A Conceptual Framework for the Development of Debriefing Skills: A Journey of Discovery, Growth, and Maturity

Exploring the Meta-debrief: Developing a Toolbox for Debriefing the Debrief

SUMMARY STATEMENT

Otherwise known as debriefing the debrief, meta-debriefing describes the practice of debriefing simulation facilitators after they have facilitated, or observed, a debriefing. It is a vital component of enhancing debriefing skills, irrespective of where debriefers may be in terms of their professional development journey from novice to expert. We present the following 4 fundamental pillars, which underpin the creation of an impactful meta-debriefing strategy: theoretically driven, psychologically safe, context dependent, and formative in function. Furthermore, we describe various strategies that, underpinned by these 4 key pillars, contribute to a toolbox of techniques that enable meta-debriefers to develop proficiency and flexibility in their practice. We have synthesized and critically reviewed the current evidence base, derived mostly from the debriefing literature, and highlighted gaps to address in meta-debriefing contexts. We hope this article stimulates discussion among simulation practitioners, progresses the science and art of meta-debriefing, and prompts further research so that meta-debriefing can become an integral evidence-based component of our faculty development processes.

A competency framework for simulation facilitation in low-resource settings: a modified Delphi study

BACKGROUND

Skilled facilitators are essential to drive effective simulation training in healthcare. Competency-based frameworks support the development of facilitation skills but, to our knowledge, there are no frameworks that specifically address context-sensitive priorities developed with practitioners working in low-resource settings.

METHODS

We aimed to develop a core competency framework for healthcare simulation facilitation in low-resource settings using a modified Delphi process. We drew on the domain expertise of members of the Vital Anaesthesia Simulation Training Community of Practice, with the study guided by a four-member steering group experienced in the conduct of simulation in low-resource settings. In survey round 1, participants (n = 54) were presented with an initial competency set derived from a previous qualitative study and co-created a set of 57 competencies for effective simulation facilitation in low-resource settings. In survey round 2, participants (n = 52) ranked competencies by relevance into three performance categories: techniques; artistry; and values. In survey round 3, participants (n = 50) ranked competencies on their importance. The steering group collated results and presented a draft core competency framework. In survey round 4, participants (n = 50) voted with 98% agreement that this framework represented the most relevant and important competencies for effective facilitation of simulation sessions in low-resource settings.

RESULTS

The final 32-item framework encompasses core competencies found in existing standards and includes important new concepts such as demonstration of cultural sensitivity; humility; ability to recognise and respond to potential language barriers; facilitation team collaboration; awareness of logistics; and contingency planning.

DISCUSSION

This competency-based framework highlights specific practices required for effective simulation facilitation in low-resource settings. Further work is required to refine and validate this tool to train simulation facilitators to deliver effective training to improve patient safety.

Using simulation scenarios and a debriefing structure to promote feedback skills among interprofessional team members in clinical practice

BACKGROUND

Team reflexivity and peer feedback in daily clinical work can improve patient safety. However, teams do not always engage in reflection after patient care. A reason could be that team members may lack skills in engaging in team reflection. This study explores the use of interprofessional team-based simulations to encourage and equip teams for reflective conversations in the real-world clinical practice.

METHODS

This was a prospective, explorative study of team members' perceptions of the use of in situ simulation-based scenarios with critically ill patient cases to train team-based reflections and peer feedback. The study took place in two neurological wards. Prior to the intervention, a 1-day observation in each ward and semi-structured short interviews with physicians and nurses were conducted.

RESULTS

A total of 94 staff members, 57 nurses, 8 nurse assistants and 29 physicians participated in the in situ simulation scenarios. All team members showed appreciation of the safe learning environment. The authors found that the simulations and the debriefing structure provided an opportunity for training of team reflexivity and feedback. The team members evaluated the simulation-based training very positively, and their initial reaction indicated that they found peer feedback useful for the individual and the team. This approach allowed them to reflect on their own clinical practice.

CONCLUSION

The simulation-based training scenarios and the debriefing structure promoted team members' team reflexivity and peer feedback skills. The method is feasible and could be used in other specialties and situations. The team members' reactions to feedback were positive, and based on their reflections, there is a potential to increase both individual and team skills as well as improve patient treatment.

How to deliver effective paediatric simulation based education

Simulation based education (SBE) is an educational tool increasingly used in the approach to the initial and ongoing education of healthcare professionals. Like all education tools, SBE needs to be used appropriately to achieve the desired outcomes. Using Cognitive Load Theory (CLT) in the instructional design of simulations is essential to maximise participant learning by reducing extraneous load and optimising intrinsic load. Educators can modify task fidelity, task complexity and instructional support to optimise learning. Specific methodologies can be used in program design such as rapid cycle deliberate practice, round the table teaching, low dose high frequency and flipped classroom. Fidelity and authenticity are important factors to consider when choosing design elements to ensure learner engagement, but not to overwhelm cognitive load. An integral part of SBE is the feedback or debriefing component. Several evidence-based methodologies can be employed to facilitate post simulation learning, including Debriefing with Good Judgement and PEARLS. Educators also need to consider faculty education and development, such as the discovery, growth and maturity model.

Use of different debriefing methods after in situ simulation with intensive care unit nurses

BACKGROUND

The debriefing phase is the simulation phase where performance improves and learning occurs.

AIM

This study examined the effects of the learning conversation (LC)-based, 3D (defusing, discovering and deepening) model-based and unstructured debriefing methods on satisfaction and debriefing experience after in-situ simulation among intensive care unit (ICU) nurses.

STUDY DESIGN

In this randomized controlled experimental study, three debriefing methods were compared, according to which 119 ICU nurses were divided into the following groups: LC group (n = 38), 3D group (n = 40) and control group (n = 41). In- situ simulation was performed with an intensive care patient scenario. p < .05 was considered statistically significant.

RESULTS

The total Debriefing Experience Scale-Experience with Debriefing part scores were 89.76 ± 8.10 in the LC group, 88.90 ± 8.70 in the 3D group and 88.29 ± 7.28 in the control group. No significant difference was found in debriefing experience and satisfaction between the groups (p > .05), but a significant difference was observed in the LC group. The groups showed a homogeneous distribution regarding participant characteristics.

CONCLUSION

Debriefing experience and satisfaction do not differ between the methods.

RELEVANCE TO CLINICAL PRACTICE

Implementation of the simulation in the ICU in - situ with ICU nurses is beneficial in obtaining a fidelity experience. Performing the debriefing application after simulation in line with the model supports the International Nursing Association for Clinical Simulation and Learning (INACSL) debriefing standards.

Assessing Healthcare Simulation Facilitation: A Scoping Review of Available Tools, Validity Evidence, and Context Suitability for Faculty Development in Low-Resource Settings

SUMMARY STATEMENT

Assessment tools support simulation facilitation skill development by guiding practice, structuring feedback, and promoting reflective learning among educators. This scoping review followed a systematic process to identify facilitation assessment tools used in postlicensure healthcare simulation. Secondary objectives included mapping of the validity evidence to support their use and a critical appraisal of their suitability for simulation faculty development in low-resource settings. Database searching, gray literature searching, and stakeholder engagement identified 11,568 sources for screening, of which 72 met criteria for full text review. Thirty sources met inclusion; 16 unique tools were identified. Tools exclusively originated from simulation practice in high-resource settings and predominantly focused on debriefing. Many tools have limited validity evidence supporting their use. In particular, the validity evidence supporting the extrapolation and implications of assessment is lacking. No current tool has high context suitability for use in low-resource settings.

Embracing different languages and local differences: Co-constructive patient simulation strengthens host countries' clinical training in psychiatry

BACKGROUND

Global education in psychiatry is heavily influenced by knowledge from Western, high-income countries, which obscures local voices and expertise.

AIM

To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.

METHODS

We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries, speaking their native languages, and following an adaptation of the co-constructive patient simulation (CCPS) model. As local faculty became increasingly familiar with the CCPS approach, they took on the role of facilitators-in their country's native language.

RESULTS

Fifty-three learners participated: 19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye (as a group that met online during 3 consecutive months); and 24 trainees and 7 faculty in Israel (divided into 3 groups, in parallel in-person sessions during a single training day). Each of the six cases reflected local realities and clinical challenges, and was associated with specific learning goals identified by each case-writing trainee.

CONCLUSION

Human simulation has not been fully incorporated into psychiatric education: The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development. Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice. Finally, the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

Exploring in-person self-led debriefings for groups of learners in simulation-based education: an integrative review

BACKGROUND

Facilitator-led debriefings are well-established for debriefing groups of learners in immersive simulation-based education. However, there has been emerging interest in self-led debriefings whereby individuals or groups of learners conduct a debriefing themselves, without the presence of a facilitator. How and why self-led debriefings influence debriefing outcomes remains undetermined.

RESEARCH AIM

The aim of this study was to explore how and why in-person self-led debriefings influence debriefing outcomes for groups of learners in immersive simulation-based education.

METHODS

An integrative review was conducted, searching seven electronic databases (PubMed, Cochrane, Embase, ERIC, SCOPUS, CINAHL Plus, PsychINFO) for peer-reviewed empirical studies investigating in-person self-led debriefings for groups of learners. Data were extracted, synthesised, and underwent reflexive thematic analysis.

RESULTS

Eighteen empirical studies identified through the search strategy were included in this review. There was significant heterogeneity in respect to study designs, aims, contexts, debriefing formats, learner characteristics, and data collection instruments. The synthesised findings of this review suggest that, across a range of debriefing outcome measures, in-person self-led debriefings for groups of learners following immersive simulation-based education are preferable to conducting no debriefing at all. In certain cultural and professional contexts, such as postgraduate learners and those with previous debriefing experience, self-led debriefings can support effective learning and may provide equivalent educational outcomes to facilitator-led debriefings or self-led and facilitator-led combination strategies. Furthermore, there is some evidence to suggest that self-led and facilitator-led combination approaches may optimise participant learning, with this approach warranting further research. Reflexive thematic analysis of the data revealed four themes, promoting self-reflective practice, experience and background of learners, challenges of conducting self-led debriefings and facilitation and leadership. Similar to facilitator-led debriefings, promoting self-reflective practice within groups of learners is fundamental to how and why self-led debriefings influence debriefing outcomes.

CONCLUSIONS

In circumstances where simulation resources for facilitator-led debriefings are limited, self-led debriefings can provide an alternative opportunity to safeguard effective learning. However, their true value within the scope of immersive simulation-based education may lie as an adjunctive method alongside facilitator-led debriefings. Further research is needed to explore how to best enable the process of reflective practice within self-led debriefings to understand how, and in which contexts, self-led debriefings are best employed and thus maximise their potential use.

Mapping the Terrain of Faculty Development for Simulation: A Scoping Review

ABSTRACT

Understanding what interventions and approaches are currently being used to improve the knowledge, skills, and effectiveness of instructors in simulation-based education is an integral step for carving out the future of simulation. The current study is a scoping review on the topic, to uncover what is known about faculty development for simulation-based education.We screened 3259 abstracts and included 35 studies in this scoping review. Our findings reveal a clear image that the landscape of faculty development in simulation is widely diverse, revealing an array of foundations, terrains, and peaks even within the same zone of focus. As the field of faculty development in simulation continues to mature, we would hope that greater continuity and cohesiveness across the literature would continue to grow as well. Recommendations provided here may help provide the pathway toward that aim.

Debriefing Methods for Simulation in Healthcare: A Systematic Review

ABSTRACT

Debriefing is a critical component in most simulation experiences. With the growing number of debriefing concepts, approaches, and tools, we need to understand how to debrief most effectively because there is little empiric evidence to guide us in their use. This systematic review explores the current literature on debriefing in healthcare simulation education to understand the evidence behind practice and clarify gaps in the literature. The PICO question for this review was defined as "In healthcare providers [P], does the use of one debriefing or feedback intervention [I], compared to a different debriefing or feedback intervention [C], improve educational and clinical outcomes [O] in simulation-based education?" We included 70 studies in our final review and found that our current debriefing strategies, frameworks, and techniques are not based on robust empirical evidence. Based on this, we highlight future research needs.

Testing the Impact of an Asynchronous Online Training Program With Repeated Feedback

BACKGROUND

Learning to effectively debrief with student learners can be a challenging task. Currently, there is little evidence to support the best way to train and evaluate a debriefer's competence with a particular debriefing method.

PURPOSE

The purpose of this study was to develop and test an asynchronous online distributed modular training program with repeated doses of formative feedback to teach debriefers how to implement Debriefing for Meaningful Learning (DML).

METHODS

Following the completion of an asynchronous distributed modular training program, debriefers self-evaluated their debriefing and submitted a recorded debriefing for expert evaluation and feedback using the DML Evaluation Scale (DMLES).

RESULTS

Most debriefers were competent in DML debriefing after completing the modular training at time A, with DMLES scores increasing with each debriefing submission.

CONCLUSION

The results of this study support the use of an asynchronous distributed modular training program for teaching debriefers how to implement DML.

"Asking for help is a strength"-how to promote undergraduate medical students' teamwork through simulation training and interprofessional faculty

The ability to team up and safely work in any kind of healthcare team is a critical asset and should be taught early on in medical education. Medical students should be given the chance to "walk the talk" of teamwork by training and reflecting in teams. Our goal was to design, implement and evaluate the feasibility of a simulation-based teamwork training (TeamSIM) for undergraduate medical students that puts generic teamwork skills centerstage. We designed TeamSIM to include 12 learning objectives. For this pre-post, mixed-methods feasibility study, third-year medical students, organized in teams of 11-12 students, participated and observed each other in eight simulations of different clinical situation with varying degrees of complexity (e.g., deteriorating patient in ward; trauma; resuscitation). Guided by an interprofessional clinical faculty with simulation-based instructor training, student teams reflected on their shared experience in structured team debriefings. Using published instruments, we measured (a) students' reactions to TeamSIM and their perceptions of psychological safety via self-report, (b) their ongoing reflections via experience sampling, and (c) their teamwork skills via behavior observation. Ninety four students participated. They reported positive reactions to TeamSIM (M = 5.23, SD = 0.5). Their mean initial reported level of psychological safety was M = 3.8 (SD = 0.4) which rose to M = 4.3 (SD = 0.5) toward the end of the course [T(21) = -2.8, 95% CI -0.78 to-0.12, p = 0.011 (two-tailed)]. We obtained n = 314 headline reflections from the students and n = 95 from the faculty. For the students, the most frequent theme assigned to their headlines involved the concepts taught in the course such as "10 s for 10 min." For the faculty, the most frequent theme assigned to their headlines were reflections on how their simulation session worked for the students. The faculty rated students' teamwork skills higher after the last compared to the first debriefing. Undergraduate medical students can learn crucial teamwork skills in simulations supported by an experienced faculty and with a high degree of psychological safety. Both students and faculty appreciate the learning possibilities of simulation. At the same time, this learning can be challenging, intense and overwhelming. It takes a team to teach teamwork.

Ongoing training and peer feedback in simulation-based learning for local faculty development: A participation action research study

BACKGROUND

Simulation-based learning (SBL) is often used in healthcare education. Professional development has been identified as crucial to the success of SBL. Effective, high-quality SBL requires facilitators who are multiskilled and have a range of SBL-related knowledge, skills and attitudes, which require time and practice to acquire. However, investment in facilitators' competence is often limited, particularly at smaller institutions without an associated simulation centre.

OBJECTIVES

The purpose of this study is to describe how a smaller university college with limited resources and limited facilitation experience has initiated continuing professional development and how this continuing professional development has contributed to maintaining and developing SBL facilitators' competence.

METHOD

Participatory action research has been used to improve the practice of SBL facilitators at a university college in Norway. The evaluations and reflections of 10 facilitators engaged in professional development and 44 national simulation conference participants have been analysed by way of Vaismoradi's qualitative content analysis.

RESULTS

A culture of participation and engagement and a clear professional development structure are both of crucial importance in the implementation and maintenance of continuing professional development in SBL. When these are present, not only does facilitation become more transparent, but facilitators become more aware of their own strengths and weaknesses, manage to address these and perceive an improvement in their confidence and competence.

CONCLUSIONS

Facilitators at smaller institutions without an associated simulation centre can improve their competence and confidence in SBL beyond the initial course, despite the absence of experienced mentors. The results indicate the importance of engaging in ongoing training and self-reflection based on peer feedback, the facilitators' own experience and up-to-date literature. Implementing and maintaining professional development at smaller institutions requires a clear structure, clear expectations and a culture of participation and development.

The Debriefing Assessment in Real Time (DART) tool for simulation-based medical education

BACKGROUND

Debriefing is crucial for enhancing learning following healthcare simulation. Various validated tools have been shown to have contextual value for assessing debriefers. The Debriefing Assessment in Real Time (DART) tool may offer an alternative or additional assessment of conversational dynamics during debriefings.

METHODS

This is a multi-method international study investigating reliability and validity. Enrolled raters (n = 12) were active simulation educators. Following tool training, the raters were asked to score a mixed sample of debriefings. Descriptive statistics are recorded, with coefficient of variation (CV%) and Cronbach's α used to estimate reliability. Raters returned a detailed reflective survey following their contribution. Kane's framework was used to construct validity arguments.

RESULTS

The 8 debriefings (μ = 15.4 min (SD 2.7)) included 45 interdisciplinary learners at various levels of training. Reliability (mean CV%) for key components was as follows: instructor questions μ = 14.7%, instructor statements μ = 34.1%, and trainee responses μ = 29.0%. Cronbach α ranged from 0.852 to 0.978 across the debriefings. Post-experience responses suggested that DARTs can highlight suboptimal practices including unqualified lecturing by debriefers.

CONCLUSION

The DART demonstrated acceptable reliability and may have a limited role in assessment of healthcare simulation debriefing. Inherent complexity and emergent properties of debriefing practice should be accounted for when using this tool.

Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings

BACKGROUND

Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings.

METHODS

In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection.

RESULTS

The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes.

CONCLUSION

When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.

Impact of the PEARLS Healthcare Debriefing cognitive aid on facilitator cognitive load, workload, and debriefing quality: a pilot study

BACKGROUND

The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool is a cognitive aid designed to deploy debriefing in a structured way. The tool has the potential to increase the facilitator's ability to acquire debriefing skills, by breaking down the complexity of debriefing and thereby improving the quality of a novice facilitator's debrief. In this pilot study, we aimed to evaluate the impact of the tool on facilitators' cognitive load, workload, and debriefing quality.

METHODS

Fourteen fellows from the New York City Health + Hospitals Simulation Fellowship, novice to the PEARLS Healthcare Debriefing Tool, were randomized to two groups of 7. The intervention group was equipped with the cognitive aid while the control group did not use the tool. Both groups had undergone an 8-h debriefing course. The two groups performed debriefings of 3 videoed simulated events and rated the cognitive load and workload of their experience using the Paas-Merriënboer scale and the raw National Aeronautics and Space Administration task load index (NASA-TLX), respectively. The debriefing performances were then rated using the Debriefing Assessment for Simulation in Healthcare (DASH) for debriefing quality. Measures of cognitive load were measured as Paas-Merriënboer scale and compared using Wilcoxon rank-sum tests. Measures of workload and debriefing quality were analyzed using mixed-effect linear regression models.

RESULTS

Those who used the tool had significantly lower median scores in cognitive load in 2 out of the 3 debriefings (median score with tool vs no tool: scenario A 6 vs 6, p=0.1331; scenario B: 5 vs 6, p=0.043; and scenario C: 5 vs 7, p=0.031). No difference was detected in the tool effectiveness in decreasing composite score of workload demands (mean difference in average NASA-TLX -4.5, 95%CI -16.5 to 7.0, p=0.456) or improving composite scores of debriefing qualities (mean difference in DASH 2.4, 95%CI -3.4 to 8.1, p=0.436).

CONCLUSIONS

The PEARLS Healthcare Debriefing Tool may serve as an educational adjunct for debriefing skill acquisition. The use of a debriefing cognitive aid may decrease the cognitive load of debriefing but did not suggest an impact on the workload or quality of debriefing in novice debriefers. Further research is recommended to study the efficacy of the cognitive aid beyond this pilot; however, the design of this research may serve as a model for future exploration of the quality of debriefing.

Sandbox of Competence: A Conceptual Model for Assessing Professional Competence

This article aims to propose a conceptual model for evaluating the knowledge stage of a professional activity. Starting from an integrative literature review, a method that allows us to assess, criticize and synthesize empirical or theoretical knowledge, we explore the evolutions of the model by Dreyfus and Dreyfus (1980). The collection and analysis process followed a six-stage process, starting from a guiding question and proceeding to a literature search, so that data collection and critical analysis of information could be carried out in a structured and codified way, enabling the discussion of results and, finally, the presentation of the review. As a result, we suggest a model capable of classifying a professional competence in accordance with the literature, through a model that considers practice, theoretical/technical knowledge, and attitude as axes for the evolution of learning. The suggested model contributes to the construction of a skills assessment instrument.

Guideline No. 431: Postpartum Hemorrhage and Hemorrhagic Shock

OBJECTIVE

This guideline aims to provide evidence for prevention, recognition, and treatment of postpartum hemorrhage including severe hemorrhage leading to hemorrhagic shock.

TARGET POPULATION

All pregnant patients.

BENEFITS, HARMS, AND COSTS

Appropriate recognition and treatment of postpartum hemorrhage can prevent serious morbidity while reducing costs to the health care system by minimizing more costly interventions and length of hospital stays.

EVIDENCE

Medical literature, PubMed, ClinicalTrials.gov, the Cochrane Database, and grey literature were searched for articles, published between 2012 and 2021, on postpartum hemorrhage, uterotonics, obstetrical hemorrhage, and massive hemorrhage protocols.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

INTENDED AUDIENCE

All members of the health care team who care for labouring or postpartum women, including, but not restricted to, nurses, midwives, family physicians, obstetricians, and anesthesiologists.

RECOMMENDATIONS

Simulation debriefing as part of simulation for clinical teaching and learning in nursing education: A scoping review

AIM

To map the evidence of the simulation debriefing phase in simulation activities of nursing education, to address and inform clinical teaching and learning in nursing.

DESIGN

A scoping review.

METHODS

A systematic review of literature published between 2008-2021 was conducted using CINAHL & ERIC, MEDLINE, EMBASE, APA PsycInfo, the Cochrane Library and JBI Evidence synthesis. Inclusion criteria were primary studies published in English on simulation debriefing at all levels in nursing education.

RESULTS

Of 140 included references, only 80% (N = 112) framed simulation debriefing theoretically either by specific theories/models or as a literature review of the topic. A variety of simulation debriefing methods were identified; however, debriefing methods were only described in 79% (N = 110) of the references. There appears to be a gap in consensus concerning the theoretical or methodological frameworks characterizing simulation debriefing in nursing education. The majority of studies (86%) were conducted at a bachelor's degree level (N = 121).

Exploring facilitator gaze patterns during difficult debriefing through eye-tracking analysis: a pilot study

Managing difficult debriefing can be challenging for simulation facilitators. Debriefers may use eye contact as a strategy to build and maintain psychological safety during debriefing. Visual dominance ratio (VDR), a measure of social power, is defined as the percentage of time making eye contact while speaking divided by the percentage of time making eye contact while listening. Little is known about eye gaze patterns during difficult debriefings.

To demonstrate the feasibility of examining eye gaze patterns (i.e. VDR) among junior and senior facilitators during difficult debriefing.

We recruited 10 trained simulation facilitators (four seniors and six juniors) and observed them debriefing two actors. The actors were scripted to play the role of learners who were engaged in the first scenario, followed by upset (emotional) and confrontational in the second and third scenarios, respectively. The participant facilitators wore an eye-tracking device to record their eye movements and fixation duration. The fixation durations and VDRs were calculated and summarized with median and interquartile range. We explore the effect of scenarios and training level on VDRs using Friedman tests and Wilcoxon rank sum tests.

All 10 participants completed all three scenarios. There were no statistically significant differences in VDRs between the junior and senior facilitators for all three scenarios (baseline:

The use of eye-tracking device to measure VDR during debriefings is feasible. We did not demonstrate a difference between junior and seniors in eye gaze patterns during difficult debriefings.

Who Can Debriefing Assessment for Simulation in Healthcare? Different Perspectives on Teledebriefing Assessments

INTRODUCTION

Virtual debriefing is a cardinal element to achieve the effectiveness of telesimulation. There are different instruments to assess face-to-face debriefing to determine the degree of effectiveness of debriefing; Debriefing Assessment for Simulation in Healthcare (DASH) instrument is one of them. This study aims to describe and compare the evaluation of raters, instructors, and students during a virtual debriefing using the DASH.

METHODS

A cross-sectional study was performed evaluating the virtual debriefing of 30 instructors after a heart failure telesimulation scenario. The evaluation was conducted by 30 instructors, 338 undergraduate students in the seventh semester, and 7 simulation raters. The 3 versions of the DASH instrument in Spanish were applied, respectively.

RESULTS

Two comparisons were made, student versus instructor and rater versus instructor. Cronbach α was 0.97 for each version. The averages of the results on the DASH instrument were: 6.61 (3.34-7.0), 5.95 (4.65-7.0), and 4.84 (2.68-6.02) for student, rater, and instructor versions, respectively. The size effect between student and debriefer perspectives was 0.42. In contrast, the size effect between instructor and rater was 0.72. All differences were significant.

CONCLUSIONS

There are different rates between the persons who use the DASH. In this study, from the perspective of the instructor and rater, the difference was 1 point with a wide range, in contrast with the difference between instructor and student, which is relatively minor. It is necessary to consider the perspectives of experts in the subject to achieve a virtual debriefing of high quality and improve a debriefing by using the DASH.

PRE-scripted debriefing for Paediatric simulation Associated with Resuscitation EDucation (PREPARED): A multicentre, cluster randomised controlled trial

Aim

Scripted debriefing tools may improve the performance of novices debriefing in resuscitation courses, but this has not previously been measured. The aim of this study was to determine the impact of a script on the quality of debriefs in a statewide paediatric resuscitation course.

Methods

This cluster-randomised controlled trial compared scripted debriefing (intervention) versus non-scripted debriefing (control) for participants in a paediatric resuscitation course. The trial was conducted across participating sites in Queensland, Australia, from November 2017 to February 2020. Debriefing quality was measured using the Observational Structured Assessment of Debriefing (OSAD) tool. The OSAD tool rates 8 domains that comprise the elements of an ideal debrief. OSAD scores between scripted and non-scripted groups were compared, overall and after stratification by debriefer experience and site size.

Results

Seventy debriefings occurred across 19 sites (intervention, n = 34, control n = 36). There was a statistically significant increase in total OSAD scores in the scripted group, compared to non-scripted (mean difference (MD) = 3.5, 95% confidence interval (CI) 0.7–6.2, p = 0.01). The categories of ‘reflection’ and ‘analysis’ had the greatest difference in OSAD scores in the scripted group (MD = 0.8, 95%CI 0.2–1.3, p = 0.005; MD = 0.6, 95%CI 0.2–1.0, p = 0.007). After stratification, overall OSAD scores improved for novices (MD = 4.1, 95%CI 0.5–7.7, p = 0.03) and large centres (MD = 5.2, 95%CI 1.1–9.2, p = 0.01).

Conclusion

Providing debriefing scripts to faculty facilitating simulated paediatric resuscitation scenarios improved the quality of debriefing, especially for novices and those at large sites. The development and provision of debriefing scripts for large-scale paediatric resuscitation courses should be considered.

Pilot study of the DART tool - an objective healthcare simulation debriefing assessment instrument

BACKGROUND

Various rating tools aim to assess simulation debriefing quality, but their use may be limited by complexity and subjectivity. The Debriefing Assessment in Real Time (DART) tool represents an alternative debriefing aid that uses quantitative measures to estimate quality and requires minimal training to use. The DART is uses a cumulative tally of instructor questions (IQ), instructor statements (IS) and trainee responses (TR). Ratios for IQ:IS and TR:[IQ + IS] may estimate the level of debriefer inclusivity and participant engagement.

METHODS

Experienced faculty from four geographically disparate university-affiliated simulation centers rated video-based debriefings and a transcript using the DART. The primary endpoint was an assessment of the estimated reliability of the tool. The small sample size confined analysis to descriptive statistics and coefficient of variations (CV%) as an estimate of reliability.

RESULTS

Ratings for Video A (n = 7), Video B (n = 6), and Transcript A (n = 6) demonstrated mean CV% for IQ (27.8%), IS (39.5%), TR (34.8%), IQ:IS (40.8%), and TR:[IQ + IS] (28.0%). Higher CV% observed in IS and TR may be attributable to rater characterizations of longer contributions as either lumped or split. Lower variances in IQ and TR:[IQ + IS] suggest overall consistency regardless of scores being lumped or split.

CONCLUSION

The DART tool appears to be reliable for the recording of data which may be useful for informing feedback to debriefers. Future studies should assess reliability in a wider pool of debriefings and examine potential uses in faculty development.

„Die Puppe hat Luftnot“ – Simulation zum interprofessionellen Lernen im Team: aber sinnvoll!

Ausbildungskonzepte, die eine Simulation von Fällen und Szenarien aller Art nutzen, haben breiten Eingang in Curricula und Praxis gefunden. Ein Vertrauen in technische Simulationsmethoden ohne qualifizierte Ausbildung in der Methode kann schaden. Deswegen sollte nach der Auswahl der korrekten Simulationsmethode großer Wert auf die Durchführung der Simulation gelegt werden. Neben einem strukturierten Design der simulierten Szenarien und der korrekten technischen Durchführung ist für den Lernerfolg vor allem das Debriefing, die Nachbesprechung, entscheidend. Prüfungen mit Simulation als Methode sind nur zu empfehlen, wenn sie von Trainings getrennt durchgeführt werden und die Bewertung nach transparenten, validierten Kriterien erfolgt.

Debriefing for Meaningful Learning: Implementing a Train-the-Trainer Program for Debriefers

Debriefing for Meaningful Learning (DML) is a method of debriefing grounded in the theory of reflection used following a simulation or clinical learning experience to engage participants in an interactive dialogue aimed at examining and evaluating their thinking and decision-making processes. With increasing adoption of DML worldwide, a sustainable training program for nurse educators is needed. Attending conferences and workshops that provide training is challenging for many nurse educators because of time and cost constraints. One promising solution is the train-the-trainer (TTT) model. In this article, the development and implementation of a TTT model of DML debriefer training, adaptable to both academic and clinical nursing professional development, is described. [J Contin Educ Nurs. 2022;53(7):321-327.].

Le débriefing par revue après action pour la simulation en santé : applications à la médecine d’urgence

Introduction : Le débriefing est une analyse postévénementielle qui est une partie fondamentale du processus d’apprentissage par simulation. Il est une évaluation formative permettant d’explorer les raisons des déficits de performance dans un objectif d’amélioration des performances. La revue après action (RAA) est une technique du débriefing développée par l’armée américaine et qui explore en équipe les intentions derrière les actions. L’objectif de ce travail a été de décrire les principes de la revue après action en tant que technique et d’en déterminer l’intérêt, les avantages et les inconvénients en simulation en santé, notamment en médecine d’urgence.

Méthodes : Revue narrative de la littérature traitant du débriefing en simulation par revue après action. Après analyse de la littérature dans les bases Medline, Web of Science, ScienceDirect, Pascal & Francis et Defense Technical Information Center, les articles ont été inclus s’ils répondaient aux critères suivants : apprentissage par simulation, revue après action comme méthode de débriefing.

Résultats : Quinze manuscrits ont été inclus. La revue après action permet une analyse non punitive et objective de la simulation. Ses principales forces sont d’analyser collectivement les performances d’équipe et de proposer des mesures correctives. Ses principales limites sont l’absence de débriefing individuel et son inefficacité en cas d’insuffisance de formation du débriefeur.

Conclusion: La revue après action est un format de débriefing favorisant les apprentissages et l’amélioration des performances d’équipe, mais explore peu les performances individuelles.

Immediate faculty feedback using debriefing timing data and conversational diagrams

BACKGROUND

Debriefing is an essential skill for simulation educators and feedback for debriefers is recognised as important in progression to mastery. Existing assessment tools, such as the Debriefing Assessment for Simulation in Healthcare (DASH), may assist in rating performance but their utility is limited by subjectivity and complexity. Use of quantitative data measurements for feedback has been shown to improve performance of clinicians but has not been studied as a focus for debriefer feedback.

METHODS

A multi-centre sample of interdisciplinary debriefings was observed. Total debriefing time, length of individual contributions and demographics were recorded. DASH scores from simulation participants, debriefers and supervising faculty were collected after each event. Conversational diagrams were drawn in real-time by supervising faculty using an approach described by Dieckmann. For each debriefing, the data points listed above were compiled on a single page and then used as a focus for feedback to the debriefer.

RESULTS

Twelve debriefings were included (µ = 6.5 simulation participants per event). Debriefers receiving feedback from supervising faculty were physicians or nurses with a range of experience (n = 7). In 9/12 cases the ratio of debriefer to simulation participant contribution length was ≧ 1:1. The diagrams for these debriefings typically resembled a fan-shape. Debriefings (n = 3) with a ratio < 1:1 received higher DASH ratings compared with the ≧ 1:1 group (p = 0.038). These debriefings generated star-shaped diagrams. Debriefer self-rated DASH scores (µ = 5.08/7.0) were lower than simulation participant scores (µ = 6.50/7.0). The differences reached statistical significance for all 6 DASH elements. Debriefers evaluated the 'usefulness' of feedback and rated it 'highly' (µ= 4.6/5).

CONCLUSION

Basic quantitative data measures collected during debriefings may represent a useful focus for immediate debriefer feedback in a healthcare simulation setting.

Implementation of a virtual escape room mock code to comply with social distancing

BACKGROUND

Despite a global pandemic with social distancing regulations, nurses must continue to participate in continuing education to ensure competency for the care they provide. Mock codes are common yearly competencies that nurses must participate in to grow their critical thinking and show mastery of the skills. Maintaining mock codes which were usually in person, became a struggle in order to comply with social distancing.

METHOD

A virtual escape room mock code was implemented as a substitute for in-person education to sustain continued education during a time of social distancing. The aim was to determine if the virtual sessions met the perceived expectations of the nurses in comparison to previous in-person sessions. The session was designed based upon the Community of Inquiry framework for participants to work together in a meaningful capacity. After completion of the session, a survey which included an adaption of the Student Satisfaction and Self-Confidence in Learning Survey, was disseminated to pediatric and Pediatric Intensive Care Unit (PICU) nurses to gauge their satisfaction and perceptions compared to an in-person method.

RESULTS

Results indicated that the nurses felt satisfaction and self-confidence in learning and that virtual session provided equal education as compared to previous in-person sessions.

CONCLUSION

The virtual escape room mock code engaged the nursing staff in an interactive educational opportunity which fulfilled their annual competency requirement.

Debriefing for Simulation-Based Medical Education: A Survey From the International Network of Simulation-Based Pediatric Innovation, Research and Education

CONTEXT

Current debriefing approaches and faculty development strategies for simulation educators differ around the world. We aim to describe the status of current debriefing practice and faculty development for simulation educators in this study.

METHODS

We distributed a paper-based survey during 2 international conferences to obtain data from active International Network for Simulation-based Pediatric Innovation, Research and Education members. The survey was tested to ensure content validity and consisted of the following 3 constructs: demographic characteristics, current debriefing practice, and issues related to faculty development.

RESULTS

One hundred nine of 114 participants (96%) completed the survey. Debriefing practice differs in terms of timing, duration, framework, and conversational framework. Most debriefings were less than 30 minutes (93/109, 85%), with many educators not using objective data during debriefing (47/109, 43%). Three- or 4-phase debriefing frameworks were used most commonly (66/109, 61%). Most participants have access to some faculty development opportunities (99/109, 91%). Barriers to faculty development are related to time and resource constraints (eg, freeing up facilitator's time: 75/109, 69%, competing priorities 64/109, 59%). Most participants indicated that their needs for debriefing to improve learning outcomes were met (95/109, 87%). The desired content for future faculty development opportunities varies between educators with different levels of expertise.

CONCLUSIONS

Approaches to debriefing among members of an international pediatric simulation network vary considerably. Although faculty development opportunities were available to most participants, future simulation programs should work on addressing barriers and optimizing faculty development plans to meet the needs of their educators.

Effectiveness of co-debriefing to develop clinical skills in basic life support: randomized pilot study

ABSTRACT Objective To compare the effectiveness of co-debriefing with debriefing with a facilitator in the development of clinical competences in nursing students in the simulated care of cardiac arrest. Method Randomized pilot study, carried out at a university in Minas Gerais, Brazil, in August 2021, with 17 students, to compare debriefing with a facilitator (control n=8) with co-debriefing (intervention n=9). Pre- and post-test, Objective Structured Clinical Examination and scales were used to assess behavioral skills. Wilcoxon and Mann-Whitney nonparametric comparison tests were used for analysis. Results The intervention group performed better than the control for knowledge about basic life support (control=17.00±2.39 and intervention=19.22 ± 0.66, p=0.021) and psychomotor skills (control=8.12±0.13 and intervention=8.50 ± 0.001, p<0.001). There were no significant differences for behavioral skills. Conclusion Co-debriefing appears to be more effective than debriefing with a facilitator to develop clinical skills in basic life support in nursing.

Efetividade do co-debriefieng para desenvolver competências clínicas no suporte básico de vida: estudo piloto randomizado

RESUMO Objetivo Comparar a efetividade entre co-debriefing com debriefing com facilitador no desenvolvimento de competências clínicas em estudantes de enfermagem no atendimento simulado da parada cardiorrespiratória. Método Estudo-piloto randomizado, realizado em uma universidade de Minas Gerais, Brasil, em agosto de 2021 com 17 estudantes, para comparar o debriefing com um facilitador (controle n=8) e com o co-debriefing (intervenção n=9). Utilizaram-se pré e pós-teste, Exame Clínico Objetivo Estruturado e escalas para avaliar as habilidades comportamentais. Adotaram-se testes de comparação não paramétricos Wilcoxon e Mann-whitney para análise. Resultados O grupo intervenção obteve desempenho superior ao controle para o conhecimento sobre o suporte básico de vida (controle=17,00±2,39 e intervenção=19,22 ± 0,66, p=0,021) e habilidades psicomotoras (controle=8,12±0,13 e intervenção=8,50 ± 0,001, p<0,001). Não houve diferenças significativas para as habilidades comportamentais. Conclusão O co-debriefing parece ser mais efetivo do que o debriefing como um facilitador para desenvolver competências clínicas no suporte básico de vida em enfermagem.

Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis

AIMS

Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction.

REVIEW METHODS

We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels.

RESULTS

A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences.

CONCLUSION

These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.

Effects of using a cognitive aid on content and feasibility of debriefings of simulated emergencies

Background: Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated. Methods: In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool - a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) - or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM). Results: The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants' satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions. Conclusion: The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.

Effects of a Debriefing Workshop for Simulation Educators in Nursing

Simulation educators play an essential role in debriefing to induce learning outcomes following a simulation activity. Training programs are needed to ensure and maintain the simulation educator's debriefing competency. This study aimed to identify the effects of a 4-hour debriefing workshop on knowledge, debriefing competency, and satisfaction. A one-group pretest-posttest design was used. The debriefing workshop consisted of a lecture, a practicum for debriefing competency rating (peer evaluation, learner evaluation), a presentation, and a group discussion. A convenience sample of 22 simulation educators completed a self-administered questionnaire. The pretest-posttest difference in knowledge and debriefing competency was analyzed using a paired t test. The results indicated that simulation educators had a higher posttest than pretest knowledge score. Training also significantly improved the overall elements of the perceived simulation educator debriefing competency. The simulation educators were generally satisfied with the debriefing workshop. The debriefing workshop positively affected the simulation educators' knowledge, debriefing competency, and satisfaction. Further study is needed to identify the translational effects of a faculty development program regarding debriefing on learner outcomes.

Fundamental underpinnings of simulation education: describing a four-component instructional design approach to healthcare simulation fellowships

Although in 2020, there are more than 120 healthcare simulation fellowships established globally, there is a paucity of literature on how to design fellowship programs most effectively, to equip graduates with the knowledge, skills, and attitudes of a competent simulation educator. Offering a systematic structure to approach simulation fellowship programmatic design may aid in better achieving program goals. In this manuscript, we present the application of the 4-component instructional design model as a blueprint to the development of Simulation Education Fellowships. We offer examples used at the NYC Health + Hospitals simulation fellowship to illustrate how the 4-component model informs fellowship program design which promotes the development of a simulation educator. This manuscript will provide a roadmap to designing curricula and assessment practices including self-reflective logbooks to focus the path toward achieving desired skills and shape future conversations around programmatic development.

"A debriefer must be neutral" and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing

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.

A Developing Nation's Experience in Using Simulation-Based Training as a Preparation Tool for the Coronavirus Disease 2019 Outbreak

Supplemental Digital Content is available in the text.

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic affected and overwhelmed many health care systems around the world at an unprecedented speed and magnitude with devastating effects. In developing nations, smaller hospitals were unprepared to face this outbreak nor had strategies in place to do so at the beginning. Here, we describe the preparation in an anesthetic department using simulation-based training over 2 weeks, as the number of cases rose rapidly.

METHODS:

Three areas of priority were identified as follows: staff safety, patient movement, and possible clinical scenarios based on simulation principles in health care education. Staff was rostered and rotated through stations for rapid-cycle deliberate practice to learn donning and doffing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR). For difficult airway management, Peyton’s 4 steps for skills training and Harden’s Three Circle model formed the structure in teaching the core skills. Several clinical scenarios used system probing to elicit inadequacies followed by formal debriefing to facilitate reflection. Finally, evaluation was both immediate and delayed with an online survey after 1 month to examine 4 levels of reaction, learning, behavior, and impact based on the Kirkpatrick Model. Frequency and thematic analysis were then conducted on the quantitative and qualitative data, respectively.

RESULTS:

A total of 15 of 16 (93%) consultants, 16 (100%) specialists, and 81 (100%) medical officers in the department completed training within 2 consecutive weeks. Reaction and part of the learning were relayed immediately to trainers during training. In total, 42 (39%) trained staff responded to the survey. All were satisfied and agreed on the relevance of training. A total of 41 respondents (98%; 95% confidence interval [CI], 87-99) answered 16 of 20 questions correctly on identifying aerosol-generating procedures (AGP), indications for PPE, planning and preparation for airway management to achieve adequate learning. About 43% (95% CI, 27-59) and 52% (95% CI, 36-68) recalled donning and doffing steps correctly. A total of 92 responses from 33 respondents were analyzed in the thematic analysis. All respondents reported at least 1 behavioral change in intended outcomes for hand hygiene practice (20%), appropriate use of PPE (27%), and airway management (10%). The emerging outcomes were vigilance, physical distancing, planning, and team communication. Finally, the impact of training led to the establishment of institutional guidelines followed by all personnel.

CONCLUSIONS:

Simulation-based training was a useful preparation tool for small institutions with limited time, resources, and manpower in developing nations. These recommendations represent the training experience to address issues of “when” and “how” to initiate urgent “medical education” during an outbreak.

Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19

BACKGROUND

Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic.

METHODS

We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10-25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed.

RESULTS

During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7-13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%).

CONCLUSION

Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.

Focusing on explicit debriefing for novice learners in healthcare simulations: A randomized prospective study

INTRODUCTION

Debriefing is essential in simulation-based training, but it is not clear what exactly constitutes a successful debriefing session. Research in educational sciences shows that a structured, explicit and trainer-directed approach is systematically more effective than an implicit, reflective approach with minimal guidance, particularly for novice or intermediate learners. The aim of this study is to compare explicit strongly trainer-guided debriefing with implicit and weakly guided debriefing in nursing training.

METHOD

Single-centre randomized prospective study comparing effectiveness of explicit and implicit debriefing techniques. We focused on the description and the analysis phases of the debriefing. Our main aim was to assess the effectiveness of debriefing in terms of knowledge improvement. We also assessed its effectiveness for self-efficacy and self-confidence.

RESULTS

136 nursing students participated in 46 simulation sessions. Knowledge, self-efficacy and self-confidence increased in all conditions. The results also showed that debriefing with explicit analysis improved learning significantly when compared to the control session.

CONCLUSION

Although the results revealed a beneficial effect of simulation training on self-efficacy, the explicit debriefing technique was shown to produce greater knowledge improvement than the implicit debriefing method in novice learners. Consequently, debriefing technique should be adapted to the objectives of the training and learners.