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“Let’s talk about it”: translating lessons from healthcare simulation to clinical event debriefings and clinical coaching conversations

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Abstract

Despite proven benefits for team and individual performance, a number of perceived barriers limit clinical post-event debriefings, which impacts healthcare team functioning and patient care. An overemphasis on debriefing after rare events such as cardiac arrest and major trauma resuscitations necessarily means that debriefings will also occur infrequently as well. Similarly, individual coaching conversations that would help promote trainee skill acquisition are lacking. This situation stands in stark contrast to other experiential learning domains such as healthcare simulation, which view structured feedback, coaching, and debriefing as integral to its educational practices. Better translation of relevant lessons from healthcare simulation to clinical settings could enhance workplace learning and drive continuous performance improvements, benefitting both clinicians and patients. This paper aims to: (a) broaden the scope of ‘debriefing’ in clinical settings, (b) translate valuable principles and strategies from healthcare simulation, clinical education, and psychology literatures to clinical post-event debriefings and coaching conversations in pediatric emergency departments and (c) offer guidance and practical strategies to help busy clinicians implement both clinical event debriefings and coaching conversations in pediatric emergency departments.

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... Also called after-action reviews, after-event reviews, and post-event reviews, debriefings aim to provide the structure for shifting from automatic/habitual to more conscious/deliberate action and information processing (Ellis and Davidi, 2005;DeRue et al., 2012). Debriefings allow for reflection and self-explanation, data verification and feedback, understanding the relationship between teamwork and task work, uncovering and closing knowledge gaps and disparity in shared cognition, structured information sharing, goal setting and action planning, as well as changes in attitudes, motivation, and self and collective efficacy (Ellis and Davidi, 2005;Rudolph et al., 2007Rudolph et al., , 2008DeRue et al., 2012;Eddy et al., 2013;Tannenbaum and Goldhaber-Fiebert, 2013;Kolbe et al., 2015;Eppich et al., 2016;Sawyer et al., 2016b;Allen et al., 2018). In healthcare, debriefings are particularly suited for ad hoc teams. ...
... In healthcare, debriefings are particularly suited for ad hoc teams. While they have become a core ingredient of simulation-based team training Eppich et al., 2015;Sawyer et al., 2016a), their use in daily clinical practice is still limited (Tannenbaum and Goldhaber-Fiebert, 2013) given their vast potential (Mullan et al., 2014;Kessler et al., 2015;Eppich et al., 2016). ...
... In disciplines such as healthcare and medical education, there is far more conceptual than empirical work on debriefings. The conceptual work has focused on how to conduct debriefings (Rudolph et al., 2007(Rudolph et al., , 2008(Rudolph et al., , 2013(Rudolph et al., , 2014Cheng et al., 2014;Eppich et al., 2015Eppich et al., , 2016Kessler et al., 2015;Sawyer et al., 2016a;Cheng et al., 2017;Kolbe and Rudolph, 2018;Endacott et al., 2019). The empirical work has focused on communication in debriefings, albeit rather unsystematically and rarely applying rigorous team science methodology (e.g., Husebø et al., 2013;Kihlgren et al., 2015). ...
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In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
... B. Drucktiefe oder No-Flow-Zeit). In einigen USamerikanischen Kliniken werden Cold debriefings regelhaft im wöchentlichen Abstand als feste Instanz durchgeführt [5,6]. Durch diese festen Intervalle wird eine Kultur geschaffen, in der das Sprechen über kritische Ereignisse zur Normalität wird. ...
... Ein Debriefing-Instrument als Hilfestellung für die klinische Nachbesprechung zeigt . Abb. 2 [5,6]. Eine mögliche Fragemethode, die in Simulationstrainerkursen im deutschsprachigen Raum gelehrt wird, ist die 3B-Methode. ...
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Regelmäßige Debriefings (Nachbesprechungen) kritischer Ereignisse in der Kindernotfallversorgung können das Patienten-Outcome und die Teamzusammenarbeit verbessern. Die Reflexion ermöglicht Lernen in Teams, um in Zukunft besser zu werden und die Wiederholung von Fehlern zu vermeiden. Allerdings werden Debriefings im klinischen Alltag noch immer unregelmäßig und qualitativ unzureichend durchgeführt. Ursachen sind mangelnde Zeit, Fehlen erfahrener Debriefer und fehlende Unterstützung durch Verantwortungsträger. Debriefings können je nach Bedarf zu unterschiedlichen Zeitpunkten mit unterschiedlicher Dauer stattfinden: kurze „hot debriefings“ noch am Tag des Geschehens oder längere „cold debriefings“ einige Tage später. Im Mittelpunkt stehen immer das Lernen und Erarbeiten zukunftsorientierter Lösungen. Auslöser zur Durchführung von Debriefings können neben akut lebensbedrohlichen Ereignissen auch potenziell kritische Situationen, wie z. B. Intubationen, sein. Eine Strukturierung von Nachbesprechungen durch Debriefing-Skripte erleichtert die Durchführung und ermöglicht auch unerfahrenen Moderatoren, alle Aspekte abzuarbeiten. Neben der Diskussion schwieriger Abläufe sollten unbedingt positive Aspekte besprochen werden, um diese zu bestärken und das Lernen am positiven Beispiel zu ermöglichen. Dabei sollten die Beweggründe eines Verhaltens erfragt und nicht nur die nach außen sichtbaren Leistungen bewertet werden. Damit kann ein bedarfsorientiertes Lernen mit Erarbeitung von Lösungen stattfinden. Hilfreich sind spezielle Fragetechniken, ehrliches Interesse und eine positive Sicherheitskultur.
... has been positioned mainly in simulated contexts. 4,10 Clinical event debriefing after patient care episodes is challenging that contextual divide between feedback and debriefing, 6,[11][12][13][14][15] highlighting the overlap in purpose and structure. ...
... Definitions of debriefing emphasize a predictable process of guiding learners following an experience in a A C C E P T E D structured, interactive, reflective discussion that offers a systematic analysis of their experience and its meaning. 10,13,30 Much of the debriefing literature can be traced to the topics of organizational contexts and theory. When thinking about optimizing an organization's structure, organizational theory at one point emphasized an organization's size, technology, and environment. ...
Article
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Feedback and debriefing are experience-informed dialogues upon which experiential models of learning often depend. Efforts to understand each have largely been independent of each other, thus splitting them into potentially problematic factions. Given their shared purpose of improving future performance, the authors asked whether efforts to understand these dialogues are, for theoretical and pragmatic reasons, best advanced by keeping these concepts unique, or whether some unifying conceptual framework could better support educational contributions and advancements in medical education.
... Specific information about the debriefing process can be provided in the same way as we would expect to be notified of a prospective conference timetable. A combination of factors appears to contribute to implementation success, including local context, historical culture, transparent processes and the overall quality of CD facilitation (Salas et al. 2008;Eppich et al. 2016). ...
... Only then should we discuss or judge performance. During this 'analysis phase' we advise to focus discussions on team-based factors and collective problem solving, rather than individual errors (Kessler et al. 2015;Eppich et al. 2016). ...
Article
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Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.
... Debriefing, which allows for emotional processing and reflection upon areas for possible improvement, has been found to be one way in which to increase overall performance, reduce equipment-related problems, and improve communication and teamwork. 1,2 However, despite being well established in the military and other high-stakes industries such as aviation, debriefing remains poorly established in the ED settings. 3,4 Given that the benefits of post-simulation debriefings have been widely accepted in other settings, there is likely significant utility in implementing a debriefing protocol in the Emergency Department as well. ...
... 3,4 Given that the benefits of post-simulation debriefings have been widely accepted in other settings, there is likely significant utility in implementing a debriefing protocol in the Emergency Department as well. 2,5,6 IMPORTANCE While staff have often stated that they would like to be provided a formal debriefing model after treating a cardiac arrest or other critically ill patient, few EDs have such protocols in place and there is often no formal training offered during medical education on how to debrief after a situation. 4,[7][8][9][10] When given the option, however, people usually prefer to debrief with persons facing the same stressful situation. ...
Article
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Context: Regular debriefing has been associated with improved resource utilization and measurable improvements in team performance in crisis situations. While Emergency Department (ED) staff have often stated that they would like to be provided a formal debriefing model after "code blue" and similar events, few EDs have such protocols in place. Methods: The study consisted of two data collection processes: (1) completion of a 7-item survey distributed pre-intervention, 6-months post-intervention, and 1-year post-intervention, and (2) completion of a Rapid Post-Code Debriefing form. Overall responses were measured on a possible 0-10 scale and individual responses were tracked. The debrief process was triggered by one of four criteria and followed a standard format using a readily available form. Results: A total of 178 pre- and post-debriefing protocol implementation survey responses were collected throughout the duration of the study. Of those, 79 (44.4%) were pre-protocol response surveys. The post-protocol responses were comprised of 51 (51.5%) six month and 48 (48.5%) 12-month surveys. The average overall satisfaction with code-response performance increased significantly following the implementation of the debriefing protocol, from M=6.661, SD=2.028 to M=7.90, SD=1.359 (independent t-test = 5.069, p<0.001). There was a statistically significant decrease regarding how respondents felt emotionally supported after a code by their staff, (Pearson Chi Square 14.977, df 4, p = 0.005). Conclusion: During this study, implementation of a post-code debriefing resulted in increased overall satisfaction with how codes had been conducted and there was a significant change in how staff felt in regards to code team leaders and an expectation of "returning to work." However, there a noted overall decrease in perceptions of feeling supported by other staff involved during the code. Further studies in both community and academic-based ED settings are needed to further explore these complex relationships.
... Post-event debriefing, which offers an opportunity not only to discuss organizational performance in the response, but also an opportunity for staff to discuss their experiences and 'make sense' of emotions after the event, was identified as another common support mechanism and was reported to be useful by participants in this study. For a generation or more, health professionals have had extensive exposure to an educational intervention consisting of simulated clinical practice, followed by a debriefing conversation that has an explicit goal of analysing the event to improve future practice (Eppich, Mullan, Brett-Fleegler, & Cheng, 2016;Fanning & Gaba, 2007;Tannenbaum & Cerasoli, 2012). This practice has further developed into the common practice of post-event debriefing after clinical events (Eppich et al., 2016). ...
... For a generation or more, health professionals have had extensive exposure to an educational intervention consisting of simulated clinical practice, followed by a debriefing conversation that has an explicit goal of analysing the event to improve future practice (Eppich, Mullan, Brett-Fleegler, & Cheng, 2016;Fanning & Gaba, 2007;Tannenbaum & Cerasoli, 2012). This practice has further developed into the common practice of post-event debriefing after clinical events (Eppich et al., 2016). This practice of debriefing is distinct from psychological debriefing used as an intervention for post-traumatic stress. ...
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Background Responding to a mass casualty event can cause significant distress, even for highly trained medical and emergency services personnel. Objective The purpose of the study was to understand more about first responders’ perspectives about their participation in major incident responses, specifically how and which individual and system factors contributed to their preparedness or may have enabled or hindered their response. The aim of the work was to improve preparedness and response for future incidents. Methods This study reports a detailed analysis of qualitative interview data from frontline staff who responded to a large mass casualty terrorist incident in the UK in 2017. Data highlighted the psychological distress caused by responding to terrorist events and thus became the focus of further, detailed analysis. Results Participants (n = 21) articulated in their own words the psychological distress experienced by many of the first responders to the event. Participants reported that they were not prepared to deal with psychological impact associated with this mass casualty terrorist incident and their role in the response, and that follow-up support was inconsistent. Multiple factors were identified as potentially increasing psychological distress. Social support provided by peers and organizational debriefs were identified as two most common support mechanisms. Organizational support was identified as inconsistent. Conclusions This research contributes to the literature the voices of first responders to UK terrorist incidents, building on existing findings while further contributing unique contextual perspectives. This research reinforces the importance of psychosocial support for those who respond to these tragic incidents, and offers a number of recommendations for organizational preparedness for future events. Abbreviations A&E: Accident and Emergency; EPRR: Emergency Preparedness, Resilience and Response; ERD: Emergency Response Department; HEPE: Health Emergency Preparedness Exercise; PHE: Public Health England; PHE REGG: Public Health England Research Ethics and Governance Group; MCI: Mass Casualty Incident; NHS: National Health Service
... 49,51 Targeted peer coaching may also involve more in-depth learner self-assessment and reflective discussion via focused facilitation. 52 For targeted coaching, we encourage preview statements to introduce the topic of discussion, followed by questions that either promote learner self-assessment or focused facilitation. Regardless of method, targeted peer coaching sessions are short, focused interactions with the goal of immediately improving one or two specific debriefing skills. ...
... For example, within our simulation programs, we teach educators a blended approach to debriefing healthcare simulation, known as: Promoting Excellence and Reflective Learning in Simulation (PEARLS). 2,52,53 Peer coaches also use the PEARLS approach when conducting a debriefing of the debriefing. This includes the selective use of learner self-assessment, focused facilitation, and directive feedback during the debriefing process. ...
Article
Statement: Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.
... Um Debriefings im Krankenhaus zu etablieren, bietet es sich an, sie nicht nur nach besonders kritischen Ereignissen (z. B. Reanimationen) sondern regelmässig durchzuführen(Eppich et al. 2016).Neben Briefings und Debriefings bieten Trainings eine Möglichkeit, Speaking Up gezielt zu verbessern. Empirische Untersuchungen zur Wirksamkeit solcher Trainings zeigen gemischte Befunde(O'Connor et al. 2013;Pian- Smith et al. 2009;Raemer et al. 2016;Sayre et al. 2012), was angesichts der oben geschilderten, komplexen Speaking Up-Hürden nicht verwundert. ...
... Ein anderes wichtiges Element, einerseits zur der Qualitätskontrolle, aber auch zur Schulung in der Handhabung von Notfallszenarien ist das regelmäßige Durchführen von Nachbesprechungen, sog. Debriefing [39] ...
Article
In der Notfallmedizin spielt die interdisziplinäre Teamarbeit eine zentrale Rolle und ist zur Bewältigung vieler Krisensituationen wie der Reanimation elementar. Eine funktionierende Teamarbeit wiederum bedingt eine umsichtige Teamleitung und Führung. Gerade in der Notfallmedizin sind Teamleiter durch eine besonders hohe Arbeitsbelastung gefordert. Um in diesen Situationen die notwendige Übersicht zu behalten, ist eine Leuchtturmführung wichtig. Die effiziente Teamleitung während einer Reanimation, aber auch in andren Notfallsituationen ist lernbar und sollte deshalb integraler Bestandteil von Notfall- sowie Reanimationskursen sein.
... participants aim to explore and understand relationships among events, actions, thoughts, and feeling processes, as well as performance outcomes of the simulation (Rudolph et al. 2008;Salas et al. 2008). Not limited to simulated settings, debriefings after clinical cases also help teams learn (Mullan et al. 2014;Eppich et al. 2016). Despite the vast benefits, ranging from fewer mistakes to better performance, more speaking up, and shorter work duration (Tannenbaum and Cerasoli 2013;Vashdi et al. 2013;Weiss et al. 2017), debriefing in teams does not come easy. ...
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Due to increasing complexity in healthcare, clinicians must often make decisions under uncertain conditions in which teams must be flexible and process emerging information “on the fly” in order to adapt to changing circumstances. A crucial strategy that helps teams to adapt, learn, and develop is team reflexivity (TR) – a team’s ability to collectively reflect on group objectives, strategies, processes, and outcomes of past and current performance and to adapt accordingly. We provide 12 evidence-based tips on incorporating TR into simulation-based team training (SBTT). The first three points elaborate on basic principles of TR, when TR can take place and why it matters. The following nine tips are then organized according to three phases in which teams are able to engage in TR: pre-action, in-action, and post-action. SBTT represents an ideal venue to train various TR behaviors that foster team learning and improve patient care.
... Incorporating best practices outlined in the INACSL (2016) standards in all areas of simulation, from design to faculty education through debriefing, must be intentionally planned and implemented. Debriefing must be included to help learners continue to hone critical thinking skills and reflective practice (Eppich, Mullan, Brett-Fleegler, & Cheng, 2016). The DML can be an appropriate tool for these situations, widening the focus of the simulation beyond tasks to reflection on how participants think and approach patient care as well as ways to improve teamwork. ...
Article
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The National League for Nursing and International Nursing Association for Clinical Simulation and Learning stress that debriefing fosters critical reflection and is essential to all educational settings. The call to action for nurse educators is to incorporate theory-based debriefing throughout the curriculum. This article reports on how one school of nursing implemented the theory-based model, Debriefing for Meaningful Learning
... Also encouraging was the increased perception of the role of debriefing the team after a trauma case. We believe that this is particularly important point, as a structured debriefing can improve future team performance [22]. ...
Article
Background Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC–DATC courses in candidates’ self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario.Methods Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC–DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most.ResultsAll participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course.Conclusions Joint training in the DSTC–DATC courses improved candidates’ perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.
... Specifically, instructors should attend to the established debriefing processes, tailor debriefings to context, use debriefing scripts to promote debriefing effectiveness, and view training as an opportunity to model debriefing practice and to prepare learners for the process of a debriefing after actual clinical events. 183 • Learners need performance data to improve; these data should be included in debriefings whenever possible. Quantitative data provided during resuscitation education should come from several sources, including instructors, CPR devices, and data from simulators. ...
Article
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The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
... Reflections such as debriefings have to be explicitly initiated because groups do not naturally engage in shared reflective experiences (Tannenbaum, Beard, & Cerasoli, 2013). While the number of debriefing approaches is growing (Eppich, Mullan, Brett-Fleegler, & Cheng, 2016;Kessler, Cheng, & Mullan, 2015;Kolbe, Marty, Seelandt, & Grande, 2016;Mullan, Kessler, & Cheng, 2014;Weiss, Kolbe, Grote, Spahn, & Grande, 2016), empirical insights into debriefing interaction patterns are scarce . Few studies have examined actual debriefing conversations and how differences in debriefers' communication influence learners' outcomes (Husebø, Dieckmann, Rystedt, Søreide, & Friberg, 2013). ...
... In fact, since debriefing is one of the most important components of simulationbased learning, there is likely a place for a formal debriefing at the end of the surgical skills session, thus enhancing the learning experience of the participants. 37 Corrections at this stage might have a durable effect on the trainees and reinforce the acquisition of new skills. Possibly the greatest impact will be on the acquisition of non-technical skills, such as decision-making, situational awareness and communication. ...
Article
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Severe trauma will produce both anatomical organ injury and a severe systemic illness with high mortality, requiring a unique surgical strategy. Attention to physiology, excellent situational awareness, proper surgical technique in different anatomical regions, and a distinct mindset are crucial. Damage Control Surgery (DCS) consists of performing an initial abbreviated operation to halt the bleeding followed by the correction of metabolic derangements. Definitive organ repair will only be performed after the restoration of physiology. Surgical training needs to incorporate these concepts, which are quite distinct from the elective practice. Postgraduate courses, such as the Definitive Surgical Trauma Care (DSTC™) course, aim to provide trainees with both technical and decision-making skills for trauma surgery, particularly in a damage control setting. In these courses, training can occur in a multidisciplinary environment and non-technical skills, such as leadership, communication and situational awareness, are paramount. Educational principles such as debriefing could increase the didactic experience of DSTC™ course participants, particularly after the surgical skills session.
... With a mix of team members who over-, under-, and accurately estimate CPR quality after cardiac arrest care, it is important provide a forum to review objective CPR quality data to ensure everyone is aware of the nature of their performance gaps. Post event performance review in the form of clinical debriefing provides a venue to discuss patient management decisions, celebrate successes, and explore opportunities for improvement (16,18,19,35,36). The use of CPR feedback defibrillators provides opportunity to download and display objective CPR performance data during debriefing (13,14). ...
Article
Objectives: We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest. Design: Prospective, observational study. Setting: We conducted secondary analysis of data collected from a multicenter, randomized trial of providers who participated in a simulated pediatric cardiac arrest. Subjects: Two-hundred pediatric acute care providers. Interventions: Participants were randomized to having a cardiopulmonary resuscitation coach versus no cardiopulmonary resuscitation coach. Cardiopulmonary resuscitation coaches provided feedback on cardiopulmonary resuscitation performance and helped to coordinate key tasks. All teams used cardiopulmonary resuscitation feedback technology. Measurements and main results: Cardiopulmonary resuscitation quality was collected by the defibrillator, and perceived cardiopulmonary resuscitation quality was collected by surveying participants after the scenario. We calculated the difference between perceived and measured quality of cardiopulmonary resuscitation and defined accurate perception as no more than 10% deviation from measured quality of cardiopulmonary resuscitation. Teams with a cardiopulmonary resuscitation coach were more likely to accurately estimate chest compressions depth in comparison to teams without a cardiopulmonary resuscitation coach (odds ratio, 2.97; 95% CI, 1.61-5.46; p < 0.001). There was no significant difference detected in accurate perception of chest compressions rate between groups (odds ratio, 1.33; 95% CI, 0.77-2.32; p = 0.32). Among teams with a cardiopulmonary resuscitation coach, the cardiopulmonary resuscitation coach had the best chest compressions depth perception (80%) compared with the rest of the team (team leader 40%, airway 55%, cardiopulmonary resuscitation provider 30%) (p = 0.003). No differences were found in perception of chest compressions rate between roles (p = 0.86). Conclusions: Healthcare providers improved their perception of cardiopulmonary resuscitation depth with a cardiopulmonary resuscitation coach present. The cardiopulmonary resuscitation coach had the best perception of chest compressions depth.
... h. Vor-und Nachbesprechungen) medizinischer Notfallteams wichtig zu wissen, welche Verhaltensweisen auf welche Art wirksam sind (Eppich et al. 2016;Fernandez Castelao et al. 2015;Kolbe et al. 2014Kolbe et al. , 2015Schmutz et al. 2015;Seelandt et al. 2014, Tschan et al. 2015Weiss et al. 2016). ...
Article
Die Beobachtung von Gruppenprozessen ermöglicht Aufschlüsse darüber, was erfolgreiche Gruppen anders machen als weniger erfolgreiche Gruppen. Typischerweise werden dafür Beobachtungsdaten zunächst transkribiert oder in eine Kodiersoftware überführt und anschließend Einheiten segmentiert, denen Inhaltskategorien aus Kategoriensystemen zugeordnet werden. Während es für die Transkription und Kodierung etablierte Verfahren gibt, bleibt die Segmentierung der Kodiereinheiten häufig der Intuition der Kodierenden überlassen. Dies schränkt die Reliabilität des Kodierens ein. Es fehlen standardisierte und überprüfte Vorgehensweisen für die Bildung von Kodiereinheiten, die für gruppenpsychologische Fragestellungen geeignet sind. Ziel der hier vorgestellten Methode zur systematischen Bildung von Kodiereinheiten ist es, ein transparentes, sparsames und allgemein anwendbares Vorgehen zur Erhöhung der Reliabilität von Kodierungen zu ermöglichen. Wir stellen SYNSEG vor – eine Methode zur syntaxgeleiteten Segmentierung von Kodiereinheiten anhand von zehn Regeln, die auf der deutschen Grammatik basieren. Wir diskutieren sowohl eine Realitätsprüfung als auch mögliche Anwendungen von SYNSEG in der Gruppenforschung und -beratung.
... While there are several educational debriefing models used in simulation, they generally follow the structure of the initial emotional reactions, a description and analysis of the events in simulation, followed by a summary of how these lessons can be incorporated into future practice (Dufrene & Young, 2014). This is similar to debriefing clinical events, in that the goal is to reflect on performance and to learn ways to improve clinical performance for future clinical events (Eppich, Mullan, Brett-Fleegler, & Cheng, 2016;Goldman et al., 2018). ...
Article
Aims and objectives: The purpose of this scoping review is to synthesize and map the literature on the psychological outcomes reported following debriefing of healthcare providers who experience expected and unexpected patient death in either clinical practice or simulation setting. Background: Patient death occurs in both the clinical and simulation environments and can result in psychological stress in healthcare providers and students. While debriefing following patient death has demonstrated the ability to promote positive psychological outcomes, addressing the psychological or emotional stress of the event is inconsistently addressed. Design: A scoping review was conducted using the Arksey and O'Malley framework. Method: The Cochrane Library, MEDLINE, CINAHL, PsycINFO, JBI, and Scopus databases were searched with English language constraints and no limit on publication date. The Scoping Reviews (PRISMA-ScR) Checklist was used (Tricco et al., 2018) (see Supplementary File 1). Results: Eighteen articles (16 research papers, 2 review papers) met the inclusion criteria. Of the 16 research papers, 9 reported on debriefing models in the simulation environment and 7 in the clinical setting. The types of debriefing models found in the simulation setting tended to focus on healthcare providers' learning, while those in the clinical setting typically focused on healthcare providers' emotional reactions and resulted in positive psychological effects. Conclusion: Debriefing has the potential to positively affect psychological outcomes of healthcare providers who experience patient death. The type of debriefing that is selected is a key component to achieving these positive outcomes.
... We conducted a semi-structured debriefing of 15-25 min for all participants at each simulation. The debriefing guide was based on PEARLS [34,35]. During the debriefing, we used plus-delta in the analysis phase [36] and strived to use advocacy inquiry [37] when suited. ...
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Background Early recognition and call for help, fast initiation of chest compressions, and early defibrillation are key elements to improve survival after cardiac arrest but are often not achieved. We aimed to investigate what occurs during the initial treatment of unannounced in situ simulated inhospital cardiac arrests and reasons for successful or inadequate initial resuscitation efforts. Methods We conducted unannounced full-scale in situ simulated inhospital cardiac arrest followed by a debriefing. Simulations and debriefings were video recorded for subsequent analysis. We analyzed quantitative data on actions performed and time measurements to key actions from simulations and qualitative data from transcribed debriefings. Results We conducted 36 simulations. Time to diagnosis of cardiac arrest was 37 (27; 55) s. Time to first chest compression from diagnosis of cardiac arrest was 37 (18; 74) s, time to calling the cardiac arrest team was 144 (71; 180) s, and time to first shock was 221 (181; 301) s. We observed participants perform several actions after diagnosing the cardiac arrest and before initiating chest compressions. Domains emerging from the debriefings were teaming and resources . Teaming included the themes communication , role allocation , leadership , and shared knowledge , which all included facilitators and barriers. Resources included the themes knowledge , technical issues , and organizational resources , of which all included barriers, and knowledge also included facilitators. Conclusion Using unannounced in situ simulated cardiac arrests, we found that key elements such as chest compressions, calling the cardiac arrest team, and defibrillation were delayed. Perceived barriers to resuscitation performance were leadership and teaming, whereas experience, clear leadership, and recent training were perceived as important facilitators for treatment progress.
... Um Debriefings im Krankenhaus zu etablieren, bietet es sich an, sie nicht nur nach besonders kritischen Ereignissen (z. B. Reanimationen) sondern regelmässig durchzuführen(Eppich et al. 2016).Neben Briefings und Debriefings bieten Trainings eine Möglichkeit, Speaking Up gezielt zu verbessern. Empirische Untersuchungen zur Wirksamkeit solcher Trainings zeigen gemischte Befunde(O'Connor et al. 2013;Pian- Smith et al. 2009;Raemer et al. 2016;Sayre et al. 2012), was angesichts der oben geschilderten, komplexen Speaking Up-Hürden nicht verwundert. ...
Article
In diesem Artikel beschreiben wir die Relevanz des Schweigens vs. Speaking Up für die Patientenbehandlung im Krankenhaus. Schweigen bedeutet, absichtlich potentiell wichtige Informationen, Bedenken, Vorschläge oder Fragen zurückzuhalten. Das erwünschte Gegenteil des Schweigens ist Speaking Up – das absichtliche Äussern einer Idee, einer persönlichen Meinung oder Sorge und das Nachfragen bei Zweifeln – in der Regel gegenüber Vorgesetzten, aber auch gegenüber Kollegen/-innen. Speaking Up dient nicht nur der Prävention und schnellen Behebung von Fehlern, z. B. durch aufmerksam Machen und Nachfragen. Es ermöglicht auch das Zusammenarbeiten im hochkomplexen Arbeitsfeld Krankenhaus und ist ein zentrales Element organisationalen Lernens. Problematisch ist, dass in Krankenhäusern das Schweigen im Vergleich zu Speaking Up überwiegt. Wir erläutern anhand des aktuellen Forschungsstandes, dass die Gründe für Schweigen im Klima und in den sozialen Interaktionsprozessen der Gruppen und Organisationen anstatt in fehlender Motivation oder persönlicher Inkompetenz zum Speaking Up liegen. Basierend auf paradoxen Interventionen geben wir sowohl paradoxe Ratschläge – scherzhafte, kurzweilige und nicht ernstgemeinte Empfehlungen für ungewolltes Schweigen anstatt Speaking Up, als auch Speaking Up-begünstigende Handlungsempfehlungen.
... Clinical event debriefing adapts learnings from simulation debriefing to allow clinicians time to reflect and collectively learn after significant clinical events. 1 Debriefing provides the opportunity to discuss interactions within the clinical environment to improve performance in the future. [7][8][9] The American Heart Association, the International Liaison Committee on Resuscitation, and the National Academy of Sciences recommends clinical event debriefing as a tool to improve resuscitation team performance. [10][11][12] Debriefings are categorized by time in relation to the initial event, with "hot" debriefings occurring in the minutes to hours following the event and "cold" debriefings occurring in the days to weeks following an incident. ...
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Introduction: Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple pediatric centers. Methods: Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative. Data from 283 IHCA events reported between February 2016 and April 2018 were analyzed. We used a Plus/Delta framework to collect debriefing content and performed a qualitative analysis utilizing a modified Team Emergency Assessment Measurement Framework. Univariate and regression models were applied, accounting for clustering by site. Results: CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 26 days [IQR 11, 41] with a median duration of 60 minutes [20, 60]. Attendance was variable across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], respiratory therapists 0 [0, 1], and administrators 1 [0, 1]. "Plus" comments reported per event were most commonly clinical standards 47% (44/93), cooperation 29% (27/93), and communication 17% (16/93). "Delta" comments were in similar categories: clinical standards 44% (41/93), cooperation 26% (24/93), and communication 14% (13/93). Conclusions: CDs were performed after 33% of cardiac arrests in this multicenter pediatric IHCA collaborative. The majority of plus and delta comments could be categorized as clinical standards, cooperation and communication.
... lww.com/SIH/A519) was integrated into the Sim for Life: Foundations course: principles of adult learning, 33 role of simulation-based education, 34-36 teamwork concepts, [37][38][39][40] scenario design (including writing learning objectives), 36,41 prebriefing, 42 scenario execution (including enhancing realism and immersion 43 ), and creating a debriefing plan and debriefing. 1,[21][22][23][24][25][26][44][45][46] A specific emphasis was placed on identifying and describing teamwork concepts and highlighting strategies on how to improve teamwork during clinical care. ...
Introduction: Despite the importance of debriefing, little is known about the effectiveness of training programs designed to teach debriefing skills. In this study, we evaluated the effectiveness of a faculty development program for new simulation educators at Mbarara University of Science and Technology in Uganda, Africa. Methods: Healthcare professionals were recruited to attend a 2-day simulation educator faculty development course (Sim for Life: Foundations), covering principles of scenario design, scenario execution, prebriefing, and debriefing. Debriefing strategies were contextualized to local culture and focused on debriefing structure, conversational strategies, and learner centeredness. A debriefing worksheet was used to support debriefing practice. Trained simulation educators taught simulation sessions for 12 months. Debriefings were videotaped before and after initial training and before and after 1-day refresher training at 12 months. The quality of debriefing was measured at each time point using the Objective Structured Assessment of Debriefing (OSAD) tool by trained, calibrated, and blinded raters. Results: A total of 13 participants were recruited to the study. The mean (95% confidence interval) OSAD scores pretraining, posttraining, and at 12 months before and after refresher were 18.2 (14.3-22.1), 26.7 (22.8-30.6), 25.5 (21.2-29.9), and 27.0 (22.4-31.6), respectively. There was a significant improvement from pretraining to posttraining (P < 0.001), with no significant decay from posttraining to 12 months (P = 0.54). There was no significant difference in OSAD scores pre- versus post-refresher training at 12 months (P = 0.49). Conclusions: The Sim for Life Foundations program significantly improves debriefing skills with retention of debriefing skills at 12 months.
... Debriefing was structured based on the Promoting Excellence and Reflective Learning in Simulation (PEARLS) debriefing script developed by Eppich and colleagues. 13,14 Together, the fellow and faculty facilitators first asked the group for initial thoughts and reactions using open-ended questions and guiding all of the participants to discuss what went well and what did not go well in the case. The fellow leading the simulation reviewed key learning points. ...
Article
Introduction: During the course of fellowship training, pediatric critical care fellows are expected to develop a broad and in-depth understanding of the pathophysiology of multiple disease processes. The simulation-based pediatric critical care pathophysiology curriculum we present uses scenarios created by pediatric critical care fellows to teach complex pathophysiology. Methods: Each of the three representative cases presented covered a specific pathophysiologic process and required participants to acutely manage (1) an 18-year-old patient with altered mental status in the setting of hepatic encephalopathy; (2) an 8-year-old patient with sepsis, coagulopathy, and acute kidney injury; or (3) a 12-year-old patient with status epilepticus. Each case could be conducted in a simulation suite or an acute care unit bed. We assessed learners' knowledge and attitudes at the end of these simulations with a structured debriefing session and via completion of an evaluation form. The simulations were then followed by a 30-minute interactive didactic session on the topic. Results: Each scenario had six fellow participants who completed evaluations. After completing each of the three case scenarios presented, the majority of participating pediatric critical care fellows indicated that the content was relevant and sufficiently challenging. They also indicated that these simulation scenarios would improve their clinical practice. Discussion: This fellow-developed simulation curriculum is novel, highlighting the relevance for critical care fellows' understanding of realistic clinical scenarios while promoting advanced management skills with a pathophysiology focus.
... In . Abb. 2 ist das PEARLS Healthcare Debriefing Instrument als Hilfestellung für die klinische Nachbesprechung gezeigt [6,7]. ...
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Communication errors and system problems negatively impact teamwork and shared decision-making and can cause patient harm. However, regular debriefings after critical events positively impact teamwork and patient outcome in pediatric emergency care. Team reflection promotes learning, helps teams to improve and to minimize errors from being repeated in the future. Nevertheless, debriefings in daily practice have not yet become a standard quality marker. Reasons include lack of time, lack of experienced debriefers and lack of support from the key stakeholders. Debriefings can take place at different timepoints with variable duration as needed. Due to the global pandemic, virtual debriefings or hybrid events with a mix of virtual and in-person participation are not only currently relevant but may perhaps also be of future relevance. Debriefings should focus on collaborative learning and future-oriented improvements. Not only life-threatening events but also potentially critical situations such as routine intubations warrant debriefings. Debriefing scripts promote a structured approach and allow even inexperienced moderators to navigate all relevant aspects. In addition to areas of challenge, debriefings should also explore and reinforce positive performance to facilitate learning from success. Debriefers should discuss not only obvious observable accomplishments, but also motivations behind key behaviors. This strategy promotes needs-based learning and focuses on solutions. Helpful strategies include specific questioning techniques, genuine interest and a positive safety culture.
... For the purpose of this study, a semi-structured interview guide with questions related to challenges and success criteria for debriefings in the clinical setting was designed. The data collection instrument was developed based on research in organizational behavior (with a particular focus on difficult conversations) [66][67][68][69][70], debriefings in healthcare [5,26,30,38,40,[63][64][65][71][72][73][74][75], and circular questioning [44,55]. Content areas were (1) experiences with debriefings in clinical and training settings; (2) characteristics of debriefings with respect to participants, place, duration, frequency, and organizational routines; (3) mental models with respect to effectiveness of debriefings and differences between debriefings and other kinds of conversations; (4) leadership in debriefings; (5) psychological safety; and (6) double-loop learning. ...
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Background The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. Methods We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. Results In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. Conclusion The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.
... Specifically, instructors should attend to the established debriefing processes, tailor debriefings to context, use debriefing scripts to promote debriefing effectiveness, and view training as an opportunity to model debriefing practice and to prepare learners for the process of a debriefing after actual clinical events. 183 • Learners need performance data to improve; these data should be included in debriefings whenever possible. Quantitative data provided during resuscitation education should come from several sources, including instructors, CPR devices, and data from simulators. ...
This study evaluated the impact of a pilot coaching project that included peer coaching in an early childhood program in the Northeast. A total of 18 coaches provided coaching with 15 teachers. Peer coaches included a participant-selected teacher or a director-selected teacher; program administrators also provided coaching. A one-page coaching form included columns to document the coaches’ observations and notes on teacher strengths and suggestions for improvement. Reflection forms, completed by teachers following coaching, captured perceptions about the coaching process. Results suggested that, compared to other coaches, administrators were most likely to provide specific feedback to teachers. Teachers were most comfortable being observed by a self-selected peer coach and most comfortable receiving feedback from a director-selected peer coach. Participants shared perceived benefits of and challenges to engaging in the peer coaching process. Findings and implications for program-level peer coaching initiatives are discussed.
Article
Background Inconsistent clinical educator preparation to guide students’ thinking, engage reflection, and provide immediate feedback impacts student's decision-making. Clinical coaching, a teaching framework, promotes one-to-one teaching, questioning, and feedback between the educator and student. There are limited studies measuring the impact of clinical coaching education on educators. Methods A quasi experimental design was conducted in 2019 with 36 clinical nursing instructors from two undergraduate programs. Data were collected using the Clinical Coaching Interactions Inventory: Educator Group Version. A match-paired Wilcoxon test was used for analysis of responses. Results Clinical educators reported a statistical increase in the use of one higher-order question—asking students to synthesize clinical knowledge and reasoning. Conclusions The findings suggest that a clinical coaching education program improves clinical nurse educators’ ability to engage students in synthesizing knowledge, which can help in prioritizing care. These findings may promote clinical coaching strategies for clinical faculty to improve clinical reasoning skills in students.
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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.
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Developed by the leading experts in neonatal simulation, this innovative new resource delivers neonatology health care providers and educators essential guidance on designing, developing, and implementing simulation-based neonatal education programs. Available for purchase at https://shop.aap.org/neonatal-simulation-a-practical-guide-paperback/ (NOTE: This book features a full text reading experience. Click a chapter title to access content.)
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A collection of the first 12 months of the Simulcast Journal Club, an online, open access journal club featuring healthcare simulation literature. Each month includes the expert commentaries from a number of world renowned simulation experts.
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Healthcare is recognised as a complex adaptive socio-technical system made up of multiple components which interact in unpredictable ways, creating ever-changing latent problems. There has been a growing interest in the role that resilience has in improving safety in complex systems such as healthcare. This chapter discusses the role of simulation in enhancing the resilient performance of healthcare teams and systems, and the implications this has for the way we deliver simulation. We elaborate on resilience in healthcare principles, how these principles can be integrated into simulation, and demonstrate how this has been put into practice with an in-situ simulation-based team training programme in an intensive care unit in New Zealand.
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Cambridge Core - Communications - The Cambridge Handbook of Group Interaction Analysis - edited by Elisabeth Brauner
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Zusammenfassung Hintergrund Die Patientensicherheit zu gewährleisten ist ein zentrales Anliegen in der Gesundheitsversorgung, deren Behandlungsprozesse eine komplexe und mit vielen Risiken behaftete Aufgabe darstellt. Im Spitalalltag kommt es denn auch immer wieder zu unerwünschten, kritischen Ereignissen, die Patienten schädigen. Hierbei untersuchen die Sicherheitswissenschaften deren Entstehung, Begleitumstände und Verbesserungsmassnahmen. Dabei kommen mit Safety-I und Safety-II zwei sich ergänzende Ansätze zur Geltung. Während Safety-I darauf abzielt, unerwünschte Ereignisse zu minimieren, fokussiert der Safety-II-Ansatz auf das Verstehen des Systems als Ganzes, aus dessen Normalbetrieb gleichermaßen erwünschte und unerwünschte Ereignisse hervorgehen. Am für diese Studie ausgewählten Universitätskrankenhaus der Schweiz ist der Safety-I-Ansatz (Fokus auf Fehlleistungen und Korrekturen negativer Auswirkungen für die Patientensicherheit) durch die Implementierung des Critical Incident Report System (CIRS) ein fester Bestandteil. Gegenstand der Untersuchung ist es zu erheben, ob und inwiefern der Safety-II-Ansatz (Fokus auf dem Normalbetrieb und Verständnis der positiven Auswirkungen für die Patientensicherheit) bereits umgesetzt wird und welche Maßnahmen seine Integration im klinischen Alltag unterstützen können. Methode Mittels Beobachtungen wurden die Strukturen der Tagesfeedbacks auf sechs verschiedenen Krankenhausabteilungen erfasst, um herauszufinden, ob sie potentielle Startpunkte zur Implementierung des Safety-II-Ansatzes darstellen. Die darauffolgenden Experteninterviews (n = 7) thematisierten mittels des Resilient Assessment Grid (RAG) vier Potentiale des Safety-II-Ansatzes. Die anschließende Fokusgruppe befasste sich mit der Frage, welche Maßnahmen für die Integration des Safety-II-Ansatzes im Klinikalltag zentral sind. Ergebnisse Es zeigte sich, dass die Abteilungsteams teilweise nach dem Safety-II-Ansatz handeln. Während der Team Huddles werden oft bereits positive Erfahrungen miteinander ausgetauscht. Die Experteninterviews zeigten, dass die RAG-Potentiale Reagieren, Lernen und Erwarten bereits zufriedenstellend realisiert wurden, während das Potential Überwachen abfiel. In der Fokusgruppe wird der Safey-II-Ansatz der Unternehmenskultur zugeordnet und weniger als Paradigmenwechsel betrachtet, welcher noch in den Arbeitsalltag integriert werden müsste. Diskussion Für eine erfolgreiche Etablierung des Safety-II-Ansatzes ist es demnach wichtig, nicht nur auf unerwünschte Ereignisse zu fokussieren. Es gilt auch, sich den oft nicht direkt sichtbaren erwünschten Ereignissen zu widmen, die die Patientensicherheit gewährleisten, diese systematisch zu reflektieren und so zur Weiterentwicklung der Organisationskultur beizutragen. Wenn besser verstanden wird, wie das System des klinischen Alltags mit seinen vielen Subsystemen funktioniert, kann man unerwünschten Ereignissen beispielsweise mittels regelmäßiger Feedbackrunden und Debriefings proaktiv entgegenwirken und so die Patientensicherheit erhöhen.
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Debriefing, die Nachbesprechung eines Simulationsszenarios, ist ein sehr wichtiger Bestandteil des simulationsgestützten Lernens. Viele der Reflexionen und Einsichten, die sich im Zusammenhang mit der Simulation ergeben, werden hier bewusst und explizit gemacht. Debriefings haben verschiedene Phasen, in der der Debriefer mit den Teilnehmern daran arbeitet, die Lernziele der Simulation umzusetzen. Gerade in den letzten Jahren bekam diese Kursphase viel Aufmerksamkeit, und eine Reihe von Verfahren wurde entwickelt. Gemeinsam ist diesen Modellen in der Regel, dass die Gruppe sich einen Überblick darüber verschafft, was im Szenario konkret geschah, dann einzelne Aspekte genauer analysiert und schließlich beschreibt, welche Lerneinsichten und Änderungsintentionen sich aus der Diskussion ergeben haben. Viele Faktoren beeinflussen, wie ein Debriefing abläuft, z. B. die Gruppendynamik, kulturelle Unterschiede und Gemeinsamkeiten innerhalb der Gruppe oder die Erfahrung der Debriefer und Teilnehmer. Zunehmend werden Debriefingmethoden, die in der Simulation entwickelt wurden, auch in klinischen Zusammenhängen eingesetzt.
Article
Background Prior to the study, debriefings post-real-life cardiopulmonary arrest at the associated hospital were conducted only 3% of the time. However, debriefings post-cardiopulmonary arrests are recommended by multiple entities to improve team performance. Methods A course on teamwork, education on a structured method of debriefing, and debriefing practice via simulated role-play were provided to resuscitation team members. A prospective, mixed methods study including team member perceptions of debriefings and the number of debriefings conducted post-cardiopulmonary arrests were measured after the intervention. Results Debriefings increased from 3% to 39%. Debriefings were valued by all team members. Themes generated from team members’ comments included improvement, communication, and team function. Conclusions Debriefings post-real-life cardiopulmonary arrest events are feasible in a hospital setting. Teamwork principles training with simulated role-play of debriefing can impact the process of whether debriefings occur and are highly regarded by multidisciplinary team members.
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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.
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Debriefing framework and approach inform a number of factors, including participant group and learning needs, type of predetermined learning objectives, and those debriefing points that emerge from the discussion. Although general principles for healthcare debriefing exist, special considerations apply for emergency care settings. In emergency medicine, debriefings should highlight the unique logistic and cognitive demands on individuals as well as interprofessional, multi-disciplinary teams. One size does not fit all, and debriefing approach for various components of any one simulation scenario are not mutually exclusive. For emergency settings, aspects about individual thought processes, teamwork, and systems issues may be relevant for a single debriefing session. Debriefing is an essential element of healthcare simulation and the information summarized here helps educators develop and implement an informed strategy.
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Objectives To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. Design Systematic review and meta-analysis. Data source PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. Eligibility criteria Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. Data extraction and synthesis Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. results The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. Conclusion Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.
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Objectives To provide an outline for the delivery of an educational course or lecture about functional neurological disorders (FND) that is directed towards health professionals with varying clinical knowledge and to highlight the educational efficacy that can be derived from a well-designed educational platform. Method Through multidisciplinary collaboration, a course designed to develop the skills for diagnosis and management of FND was created. Elements essential to the delivery of education are: (A) knowledge creation; (B) facilitating multidisciplinary cross-pollination; (C) listening to patients’ experiences; (D) communication skills practice; (E) case studies; (F) discipline specific mentoring; (G) establishing and addressing participant learning goals and (H) developing collegial and referral networks. Changes in participants’ knowledge and clinical practice were assessed via anonymous questionnaires before and after the course. Results Dramatically improved knowledge and confidence in assessment and management of people with FND has been found both immediately following the course as well as on 6-month follow-up. Conclusion It is possible to make real change in the understanding and management of medical and allied health clinicians working with people with FND with a low-cost intervention. Also, the development of educational networks and multidisciplinary collaboration can lead to the creation of therapeutic platforms for the diagnosis, management and advocacy of this patient group.
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Training in postgraduate medicine faces many challenges, including understaffed and overcrowded environments (Wiese et al., Syst Rev 6(1):10, 2017), reduced hours for training (Asch et al., N Engl J Med 376(18):1704–6, 2017) and more recently in the UK, concern regarding how reflective education might be used inappropriately (Dyer and Cohen, BMJ 360:k572, 2018). Nonetheless, postgraduate clinical education remains both exciting and rewarding. It is these challenges that drives trainers to deliver the most effective training and supervision for their learners. Over the course of this chapter, we will aim to summarise some of the latest advances in neonatal training, as well as provide practical insights on how best to apply these in clinical practice. We will explore simulation training, particularly focusing on the role of ‘in situ’ simulation training delivered at the ‘point of care’ and recent developments in debriefing techniques, both for simulation sessions and for real clinical situations. We will consider the role of technology, how to use educational principles to deliver effective sessions and reflect on how some of the newer technologies may enhance learning and their application in neonatal education. We will explore developments in practical skills teaching, particularly the use of rapid cycle deliberate practice and will look at newer developments in technology enhanced learning. It is important to think about the underlying educational principles when designing neonatal teaching sessions (Sandars et al., Med Teach 37(11):1039–42, 2015) Simulation technology is a tool to enable us to deliver effective learning and it is important to choose the ‘right tool for the job.’ It is unnecessary to use the latest high-fidelity mannequin to simulate breaking bad news to a parent. A good way to approach a session is to ask—‘what are the learning objectives?’ and ‘is this the best teaching method to achieve those objectives?’
Article
Aim This study assessed the impact of a scripted, post‐event debriefing tool in identifying logistical, procedural, personnel and performance obstacles and successes in a clinical setting. It was predicted that the debriefing tool would highlight the importance of routine debriefing following challenging clinical events. Methods The study was conducted in a 22‐bed neonatal intensive care unit at a tertiary hospital and involved all staff members in the perinatal service. The debriefing tool, a two‐page form providing a structured, scripted approach, was used at the earliest opportunity after acute clinical deteriorations, emergency caesarean sections and any other critical events as decided by the neonatal team. Sessions were facilitated by either a nursing or medical member of the neonatal team. Following a 2‐month trial, impact was measured via the comparison of before and after survey questions as well as review of a database of issues raised, subsequent actions and outcomes. Results Significant, positive changes were observed for survey questions specific to the frequency of debriefing, team communication, provision of learning opportunities and identification of logistical, equipment and procedural issues. In addition, the database highlighted the significant positive impact in day‐to‐day practice as a result of changes initiated by the debriefing tool. All participants requested the unit to continue using the tool. Conclusion Scripted, post‐event debriefing is achievable and valuable in the clinical setting. It encourages a supportive workplace culture and empowers team members to initiate practical change in their organisations.
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Background Debriefing is a significant component of simulation-based education (SBE). Regardless of how and where immersive simulation is used to support learning, debriefing has a critical role to optimise learning outcomes. Although the literature describes different debriefing methods and approaches that constitute effective debriefing, there are discrepancies as to what is actually practised and how experts or experienced debriefers perceive and approach debriefing. This study sought to explore the self-reported practices of expert debriefers. Methods We used a qualitative approach to explore experts’ debriefing practices. Peer-nominated expert debriefers who use immersive manikin-based simulations were identified in the healthcare simulation community across Australia. Twenty-four expert debriefers were purposively sampled to participate in semi-structured telephone interviews lasting 45–90 min. Interviews were transcribed and independently analysed using inductive thematic analysis. ResultsCodes emerging through the data analysis clustered into four major categories: (1) Values: ideas and beliefs representing the fundamental principles that underpinned interviewees’ debriefing practices. (2) Artistry: debriefing practices which are dynamic and creative. (3) Techniques: the specific methods used by interviewees to promote a productive and safe learning environment. (4) Development: changes in interviewees’ debriefing practices over time. Conclusions The “practice development triangle” inspired by the work of Handal and Lauvas offers a framework for our themes. A feature of the triangle is that the values of expert debriefers provide a foundation for associated artistry and techniques. This framework may provide a different emphasis for courses and programmes designed to support debriefing practices where microskill development is often privileged, especially those microskills associated with techniques (plan of action, creating a safe environment, managing learning objectives, promoting learner reflection and co-debriefing). Across the levels in the practice development triangle, the importance of continuing professional development is acknowledged. Strengths and limitations of the study are noted.
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Psychological safety plays a vital role in helping people overcome barriers to learning and change in interpersonally challenging work environments. This article focuses on two such contexts—health care and education. The authors theorize differences in psychological safety based on work type, hierarchical status, and leadership effectiveness. Consistent with prior research, the authors employ cross-industry comparison to highlight distinctive features of different professions. The goal is to illuminate similarities and differences with implications for future psychological safety research. To do this, the authors review relevant literature and present analyses of large data samples in each industry to stimulate further research on psychological safety in both sectors, separately and together.
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Statement: Better debriefing practices may enhance the impact of simulation-based education. Emerging literature suggests that learner-centered debriefing may be effective in helping instructors identify and address learner needs while building learner's engagement and sense of responsibility for learning. This contrasts with instructor-centered approaches to debriefing, where instructors maintain unilateral control over both the process and content of the debriefing, thus limiting input and direction from learners. Although different approaches to debriefing for simulation-based education exist, the simulation literature is largely mute on the topic of learner-centered debriefing. In this article we will (1) compare and contrast learner- versus instructor-centered approaches to teaching; (2) provide a rationale for applying more learner-centered approaches to debriefing; (3) introduce a conceptual framework that highlights the key dimensions of learner- versus instructor-centered debriefing; (4) describe key variables to consider when managing the balance between learner- and instructor-centered debriefing; and (5) describe practical learner-centered strategies for various phases of debriefing.
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Introduction: The guidelines offered in this paper aim to amalgamate the literature on formative feedback into practical Do's, Don'ts and Don't Knows for individual clinical supervisors and for the institutions that support clinical learning. Methods: The authors built consensus by an iterative process. Do's and Don'ts were proposed based on authors' individual teaching experience and awareness of the literature, and the amalgamated set of guidelines were then refined by all authors and the evidence was summarized for each guideline. Don't Knows were identified as being important questions to this international group of educators which if answered would change practice. The criteria for inclusion of evidence for these guidelines were not those of a systematic review, so indicators of strength of these recommendations were developed which combine the evidence with the authors' consensus. Results: A set of 32 Do and Don't guidelines with the important Don't Knows was compiled along with a summary of the evidence for each. These are divided into guidelines for the individual clinical supervisor giving feedback to their trainee (recommendations about both the process and the content of feedback) and guidelines for the learning culture (what elements of learning culture support the exchange of meaningful feedback, and what elements constrain it?) CONCLUSION: Feedback is not easy to get right, but it is essential to learning in medicine, and there is a wealth of evidence supporting the Do's and warning against the Don'ts. Further research into the critical Don't Knows of feedback is required. A new definition is offered: Helpful feedback is a supportive conversation that clarifies the trainee's awareness of their developing competencies, enhances their self-efficacy for making progress, challenges them to set objectives for improvement, and facilitates their development of strategies to enable that improvement to occur.
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Psychological safety describes people's perceptions of the consequences of taking interpersonal risks in a particular context such as a workplace. First explored by pioneering organizational scholars in the 1960s, psychological safety experienced a renaissance starting in the 1990s and continuing to the present. Organizational research has identified psychological safety as a critical factor in understanding phenomena such as voice, teamwork, team learning, and organizational learning. A growing body of conceptual and empirical work has focused on understanding the nature of psychological safety, identifying factors that contribute to it, and examining its implications for individuals, teams, and organizations. In this article, we review and integrate this literature and suggest directions for future research. We first briefly review the early history of psychological safety research and then examine contemporary research at the individual, group, and organizational levels of analysis. We assess what has been learned and discuss suggestions for future theoretical development and methodological approaches for organizational behavior research on this important interpersonal construct.
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Teamwork is a vital component of optimal patient care. In both clinical settings and medical education, a variety of approaches are used for the development of teamwork skills. Yet, for team members to receive the full educational benefit of these experiential learning opportunities, postsimulation feedback regarding the team's performance must be incorporated. Debriefings are among the most widely used form of feedback regarding team performance. A team debriefing is a facilitated or guided dialogue that takes place between team members following an action period to review and reflect on team performance. Team members discuss their perceptions of what occurred, why it occurred, and how they can enhance their performance. Simulation debriefing allows for greater control and planning than are logistically feasible for on-the-job performance. It is also unique in that facilitators of simulation-based training are generally individuals external to the team, whereas debriefing on the job is commonly led by an internal team member or conducted without a specified facilitator. Consequently, there is greater opportunity for selecting and training facilitators for team simulation events. Thirteen Best Practices: The 13 best practices, extracted from existing training and debriefing research, are organized under three general categories: (1) preparing for debriefing, (2) facilitator responsibilities during debriefing, and (3) considerations for debriefing content. For each best practice, considerations and practical implications are provided to facilitate the implementation of the recommended practices. The 13 best practices presented in this article should help health care organizations by guiding team simulation administrators, self-directed medical teams, and debriefing facilitators in the optimization of debriefing to support learning for all team members.
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Objectives: The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. Methods: A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported. Results: Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. Conclusion: PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.
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This paper presents a model of team learning and tests it in a multimethod field study. It introduces the construct of team psychological safety—a shared belief held by members of a team that the team is safe for interpersonal risk taking—and models the effects of team psychological safety and team efficacy together on learning and performance in organizational work teams. Results of a study of 51 work teams in a manufacturing company, measuring antecedent, process, and outcome variables, show that team psychological safety is associated with learning behavior, but team efficacy is not, when controlling for team psychological safety. As predicted, learning behavior mediates between team psychological safety and team performance. The results support an integrative perspective in which both team structures, such as context support and team leader coaching, and shared beliefs shape team outcomes.
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Coaching in emergency medicine - Volume 12 Issue 6 - Constance LeBlanc, Jonathan Sherbino
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Describing what simulation centre leaders see as the ideal debriefing for different simulator courses (medical vs. crisis resource management (CRM)-oriented). Describing the practice of debriefing based on interactions between instructors and training participants. Study 1 - Electronic questionnaire on the relevance of different roles of the medical teacher for debriefing (facilitator, role model, information provider, assessor, planner, resource developer) sent to simulation centre leaders. Study 2 - Observation study using a paper-and-pencil tool to code interactions during debriefings in simulation courses for CRM for content (medical vs. CRM-oriented) and type (question vs. utterance). Study 1 - The different roles were seen as equally important for both course types with the exception of 'information provider' which was seen as more relevant for medical courses. Study 2 - There were different interaction patterns during debriefings: line - involving mostly the instructor and one course participant, triangle - instructor and two participants, fan - instructor and all participants in a dyadic form and net - all participants and the instructor with cross references. What simulation centre heads think is important for the role mix of simulation instructors is (at least partly) not reflected in debriefing practice.
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This manual is a practical guide to help airline instructors effectively facilitate debriefings of Line Oriented Simulations (LOS). It is based on a recently completed study of Line Oriented Flight Training (LOFT) debriefings at several U.S. airlines. This manual presents specific facilitation tools instructors can use to achieve debriefing objectives. The approach of the manual is to be flexible so it can be tailored to the individual needs of each airline. Part One clarifies the purpose and objectives of facilitation in the LOS setting. Part Two provides recommendations for clarifying roles and expectations and presents a model for organizing discussion. Part Tree suggests techniques for eliciting active crew participation and in-depth analysis and evaluation. Finally, in Part Four, these techniques are organized according to the facilitation model. Examples of how to effectively use the techniques are provided throughout, including strategies to try when the debriefing objectives are not being fully achieved.
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Statement: Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. Debriefing occurs either after (postevent) or during (within-event) the simulation. The debriefing conversation can be guided by either a facilitator (facilitator-guided) or the simulation participants themselves (self-guided). Postevent facilitator-guided debriefing may incorporate several conversational structures. These conversational structures break the debriefing discussion into a series of 3 or more phases to help organize the debriefing and ensure the conversation proceeds in an orderly manner. Debriefing process elements are an array of techniques to optimize reflective experience and maximize the impact of debriefing. These are divided here into the following 3 categories: essential elements, conversational techniques/educational strategies, and debriefing adjuncts. This review provides both novice and advanced simulation educators with an overview of various methods of conducting healthcare simulation debriefing. Future research will investigate which debriefing methods are best for which contexts and for whom, and also explore how lessons from simulation debriefing translate to debriefing in clinical practice.
Chapter
This chapter highlights the essential role of discourse in learning and the development of physicians’ professional identity. Shared understanding and co-construction of clinical experiences—and learning—are mediated through talk. We argue how contemporary continuing professional development focuses on knowledge acquisition that is divorced from authentic clinical practice. We provide examples of structures that strengthen collective learning processes and steer the discourse of practice in ways that promote learning. Patient focused-quality improvement projects and simulations aligned to workplace needs could meet the requirement for continuous professional development to be both measurable and linked to authentic practice. Future work could usefully further explore how steering the talk of practice can promote learning.
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Post-event debriefings are a foundational behavior of high performing teams. Despite the inherent value of post-event debriefings, the frequency with which they are used in neonatal care is extremely low. If post-event debriefings are so beneficial, why aren't they conducted more frequently? The reasons are many, but solutions are available. In this report, we provide practical advice on conducting post-event debriefing in neonatal care. In addition, we examine the perceived barriers to conducting post-event debriefings, and offer strategies to overcome them. Finally, we consider opportunities to foster a culture change within neonatal care which integrates debriefing as standard daily work. By establishing a safety culture in neonatal care that encourages and facilitates effective post-event debriefings, patient safety can be enhanced and clinical outcomes can be improved.Journal of Perinatology advance online publication, 31 March 2016; doi:10.1038/jp.2016.42.
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Mastery learning is a powerful educational strategy in which learners gain knowledge and skills that are rigorously measured against predetermined mastery standards with different learners needing variable time to reach uniform outcomes. Central to mastery learning are repetitive deliberate practice and robust feedback that promote performance improvement. Traditional health care simulation involves a simulation exercise followed by a facilitated postevent debriefing in which learners discuss what went well and what they should do differently next time, usually without additional opportunities to apply the specific new knowledge. Mastery learning approaches enable learners to "try again" until they master the skill in question. Despite the growing body of health care simulation literature documenting the efficacy of mastery learning models, to date insufficient details have been reported on how to design and implement the feedback and debriefing components of deliberate-practice-based educational interventions. Using simulation-based training for adult and pediatric advanced life support as case studies, this article focuses on how to prepare learners for feedback and debriefing by establishing a supportive yet challenging learning environment; how to implement educational interventions that maximize opportunities for deliberate practice with feedback and reflection during debriefing; describing the role of within-event debriefing or "microdebriefing" (i.e., during a pause in the simulation scenario or during ongoing case management without interruption), as a strategy to promote performance improvement; and highlighting directions for future research in feedback and debriefing for mastery learning.
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To develop and conduct feasibility testing of an evidence-based and theory-informed model for facilitating performance feedback for physicians so as to enhance their acceptance and use of the feedback. To develop the feedback model (2011-2013), the authors drew on earlier research which highlights not only the factors that influence giving, receiving, accepting, and using feedback but also the theoretical perspectives which enable the understanding of these influences. The authors undertook an iterative, multistage, qualitative study guided by two recognized research frameworks: the UK Medical Research Council guidelines for studying complex interventions and realist evaluation. Using these frameworks, they conducted the research in four stages: (1) modeling, (2) facilitator preparation, (3) model feasibility testing, and (4) model refinement. They analyzed data, using content and thematic analysis, and used the findings from each stage to inform the subsequent stage. Findings support the facilitated feedback model, its four phases-build relationship, explore reactions, explore content, coach for performance change (R2C2)-and the theoretical perspectives informing them. The findings contribute to understanding elements that enhance recipients' engagement with, acceptance of, and productive use of feedback. Facilitators reported that the model made sense and the phases generally flowed logically. Recipients reported that the feedback process was helpful and that they appreciated the reflection stimulated by the model and the coaching. The theory- and evidence-based reflective R2C2 Facilitated Feedback Model appears stable and helpful for physicians in facilitating their reflection on and use of formal performance assessment feedback.
Article
Feedback has long been recognized as the “cornerstone of effective clinical teaching.”1 Recently, we have seen emphasis shift from an instructor-centric paradigm to a learner-centric model that aims to understand how learners seek, receive, and incorporate feedback. These are crucial first steps in improving feedback effectiveness. Rather than continuing to focus on feedback delivery methods, recent publications highlight the importance of the learner's perspective in the feedback conversation through nurturing the skill of “reflection-in-action” and promoting a culture of “informed self-assessment.”2,3 This paradigm shift represents a welcome change, as a focus on learner-dependent variables better aligns with what really matters in the feedback conversation—improving learner performance. To ultimately improve performance, we must better understand what causes the feedback magic to occur: Which conditions of the learning environment spark recipient engagement, reflection, and motivation to change behavior?4
Article
Statement: Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing be used to improve debriefing quality within programs? (5) How can we individualize debriefing training opportunities to the learning needs of our educators?
Article
Objectives The objective of this study was to evaluate the effectiveness of high versus low fidelity manikins in the context of advanced life support training for improving knowledge, skill performance at course conclusion, skill performance between course conclusion and one year, skill performance at one year, skill performance in actual resuscitations, and patient outcomes. Methods A systematic search of Pubmed, Embase and Cochrane databases was conducted through Jan 31, 2014. We included two-group non-randomized and randomized studies in any language comparing high vs. low fidelity manikins for advanced life support training. Reviewers worked in duplicate to extract data on learners, study design, and outcomes. The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the overall quality of evidence for each outcome. Results 3840 papers were identified from the literature search of which 14 were included (13 randomized controlled trials; 1 non-randomized controlled trial). Meta-analysis of studies reporting skill performance at course conclusion demonstrated a moderate benefit for high fidelity manikins when compared with low fidelity manikins [Standardized Mean Difference 0.59; 95% CI 0.13 to 1.05]. Studies measuring skill performance at one year, skill performance between course conclusion and one year, and knowledge demonstrated no significant benefit for high fidelity manikins. Conclusion The use of high fidelity manikins for advanced life support training is associated with moderate benefits for improving skills performance at course conclusion. Future research should define the optimal means of tailoring fidelity to enhance short and long term educational goals and clinical outcomes.
Statement: We describe an integrated conceptual framework for a blended approach to debriefing called PEARLS [Promoting Excellence And Reflective Learning in Simulation]. We provide a rationale for scripted debriefing and introduce a PEARLS debriefing tool designed to facilitate implementation of the new framework. The PEARLS framework integrates 3 common educational strategies used during debriefing, namely, (1) learner self-assessment, (2) facilitating focused discussion, and (3) providing information in the form of directive feedback and/or teaching. The PEARLS debriefing tool incorporates scripted language to guide the debriefing, depending on the strategy chosen. The PEARLS framework and debriefing script fill a need for many health care educators learning to facilitate debriefings in simulation-based education. The PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration.
Article
In the busy clinical environment, clinicians often struggle to turn clinical events into learning opportuni-ties. Educational methods in this setting should work within the time constraints of duty work hour restric-tions, be tailored to the relevant educational needs of adult learners, and engage interprofessional partners whenever possible. These teaching moments should ad-dress the Accreditation Council for Graduate Medical Education (ACGME) core competencies and provide the educator with bidirectional learning opportunities as well. Seizing the educational potential of clinical events can be challenging for clinician-educators. Postevent de-briefing is an underused educational mode that satis-fies all of these goals. Benefits of Debriefing Why should clinician-educators strive to include more debriefing in the clinical environment and how does postevent debriefing address the core competencies? Debriefing is a discussion of actions and thought pro-cesses after an event to promote reflective learning and improved clinical performance. When applied to Kolb's theory of experiential learning, the clinical encounter represents the "concrete experience," whereas debriefing encompasses the next 2 steps: "reflective observation," in which the educator reviews and reflects on the previous experience, and "abstract conceptualization," in which the learner identifies new concepts to apply to future practice. Debriefing after simulated clinical experiences and procedural skills is an effective educational strategy.
Article
One vital aspect of emergency medicine management is communication after episodes of care to improve future performance through group reflection on the shared experience. This reflective activity in teams is known as debriefing, and despite supportive evidence highlighting its benefits, many practitioners experience barriers to implementing debriefing in the clinical setting. The aim of this article is to review the current evidence supporting post-event debriefing and discuss practical approaches to implementing debriefing in the emergency department. We will address the “who, what, when, where, why and how” of debriefing and provide a practical guide for the clinician to facilitate debriefing in the clinical environment.
Article
Background: Medical resuscitations of critically ill children in the emergency department are stressful events requiring a coordinated team effort. Current guidelines recommend debriefing after such events to improve future performance. Debriefing practices within pediatric emergency departments by pediatric emergency medicine (PEM) fellows in the United States has not been studied. Objective: The aim of this study was to describe the current debriefing experience of PEM fellows in the United States. Methods: A 10-item, anonymous questionnaire regarding debriefing characteristics was distributed to fellows in US Accreditation Council for Graduate Medical Education-accredited PEM programs via e-mail and paper format from December 2011 to March 2012. Results were summarized using descriptive statistics. Results: Of 393 eligible PEM fellows, 201 (51.1%) completed the survey. The 201 respondents included 82 first-year fellows (40.8%), 71 second-year fellows (35.3%), and 48 third-year fellows (23.9%). Ninety-nine percent had participated in medical resuscitations during their fellowship training, yet 88.0% reported no formal teaching on how to debrief. There was wide variability in the format and timing of debriefings. The majority of debriefings were led by PEM attending physicians (65.5%) and PEM fellows (19.6%). Most (91.5%) of the fellows indicated they would like further education about debriefing. Conclusions: The majority of PEM fellows do not receive formal training on how to debrief after a critical event and may have limited experience in leading debriefings. Debriefing training should be considered part of the educational curriculum during PEM fellowship.
Article
In the absence of theoretical or empirical agreement on how to establish and maintain engagement in instructor-led health care simulation debriefings, we organize a set of promising practices we have identified in closely related fields and our own work. We argue that certain practices create a psychologically safe context for learning, a so-called safe container. Establishing a safe container, in turn, allows learners to engage actively in simulation plus debriefings despite possible disruptions to that engagement such as unrealistic aspects of the simulation, potential threats to their professional identity, or frank discussion of mistakes. Establishing a psychologically safe context includes the practices of (1) clarifying expectations, (2) establishing a "fiction contract" with participants, (3) attending to logistic details, and (4) declaring and enacting a commitment to respecting learners and concern for their psychological safety. As instructors collaborate with learners to perform these practices, consistency between what instructors say and do may also impact learners' engagement.
Article
Objectives: Debriefing is a common feature of technology-enhanced simulation (TES) education. However, evidence for its effectiveness remains unclear. We sought to characterise how debriefing is reported in the TES literature, identify debriefing features that are associated with improved outcomes, and evaluate the effectiveness of debriefing when combined with TES. Methods: We systematically searched databases, including MEDLINE, EMBASE and Scopus, and reviewed previous bibliographies for original comparative studies investigating the use of TES with debriefing in training health care providers. Reviewers, in duplicate, evaluated study quality and abstracted information on instructional design, debriefing and outcomes. Effect sizes (ES) were pooled using random-effects meta-analysis. Results: From 10 903 potentially eligible studies, we identified 177 studies (11 511 learners) that employed debriefing as part of TES. Key characteristics of debriefing (e.g. duration, educator presence and characteristics, content, structure/method, timing, use of video) were usually incompletely reported. A meta-analysis of four studies demonstrated that video-assisted debriefing has negligible and non-significant effects for time skills (ES = 0.10) compared with non-video-assisted debriefing. Meta-analysis demonstrated non-significant effects in favour of expert modelling with short debriefing in comparison with long debriefing (ES range = 0.21-0.74). Among studies comparing terminal with concurrent debriefing, results were variable depending on outcome measures and the context of training (e.g. medical resuscitation versus technical skills). Eight additional studies revealed insight into the roles of other debriefing-related factors (e.g. multimedia debriefing, learner-led debriefing, debriefing duration, content of debriefing). Among studies that compared simulation plus debriefing with no intervention, pooled ESs were favourable for all outcomes (ES range = 0.28-2.16). Conclusions: Limited evidence suggests that video-assisted debriefing yields outcomes similar to those of non-video-assisted debriefing. Other debriefing design features show mixed or non-significant results. As debriefing characteristics are usually incompletely reported, future debriefing research should describe all the key debriefing characteristics along with their associated descriptors.
Article
Importance Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. Objective To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. Design Prospective, randomized, factorial study design. Setting The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. Participants We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. Intervention Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Main Outcomes and Measures Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). Results There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. Conclusions and Relevance The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.
Article
Pediatrics has embraced technology-enhanced simulation (TES) as an educational modality, but its effectiveness for pediatric education remains unclear. The objective of this study was to describe the characteristics and evaluate the effectiveness of TES for pediatric education. This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. A systematic search of Medline, Embase, CINAHL, ERIC, Web of Science, Scopus, key journals, and previous review bibliographies through May 2011 and an updated Medline search through October 2013 were conducted. Original research articles in any language evaluating the use of TES for educating health care providers at any stage, where the content solely focuses on patients 18 years or younger, were selected. Reviewers working in duplicate abstracted information on learners, clinical topic, instructional design, study quality, and outcomes. We coded skills (simulated setting) separately for time and nontime measures and similarly classified patient care behaviors and patient effects. We identified 57 studies (3666 learners) using TES to teach pediatrics. Effect sizes (ESs) were pooled by using a random-effects model. Among studies comparing TES with no intervention, pooled ESs were large for outcomes of knowledge, nontime skills (eg, performance in simulated setting), behaviors with patients, and time to task completion (ES = 0.80-1.91). Studies comparing the use of high versus low physical realism simulators showed small to moderate effects favoring high physical realism (ES = 0.31-0.70). TES for pediatric education is associated with large ESs in comparison with no intervention. Future research should include comparative studies that identify optimal instructional methods and incorporate pediatric-specific issues into educational interventions.
Article
In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events. Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU. Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers. Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed "excellent cardiopulmonary resuscitation," prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91-6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01-7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9-10.6; p < 0.01). Implementation of an interdisciplinary, postevent quantitative debriefing program was significantly associated with improved cardiopulmonary resuscitation quality and survival with favorable neurologic outcome.
Article
Introduction Previous studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e. “Milestones”. We developed a simulation-based teaching approach “Rapid Cycle Deliberate Practice” (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e. “first-five minutes” (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to “try again” over lengthy debriefing. Participants: Pediatric residents from an academic medical center. Methods Prospective pre-post interventional study of residents managing a simulated cardiopulmonary arrest. Main outcome measures include: (1) interval between onset of pulseless ventricular tachycardia to initiation of compressions and (2) defibrillation. Results Seventy pediatric residents participated in the pre-intervention and fifty-one in the post-intervention period. Baseline characteristics were similar. The RCDP-FFM intervention was associated with a decrease in: no-flow fraction: [pre:74% (5%-100%) vs. post:34% (26%-53%); p < 0.001)], no-blow fraction: [pre:39% (22%-64%) median (IQR) vs. post:30% (22%-41%); p = 0.01], and pre-shock pause: [pre:84 sec (26-162) vs. post:8 sec (4-18); p < 0.001]. Survival analysis revealed RCDP-FFM was associated with starting compressions within one minute of loss of pulse: [Adjusted Hazard Ratio (HR): 3.8(95% CI: 2.0–7.2)] and defibrillating within 2 minutes: [HR: 1.7(95% CI: 1.03-2.65)]. Third year residents were significantly more likely than first years to defibrillate within 2 minutes: [HR: 2.8(95% CI: 1.5-5.1)]. Conclusions Implementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency.
Article
The rapidly evolving medical education landscape requires restructuring the approach to teaching and learning across the continuum of medical education. The deliberate practice strategies used to coach learners in disciplines beyond medicine can also be used to train medical learners. However, these deliberate practice strategies are not explicitly taught in most medical schools or residencies. The authors designed the Doctor Coach framework and competencies in 2007-2008 to serve as the foundation for new faculty development and resident-as-teacher programs. In addition to teaching deliberate practice strategies, the programs model a deliberate practice approach that promotes the continuous integration of newly developed coaching competencies by participants into their daily teaching practice. Early evaluation demonstrated the feasibility and efficacy of implementing the Doctor Coach framework across the continuum of medical education. Additionally, the Doctor Coach framework has been disseminated through national workshops, which have resulted in additional institutions applying the framework and competencies to develop their own coaching programs. Design of a multisource evaluation tool based on the coaching competencies will enable more rigorous study of the Doctor Coach framework and training programs and provide a richer feedback mechanism for participants. The framework will also facilitate the faculty development needed to implement the milestones and entrustable professional activities in medical education.
Article
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.
Article
Objective: To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on team performance during a simulated crisis. Background: Although instructor-led simulation debriefing is considered the "gold standard" in team-based simulation education, cost and logistics are limiting factors for its implementation. Within-team debriefing, led by the individuals of the team itself rather than an external instructor, has the potential to address these limitations. Methods: One hundred twenty subjects were grouped into 40 operating room teams consisting of 1 anesthesia trainee, 1 surgical trainee, and 1 staff circulating operating room nurse. All teams managed a simulated crisis scenario (pretest). Teams were then randomized to either a within-team debriefing group or an instructor-led debriefing group. In the within-team debriefing group, the teams reviewed the video of their scenario by themselves. The teams in the instructor-led debriefing group reviewed their scenario guided by a trained instructor. Immediately after debriefing, all teams managed a different intraoperative crisis scenario (posttest). All sessions were videotaped. Blinded expert examiners used the validated Team Emergency Assessment Measure scale to assess crisis resource management performance of all teams in random order. Result: Team performance significantly improved from pretest to posttest (P = 0.008) regardless of the type of debriefing. There was no significant difference in the degree of improvement between within-team debriefing and instructor-led debriefing (P = 0.52). Conclusions: Within-team debriefing results in measurable improvements in team performance in simulated crisis scenarios. This form of debriefing may be as effective as instructor-led team debriefing, which could improve resource utilization and feasibility of team-based simulation (NCT01067378).
Article
BACKGROUND: Improving patient safety by training teams to successfully manage emergencies is a major concern in healthcare. Most current trainings use simulation of emergency situations to practice and reflect on relevant clinical and behavioural skills. We developed TeamGAINS, a hybrid, structured debriefing tool for simulation-based team trainings in healthcare that integrates three different debriefing approaches: guided team self-correction, advocacy-inquiry and systemic-constructivist techniques. METHODS: TeamGAINS was administered during simulation-based trainings for clinical and behavioural skills for anaesthesia staff. One of the four daily scenarios involved all trainees, whereas the remaining three scenarios each involved only two trainees with the others observing them. Training instructors were senior anaesthesiologists and psychologists. To determine debriefing quality, we used a post-test-only (debriefing quality) and a pre-post-test (psychological safety, leader inclusiveness), no-control-group design. After each debriefing all trainees completed a self-report debriefing quality scale which we developed based on the Debriefing Assessment for Simulation in Healthcare and the Observational Structured Assessment of Debriefing. Perceived psychological safety and leader inclusiveness were measured before trainees' first (premeasure) and after their last debriefing (postmeasure) at which time trainees' reactions to the overall training were measured as well. RESULTS: Four senior anaesthetists, 29 residents and 28 nurses participated in a total of 40 debriefings resulting in 235 evaluations. Utility of debriefings was evaluated as highly positive. Pre-post comparisons revealed that psychological safety and leader inclusiveness significantly increased after the debriefings. CONCLUSIONS: The results indicate that TeamGAINS could provide a useful debriefing tool for training anaesthesia staff on all levels of work experience. By combining state-of-the-art debriefing methods and integrating systemic-constructivist techniques, TeamGAINS has the potential to allow for a surfacing, reflecting on and changing of the dynamics of team interactions. Further research is necessary to systematically compare the effects of TeamGAINS' components on the debriefing itself and on trainees' changes in attitudes and behaviours.
Article
Debriefs (or "after-action reviews") are increasingly used in training and work environments as a means of learning from experience. We sought to unify a fragmented literature and assess the efficacy of debriefs with a quantitative review. Used by the U.S. Army to improve performance for decades, and increasingly in medical, aviation, and other communities, debriefs systematize reflection, discussion, and goal setting to promote experiential learning. Unfortunately, research and theory on debriefing has been spread across diverse disciplines, so it has been difficult to definitively ascertain debriefing effectiveness and how to enhance its effectiveness. We conducted an extensive quantitative meta-analysis across a diverse body of published and unpublished research on team- and individual-level debriefs. Findings from 46 samples (N = 2,136) indicate that on average, debriefs improve effectiveness over a control group by approximately 25% (d = .67). Average effect sizes were similar for teams and individuals, across simulated and real settings, for within- or between-group control designs, and for medical and nonmedical samples. Meta-analytic methods revealed a bolstering effect of alignment and the potential impact of facilitation and structure. Organizations can improve individual and team performance by approximately 20% to 25% by using properly conducted debriefs. Debriefs are a relatively inexpensive and quick intervention for enhancing performance. Our results lend support for continued and expanded use of debriefing in training and in situ. To gain maximum results, it is important to ensure alignment between participants, focus and intent, and level of measurement.
Article
Objectives: To explore the current status of performance feedback (debriefing) in the operating room and to develop and evaluate an evidence-based, user-informed intervention termed "SHARP" to improve debriefing in surgery. Background: Effective debriefing is a key educational technique for optimizing learning in surgical settings. However, there is a lack of a debriefing culture within surgery. Few studies have prospectively evaluated educational interventions to improve the quality and quantity of performance feedback in surgery. Methods: This was a prospective pre- and post-study of 100 cases involving 22 trainers (attendings) and 30 surgical residents (postgraduate years 3-8). A trained researcher assessed the quality of debriefings provided to the trainee using the validated Objective Structured Assessment of Debriefing (OSAD) tool alongside ethnographic observation. Following the first 50 cases, an educational intervention termed "SHARP" was introduced and measures repeated for a further 50 cases. User satisfaction with SHARP was assessed via questionnaire. Twenty percent of the cases were observed independently by a second researcher to test interrater reliability. Results: Interrater reliability for OSAD was excellent (ICC = 0.994). Objective scores of debriefing (OSAD) improved significantly after the SHARP intervention: median pre = 19 (range, 8-31); median post = 33 (range, 26-40), P < 0.001. Strong correlations between observer (OSAD) and trainee rating of debriefing were obtained (median ρ = 0.566, P < 0.01). Ethnographic observations also supported a significant improvement in both quality and style of debriefings. Users reported high levels of satisfaction in terms of usefulness, feasibility, and comprehensiveness of the SHARP tool. Conclusions: SHARP is an effective and efficient means of improving performance feedback in the operating room. Its routine use should be promoted to optimize workplace-based learning and foster a positive culture of debriefing and performance improvement within surgery.
Article
In the new work order, more and more work is talk, and much of the new kinds of textual or discourse work that employees, including production line workers, are undertaking, is enacted during team meetings. Learning to be a team member involves learning to talk. This paper presents ethnographic and discourse data from a large, Australian manufacturing workplace to argue that central to the participatory practices of working in teams is the development of discursive networks of participation, constructed to elicit “bottom up” engagement with work-related problems and issues, and produce offers of worker involvement, rather than relying on more traditional, “top down” management commands and control of workplace knowledge. In the case presented here, the team members are production line workers from different areas of the workplace and thus they hold, and (can) contribute, different kinds of knowledge to the team meetings. The developing discourses of offers and suggestions for improvements can be seen as producing self-regulating (organisational) workers.
Article
Aim: Multiple guidelines recommend debriefing of resuscitations to improve clinical performance. We implemented a novel standardized debriefing program using a Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) tool. Methods: Following the development of the evidence-based DISCERN tool, we conducted an observational study of all resuscitations (intubation, CPR, and/or defibrillation) at a pediatric emergency department (ED) over one year. Resuscitation interventions, patient survival, and physician team leader characteristics were analyzed as predictors for debriefing. Each debriefing's participants, time duration, and content were recorded. Thematic content of debriefings was categorized by framework approach into Team Emergency Assessment Measure (TEAM) elements. Results: There were 241 resuscitations and 63 (26%) debriefings. A higher proportion of debriefings occurred after CPR (p<0.001) or ED death (p<0.001). Debriefing participants always included an attending and nurse; the median number of staff roles present was six. Median intervals (from resuscitation end to start of debriefing) & debriefing durations were 33 (IQR 15, 67) and 10 min (IQR 5, 12), respectively. Common TEAM themes included co-operation/coordination (30%), communication (22%), and situational awareness (15%). Stated reasons for not debriefing included: unnecessary (78%), time constraints (19%), or other reasons (3%). Conclusions: Debriefings with the DISCERN tool usually involved higher acuity resuscitations, involved most of the indicated personnel, and lasted less than 10 min. Future studies are needed to evaluate the tool for adaptation to other settings and potential impacts on education, quality improvement programming, and staff emotional well-being.