Comparison of Simulation Debriefing Methods

Leadership Lingo: Developing a Shared Language of Leadership Behaviors to Enrich Debriefing Conversations

INTRODUCTION

Leadership in medical emergencies is variable and frequently suboptimal, contributing to poor patient care and outcomes. Simulation training can improve leadership in both simulated practice and real clinical emergencies. Thoughtful debriefing is essential. However, unclear language around leadership limits facilitators' capacity for transformative reflective discussion.

METHODS

Internal medicine trainees participated in simulated medical emergency scenarios. Video recordings of consenting participants were analyzed using template analysis. A priori codes from existing literature formed an initial coding template. This was modified with inductive codes from the observed behaviors to develop a taxonomy of leadership behaviors in simulated medical emergencies. The taxonomy was then transformed into an infographic, to be used as a leadership debriefing tool.

RESULTS

The taxonomy of leadership behaviors consisted of the following 4 themes: Structuring, Decision making, Supporting, and Communicating. Structuring behaviors shaped the team, ensuring that the right people were in the right place at the right time. Decision-making behaviors steered the team, setting a direction and course of action. Communicating behaviors connected the team, sharing valuable information. Supporting behaviors nurtured the team, guiding team members to perform at their optimum level.

CONCLUSIONS

Debriefing-as-imagined is not always debriefing-as-done. A shared language of leadership can connect educators and learners, advancing critical debriefing conversations and enabling facilitators to drive meaningful reflective discussion. The use of infographics in simulation offers an opportunity to support educators in facilitating complex debriefing conversations.

The evaluation of video-assisted debriefing for improving performance in simulated medical student resuscitations

Objectives

Simulation-based training is commonly used in medical education. However, there is a gap in knowledge regarding best practices in debriefing. We aimed to identify novel solutions to this by adapting video-assisted debriefing (VAD) methodologies used in athletic training. We hypothesized that utilizing VAD would lead to improvements in performance during advanced cardiac life support (ACLS)-based simulations compared to traditional verbal debriefing (VD).

Methods

The study was conducted at a single medical school. Participants were fourth-year medical students engaging in ACLS simulation-based training as part of their emergency medicine rotation. After completing an ACLS-based simulation, participants received either VD or VAD and then completed a second simulation scenario. Our primary outcome was ACLS performance, graded by blinded reviewers utilizing a previously developed modified checklist. Secondary outcomes included time from cardiac arrest to initiation of cardiopulmonary resuscitation (CPR) and first defibrillation. Measurements were made before and after the interventional debrief, referred to as pre- and postdebrief. A modified Likert-scale survey was used to subjectively assess the student's overall experience.

Results

Forty-six groups of 275 students were included in the study. Mean ACLS performance score for VD and VAD postdebrief were 85% and 82%, respectively (p = 0.27). Mean time from arrest to CPR initiation for VD and VAD postdebrief groups were 20 and 24 s, respectively (p = 0.46). Mean time from arrest to defibrillation for VD and VAD postdebrief groups were 50 and 59 s, respectively (p = 0.39). For the Likert surveys, 85% or more of participants in both groups indicated that the session was "very helpful" in all survey categories.

Conclusions

VD and VAD both led to improvements in ACLS performance, time to initiation of CPR, and defibrillation among fourth-year medical students. Though postdebrief results were not statistically significantly different by comparison, overall VD led to greater improvement overall across all outcomes.

[Developing ISP skills: the challenge facing the Sdis medical training department]

Teaching can be taught! In order to develop and maintain the skills of its caregivers, the Departemental Fire and Rescue Service 77 Health Sub-Directorate is engaged in an innovative pedagogical dynamic, combining a real engineering of its training programs in compliance with the principles of active pedagogy, full and regular training of its teaching teams.

Development and evaluation of case video-based debriefing on a simulation of high-risk neonatal care for nursing students in South Korea: a mixed-methods study

BACKGROUND

The debriefing process after health care simulations should provide a psychologically safe learning environment for nursing students. Case video-based debriefing on a simulation of high-risk neonatal care can help nursing students feel psychologically safe and make learning more effective. In this study, we developed case video-based debriefing materials for a simulation of high-risk neonatal care for nursing students in South Korea and evaluated their effects.

METHODS

This mixed-methods study, consisting of a survey and an in-depth interview, was conducted between August and December 2022. The participants were 27 nursing students for the development of the case video-based debriefing and 51 nursing students for the evaluation of its effects (25 in the experimental group and 26 in the control group) at a university in South Korea. A case video-based debriefing on a simulation of high-risk neonatal care was developed, and the experimental group took part in case video-based debriefing. The participants' self-efficacy, critical thinking, state anxiety, and satisfaction with practice were examined. The experimental group's learning experiences were explored. Quantitative data were analyzed using the chi-square test, the unpaired t-test, and repeated-measures analysis of variance. Qualitative content analysis was conducted.

RESULTS

In the experimental group, critical thinking and satisfaction with practice increased to a greater extent than in the control group. However, the changes in self-efficacy and state anxiety were not significantly different between the experimental and control groups. Four categories were extracted from nursing students who participated in the case video-based debriefing: "learning facilitated by the simulation," "expanded learning," "safe learning environment," and "efficient utilization of case videos."

CONCLUSIONS

Case video-based debriefing on a simulation of high-risk neonatal care effectively enhanced nursing students' critical thinking and satisfaction with practice, and it will be utilized to improve nursing students' competency in high-risk neonatal care.

After-Action Reviews and Long-Term Performance: An Experimental Examination in the Context of an Emergency Simulation

OBJECTIVE

The present study examined the effectiveness of after-action reviews (AARs; also known as debriefing) in mitigating skill decay.

BACKGROUND

Research on the long-term effectiveness of AARs is meager. To address this gap in the literature, we conducted an experimental study that also overcomes some research design issues that characterize the limited extant research.

METHOD

Eighty-four participants were randomly assigned to an AAR or non-AAR condition and trained to operate a PC-based fire emergency simulator. During the initial acquisition phase, individuals in the AAR condition were allowed to review their performance after each practice session, whereas individuals in the non-AAR condition completed a filler task. About 12 weeks later, participants returned to the lab to complete four additional practice sessions using a similar scenario (i.e., the retention and reacquisition phase).

RESULTS

The performance of participants in the AAR condition degraded more after nonuse but also recovered faster than the performance of participants in the non-AAR condition, although these effects were fairly small and not statistically significant.

CONCLUSION

Consistent with the limited research on the long-term effectiveness of AARs, our findings failed to support their effectiveness as a decay-prevention intervention. Because the present study was conducted in a laboratory setting using a relatively small sample of undergraduate students, additional research is warranted.

APPLICATION

Based on the results of the present study, we suggest some additional strategies that trainers might consider to support long-term skill retention when using AARs.

Comparative effectiveness of demonstration using hybrid simulation versus task-trainer for training nursing students in using pulse-oximeter and suction: A randomized control trial

BACKGROUND

Educating medical professionals on the emergency protocol for cardiac arrest can improve survival.

OBJECTIVES

This study aimed to compare the effectiveness of demonstration using hybrid simulation versus task-trainer for training nursing students in using pulse-oximeter and suction following cardiac arrest.

DESIGN

This randomized clinical trial was conducted in 2019.

SETTING

The study was carried out in a nursing school in Tehran, Iran.

PARTICIPANTS

Nursing students.

METHODS

Nursing students were recruited and randomly assigned to one of three groups: a demonstration training group using hybrid simulation (standardized patient and task-trainer) in a transport ambulance (N = 15), a demonstration training group using task-trainer in skill lab (N = 15), and a control group (N = 15). No education was performed in the control group. Each student was evaluated pre and post-training on the use of a pulse-oximeter along with knowledge and skill of suction. Students were evaluated using a knowledge questionnaire and an appraisal checklist.

RESULTS

All three groups increased their abilities in using pulse-oximeter and suction two weeks post-training session. The trial groups demonstrated better scores on the knowledge questionnaire and skill checklist in comparison to the control group. However, hybrid simulation and task-trainer groups showed no significant difference in knowledge and skill on the use of two modes.

CONCLUSION

The use of demonstration using hybrid simulation in a transport ambulance and task-trainer in skill lab were equally effective in educating nursing students on the use of pulse-oximeter and suction following a cardiac arrest.

Debriefing and Learning Strategies: A Comparison between Two Reflective Analysis Styles with/without a Graphical Record of Strengths/Weaknesses

Background: Clinical simulation efficiently complements the training of Nursing Degree students. The debriefing phase is the most important feature of simulation-based learning, where the students are able to acquire the necessary competences. It is at this stage where learning strategies and motivation play a crucial role. The objective of the study was to analyze the relationship between the style of debriefing utilized in the simulation sessions, and the learning strategies of Nursing Degree students who participated in a high-fidelity clinical simulation. Method: This was a quasi-experimental study conducted with a sample of 200 students in their third and fourth years at university. To obtain the data, an evaluation Questionnaire for the Evaluation of Learning Strategies of University Students (CEVEAPEU) was utilized, as well as two different types of structured debriefing styles, namely, with or without a graphical representation of the strengths/weaknesses during the analytical phase. The data analysis was performed with the SPSS^® v25 program. Results: Statistically significant differences were found, with higher scores obtained when utilizing debriefing with a graphical representation, on both scales of the questionnaire (affective and cognitive), on the motivational, metacognitive and processing, and use of information subscales, and twelve learning strategies mostly belonging to the subscales of motivation; searching, collecting, and selecting information; and processing and using information. Conclusion: Debriefing with a graphical representation is deemed, a priori, as the most adequate approach for our context, based on the greater number of learning strategies utilized by our students. The use of a written graphical record of the strengths and weaknesses in the analytical phase is recommended.

Effect of Computer Debriefing on Acquisition and Retention of Learning After Screen-Based Simulation of Neonatal Resuscitation: Randomized Controlled Trial

BACKGROUND

Debriefing is key in a simulation learning process.

OBJECTIVE

This study focuses on the impact of computer debriefing on learning acquisition and retention after a screen-based simulation training on neonatal resuscitation designed for midwifery students.

METHODS

Midwifery students participated in 2 screen-based simulation sessions, separated by 2 months, session 1 and session 2. They were randomized in 2 groups. Participants of the debriefing group underwent a computer debriefing focusing on technical skills and nontechnical skills at the end of each scenario, while the control group received no debriefing. In session 1, students participated in 2 scenarios of screen-based simulation on neonatal resuscitation. During session 2, the students participated in a third scenario. The 3 scenarios had an increasing level of difficulty, with the first representing the baseline level. Assessments included a knowledge questionnaire on neonatal resuscitation, a self-efficacy rating, and expert evaluation of technical skills as per the Neonatal Resuscitation Performance Evaluation (NRPE) score and of nontechnical skills as per the Anaesthetists' Non-Technical Skills (ANTS) system. We compared the results of the groups using the Mann-Whitney U test.

RESULTS

A total of 28 midwifery students participated in the study. The participants from the debriefing group reached higher ANTS scores than those from the control group during session 1 (13.25 vs 9; U=47.5; P=.02). Their scores remained higher, without statistical difference during session 2 (10 vs 7.75; P=.08). The debriefing group had higher self-efficacy ratings at session 2 (3 vs 2; U=52; P=.02). When comparing the knowledge questionnaires, the significant baseline difference (13 for debriefing group vs 14.5 for control group, P=.05) disappeared at the end of session 1 and in session 2. No difference was found for the assessment of technical skills between the groups or between sessions.

CONCLUSIONS

Computer debriefing seems to improve nontechnical skills, self-efficacy, and knowledge when compared to the absence of debriefing during a screen-based simulation. This study confirms the importance of debriefing after screen-based simulation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03844009; https://clinicaltrials.gov/ct2/show/NCT03844009.

Eye-opening facilitator behaviours: an Interaction Analysis of facilitator behaviours that advance debriefings

INTRODUCTION

Analyses of simulation performance taking place during postsimulation debriefings have been described as iterating through phases of unawareness of problems, identifying problems, explaining the problems and suggesting alternative strategies or solutions to manage the problems. However, little is known about the mechanisms that contribute to shifting from one such phase to the subsequent one. The aim was to study which kinds of facilitator interactions contribute to advancing the participants' analyses during video-assisted postsimulation debriefing.

METHODS

Successful facilitator behaviours were analysed by performing an Interaction-Analytic case study, a method for video analysis with roots in ethnography. Video data were collected from simulation courses involving medical and midwifery students facilitated by highly experienced facilitators (6-18 years, two paediatricians and one midwife) and analysed using the Transana software. A total of 110 successful facilitator interventions were observed in four video-assisted debriefings and 94 of these were included in the analysis. As a starting point, the participants' discussions were first analysed using the phases of a previously described framework, uPEA (unawareness (u), problem identification (P), explanation (E) and alternative strategies/solutions (A)). Facilitator interventions immediately preceding each shift from one phase to the next were thereafter scrutinised in detail.

RESULTS

Fifteen recurring facilitator behaviours preceding successful shifts to higher uPEA levels were identified. While there was some overlap, most of the identified facilitator interventions were observed during specific phases of the debriefings. The most salient facilitator interventions preceding shifts to subsequent uPEA levels were respectively: use of video recordings to draw attention to problems (P), questions about opinions and rationales to encourage explanations (E) and dramatising hypothetical scenarios to encourage alternative strategies (A).

CONCLUSIONS

This study contributes to the understanding of how certain facilitator behaviours can contribute to the participants' analyses of simulation performance during specific phases of video-assisted debriefing.

Debriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis

OBJECTIVES

Simulation can serve as an effective educational method to provide experience and opportunities to learn about the nursing management of clinical cases in a secure environment. Numerous debriefing methods have been used in simulation in nurse education to improve clinical competencies and learning outcomes. However, there is insufficient evidence to identify the debriefing methods that are most effective in improving learning outcomes. In this systematic review and meta-analysis, the focus is on debriefing methods and learning outcomes in simulation in nurse education.

DESIGN

This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.

DATA SOURCES

Studies published from January 1995 to December 2016 were identified from PubMed, Embase, MEDLINE, PsycINFO, Web of Science, CINAHL, the Cochrane Library, and Korean databases.

REVIEW METHODS

Experimental studies that used debriefing methods in simulation in nurse education were included as review studies. Studies that used identical validated measurement tools were included in the meta-analysis. We applied a random-effects model with subgroups. Effect sizes for learning outcomes according to debriefing methods were calculated using standardized mean differences.

RESULTS

A total of 18 studies were selected through systematic review and 7 studies were included in the meta-analysis using four types of scales measuring learning outcomes after debriefing. The overall effect size of the learning outcomes, according to the type of debriefing method, was 0.31. The results regarding debriefing methods were statistically non-significant in the learning outcomes (95% CI [-0.33-0.96], Z = 0.95, p = 0.34). A symmetric shape indicated a lack of publication bias.

CONCLUSIONS

The study findings indicated that structured debriefing helped to improve learning. Future studies are needed to provide effective debriefing strategies with larger sample sizes.

The utilization of debriefing for simulation in healthcare: A literature review

The aim of this review was to examine how debriefings have been conducted in healthcare simulations. Using keywords, our search yielded 962 studies through databases. After removing duplicates, we found 20 studies that met inclusion and exclusion criteria. Through ancestry searches, we found two more studies. A total of 22 studies were reviewed. From each study, detailed information about debriefing was extracted based on six criteria, namely, timing, facilitator, place of occurrence, method, length, and structure. Various types of debriefings were available according to learning objectives, learners' abilities, availability of resources, and context of simulations. We found that peer-led debriefing might be more appropriate for experienced healthcare professionals than unlicensed students due to a gap in knowledge and problem-solving skills between them. In addition, we found that tele-debriefing was feasible in some studies. Although types of individual debriefing varied across the studies, a substantial number of debriefings closely aligned to the standards for high-quality debriefing.

The impact of debriefing modalities on nurse practitioner students' knowledge and leadership skills in managing fatal dysrhythmias: A pilot study

Acute care nurse practitioners (ACNPs) require special training and educational preparation to meet their role expectations. Using high fidelity simulation with debriefing modalities is considered one of the innovative learning strategies in graduate nursing. No studies have investigated debriefing modalities in nurse practitioner programs specially ACNPs leadership skills. The purpose of this study was to examine the difference in students' knowledge, code team leader skills and self-efficacy using two debriefing modalities. A two group, pretest-posttest quasi-experimental design was used. Students were divided into video-assisted debriefing group vs. verbal debriefing following a simulation scenario of managing emergency codes. There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both groups between two-time points. There was a general improvement in teams' performance. Students preferred verbal debriefing over video-assisted debriefing. The debriefing session plays an important role in graduate nursing education. Acute care nurse practitioners are lacking a formal leadership training to meet their advanced role. Nurse Educators, and simulation/debriefing leaders may benefit from our study results to develop a structured, formal curriculum and educational instruction focusing on acute care nurse practitioners' role change especially leading a resuscitation team.

Prelicensure nursing students' perspectives on video-assisted debriefing following high fidelity simulation: A qualitative study

BACKGROUND

Video-assisted debriefing has not attracted sufficient attention on exploring learners' perceptions. A full understanding of learners' attitudes and perceptions towards video-assisted debriefing sets the foundation for effective learning, which should be considered when integrating video-assisted debriefing to the nursing curricula. However, limited evidence on learners' perspectives makes it difficult to fully understand this phenomenon.

OBJECTIVES

To explore prelicensure nursing students' experiences and perspectives on video-assisted debriefing following a high-fidelity simulation.

DESIGN

An exploratory qualitative approach using focus groups.

SETTING

This study was conducted at a local university in Singapore.

PARTICIPANTS

A purposive sample of 27 prelicensure nursing students in Singapore were recruited.

METHODS

Six focus group interviews were conducted. Thematic analysis was used to analyze the transcribed data.

RESULTS

Three themes and eight subthemes were derived from the data analysis. The themes included journey from traditional verbal debriefing to video-assisted debriefing, praise and criticism of video-assisted debriefing, and the road to successful video-assisted debriefing.

CONCLUSIONS

Nursing students revealed that video-assisted debriefing not only complemented the drawback of verbal debriefing by offering objective evidence but also improved their attitudes and behaviors through the unique experience of an emotional roller coaster. Learners should be desensitized to the fear of video and their discriminating capabilities should be developed prior to video-assisted debriefing. The findings can serve as a reference when designing and integrating video-assisted debriefing interventions into simulation-based education.

Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England

OBJECTIVE

Acutely unwell patients in the primary care setting are uncommon, but their successful management requires involvement from staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this within primary care. Enhancing interprofessional working could ultimately improve care of the acutely ill patient. This proof of concept study aimed to develop an in situ simulation of a medical emergency to use within primary care, and assess its acceptability and utility through participants' reported experiences.

SETTING

Three research-active General Practices in south east England. Nine staff members per practice consented to participate, representing clinical and non-clinical professions.

METHODS

The intervention of an in situ simulation scenario of a cardiac arrest was developed by the research team. For the evaluation, staff participated in individual qualitative semistructured interviews following the in situ simulation: these focused on their experiences of participating, with particular attention on interdisciplinary training and potential future developments of the in situ simulation.

RESULTS

The in situ simulation was appropriate for use within the participating General Practices. Qualitative thematic analysis of the interviews identified four themes: (1) apprehension and (un)willing participation, (2) reflection on the simulation design, (3) experiences of the scenario and (4) training.

CONCLUSIONS

This study suggests in situ simulation can be an acceptable approach for interdisciplinary team training within primary care, being well-received by practices and staff. This contributes to a fuller understanding of how in situ simulation can benefit both workforce and patients. Future research is needed to further refine the in situ simulation training session.

Kirkpatrick's Evaluation of Simulation and Debriefing in Health Care Education: A Systematic Review

BACKGROUND

Simulation is an integral component of health care education. Research suggests a positive relationship between simulation and learning outcomes. Kirkpatrick's framework is a four-level model based on the premise that learning resulting from training programs can be classified into four levels: reaction, learning, behavior, and results. Evaluation of educational impact provides valuable feedback to educators that may assist with development and improvement of teaching methods.

METHOD

This review is based on the PRISMA guidelines for conducting a systematic review. Inclusion criteria included articles (a) written in the English language, (b) published between 2000 and 2016, (c) describing a debriefing intervention after high-fidelity patient simulation, and (d) based in health care.

RESULTS

Thirteen studies met criteria for inclusion in the review.

CONCLUSION

Results indicated a paucity of studies at the highest levels of evaluation, indicating an area where future research is needed to assist with the development and improvement of simulation education. [J Nurs Educ. 2018;57(7):393-398.].

Evaluation of two strategies for debriefing simulation in the development of skills for neonatal resuscitation: a randomized clinical trial

OBJECTIVE

To evaluate two debriefing strategies for the development of neonatal resuscitation skills in health professionals responsible for the critical newborn care in a high-complexity university Hospital.

RESULTS

A simple blind randomized clinical trial was conducted. Twenty-four professionals (pediatricians, nurses, and respiratory therapists) were randomly assigned for two interventions; one group received oral debriefing and the other oral debriefing assisted by video. Three standardized clinical scenarios that were recorded on video were executed. A checklist was applied for the evaluation, administered by a reviewer blinded to the assignment of the type of debriefing. The two debriefing strategies increased the technical and behavioral neonatal resuscitation skills of the participants, without one being superior to the other. The coefficient of the difference in the compliance percentage between the two types of debriefing was - 3.6% (95% CI - 13.77% to 6.47%). When comparing the development of technical and behavioral skills among the professionals evaluated, no significant differences were found between the types of debriefing. The two debriefing strategies increase compliance percentages, reaching or approaching 100%. Trial Registration ClinicalTrials.gov NCT03606278. July 30, 2018. Retrospectively registered.

The State of Knowledge Regarding the Use of Simulation in Pre-Licensure Nursing Education: A Mixed Methods Systematic Review

This project is a mixed-methods systematic review on the use of simulation in pre-licensure nursing. This research question guided this review: What is the best evidence available upon which to base decisions regarding the use of simulation experiences with pre-licensure nursing students? Searches of CINAHL Plus with Full Text, MEDLINE, and ERIC were performed to identify relevant literature. These searches yielded 1220 articles. After duplicates were removed and titles and abstracts were reviewed for relevance to the inclusion criteria, the remaining 852 articles were independently assessed for quality by pairs of researchers. Forty-seven articles were retained. Findings were grouped into research using high-, medium-, and low-fidelity simulations and a group where researchers included several or all types of simulation. The conclusion is that insufficient quality research exists to guide educators in making evidence-based decisions regarding simulation. More rigorous and multi-site research is needed.

Exploring the use of high-fidelity simulation training to enhance clinical skills

The use of interprofessional simulation training to enhance nursing students' performance of technical and non-technical clinical skills is becoming increasingly common. Simulation training can involve the use of role play, virtual reality or patient simulator manikins to replicate clinical scenarios and assess the nursing student's ability to, for example, undertake clinical observations or work as part of a team. Simulation training enables nursing students to practise clinical skills in a safe environment. Effective simulation training requires extensive preparation, and debriefing is necessary following a simulated training session to review any positive or negative aspects of the learning experience. This article discusses a high-fidelity simulated training session that was used to assess a group of third-year nursing students and foundation level 1 medical students. This involved the use of a patient simulator manikin in a scenario that required the collaborative management of a deteriorating patient.

Using High-Fidelity Simulation and Video-Assisted Debriefing to Enhance Obstetrical Hemorrhage Mock Code Training

The purpose of this descriptive, one-group posttest study was to explore the nursing staff's perception of the benefits of using high-fidelity simulation during mandated obstetrical hemorrhage mock code training. In addition, the use of video-assisted debriefing was used to enhance the nursing staff's evaluation of their communication and teamwork processes during a simulated obstetrical crisis. The convenience sample of 84 members of the nursing staff consented to completing data collection forms and being videotaped during the simulation. Quantitative results for the postsimulation survey showed that 93% of participants agreed or totally agreed that the use of SimMan made the simulation more realistic and enhanced learning and that debriefing and the use of videotaped playback improved their evaluation of team communication. Participants derived greatest benefit from reviewing their performance on videotape and discussing it during postsimulation debriefing. Simulation with video-assisted debriefing offers hospital educators the ability to evaluate team processes and offer support to improve teamwork with the ultimate goal of improving patient outcomes during obstetrical hemorrhage.

Survey of factors influencing learner engagement with simulation debriefing among nursing students

Simulation-based education has escalated worldwide, yet few studies have rigorously explored predictors of learner engagement with simulation debriefing. The purpose of this cross-sectional, descriptive survey was to identify factors that determine learner engagement with simulation debriefing among nursing students. A convenience sample of 296 Korean nursing students enrolled in the simulation-based course completed the survey. A total of five instruments were used: (i) Characteristics of Debriefing; (ii) Debriefing Assessment for Simulation in Healthcare - Student Version; (iii) The Korean version of the Simulation Design Scale; (iv) Communication Skills Scale; and (v) Clinical-Based Stress Scale. Multiple regression analysis was performed using the variables to investigate the influencing factors. The results indicated that influencing factors of learning engagement with simulation debriefing were simulation design, confidentiality, stress, and number of students. Simulation design was the most important factor. Video-assisted debriefing was not a significant factor affecting learner engagement. Educators should organize and conduct debriefing activities while considering these factors to effectively induce learner engagement. Further study is needed to identify the effects of debriefing sessions targeting learners' needs and considering situational factors on learning outcomes.

Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment

BACKGROUND

Nurse educators are increasingly using high-fidelity simulators to improve prelicensure nursing students' ability to develop clinical judgment. Traditionally, oral debriefing sessions have immediately followed the simulation scenarios as a method for students to connect theory to practice and therefore develop clinical judgment. Recently, video recording of the simulation scenarios is being incorporated.

METHOD

This qualitative, interpretive description study was conducted to identify whether self-reflection on video-recorded high-fidelity simulation (HFS) scenarios helped prelicensure nursing students to develop clinical judgment. Tanner's clinical judgment model was the framework for this study.

RESULTS

Four themes emerged from this study: Confidence, Communication, Decision Making, and Change in Clinical Practice.

CONCLUSION

This study indicated that self-reflection of video-recorded HFS scenarios is beneficial for prelicensure nursing students to develop clinical judgment. [J Nurs Educ. 2016;55(9):522-527.].

Neonatal Ethics Teaching Program - Scenario-Oriented Learning in Ethics: Announcing the Diagnosis of Trisomy 21

INTRODUCTION

Delivering unexpected news to families can lead to emotionally charged conversations that cause discomfort and feelings of ineffectiveness in pediatric postgraduate trainees. Although prenatal screening exists, over 80% of trisomy 21 diagnoses continue to be made postnatally to unsuspecting parents who report a desire for better communication from health care professionals when they first receive the news of their child's diagnosis. Recognizing this area for improvement as reported in the literature, as well as the expressed desire from fellows in the University of Ottawa neonatal-perinatal medicine program for additional protected time to preemptively practice such disclosures, this trisomy 21 Scenario-Oriented Learning in Ethics workshop was developed.

METHODS

During the workshop, trainees are introduced to an evidence-based communication framework that provides them with strategies to facilitate clear knowledge translation and promote rapport with families for this specific clinical scenario. Participants are divided into small groups and practice disclosing a trisomy 21 diagnosis to a standardized patient in the role of a new mother. Each small group is supported by two trained facilitators who are experts in delivering life-altering news.

RESULTS

The pilot workshop was completed by 21 postgraduate trainees from the University of Ottawa. Qualitative evaluations were overwhelmingly positive, with feedback indicating high levels of perceived usefulness for the workshop.

DISCUSSION

By preemptively practicing evidence-based communication, we hope to increase trainee confidence and preparation for trisomy 21 disclosures and improve parents' feelings regarding the quality of communication and support provided while receiving real-life trisomy 21 diagnoses.

Implementation of Best Practices in Simulation Debriefing

ABSTRACT

This article describes how one school of nursing responded to the need to educate faculty in the pedagogy of simulation debriefing and how the International Association for Clinical Simulation and Learning Standard VI was implemented. Thirty faculty received training and were evaluated using the Debriefing Assessment for Simulation in Healthcare tool. Lessons learned and examples of student feedback are shared. Plans for future work are also described.

The Impact of Simulation Prebriefing on Perceptions of Overall Effectiveness, Learning, and Self-Confidence in Nursing Students

AIM

The aim of this study was to evaluate the impact of simulation prebriefing on nursing students' perceptions of overall effectiveness, learning, and self-confidence.

BACKGROUND

Most research highlights debriefing as the most important component influencing learning outcomes; the focus on prebriefing is limited.

METHOD

This quasiexperimental design study compared outcomes among four groups of undergraduate students (n = 119) at two schools of nursing: no prebriefing, prebriefing with learning engagement and orientation activities, prebriefing with orientation activities, and prebriefing with learning engagement activities.

RESULTS

Perceptions of overall simulation effectiveness, learning, and self-confidence were significantly higher with prebriefing (p = .000) compared to no prebriefing. No significant distinction (p >.05) was found among the prebriefing activities.

CONCLUSION

Findings from this study support the use of learning engagement and orientation activities during prebriefing in order to enhance overall simulation effectiveness.

Debriefing in Laboratory Experiences: A Quality Improvement Project

The purpose of this project was to explore (a) how nursing students regarded debriefing sessions at the end of a laboratory skills class and (b) the cognitive, affective, and social learning outcomes of debriefing sessions. Survey questionnaires were administered to 378 prelicensure nursing students after their nursing skills laboratory class that included a debriefing session. Most students either agreed or strongly agreed that debriefing facilitated the discussion about their experience and reflection on learning.

Comparison of oral and video debriefing and its effect on knowledge acquisition following simulation-based learning

Introduction

Learning from simulation takes place to a large extent in debriefing; however, there is still sparse knowledge about the advantages and disadvantages of debriefing methods. 2 common forms are video-assisted and oral only debriefing. We set out to determine if there is increased knowledge acquisition for candidates undergoing video, rather than oral debriefing.

Methods

Second year doctors were randomised to a training day with oral or video feedback. Candidates underwent an emergency clinical scenario followed by feedback. The candidates completed 30 multiple choice questions related to managing common clinical emergencies presimulation and postsimulation training.

Results

There was no significant difference in the postscore mean for the oral debriefing (128.3, SD 5.16) and video-assisted debriefing group (127.1, SD=5.96). There was significant interaction between precourse and postcourse scores with superior knowledge acquisition for candidates with lower precourse scores (p=0.008). The candidates with lowest precourse score showed significant improvement in the orally debriefed group in comparison to video debriefed group.

Discussion

Our results showed that video debriefing has equivocal effect to oral debriefing. Oral debriefing provides superior knowledge acquisition to learners with lower precourse test scores.

Simulation debriefing for clinical judgment development: A concept analysis

OBJECTIVE

The aim of this review was to provide an in-depth analysis of debriefing in nursing simulation-based learning. Specifically, the authors sought to describe the debriefing concept within the context of enhancing nursing students' clinical judgment skill.

DESIGN

Concept analysis.

DATA SOURCES

A literature review was conducted using five electronic databases with the addition of references for relevant papers reviewed. Medline Ovid, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Educational Resources Information Center (ERIC), ScienceDirect and Google Scholar were searched for articles published in English between 2005 and 2015. Search terms included clinical judgment, debriefing, and simulation.

REVIEW METHODS

The Walker and Avant systematic approach was utilized as a concept analysis framework. The analysis informed how the concept is defined in the existing literature.

RESULTS

The search resulted in a total of 47 articles. The concept of debriefing was analyzed using seven themes from Walker and Avant: concept definition, defining attributes, antecedents, consequences, empirical referents, uses of the concept, and a model case. Based on the analysis, an integrative simulation debriefing guide for promoting students' clinical judgment was presented as a vehicle for a consistent approach.

CONCLUSIONS

This review identified simulation debriefing as a structured and guided reflection process in which students actively appraise their cognitive, affective, and psychomotor performance within the context of their clinical judgment skill. Reflective debriefing provides students with an opportunity to assume an active role during the learning process. Following a structured debriefing guide can help educators and even students facilitate a learning environment that enhances students' clinical judgment development.

The effects of using high-fidelity simulators and standardized patients on the thorax, lung, and cardiac examination skills of undergraduate nursing students

BACKGROUND

Existing research literature indicates that the use of various simulation techniques in the training of physical examination skills develops students' cognitive and psychomotor abilities in a realistic learning environment while improving patient safety.

OBJECTIVES

The study aimed to compare the effects of the use of a high-fidelity simulator and standardized patients on the knowledge and skills of students conducting thorax-lungs and cardiac examinations, and to explore the students' views and learning experiences.

DESIGN

A mixed-method explanatory sequential design.

SETTINGS

The study was conducted in the Simulation Laboratory of a Nursing School, the Training Center at the Faculty of Medicine, and in the inpatient clinics of the Education and Research Hospital.

PARTICIPANTS

Fifty-two fourth-year nursing students.

METHODS

Students were randomly assigned to Group I and Group II. The students in Group 1 attended the thorax-lungs and cardiac examination training using a high-fidelity simulator, while the students in Group 2 using standardized patients. After the training sessions, all students practiced their skills on real patients in the clinical setting under the supervision of the investigator.

RESULTS

Knowledge and performance scores of all students increased following the simulation activities; however, the students that worked with standardized patients achieved significantly higher knowledge scores than those that worked with the high-fidelity simulator; however, there was no significant difference in performance scores between the groups. The mean performance scores of students on real patients were significantly higher compared to the post-simulation assessment scores (p<0.001).

CONCLUSIONS

Results of this study revealed that use of standardized patients was more effective than the use of a high-fidelity simulator in increasing the knowledge scores of students on thorax-lungs and cardiac examinations; however, practice on real patients increased performance scores of all students without any significant difference in two groups.

OSCE best practice guidelines-applicability for nursing simulations

Background

Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students' and clinicians' clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation.

Methods

A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students' opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.

Results

Few changes were made to the existing simulation plan and format. Students' responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice.

Discussion

Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations.

Conclusions

Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students' needs in rehearsing the registered nurse role.

Measuring third year undergraduate nursing students' reflective thinking skills and critical reflection self-efficacy following high fidelity simulation: A pilot study

Critical reflection underpins critical thinking, a highly desirable generic nursing graduate capability. To improve the likelihood of critical thinking transferring to clinical practice, reflective thinking needs to be measured within the learning space of simulation. This study was divided into two phases to address the reliability and validity measures of previously untested surveys. Phase One data was collected from individuals (n = 6) using a 'think aloud' approach and an expert panel to review content validity, and verbatim comment analysis was undertaken. The Reflective Thinking Instrument and Critical Reflection Self-Efficacy Visual Analogue Scale items were contextualised to simulation. The expert review confirmed these instruments exhibited content validity. Phase Two data was collected through an online survey (n = 58). Cronbach's alpha measured internal consistency and was demonstrated by all subscales and the Instrument as a whole (.849). There was a small to medium positive correlation between critical reflection self-efficacy and general self-efficacy (r = .324, n = 56, p = .048). Participant responses were positive regarding the simulation experience. The research findings demonstrated that the Reflective Thinking and Simulation Satisfaction survey is reliable. Further development of this survey to establish validity is recommended to make it viable.

Debriefing after Simulation-Based Non-Technical Skill Training in Healthcare: A Systematic Review of Effective Practice

Non-technical skills training in healthcare frequently uses high-fidelity simulation followed by a facilitated discussion known as debriefing. This type of training is mandatory for anaesthesia training in Australia and New Zealand. Debriefing by a skilled facilitator is thought to be essential for new learning through feedback and reflective processes. Key elements of effective debriefing need to be clearly identified to ensure that the training is evidence-based. We undertook a systematic review of empirical studies where elements of debriefing have been systematically manipulated during non-technical skills training. Eight publications met the inclusion criteria, but seven of these were of limited generalisability. The only study that was generalisable found that debriefing by novice instructors using a script improved team leader performance in paediatric resuscitation. The remaining seven publications were limited by the small number of debriefers included in each study and these reports were thus analogous to case reports. Generally, performance improved after debriefing by a skilled facilitator. However, the debriefer provided no specific advantage over other post-experience educational interventions. Acknowledging their limitations, these studies found that performance improved after self-led debrief, no debrief (with experienced practitioners), standardised multimedia debrief or after reviewing a DVD of the participants’ own eye-tracking. There was no added performance improvement when review of a video recording was added to facilitator-led debriefing. One study reported no performance improvement after debriefing. Without empirical evidence that is specific to the healthcare domain, theories of learning from education and psychology should continue to inform practices and teaching for effective debriefing.