 ;Levett-Jones & Lapkin, 2014 ;Cheng et al., 2014 ;Garden et al., 2015). ...
Article
We evaluated the effectiveness of a training program with high-fidelity simulation (HFS) to improve technical (TS) and non-technical skills (NTS) of residents in Emergency Medicine. We conducted a 2-year training program for the management of a critical patient based on HFS (6 sessions for every year, four teams who performed 4 scenarios per session). At the beginning of the training program, all participants received a presentation of Crisis Resource Management (CRM) principles. Each session covered a different topic in Emergency Medicine Curriculum. TSs were measured as the proportion of completed tasks in the following areas: airway, breathing, circulation, disability and exposure (ABCDE) assessment and management, completion of anamnesis based on AMPLE (allergy, medications, previous illness, last meal and event) scheme, diagnostic and therapeutic assessment. NTSs were rated by the Clinical Teamwork Scale (CTS). Scores’ values and the percentage of correctly performed actions were presented as median with interquartile range. Friedmann non-parametric test was employed to evaluate the trend of TS and NTS over the following sessions. Among the TS, the assessment and management of ABCDE and completion of therapeutic tasks improved (all p < 0.05). The completion of diagnostic tasks (p = 0.050) tended toward significant improvement. The overall CTS score (first session 61 ± 17, last session 84 ± 16, p < 0.001) as well as Communication (first 13.7 ± 3.6, last 18.7 ± 3.5, p < 0.001), Situational Awareness (first 5.3 ± 1.8, last 6.4 ± 1.4, p = 0.012) and Role Responsibility subscores (first 9.7 ± 2.8, last 12.1 ± 3.7, p < 0.001) increased through the following sessions. Therefore, HFS has proven to be an effective instrument to improve TS and NTS among Emergency Medicine residents.
Article
Why do learning games fail or succeed? Recent evidence suggests that attention forms an important moderator of learning from games. While existing media effects and learning theories acknowledge the role of attentional limits, they fail to account for the specific ways that games as interactive media steer attention. In response, we here develop the Task-Attention Theory of Game Learning. Drawing on current psychological and games research, task-attention theory argues that games as interactive media demand and structure the pursuit of tasks, which ties into distinct attentional mechanisms, namely learned attentional sets which focus attentional selection onto task-relevant features, as well as active sampling: users navigate and manipulate the game to elicit task-relevant information. This active sampling and selection precedes and moderates what information can be learned. We identify task-related game features (mechanics, goals, rewards and uncertainty) and demands (cognitive and perceptual load, pressure) that affect active sampling and attentional selection. We articulate implications and future work for game-based learning research and design, as well as wider media effects, learning, and HCI research.
Article
Feedback from undergraduate medical students recognizes high-fidelity immersive simulation-based education (SBE) as an opportunity to put clinical reasoning and behavioural skills into practice whilst guaranteeing patient safety. The tool used in SBE to bridge event experiences with meaningful reflection is the debrief. Debriefing is a facilitated reflection to guide learners through a process of detecting performance issues and exploring rationales for behaviours The aim of the study was to create pre-recorded high-fidelity simulation scenarios with the involvement of course participants, final-year medical students. Use the recorded scenarios to observe simulation, create meaningful discussion and explore both clinical and human factors. Three partially scripted scenarios were recorded involving medical, surgical and COVID-19-specific cases. This included intentionally scripted learning points, as well as unintended developments which generated additional learning. These videos were designed to be shown in a virtual setting or limited number group, therefore allowing for continued simulation training during the height of the pandemic. The virtual simulation session involved a moment-by-moment analysis of each scenario facilitated by a faculty member. This allowed for an observer-led debrief and more in-depth reflection. Most participants gave positive feedback on the perceived quality of this training modality, recognizing its potential to create an engaging environment for learning. There was recognition of its limitations; it cannot replace immersive simulation, however involving service users in the design and implementation enhanced the learning opportunities. The videos created a springboard for discussion encouraging the formation of emergent objectives, including reflecting on behaviours and attitudes. Faculty noted that students were more confident to identify and critique errors as well as challenge poor behaviours when they were not observing a peer. The participants represent a unique cohort of students whose training has been disproportionately affected by the pandemic. We hope that this course has gone some way to address this shortfall.
Article
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Debriefing is an foundamental instructional approach of simulation-based medical education in the field of healthcare simulation. In order to improve the understanding of debriefing as an instructional approach and ensure the quality of simulation-based medical education, this paper reviews the relevant critical literatures of debriefing in simulation-based medical education, and outlined the essential elements and current development status of debriefing, debriefing models, different methods used in analyze phase of debriefing, as well as the research progress of debriefing in China and abroad. Despite various debriefing models, “debriefing with good judgment” would be more likely to assure better learner improvement. In the process of debriefing, directive feedback, students' self-assessment, and focused facilitation can be reasonably used. However, there are still room for future research on how these practices could be translated and better applied in China.
Article
Objectives The purpose of this scoping review was to explore the state of the current body of knowledge on the use of nursing simulation for maternal nursing practicum with a focus on content and measured outcomes. Design This is a scoping review. Data sources The literature search was performed using five databases (CINAHL, Cochrane, EMBASE, PubMed, and Web of Science). Review method The review was conducted on quantitative and reflection/review studies that evaluated or described nursing simulation for delivery care, published between 2000 and 2020 in English and Korean. Two authors independently reviewed the studies and their references for additional literature search. Selected studies were charted to describe the study characteristics, and content and outcome of nursing simulation for delivery care. Results Fifteen articles were included in the review, of which twelve were intervention studies and three were reflection/review studies. The duration of the nursing simulations for delivery care ranged from 20 min to 4 h, with two to eight students in each simulation group. All nursing simulations focused on the normal, uncomplicated delivery process, with nine studies engaging in debriefing, but without pre- and/or post-assessments. The most frequently measured outcomes were knowledge, satisfaction, and clinical practice competency. Conclusions Studies investigating nursing simulation pedagogy for delivery care were scarce, with limitations in the study designs and large variations in nursing simulation time across studies. Scenarios for nursing simulation for delivery care were rudimentary, and they usually focused on normal uncomplicated deliveries. The development of scenarios for high-risk deliveries and integration of pre-and/or post-assessments and debriefing into the nursing simulation are recommended to improve learning outcomes.
Article
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The efficacy of Authors' developed computer-based simulation instructional package for teaching physics concepts was examined using Pretest-Posttest Experimental group design. Sixty students (30 males and 30 females) SSII students from two secondary schools in Minna, Nigeria, made-up the sample. The schools were randomly assigned to experimental and control groups. The experimental group was taught selected concept of physics using computer-based simulation package (CBSP) and traditional method was used for the control group. Physics Achievement Test (PAT) was used for collecting data for this study. PAT is a 10-item multiple-choice objective type achievement test covering two selected topics in physics. It was administered to the student as pretest and posttest. The data collected were analyzed with the t-test statistics. Results revealed that the students taught with CBSP performed better than the control group. The CBSP was found also to be gender friendly.Based on the findings, it was recommended that physics teachers should used computer-based simulation for improving the students performance in physics education.
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У сучасному світі, в епоху активного розвитку високотехнологічної медицини, суспільство пред’являє підвищені вимоги до якості надання медичних послуг. Одним із методів підвищення якості практичної підготовки студентів різних спеціальностей (майбутніх лікарів, фельдшерів, медичних сестер) є використання симуляційних технологій. Симуляційне навчання дає змогу вирішити проблему якісного оволодіння практичними навичками та командної роботи при наданні невідкладної долікарської та лікарської допомоги. Особливо важливим симуляційне навчання, як один з основних напрямів набуття практичних навичок, умінь та знань, є в період пандемії COVID-19. Ця сучасна технологія ґрунтується на реалістичному моделюванні та імітації клінічної ситуації з використанням різноманітного навчального обладнання та медичного інструментарію.
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Resumen Introducción: debido al aumento del empleo de la telesimulación en la formación de los profesionales de la salud, contar con instrumentos para valorar su efectividad es una necesidad imperante. Objetivo: describir las evidencias de validez del instrumento Simulation Effectiveness Tool - Modified (SET-M) para su uso en actividades de telesimulación dirigidas a estudiantes de tercer año de la Licenciatura de Médico Cirujano de la Universidad Nacional Autónoma de México. Métodos: mediante un estudio prospectivo, se realizó la traducción y traducción inversa del instrumento, se realizó una validación de contenido, análisis factorial exploratorio y confirmatorio, así como análisis de confiabilidad. Resultados: se encontraron 3 factores similares a la versión en inglés, brasileña y turca, alfa de Cronbach general 0,930. La media de adecuación muestral de Kaiser-Meyer-Olkin fue de 0,953 y la prueba de esfericidad de Bartlett arrojó valores significativos al 0,001. Conclusión: la versión en español de SET-M cuenta con suficientes evidencias de validez para ser utilizada en la evaluación de la efectividad de la telesimulación desde la percepción de los participantes en nuestro contexto.
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The 5 A’s of Firearm Safety Counseling is a novel framework by which clinicians can approach firearm injury prevention counseling. To evaluate this methodology as a tool for clinicians, a single-center, simulation-based randomized controlled trial was performed with clinical trainees in psychiatry, medicine, and pediatrics in an urban quaternary care center. Participants received didactic education on firearm injury epidemiology and evidence-based policies and training on a specific counseling framework, the 5 A’s of Firearm Safety Counseling which they then implemented in a simulation setting with standardized patients. Of the 29 participants who were randomized, 28 completed the trial. Most participants were psychiatry trainees (residents or subspecialty fellows). While over 60% of participants were uncomfortable or extremely uncomfortable counseling on firearm injury prior to the interventions, only 4% reported being uncomfortable after receiving education and participating in simulated encounters. There was no significant difference between the quality and content of the counseling provided before and after the didactic-only session. There was a significant difference between the quality and content of the counseling provided before and after the specific training on the 5 A’s for Firearm Safety Counseling strategy. The 5 A’s for Firearm Safety Counseling is a promising educational tool to improve quality, content, and comfort delivering patient-centered counseling on firearm injury prevention in a simulation-based setting. These findings suggest that further validation in a clinical setting is warranted given there is an urgent need for feasible and effective firearm injury prevention strategies among clinicians.
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Introduction The radiography workforce is short-staffed and under increasing pressure to meet service pressures. Combined with the impact of Covid-19, where student face-to-face clinical time was abruptly halted for safety, there is cause to change the pedagogical approach to teaching diagnostic radiography to students, increasing capacity and ensuring the continuance of qualifying radiographers to support the profession. This paper shares the perceptions of first year student radiographers on a one-week simulation-based education package designed to replace one week of clinical placement experience. Methods Two cohorts of first-year radiography students engaged in a one-week simulation-based education package. Simulations increased in complexity throughout the week and included conventional imaging techniques, mobile and theatre radiography, and cross-sectional imaging. Thirty-six students consented to the thematic analysis of their reflective blogs. Results Five themes emerged from the data: feeling anxious, understanding and skill development, building confidence, communication, and patient-centred care. Conclusion The simulation package had a positive impact on students learning, no matter the stage at which it was incorporated into their clinical placement block. Students engaged well with the activities and saw value in the experience. The findings indicate that the simulation-based education package is a suitable replacement for one week of clinical placement, supporting skills development in students and providing increased placement capacity. Implications for practice A successful, engaging simulation-based education package is presented, which first year student radiographers perceived as a suitable replacement for one-week of clinical placement. Further research into the acceptability of use of simulation-based education packages in second- and third-year student radiographers would be a useful next step.
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Purpose Psychological safety is key to effective debriefing and learning. The COVID-19 pandemic necessitated rapid adaption of simulation events to virtual/hybrid platforms. We sought to determine the effect of utilizing the Community of Inquiry framework (CoI) for debriefing virtually connecting interprofessional learner teams on the psychological safety experienced during trauma simulations. Methods General surgery (GSR), emergency medicine (EMR) residents, trauma nurses/nurse practitioners and medical students participated in multiple simulation events designed to improve teamwork and leadership skills. Pre-course materials were provided before the event for learners to prepare. Briefings delineating expectations emphasized importance of and strategies employed to achieve psychological safety. Four unique clinical scenarios were run for each simulation event, with a debrief after each scenario. Virtual team-to-team debriefings were structured using the Community of Inquiry (CoI) conceptual framework. All learners completed pre-/post-assessments utilizing Inter-professional Collaborative Competencies Attainment Survey (ICCAS). Results Twenty-five learners participated (13 GSR, 5 EMR, 3 medical students, 2 trauma APRNs and 2 trauma RNs). Learner assessment found 88% (22) “agreed”/”strongly agreed” that virtual team-to-team debriefing had social, cognitive and educator presence per the CoI domains. However, one GSR and two nurse learners “strongly disagreed” with these statements. Most learners felt the debriefing was effective and safe. All participants “strongly agreed”/“agreed” the simulation achieved ICCAS competencies. Conclusions Debriefings utilizing a virtual platform are challenging with multiple barriers to ensuring psychological safety and efficacy. By structuring debriefings using the CoI framework we demonstrate they can be effective for most learners. However, educators should recognize the implications of social identity theory, particularly the effects of hierarchy, on comfort level of learners. Developing strategies to optimize virtual simulation learning environments is essential as this valuable pedagogy persists during and beyond the COVID-19 pandemic.
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Background and purpose Interprofessional education between bachelor of science pharmaceutical science (BSPS) students and Doctor of Pharmacy (PharmD) students is rare. According to the Association of American Medical Colleges, more than 80% of medical schools incorporate simulation based teaching within all four years of the curriculum. Educational activity and setting The University of Rhode Island College of Pharmacy healthcare simulation lab has developed integrated educational opportunities for both groups of students by offering independent study opportunities that allow BSPS students to collaborate with PharmD students. A recent example of this model includes BSPS student development of patient cases which are integrated into high-fidelity human patient simulators with faculty assistance. A senior BSPS student researched and designed four clinical patient cases which were presented to P3 pharmacy students. Findings In all four cases, there was an increase in knowledge and attitudes following the simulation. Qualitative comments from students noted the importance of patient education and an enhanced ability to manage disease and side effects. Summary The nature of the simulation lab at the University of Rhode Island is a platform that can be modeled by other institutions with both PharmD and BSPS programs.
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Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3). The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Diagnostic reasoning is a key competence of physicians. We explored the effects of knowledge, practice and additional clinical information on strategy, redundancy and accuracy of diagnosing a peripheral neurological defect in the hand based on sensory examination. Using an interactive computer simulation that includes 21 unique cases with seven sensory loss patterns and either concordant, neutral or discordant textual information, 21 3rd year medical students, 21 6th year and 21 senior neurology residents each examined 15 cases over the course of one session. An additional 23 psychology students examined 24 cases over two sessions, 12 cases per session. Subjects also took a seven-item MCQ exam of seven classical patterns presented visually. Knowledge of sensory patterns and diagnostic accuracy are highly correlated within groups (R2 = 0.64). The total amount of information gathered for incorrect diagnoses is no lower than that for correct diagnoses. Residents require significantly fewer tests than either psychology or 6th year students, who in turn require fewer than the 3rd year students (p < 0.001). The diagnostic accuracy of subjects is affected both by level of training (p < 0.001) and concordance of clinical information (p < 0.001). For discordant cases, refutation testing occurs significantly in 6th year students (p < 0.001) and residents (p < 0.01), but not in psychology or 3rd year students. Conversely, there is a stable 55% excess of confirmatory testing, independent of training or concordance. Knowledge and practice are both important for diagnostic success. For complex diagnostic situations reasoning components employing redundancy seem more essential than those using strategy.
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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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Barriers to simulation-based education in postgraduate and continuing education for anesthesiologists have not been well studied. We hypothesized that the level of training may influence attitudes towards simulation-based education and impact on the use of simulation. This study investigated this issue at the University of Toronto which possesses two sites equipped with high-fidelity patient simulators. A 40-question survey of experiences, perceptions, motivations and perceived barriers to simulation-based education, was distributed to 154 anesthesiologists attending a departmental conference. Data were analyzed using descriptive statistics and associations between responses were assessed using either the Chi-Square statistic or a one-way analysis of variance. The rate of response was 58%. Residents had experienced simulation-based education (96%) more often than staff (58%) and fellows (36%), (P < 0.001 respectively). Residents had also attended more simulation sessions than staff and fellows (mean 2.8 vs 1.05 and 1.04, P < 0.001 respectively). Residents and fellows found simulation-based education more relevant for their training than staff (88% vs 65%, P < 0.05). Eighty-one percent of the respondents identified at least one significant barrier that prevents or limits them from attending simulator sessions. Staff anesthesiologists perceived multiple barriers and identified 'time' and 'financial issues' as significant barriers. Anesthesiologists' level of training influences their attitudes towards and their perceptions of simulation-based education. This survey has identified perceived barriers that may limit a wider utilization of simulation. These results may be used to implement targeted actions such as course design, incentives, and information strategies, which could improve access and future use of simulation.
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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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Core physician activities of lifelong learning, continuing medical education credit, relicensure, specialty recertification, and clinical competence are linked to the abilities of physicians to assess their own learning needs and choose educational activities that meet these needs. To determine how accurately physicians self-assess compared with external observations of their competence. The electronic databases MEDLINE (1966-July 2006), EMBASE (1980-July 2006), CINAHL (1982-July 2006), PsycINFO (1967-July 2006), the Research and Development Resource Base in CME (1978-July 2006), and proprietary search engines were searched using terms related to self-directed learning, self-assessment, and self-reflection. Studies were included if they compared physicians' self-rated assessments with external observations, used quantifiable and replicable measures, included a study population of at least 50% practicing physicians, residents, or similar health professionals, and were conducted in the United Kingdom, Canada, United States, Australia, or New Zealand. Studies were excluded if they were comparisons of self-reports, studies of medical students, assessed physician beliefs about patient status, described the development of self-assessment measures, or were self-assessment programs of specialty societies. Studies conducted in the context of an educational or quality improvement intervention were included only if comparative data were obtained before the intervention. Study population, content area and self-assessment domain of the study, methods used to measure the self-assessment of study participants and those used to measure their competence or performance, existence and use of statistical tests, study outcomes, and explanatory comparative data were extracted. The search yielded 725 articles, of which 17 met all inclusion criteria. The studies included a wide range of domains, comparisons, measures, and methodological rigor. Of the 20 comparisons between self- and external assessment, 13 demonstrated little, no, or an inverse relationship and 7 demonstrated positive associations. A number of studies found the worst accuracy in self-assessment among physicians who were the least skilled and those who were the most confident. These results are consistent with those found in other professions. While suboptimal in quality, the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess. The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment.
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The small group tutorial is a cornerstone of problem-based learning. By implication, the role of the facilitator is of pivotal importance. The present investigation canvassed perceptions of facilitators with differing levels of experience regarding their roles and duties in the tutorial. In January 2002, one year after problem-based learning implementation at the Nelson R. Mandela School of Medicine, facilitators with the following experience were canvassed: trained and about to facilitate, facilitated once only and facilitated more than one six-week theme. Student comments regarding facilitator skills were obtained from a 2001 course survey. While facilitators generally agreed that the three-day training workshop provided sufficient insight into the facilitation process, they become more comfortable with increasing experience. Many facilitators experienced difficulty not providing content expertise. Again, this improved with increasing experience. Most facilitators saw students as colleagues. They agreed that they should be role models, but were less enthusiastic about being mentors. Students were critical of facilitators who were not up to date with curriculum implementation or who appeared disinterested. While facilitator responses suggest that there was considerable intrinsic motivation, this might in fact not be the case. Even if they had facilitated on all six themes, facilitators could still be considered as novices. Faculty support is therefore critical for the first few years of problem-based learning, particularly for those who had facilitated once only. Since student and facilitator expectations in the small group tutorial may differ, roles and duties of facilitators must be explicit for both parties from the outset.
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After 25 years of working with simulations, one of the author’s amazing discoveries has been that students learn much more after completig written debriefing than just oral debriefing. However, in the field of simulations, written debriefing is rarely used or even discussed. The theoretical foundation of simulation and gaming is experiential learning. The proposal in this article is to capture the excitement and energy of the simulation and oral debriefing and use it as a springboard for more learning in written debriefing. Allowing participants time to reflect on all the activity and their emotions helps them put everything in perspective. The major hurdle is the time needed to write and to evaluate the writing. However, the benefits far outweigh the costs. With written debriefing, participants can reflect about their behavior, facilitators can assess individual learning, and students can privately communicate with their professor. Written debriefing should become a major instrument in the field to promote better learning.
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Preparing to facilitate the debriefing part of a simulation game requires as much care and attention as preparing to lead the introductory and play parts. This article provides a sort of mini-manual; explaining the nature of facilitating and then guiding the reader through the three phases of description, analysis/analogy, and application. It suggests questions a facilitator might use during each of these phases.
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A d-game is a special type of framegame that structures debriefing after the completion of any experiential activity. This article presents a seven-phase model for debriefing, with each phase identified by a key type of question. It describes and discusses eight d-games that are related to various phases in the debriefing procedure. Applications of the d-games are illustrated with reference to a common base activity.
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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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Experiential learning was a major part of the author's life from the earliest days with models, pictures, and travel As a college professor, he discovered simulations and games; they changed his teaching style forever Initially the author tried one or two simulations per semester and advanced to an entire social psychology course taught only with simulations. A simulation was the starting point to great knowledge rather than an end in itself Because of the author's multifaceted approach to simulations, a renaissance approach to simulation and gaming was developed through the phases of awareness, emersion, journal writing, politics, and creativity. Seventeen principles evolved in the maturation process. One principle was, After reading all the instructions for a simulation, the playing of the simulation will not be totally understood, and it will take a leap of faith to start Another was, Designing a simulation is not simple, but the simpler ones often work better. Other principles revolved around the author's innovations and refinements, which included written journal debriefing, a social psychology course with only simulations, the six Es of debriefing, no deception in a simulation, and the written concept technique in debriefing.
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Explores the postexperience analytic discussion process (i.e., debriefing), proposes a conceptual framework of the process, and examines the roles taken by students and teachers in instructional simulations. Implications of reconceptualizing the debriefing analysis as a cognitive assimilation of experience are discussed in terms of communication in experience-based learning classrooms, student–teacher relationships, and teaching strategies and competencies. (7 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Conference Paper
Introduction The use of simulators to train crisis resource management is increasing constantly [1,2]. The detailed, video-based discussion of a simulator scenario with all participants directly after the session, with the aim to enhance self-reflection, is called, ‘debriefing’.Methods A small survey was undertaken at 14 European simulator centres and at an interdisciplinary simulator workshop during the SESAM 2000 meeting in order to define the key elements of debriefing. As the numbers are very small only descriptive results are mentioned.Results Respondents claim that debriefing is the most important part of realistic simulator training. Debriefing is crucial for a successful learning process, but if performed badly it can be the source of severe harm to the trainee. Debriefing can ‘make or break’ a simulator session and can be attributed as the ‘heart and soul of simulator training’. Therefore, training of instructors in the art of debriefing should be emphasized. The debriefing instructor requires both clinical and teaching experience. As the setting of simulator training is very intense, coaching of the instructor by a psychologist is recommended.Good debriefing requires a thorough briefing beforehand. Briefing should include (a) explaining to the participants that the session concerns learning, not performance assessment, (b) that confidentiality is maintained, and (c) that making errors is important for the training benefit. A nonthreatening atmosphere should be established and the crisis management terminology should be explained. The simulator should be explained in detail. Limitations of the simulation and how to deal with them should be stated. Admitting that the simulator is not completely realistic helps trainees suspend disbelief.Elements of successful debriefing include: creating a good and friendly atmosphere, open-ended questions, facilitating of self-debriefing, positive reinforcement, open discussions on management aspects, pointing out underlying principles that lead to misconceptions/errors, using cognitive aids, showing alternatives, stressing that everybody makes errors, concentrating on few key learning points, and pointing out the good parts with the assistance of the audio-visual equipment.Elements that should be avoided during debriefing are: closed questions, criticism using destructive language, concentrating on errors, blaming and ridiculing participants, focusing too much discussion on medical points rather than on crisis management aspects, too much instructor talking, too many teaching points, too long a debriefing period.Conclusion Debriefing is the most important part of simulator training. Serious harm to trainees may result from poorly debriefed sessions. Training and coaching of instructors should be emphasized. Continuous studying and training of debriefing techniques in an interdisciplinary team involving psychologists should be the future.
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Empirical evidence suggests that people perform poorly in dynamic tasks. The thesis of this article is that dynamic decision performance can be improved by helping people to develop more accurate mental models of the task stems through training with debriefing supported computer simulation-based interactive learning environments (CSBILEs). I report a laboratory experiment in which subjects managed a dynamic task by playing the role of fishing fleet managers. One group of participants used a CSBILE with debriefing, whereas another group used the same CSBILE but without debriefing. A comprehensive model consisting of four evaluation criteria is developed and used: task performance, structural knowledge, heuristics, and cognitive effort. It is found that debriefing was effective on all four criteria; debriefing improves task performance, helps the user learn more about the decision domain, develop heuristics, and expend less cognitive effort in dynamic decision making.
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Results obtained from the NASA/UT/LOFT survey of 8300 crew members from four airlines is presented. As simulator training is very expensive and excellence in training is the objective, some effort is justified in evaluating LOFT and in determining what it is about the best scenarios that creates positive effects. Attention is given to the effects of different scenarios, self reports of crew resource management behaviors, organization, fleet and crew position differences.
Simulation-based healthcare education has expanded tremendously over the past few years, as witnessed by the creation and growth of the Society for Simulation in Healthcare and its journal. These developments represent a turning point at which simulation is no longer seen as a novelty whose existence needs to be justified or defended by a few staunch believers. We can now move beyond reporting on the potential role of simulation or how it compares to other more traditional (yet often unproven) methods of training, and focus instead on the most effective use of simulation for healthcare education. From the perspective of the training program, the effective use of simulation may be seen as the product of three components (Fig. 1): training resources, trained educators, and curricular institutionalization. It is important to note that if any of these components are missing or deficient, the product will become zero and effective training will not occur. For example, it is not rare for an institution to obtain a simulator only to see it collect dust because faculty members were not properly trained in its operation or did not know how to introduce it into the curriculum. These components include the following. Training Resources This component refers to having appropriate simulators, task trainers, standardized patients, and computer software that meet a program’s needs. In addition, it includes having the necessary physical space and associated equipment (eg, monitors, beds, cameras, microphones, recording and playback equipment) for simulation-based training. It also encompasses the associated curriculum (eg, crisis resource management, 1 advanced life support, laparoscopic surgery), outcome measures (eg, checklists, rating forms), learning strategies (eg, experiential learning, deliberate practice 2 ), and curriculum management systems (to schedule and track learners’ time and performance). Trained Educators This component includes healthcare professionals trained in the proper use of simulation-based medical education. It also includes individuals involved in the operation, management, and administration of simulation-based training, as well as researchers dedicated to advancing the field. Curricular Institutionalization This component includes elements necessary for full adoption and integration of simulation-based medical education into an institution’s mission and culture. It involves the decision of an institution to fully embrace its goal of improving patient care and patient safety through reducing and preventing medical errors, as well as more individual goals of improving a wide range of competencies (eg, acute care skills, surgical skills, crisis resource management, teamwork, and communication). During the past four decades of simulation use in healthcare, the literature has focused almost entirely on the first component of training resources. To illustrate, a recent systematic review of the literature on high-fidelity simulation identified 10 features that led to effective learning (Table 1). 3 Nine out of the 10 features are related to training
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
One hundred thirty-two physicians who successfully completed advanced cardiac life support (ACLS) training were randomly placed in a control group or one of two groups receiving interventions designed to provide reinforcement of previously mastered knowledge and skills. These interventions included mailed periodic reprints (group 1) or quarterly patient management problems (group 2). All physicians were retested for knowledge and skills related to ACLS one year later. Fifty-two (39.4%) could successfully ventilate the mannequin, and 62 (47.0%) could perform cardiac compression adequately. No differences were noted among groups. Significant differences in knowledge were found. The control group initiated appropriate therapy in a mock-arrest situation 52% of the time, while group 1 averaged 75% and group 2 averaged 82%. These results indicate that reinforcement after continuing medical education may enhance knowledge retention, but does not maintain motor skills. Yearly recertification in ACLS skills should be considered, and frequent practice sessions should be encouraged for those physicians who are not active participants in ACLS activities.
Article
Communicating is an art. Words are its vehicle, and its goal is to convey ideas from person to person. In this article, Gibb treats communication as an interpersonal process that is greater than the sum of the words used. His analysis shows the nurse administrator ways to avoid arousing defensive behavior. The nurse administrator who understands that defensive behavior can block effective communication will be able to act in a way that conveys ideas, and can better work toward solving managerial problems.
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In an investigation into the retention of advanced cardiac life support (ACLS) knowledge over time, the authors found that ACLS scores significantly decreased for a subgroup of a sample of 40 RNs employed in critical care areas in the first year after certification. Several variables that influenced scores were identified. Recommendations for inservice educators include reconstructing the ways in which ACLS courses are taught, conducting mock mega code scenarios every 6 months, constructing mega code scenarios that reflect the reality of practice, and routinely conducting refresher courses based on problems identified in a particular group.
Article
Throughout this century there have been many efforts to reform the medical curriculum. These efforts have largely been unsuccessful in producing fundamental changes in the training of medical students. The author challenges the traditional notion that changes to medical education are most appropriately made at the level of the curriculum, or the formal educational programs and instruction provided to students. Instead, he proposes that the medical school is best thought of as a "learning environment" and that reform initiatives must be undertaken with an eye to what students learn instead of what they are taught. This alternative framework distinguishes among three interrelated components of medical training: the formal curriculum, the informal curriculum, and the hidden curriculum. The author gives basic definitions of these concepts, and proposes that the hidden curriculum needs particular exploration. To uncover their institution's hidden curricula, he suggests that educators and administrators examine four areas: institutional policies, evaluation activities, resource-allocation decisions, and institutional "slang." He also describes how accreditation standards and processes might be reformed. He concludes with three recommendations for moving beyond curriculum reform to reconstruct the overall learning environment of medical education, including how best to move forward with the Medical School Objectives Project sponsored by the AAMC.
Article
Previous investigations have established the need for improved training for management of anesthetic emergencies. Training with inexpensive screen-based anesthesia simulators may prove to be helpful. We measured the effectiveness of screen-based simulator training with debriefing on the response to simulated anesthetic critical incidents. Thirty-one 1st-year clinical anesthesia residents were randomized into 2 groups. The intervention group handled 10 anesthetic emergencies using the screen-based anesthesia simulator program and received written feedback on their management, whereas the traditional (control) group was asked to study a handout covering the same 10 emergencies. All residents then were evaluated on their management of 4 standardized scenarios in a mannequin-based simulator using a quantitative scoring system. The average point score for the simulator-with-debriefing group was 52.6 +/- 9.9 out of 95 possible points. The traditional group average point score was 43.4 +/- 5.9, p = .004. Residents who managed anesthetic problems using a screen-based anesthesia simulator handled the emergencies in a mannequin-based anesthesia simulator better than residents who were asked to study a handout covering the same problems. Computer simulations with feedback are effective as a supplement to traditional residency training methods for the management of medical emergencies.
Article
Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm. Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups. Behavior did not change after 3 months of verbal feedback; however, behavior improved after 1 month of videotape feedback (P <0.05) and total time to disposition was reduced by 50% (P <0.01). This response was sustained for the remainder of the study. Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.
Article
Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance. The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03. Fifteen emergency medicine residents--eight from postgraduate year three (PGY3) and seven from postgraduate year two (PGY2)--experienced a difficult simulator lab scenario designed to lead them into a cognitive error trap. The debriefing was a PowerPoint with audio format CD-ROM with a didactic on succinylcholine (15 minutes) and cognitive forcing strategies (30 minutes). After debriefing, residents were interviewed by an ethnographer with an 11-question (15-minute) interview and completed an eight-question written survey. The residents ranked this experience second only to direct patient care for educational effectiveness. Survey results (Likert scale, 1 = disagree completely to 5 = agree completely) included "Improved my ability to use succinylcholine" (mean = 4.73), "Improved my ability to diagnose and treat hyperkalemia" (mean = 4.6), and "Cognitive forcing strategies is a useful educational effort" (mean = 4.33). The major interview themes that evolved were that the simulation lab was a positive experience; succinylcholine knowledge was gained; mistakes caused reflection/motivation; the lab was stressful; attending feedback was desired; the lab was realistic; and cognitive forcing strategies were discussed. When asked what they learned, more of the PGY3s commented on cognitive strategies or heuristic techniques (six out of eight), whereas the PGY2s commented on knowledge gained about succinylcholine (five out of seven) and only one PGY2 mentioned cognitive strategies. Pilot data suggest that metacognitive strategies can be taught to residents, though they may be better understood by upper-level residents.
Article
This survey investigated the need, and the availability, of debriefing after critical incidents for training anaesthetists. A cross-sectional postal survey of all Australian anaesthetic trainees was conducted in May 2002. Four hundred and nineteen responses were analysed (response rate 64%). Debriefing after a critical incident was perceived by most trainees to be useful, however 36% (n = 149) had never been debriefed. Trainees ranked their preferred content for a debriefing as 'anaesthetic issues' followed by the 'psychological impact of the incident' 'patient issues' and 'surgical issues'. Almost half of respondents reported that they did not feel supported by their anaesthetic department after a negative outcome incident. Trainees who had debriefings were more likely to feel supported by senior colleagues. Debriefing after critical incidents should be an integral part of the supervision of anaesthetic trainees.
Article
The development of self-regulated learning is a major focus of our problem-based learning (PBL) medical programme. Students who are unsuccessful in assessments often seem to lack insight into the standard of their own performance, yet the ability to self-assess accurately is essential for the effective self-management of learning. The aim of this project was to evaluate the accuracy of self- and peer-assessment according to academic performance. In 2004, 175 3rd-year students undertook an integrated, case-based, short-essay, formative assessment. After the assessment they were provided with model answers and marking criteria. Students marked their own assessment paper and the paper of one of their peers. Assessment papers were subsequently marked by faculty members. The following data was available for each student: self-mark, faculty-mark, score awarded by a peer and the score that they awarded to their peer. Self-assessment and peer-assessment ability was compared to overall academic performance. Low-achieving students score themselves and their peers generously. High-achieving students score themselves more harshly than faculty. However, they score their peers accurately. In the 3rd year of the programme low-achieving students are unable to assess accurately the quality of their own work or the work of their peers in a formative written assessment. The PBL curriculum does not guarantee the appropriate development of self-assessment skills.
Article
The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system. Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups. Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.
Article
Full-scale simulation training is an accepted learning method for gaining behavioural skills in team-centred domains such as aviation, the nuclear power industry and, recently, medicine. In this study we evaluated the effects of a simulator team training method based on targets and known principles in cognitive psychology. This method was developed and adapted for a medical emergency team. In particular, we created a trauma team course for novices, and allowed 15 students to practise team skills in 5 full-scale scenarios. Students' team behaviour was video-recorded and students' attitude towards safe teamwork was assessed using a questionnaire before and after team practice. Nine of 10 observed team skills improved significantly in response to practice, in parallel with a global rating of team skills. In contrast, no change in attitude toward safe teamwork was registered. The use of team skills in 5 scenarios in a full-scale patient simulator environment implementing a training method based on targets and known principles in cognitive psychology improved individual team skills but had no immediate effect on attitude toward safe patient care.
Article
Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.
Intercultural communication, simulation and the cognitive assimilation of experience: An exploration of the post-experience analytic process
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Differences that make a difference: Intercultural communication , simulation, and the debriefing process in diverse interaction
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Flight deck performance. The human factor
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Fostering simulation-based learning in medical education with collaboration scripts Screen based anesthesia simulation with debriefing improves performance in a mannequin-based anesthesia simulator
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Training senior house officers by service based training.