Communication content during debriefing in simulation-based medical education: An analytic framework and mixed-methods analysis

Exploring communicative interactions in debriefing sessions with nursing students: A qualitative study

INTRODUCTION

Debriefing as a learning activity aims to elevate participants' competence through communicative interaction. This activity is an integral component of any formative simulation. Thus, the primary objective of this study was to explore debriefing as a communicative experience in nursing students within the context of interactive virtual simulation. The secondary objectives were: 1) To investigate the typology of interactions based on participants' discourse and 2) To identify the actions that students use to develop knowledge during debriefing.

METHOD

A qualitative exploratory study design involving six debriefing groups was conducted with 105 s-year nursing students. The debriefing sessions were analyzed following interactive virtual simulations in an in-person setting in the classroom. All sessions were recorded and transcribed verbatim. A mixed (deductive and inductive) content analysis approach was used.

RESULTS

A total of 2187 units of meaning were identified and categorized into 3 themes (interaction by participant, interaction by communicative action, and interaction by participant's communicative goal); nine subthemes (facilitator-student, student-student and student-facilitator; declarative - unidirectional, reactive - bidirectional and multidirectional-interactive; individualistic, competitive, and collaborative), and 5 categories (providing information; generating creative solutions; processing critical and deliberative information; positive interdependence and psychosocial relationships).

CONCLUSION

The students developed knowledge and practical communication skills, particularly reinforcing soft skills through collaborative interactions, predominantly multidirectional-interactive in nature. The facilitator and the interpersonal relationships among the participants fostered a safe and positive environment.

Factors Affecting Nursing Students' Reflective Thinking During Simulation Debriefing

BACKGROUND

Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear.

PURPOSE

This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students.

METHODS

This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking.

RESULTS

Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students.

CONCLUSIONS

Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing.

Practice of debriefing of critical events: a survey-based cross-sectional study of Portuguese anesthesiologists

Debriefing is an essential procedure for identifying medical errors, improving communication, reviewing team performance, and providing emotional support after a critical event. This study aimed to describe the current practice and limitations of debriefing and gauge opinions on the best timing, effectiveness, need for training, use of established format, and expected goals of debriefing among Portuguese anesthesiologists.

Methods

We performed a national cross-sectional online survey exploring the practice of anesthesiologists' debriefing practice after critical events in Portuguese hospitals. The questionnaire was distributed using a snowball sampling technique from July to September 2021. Data were descriptively and comparatively analyzed.

Results

We had replies from 186 anesthesiologists (11.3% of the Portuguese pool). Acute respiratory event was the most reported type of critical event (96%). Debriefing occurred rarely or never in 53% of cases, 59% of respondents needed more training in debriefing, and only 4% reported having specific tools in their institutions to carry it out. There was no statistical association between having a debriefing protocol and the occurrence of critical events (P=.474) or having trained personnel (P=.95). The existence of protocols was associated with lower frequencies of debriefing (P=.017).

Conclusions

Portuguese anesthesiologists know that debriefing is an essential process that increases patient safety, but among those surveyed, there is a need for an adequate debriefing culture or practice.

Trial registration

Research registry 7741 (https://www.researchregistry.com/browse-the-registry#home).

A Narrative Review of Key Studies in Medical Education in 2021: Applying Current Literature to Educational Practice and Scholarship

To remain at the forefront of clinical practice and pedagogy, pediatric medical educators must stay informed of the latest research. Yet familiarization with the growing body of literature in both pediatrics and medical education is a near-impossible task for the busy medical educator. The purpose of this annotated bibliography is to summarize key manuscripts in medical education published in 2021 that have the potential to significantly influence a pediatric medical educator's practice. Using a 2-staged iterative process, discrete author pairs reviewed 1599 abstracts from 16 medical education and specialty journals. In summary, 16 manuscripts were selected and grouped into the following 6 domains: assessment and feedback, USMLE Step 1 changes, communication, wellness, diversity and inclusion, and professional development. The authors provide abridged summaries and high-yield take-aways from these manuscripts that may impact educational practices in pediatrics. This year, we also provide a 6-year retrospective review of the journals that have had selected articles for this annotated bibliography since inception.

Debriefing interaction patterns and learning outcomes in simulation: an observational mixed-methods network study

BACKGROUND

Debriefing is effective and inexpensive to increase learning benefits of participants in simulation-based medical education. However, suitable communication patterns during debriefings remain to be defined. This study aimed to explore interaction patterns during debriefings and to link these to participants' satisfaction, perceived usefulness, and self-reported learning outcomes.

METHODS

We assessed interaction patterns during debriefings of simulation sessions for residents, specialists, and nurses from the local anaesthesia department at the Bern University Hospital, Bern, Switzerland. Network analysis was applied to establish distinctive interaction pattern categories based on recorded interaction links. We used multilevel modelling to assess relationships between interaction patterns and self-reported learning outcomes.

RESULTS

Out of 57 debriefings that involved 111 participants, discriminatory analyses revealed three distinctive interaction patterns: 'fan', 'triangle', and 'net'. Participants reported significantly higher self-reported learning effects in debriefings with a net pattern, compared to debriefings with a fan pattern. No effects were observed for participant satisfaction, learning effects after 1 month, and perceived usefulness of simulation sessions.

CONCLUSIONS

A learner-centred interaction pattern (i.e. net) was significantly associated with improved short-term self-reported individual learning and team learning. This supports good-practice debriefing guidelines, which stated that participants should have a high activity in debriefings, guided by debriefers, who facilitate discussions to maximize the development for the learners.

Implementation of microsurgery simulation in an ophthalmology clerkship in Germany: a prospective, exploratory study

BACKGROUND

Microsurgery is a growing field which requires significant precision and skill. Eyesi Surgical, which is usually introduced during residency or fellowship, is an ophthalmologic microsurgery simulator which allows users to practice abstract microsurgical skills and more specialized skills. The purpose of this study was to assess the inclusion of microsurgical simulation training during medical school.

METHODS

Seventy-nine German medical students in their 10^th semester of education completed up to two days of training on the simulator during their ophthalmology clerkship. They received an objective numeric score based on simulator performance and completed pre and post training subjective questionnaires.

RESULTS

There was no relationship found between students' Eyesi Surgical performance scores and their specialty interests (p = .8). The majority of students (73.4%) rated their microsurgical skills to be higher after simulator training than before training (p < 0.001). 92.4% of students found the Eyesi Surgical to be a useful component of the ophthalmology clerkship. Objective scores from Navigation Training Level 1 showed that students achieved better results in the criteria categories of Completing Objects and Tissue Treatment than in the categories of Instrument and Microscope Handling. The mean Total Score was 25.7 (± 17.5) out of a possible 100 points.

CONCLUSION

The inclusion of surgical simulation in the ophthalmology clerkship led to increased confidence in the microsurgical skills of medical students. Offering surgical simulation training prior to residency can help to expose students to surgical fields, identify those that have particular talent and aptitude for surgery, and assist them in deciding which specialty to pursue.