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Schwartze JT, Das S, Suggitt D, Baxter J, Tunstall S, Ronan N, Stannard H, Rezgui A, Jafar W, Baxter DN. Ward-based in situ simulation: lessons learnt from a UK District General Hospital. BMJ Open Qual 2024; 13:e002571. [PMID: 38749539 PMCID: PMC11097843 DOI: 10.1136/bmjoq-2023-002571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/02/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION In situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS impact on teamwork, technical skill performance, healthcare staff perception and latent error identification during simulated medical emergencies. MATERIALS AND METHODS Unannounced ISS sessions (n=14, n=75 staff members) using a high-fidelity mannequin were conducted in medical, paediatric and rehabilitation wards at Stepping Hill Hospital (Stockport National Health Service Foundation Trust, UK). Each session encompassed a 15 min simulation followed by a 15 min faculty-led debrief. RESULTS The clinical team score revealed low overall teamwork performances during simulated medical emergencies (mean±SEM: 4.3±0.5). Linear regression analysis revealed that overall communication (r=0.9, p<0.001), decision-making (r=0.77, p<0.001) and overall situational awareness (r=0.73, p=0.003) were the strongest statistically significant predictors of overall teamwork performance. Neither the number of attending healthcare professionals, their professional background, age, gender, degree of clinical experience, level of resuscitation training or previous simulation experience statistically significantly impacted on overall teamwork performance. ISS positively impacted on healthcare staff confidence and clinical training. Identified safety threats included unknown location of intraosseous kits, poor/absent airway management, incomplete A-E assessments, inability to activate the major haemorrhage protocol, unknown location/dose of epinephrine for anaphylaxis management, delayed administration of epinephrine and delayed/absence of attachment of pads to the defibrillator as well as absence of accessing ALS algorithms, poor chest compressions and passive behaviour during simulated cardiac arrests. CONCLUSION Poor demonstration of technical/non-technical skills mandate regular ISS interventions for healthcare professionals of all levels. ISS positively impacts on staff confidence and training and drives identification of latent errors enabling improvements in workplace systems and resources.
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Affiliation(s)
- Julian Tristan Schwartze
- Stroke Medicine, National Hospital for Neurology and Neurosurgery, London, UK
- Medical Education, Stepping Hill Hospital, Stockport, UK
| | - Souvik Das
- Emergency Department, Stepping Hill Hospital, Stockport, UK
| | | | | | - Simon Tunstall
- Department of Anaesthetics, Stepping Hill Hospital, Stockport, UK
| | - Nicholas Ronan
- Royal Stoke University Hospital Acute Medical Unit, Stoke-on-Trent, UK
| | | | - Amina Rezgui
- Acute Medicine, Stepping Hill Hospital, Stockport, UK
| | - Wisam Jafar
- Gastroenterology, Stepping Hill Hospital, Stockport, UK
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Schulze M, Streith L, Wiseman SM. Intraoperative teaching methods, models, and frameworks: A scoping review for surgical resident education. Am J Surg 2024; 231:24-40. [PMID: 38342713 DOI: 10.1016/j.amjsurg.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND This review aimed to consolidate the existing literature on intraoperative teaching strategies and highlight areas for future research. OBJECTIVE The objective is to review the research conducted regarding the implementation of various teaching frameworks for surgical learners and to present their feasibility, benefits, and limitations within surgical residencies, as well as areas for future research. METHODS Two independent investigators searched MEDLINE, EMBASE, and ERIC and reviewed articles on intraoperative teaching strategies for surgical resident education. RESULTS 3050 abstracts were reviewed, and 66 studies (2.2%) were included. The most common study type was single cohort studies (33%), followed by survey studies (17%). The majority of articles were carried out in General Surgery (50%), or a combination of surgical specialties (17%). CONCLUSIONS The BID model encompasses perioperative teaching time points and suggests a universal organizational approach to intraoperative teaching that would likely be compatible with documented competency assessments for residents.
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Affiliation(s)
- Marie Schulze
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Lucas Streith
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada.
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Gasteratos K, Michalopoulos J, Nona M, Morsi-Yeroyiannis A, Goverman J, Rakhorst H, van der Hulst RRWJ. Instructional Video of a Standardized Interprofessional Postsimulation Facilitator-guided Debriefing of a Fatality in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5583. [PMID: 38333029 PMCID: PMC10852376 DOI: 10.1097/gox.0000000000005583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024]
Abstract
Background Postsimulation facilitator-guided debriefing (PSFGD) is the process of intentional discussion of thoughts, actions, and events that took place during simulation amongst the facilitator(s) and trainees. Despite the significance of delivering high-quality debriefings, there is a lack of evidence-based guidelines. Our study aimed to provide an instructional video demonstration of a PSFGD of a fatality. Methods Fifty surgical interns participated in a burn simulation scenario in two groups. Group 1 (control, or "no exposure," n = 25) consisted of residents who received oral postsimulation debriefing from an independent faculty member who had no exposure to our instructional video on how to debrief effectively. Group 2 (intervention, or "exposure," n = 25) consisted of interns who were debriefed by the second faculty member who did watch our instructional video before the simulation and learned about "advocacy and inquiry" techniques. The outcome measures were the Debriefing Assessment for Simulation in Healthcare score and the postdebrief multiple-choice question (MCQ) quiz scores to assess debriefers' performance and interns' knowledge consolidation, respectively. Results The "exposure" group presented statistically significantly higher values for the Debriefing Assessment for Simulation in Healthcare score (P < 0.001) and MCQ score (P < 0.001) compared with the "no exposure" group. Conclusions Debriefers who followed the methodology as demonstrated in our instructional video were considered more competent, and the residents achieved higher MCQ scores. The quality of the debriefing ensures improved critical thinking and problem-solving skills. Safer practice and better patient outcomes are achieved by developing debriefing programs for educators.
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Affiliation(s)
| | | | | | | | - Jeremy Goverman
- Summer M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Hinne Rakhorst
- Department of Plastic Surgery, MST Enschede, ZGT Almelo, the Netherlands
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Abdulmohdi N, McVicar A. Student Nurses' Perceptions of the Role of High-Fidelity Simulation in Developing Decision-Making Skills for Clinical Practice: A Qualitative Research Study. SAGE Open Nurs 2024; 10:23779608241255299. [PMID: 38770422 PMCID: PMC11104027 DOI: 10.1177/23779608241255299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/28/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The integration of high-fidelity simulation (HFS) in nursing education has increased, but its effect on students' clinical decision-making skills and their ability to transfer these skills to clinical practice remains unclear. Aim This qualitative study aimed to explore nursing students' perceptions of simulation's role in developing decision-making skills for clinical practice. Methods Twenty-three self-selected final-year nursing students participated in an HFS exercise in 2016. They engaged in "think-aloud" activities during the simulation, reviewed videos of their performance, and attended a structured debriefing session. Four to six weeks later, face-to-face semistructured interviews were conducted to gather their views on the application of learning from simulation into practice. Thematic analysis was used to analyze the interview data. Results Four themes emerged from the analysis: "enhancing clinical decision-making skills," "recognition of the types of clinical decision-making," "recognition of cognitive biases," and "transferability and integrating theory into practice." Simulation improved student self-awareness, decision-making skills, and recognition of cognitive biases applied in practice. Overall, students found that the simulation improved their ability to apply theoretical knowledge gained through simulation to practice. The students' perception of the authenticity of activities in relation to real-world scenarios played a crucial role in enhancing the transferability and application of acquired knowledge from simulation to clinical practice. Conclusion The findings provide valuable insights into how simulation optimizes learning and decision-making skills, ultimately promoting effective care in clinical settings.
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Affiliation(s)
- Naim Abdulmohdi
- School of Nursing and Midwifery, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Andrew McVicar
- School of Nursing and Midwifery, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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Cavaleri R, Withington A, Chalmers KJ, Blackstock F. The Influence of Stress on Student Performance during Simulation-based Learning: A Pilot Randomized Trial. ATS Sch 2023; 4:474-489. [PMID: 38196683 PMCID: PMC10773496 DOI: 10.34197/ats-scholar.2022-0042oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/06/2023] [Indexed: 01/11/2024] Open
Abstract
Background Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions. Objective This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance. Methods Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected. Results Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (P = 0.02). Higher anxiety was correlated with poorer skill performance (r = -0.410). Conclusions Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.
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Affiliation(s)
- Rocco Cavaleri
- School of Health Sciences and
- Brain Stimulation and Rehabilitation
(BrainStAR) Lab, Western Sydney University, Penrith, New South Wales,
Australia
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Ahmad M, Page M, Goodsman D. What is simulation-based medical education (SBME) debriefing in prehospital medicine? A qualitative, ethnographic study exploring SBME debriefing in prehospital medical education. BMC MEDICAL EDUCATION 2023; 23:625. [PMID: 37661254 PMCID: PMC10476317 DOI: 10.1186/s12909-023-04592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Simulation-based medical education (SBME) debriefing - a construct distinct from clinical debriefing - is used following simulated scenarios and is central to learning and development in fields ranging from aviation to emergency medicine. However, little research into SBME debriefing in prehospital medicine exists. This qualitative study explored the facilitation and effects of prehospital SBME debriefing, and identified obstacles to debriefing, using the London's Air Ambulance Pre-Hospital Care Course (PHCC) as a model. METHOD Ethnographic observations of moulages and debriefs were conducted over two consecutive days of the PHCC in October 2019. Detailed contemporaneous field notes were made and analysed thematically. Subsequently, seven one-to-one, semi-structured interviews were conducted with four PHCC debrief facilitators and three course participants to explore their experiences of prehospital SBME debriefing. Interview data were transcribed and analysed thematically. RESULTS Four overarching themes were identified: approach to facilitation of debriefs, effects of debriefing, facilitator development, and obstacles to debriefing. The unpredictable debriefing environment was seen as both hindering and, paradoxically, benefitting SBME debriefing. Despite using varied debriefing structures, facilitators emphasised similar key debriefing components including exploring participants' reasoning and sharing experiences to improve learning and prevent future errors. Debriefing was associated with three effects: releasing emotion; learning and improving, particularly compound learning as participants progressed through sequential scenarios; and the application of learning to clinical practice. Facilitator training and feedback were central to facilitator learning and development. Several obstacles to debriefing were identified, including mismatch of participant and facilitator agendas, pressure and time. CONCLUSIONS SBME debriefing in prehospital medicine is complex, requiring an understanding of participant agendas and facilitator experience to maximise participant learning. Aspects unique to prehospital SBME debriefing were identified, notably, the unpredictable debriefing environment, and the paradoxical benefit of educational obstacles for learning. Aspects of SBME debriefing not extensively detailed in the literature were also highlighted, such as compound participant learning, facilitator candour, and facilitator learning, which require further exploration.
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Affiliation(s)
- Maria Ahmad
- Barts and the London School of Medicine and Dentistry, Institute of Health Sciences Education, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2AD, UK
| | - Michael Page
- Barts and the London School of Medicine and Dentistry, Institute of Health Sciences Education, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2AD, UK.
| | - Danë Goodsman
- Barts and the London School of Medicine and Dentistry, Institute of Health Sciences Education, Queen Mary University of London, Turner Street, Whitechapel, London, E1 2AD, UK
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7
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Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings. BMJ Qual Saf 2023; 32:160-172. [PMID: 35902231 DOI: 10.1136/bmjqs-2021-014393] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland .,ETH Zürich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland.,Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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8
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Tannenbaum SI, Greilich PE. The debrief imperative: building teaming competencies and team effectiveness. BMJ Qual Saf 2023; 32:125-128. [PMID: 36323510 DOI: 10.1136/bmjqs-2022-015259] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Philip E Greilich
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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9
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Abdulmohdi N, Mcvicar A. Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study. J Adv Nurs 2023; 79:811-824. [PMID: 36412270 PMCID: PMC10099619 DOI: 10.1111/jan.15507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario. DESIGN A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. METHODS Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher. RESULTS There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. CONCLUSION Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.
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Affiliation(s)
- Naim Abdulmohdi
- School of Nursing and Midwifery, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Andrew Mcvicar
- School of Nursing and Midwifery, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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PRE-scripted debriefing for Paediatric simulation Associated with Resuscitation EDucation (PREPARED): A multicentre, cluster randomised controlled trial. Resusc Plus 2022; 11:100291. [PMID: 36017059 PMCID: PMC9396392 DOI: 10.1016/j.resplu.2022.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Williams AM, Karmakar M, Thompson-Burdine J, Matusko N, Ji S, Kamdar N, Seiler K, Minter RM, Sandhu G. Increased Intraoperative Faculty Entrustment and Resident Entrustability Does Not Compromise Patient Outcomes After General Surgery Procedures. Ann Surg 2022; 275:e366-e374. [PMID: 32541221 DOI: 10.1097/sla.0000000000004052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intraoperative resident autonomy has been compromised secondary to expectations for increased supervision without defined parameters for safe progressive independence, diffusion of training experience, and more to learn with less time. Surgical residents who are insufficiently entrusted during training attain less autonomy, confidence, and even clinical competency, potentially affecting future patient outcomes. OBJECTIVE To determine if OpTrust, an educational intervention for increasing intraoperative faculty entrustment and resident entrustability, negatively impacts patient outcomes after general surgery procedures. METHODS Surgical faculty and residents received OpTrust training and instruction to promote intraoperative faculty entrustment and resident entrustability. A post-intervention OpTrust cohort was compared to historical and pre-intervention OpTrust cohorts. Multivariable logistic and negative binomial regression was used to evaluate the impact of the OpTrust intervention and time on patient outcomes. SETTING Single tertiary academic center. PARTICIPANTS General surgery faculty and residents. MAIN OUTCOMES AND MEASURES Thirty-day postoperative outcomes, including mortality, any complication, reoperation, readmission, and length of stay. RESULTS A total of 8890 surgical procedures were included. After risk adjustment, overall patient outcomes were similar. Multivariable regression estimating the effect of the OpTrust intervention and time revealed similar patient outcomes with no increased risk (P > 0.05) of mortality {odds ratio (OR), 2.23 [95% confidence interval (CI), 0.87-5.6]}, any complication [OR, 0.98 (95% CI, 0.76-1.3)], reoperation [OR, 0.65 (95% CI, 0.42-1.0)], readmission [OR, 0.82 (95% CI, 0.57-1.2)], and length of stay [OR, 0.99 (95% CI, 0.86-1.1)] compared to the historic and pre-intervention OpTrust cohorts. CONCLUSIONS OpTrust, an educational intervention to increase faculty entrustment and resident entrustability, does not compromise postoperative patient outcomes. Integrating faculty and resident development to further enhance entrustment and entrustability through OpTrust may help facilitate increased resident autonomy within the safety net of surgical training without negatively impacting clinical outcomes.
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Affiliation(s)
| | - Monita Karmakar
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Niki Matusko
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Sunjong Ji
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Neil Kamdar
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, MI
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI
| | - Kristian Seiler
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
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Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. The Supervisor's Toolkit: Strategies of Supervisors to Entrust and Regulate Autonomy of Residents in the Operating Room. Ann Surg 2022; 275:e264-e270. [PMID: 32224741 DOI: 10.1097/sla.0000000000003887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify what strategies supervisors use to entrust autonomy during surgical procedures and to clarify the consequences of each strategy for a resident's level of autonomy. BACKGROUND Entrusting autonomy is at the core of teaching and learning surgical procedures. The better the level of autonomy matches the learning needs of residents, the steeper their learning curves. However, entrusting too much autonomy endangers patient outcome, while entrusting too little autonomy results in expertise gaps at the end of training. Understanding how supervisors regulate autonomy during surgical procedures is essential to improve intraoperative learning without compromising patient outcome. METHODS In an observational study, all the verbal and nonverbal interactions of 6 different supervisors and residents were captured by cameras. Using the iterative inductive process of conversational analysis, each supervisor initiative to guide the resident was identified, categorized, and analyzed to determine how supervisors affect autonomy of residents. RESULTS In the end, all the 475 behaviors of supervisors to regulate autonomy in this study could be classified into 4 categories and nine strategies: I) Evaluate the progress of the procedure: inspection (1), request for information (2), and expressing their expert opinion (3); II) Influence decision-making: explore (4), suggest (5), or declare the next decision (6); III) Influence the manual ongoing action: adjust (7), or stop the resident's manual activity (8); IV) take over (9). CONCLUSIONS This study provides new insights into how supervisors regulate autonomy in the operating room. This insight is useful toward analyzing whether supervisors meet learning needs of residents as effectively as possible.
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Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Research and Innovation in Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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White H, Hayes C, Axisa C, Power T. On the Other Side of Simulation: Evaluating Faculty Debriefing Styles. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
SUMMARY STATEMENT Culture influences how we communicate, teach, and learn. Debriefings are laden with cultural influences. Without attention to cultural considerations, accepted debriefing techniques might not reach the desired outcome and, in certain cultures, may even harm teacher-learner relationships. We explore cultural considerations in healthcare simulation debriefing and offer guidance for debriefers to gain awareness of potential cultural biases.
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Affiliation(s)
- Janice C Palaganas
- From the MGH Institute of Health Professions (J.C.P.); Harvard Medical School, Boston, MA (J.C.P.); Prince of Wales Hospital, Sha Tin, Hong Kong (A.C.); and Hamad Medical Corporation, Doha, Qatar (K.L.)
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Solano QP, Hayward L, Chopra Z, Quanstrom K, Kendrick D, Abbott KL, Kunzmann M, Ahle S, Schuller M, Ötleş E, George BC. Natural Language Processing and Assessment of Resident Feedback Quality. JOURNAL OF SURGICAL EDUCATION 2021; 78:e72-e77. [PMID: 34167908 DOI: 10.1016/j.jsurg.2021.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To validate the performance of a natural language processing (NLP) model in characterizing the quality of feedback provided to surgical trainees. DESIGN Narrative surgical resident feedback transcripts were collected from a large academic institution and classified for quality by trained coders. 75% of classified transcripts were used to train a logistic regression NLP model and 25% were used for testing the model. The NLP model was trained by uploading classified transcripts and tested using unclassified transcripts. The model then classified those transcripts into dichotomized high- and low- quality ratings. Model performance was primarily assessed in terms of accuracy and secondary performance measures including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). SETTING A surgical residency program based in a large academic medical center. PARTICIPANTS All surgical residents who received feedback via the Society for Improving Medical Professional Learning smartphone application (SIMPL, Boston, MA) in August 2019. RESULTS The model classified the quality (high vs. low) of 2,416 narrative feedback transcripts with an accuracy of 0.83 (95% confidence interval: 0.80, 0.86), sensitivity of 0.37 (0.33, 0.45), specificity of 0.97 (0.96, 0.98), and an area under the receiver operating characteristic curve of 0.86 (0.83, 0.87). CONCLUSIONS The NLP model classified the quality of operative performance feedback with high accuracy and specificity. NLP offers residency programs the opportunity to efficiently measure feedback quality. This information can be used for feedback improvement efforts and ultimately, the education of surgical trainees.
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Affiliation(s)
| | - Laura Hayward
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Zoey Chopra
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Daniel Kendrick
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Marcus Kunzmann
- Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Samantha Ahle
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Mary Schuller
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Erkin Ötleş
- Department of Industrial and Operations Engineering , University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan
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Granek L, Shapira S, Roth J, Constantini S. Can Good Intraoperative Judgement Be Taught?: Pediatric Neurosurgeons' Pedagogical Approaches to Training Residents on Intraoperative Decision-Making. JOURNAL OF SURGICAL EDUCATION 2021; 78:1492-1499. [PMID: 33814338 DOI: 10.1016/j.jsurg.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore how pediatric neurosurgeons train residents in developing intraoperative decision-making judgement. DESIGN This study used the Grounded Theory Method in its study design. In-depth interviews were conducted with pediatric neurosurgeons about their approaches to training residents in intraoperative decision making. Data was analyzed line-by-line with codes and categories emerging from participants narratives. SETTING & PARTICIPANTS Twenty-six pediatric neurosurgeons from 12 countries were interviewed using video-conferencing technology. RESULTS Pediatric Neurosurgeons used a variety of training approaches that included pre-surgery discussions, didactic communication during surgery, post-surgery debriefing, allowing residents to model and observe their own intraoperative behaviors, using case studies to teach, and ongoing mentorship. In addition, they encouraged residents to ask for help when needed and emphasized the importance of empathy as a surgeon. Challenges to training residents included the notion that decision-making could only be learned through personal experience, the trainee's personality, and an over-reliance on algorithms and standardized medicine. CONCLUSIONS Training neurosurgical residents about intraoperative decision-making appears to be ad-hoc and dependent on both the institution and the availability and willingness of senior surgeons to make this a part of their pedagogy. Surgical departments could use these findings to reflect on their own teaching practices and explore whether they wish to teach these skills more explicitly, and in what ways these skills can be best taught to residents.
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Affiliation(s)
- Leeat Granek
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada.
| | - Shahar Shapira
- Department of Gender, Sexuality, and Women's Studies, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Johnson J, Misch E, Chung MT, Hotaling J, Folbe A, Svider PF, Cabrera-Muffly C, Johnson AP. Flipping the Classroom: An Evaluation of Teaching and Learning Strategies in the Operating Room. Ann Otol Rhinol Laryngol 2021; 131:573-578. [PMID: 34350805 DOI: 10.1177/00034894211036859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES With increasing restraints on resident's experiences in the operating room, with causes ranging from decreased time available to increasing operating room costs, focus has been placed on how to improve resident's education. The objectives of our study are to (1) determine barriers in education in the operating room, (2) identify effective learning and teaching strategies for residents in the operating room with a focus on the tonsillectomy procedure. METHODS An online survey was sent to all otolaryngology residents and residency programs for which contact information was available from January 2016 to March 2016 with 139 respondents. The 12-question survey focused on information regarding limitations to learning how to perform tonsillectomies as well as difficulties with teaching the same procedure. Resident responses were separated based on PGY level, and analysis was performed using t-tests and Chi squared analysis. RESULTS Common themes emerged from responses for both teaching and learning how to perform tonsillectomies. A significant limitation in learning the procedure was lack of visualization during the surgery (57% learning vs 60% teaching). For both learners and teachers, the monopolar cautery instrument was found to be the most preferred instrument to use during tonsillectomy (80% each). The majority of resident respondents (93%) felt that an instructional video would be beneficial for both learning and teaching the procedure. CONCLUSIONS Significant limitations for learning and teaching in the operating room were identified for performing tonsillectomies. Future endeavors will focus on resolving these limitations to improve surgical education. EVIDENCE LEVEL Level IV.
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Affiliation(s)
- Jared Johnson
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Emily Misch
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael T Chung
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Jeffrey Hotaling
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Adam Folbe
- Department of Otolaryngology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Cristina Cabrera-Muffly
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew P Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Yee A, Hill EJR, Brown D, Mackinnon SE. Reply: The Effect of Surgical Video on Resident Performance of Carpal Tunnel Release: A Cadaveric Simulation-Based, Prospective, Randomized, Blinded Pilot Study. Plast Reconstr Surg 2021; 148:311e-312e. [PMID: 34228029 DOI: 10.1097/prs.0000000000008130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew Yee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine
| | - Elspeth J R Hill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine
| | - Douglas Brown
- Center for Humanism and Ethics in Surgical Specialties, Department of Surgery, Washington University School of Medicine
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
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Papachristos AJ, Loveday BPT, Nestel D. Learning in the Operating Theatre: A Thematic Analysis of Opportunities Lost and Found. JOURNAL OF SURGICAL EDUCATION 2021; 78:1227-1235. [PMID: 33243675 DOI: 10.1016/j.jsurg.2020.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The operating theatre (OT) is an important learning environment. Trainees face barriers to learning in the OT that may reduce meaningful educational interactions. The impact of these barriers on the intraoperative learning experience of trainees and the strategies that they employ to overcome them are not known. This qualitative study aimed to describe the intraoperative learning experiences of senior general surgery trainees in Australia and their strategies to optimize learning in the OT. DESIGN, SETTING, PARTICIPANTS The authors developed a semi-structured interview guide based on published literature. Purposive sampling was used to identify a representative group of general surgery trainees in Australia, who were interviewed in a private setting with audio recordings deidentified for verbatim transcription and analysis. Thematic analysis was conducted using an interpretivist approach to produce a coding framework. RESULTS Ten trainees participated in the study. Themes were divided into external and internal barriers to learning, promoters of effective learning and actions to facilitate learning. External barriers included cultural neglect of an important issue, with inadequate prioritization of teaching and a lack of structure for intraoperative learning. From this, we identified the theme of missed opportunities. Internal barriers included difficulties in developing assertiveness required to address these issues and a failure to adequately plan for learning, with reliance on the mentor to initiate. Actions to facilitate learning were rarely employed by trainees, as most were unaware of strategies to maximize intraoperative learning. CONCLUSIONS Trainees find the barriers to learning in the OT difficult to address and are not well acquainted with strategies that may allow them to maximize their learning.
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Affiliation(s)
- Alexander J Papachristos
- Department of Surgery, University of Melbourne, Victoria, Australia; Department of General Surgical Specialties, Royal Melbourne Hospital, Victoria, Australia.
| | - Benjamin P T Loveday
- Department of General Surgical Specialties, Royal Melbourne Hospital, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Surgery, University of Auckland, New Zealand
| | - Debra Nestel
- Department of Surgery, University of Melbourne, Victoria, Australia
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Cheng A, Eppich W, Epps C, Kolbe M, Meguerdichian M, Grant V. Embracing informed learner self-assessment during debriefing: the art of plus-delta. Adv Simul (Lond) 2021; 6:22. [PMID: 34090514 PMCID: PMC8180042 DOI: 10.1186/s41077-021-00173-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
The healthcare simulation field has no shortage of debriefing options. Some demand considerable skill which serves as a barrier to more widespread implementation. The plus-delta approach to debriefing offers the advantages of conceptual simplicity and ease of implementation. Importantly, plus-delta promotes learners' capacity for a self-assessment, a skill vital for safe clinical practice and yet a notorious deficiency in professional practice. The plus-delta approach confers the benefits of promoting uptake of debriefing in time-limited settings by educators with both fundamental but also advanced skills, and enhancing essential capacity for critical self-assessment informed by objective performance feedback. In this paper, we describe the role of plus-delta in debriefing, provide guidance for incorporating informed learner self-assessment into debriefings, and highlight four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.
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Affiliation(s)
- A. Cheng
- KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8 Canada
| | - W. Eppich
- RSCI SIM Centre for Simulation Education and Research RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C. Epps
- Departments of Anesthesiology and Interprofessional Education, University of Tennessee Health Science Center, Memphis, USA
| | - M. Kolbe
- Simulation Center, UniversitatsSpital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - M. Meguerdichian
- Department of Emergency Medicine, NYC Health + Hospitals/Harlem, NYC Health + Hospitals/Simulation Center, Columbia University, New York, USA
| | - V. Grant
- KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8 Canada
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McNutt R, Tews M, Kleinheksel AJ. Student Performance During a Simulated Patient Encounter Has No Impact on Debriefer Adherence to PEARLS Debriefing Model. MEDICAL SCIENCE EDUCATOR 2021; 31:1141-1148. [PMID: 34457957 PMCID: PMC8368893 DOI: 10.1007/s40670-021-01290-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Debriefing is necessary for effective simulation education. The PEARLS (Promoting Excellence and Reflective Learning in Simulations) is a scripted debriefing model that incorporates debriefing best practices. It was hypothesized that student simulation performance might impact facilitator adherence to the PEARLS debriefing model. There are no published findings on the effect of student performance on debriefer behavior. METHODS Third-year medical students participated in a video-recorded, formative simulation to treat a high-fidelity mannequin for an asthma exacerbation. A faculty debriefer trained in the PEARLS model evaluated student performance with a standardized rubric and conducted a recorded debriefing. Debriefing recordings were analyzed for debriefer adherence to the PEARLS model. Debriefers were assigned a debriefing score (DS) from 0 to 13; 13 was perfect adherence to the model. Definitive intervention (DI) for asthma exacerbation was defined as bronchodilator therapy. Critical actions were as follows: a focused history, heart/lung exam, giving oxygen, and giving a bronchodilator. RESULTS Mean DS for the debriefers of students who provided DI was 8.57; 9.14 for those students who did not (P = 0.25). Mean DS for debriefers of students who completed all critical actions was 8.68; 8.52 for those students who did not (P = 0.62). Analysis of elapsed time to DI showed no relationship between the time DI was provided and DS. CONCLUSIONS Student performance had no impact on debriefer performance, suggesting the PEARLS model is an effective aid for debriefers, regardless of learner performance. These findings suggest student performance may not bias facilitators' ability to conduct quality debriefings.
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Affiliation(s)
- Richard McNutt
- Department of Emergency Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, AF 1018, 30912 Augusta, Georgia
| | - Matthew Tews
- Department of Emergency Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, AF 1018, 30912 Augusta, Georgia
| | - A. J. Kleinheksel
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
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Reed K, Reed B, Bailey J, Beattie K, Lynch E, Thompson J, Vines R, Wong KC, McCrossin T, Wilson R. Interprofessional education in the rural environment to enhance multidisciplinary care in future practice: Breaking down silos in tertiary health education. Aust J Rural Health 2021; 29:127-136. [PMID: 33982852 DOI: 10.1111/ajr.12733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Western Sydney University has implemented a rural interprofessional learning programme to promote collaborative care approaches to enhance cross-discipline communications, improve knowledge and clarity of roles and improve patient care and outcomes. DESIGN Rural interprofessinal learning is an interprofessional educational approach, consisting of simulations of complex health events. Simulation methodology frames the study with a focus on human interaction. A mixed-methods evaluation has been conducted, incorporating pre- and post- event participant surveys along with semi-structured focus groups. SETTING Simulations are conducted in the rural setting, including community settings, working farms and rural hospitals. MAIN OUTCOME MEASURES Reflexive thematic analysis was used to identify themes measuring students' perceptions of interdisciplinary care, knowlede of other health discipline roles and skills and how they believe the exercise will influence their future practice. Facilitator feedback regarding the efficacy of the simulations was also recorded and analysed using reflexive thematic analysis. PARTICIPANTS Care of simulated patient(s)/bystander(s) is primarily provided by paramedicine, nursing and medical students; however, increasing interest has expanded the programme to include students from a range of allied health professions. Simulations are facilitated by a multidisciplinary team of experienced practitioners and specialists. INTERVENTION Four rural interprofessional learning events have been held. RESULTS 120 students have participated in the evaluation. Findings include increased understanding of the contributions of other disciplines in enhancing patient care, team approaches, cross-discipline communication and a need to engage in collaborative care in future practice. CONCLUSION Creating a collaborative learning environment creates a culture of multidisciplinary care, enhancing patient care and improving outcomes. The rural interprofessional learning model is an effective interprofessional educational approach, which can be repeated, refined and improved for continual professional development.
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Affiliation(s)
- Krista Reed
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Buck Reed
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Karen Beattie
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Elizabeth Lynch
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jane Thompson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Robyn Vines
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Kam Cheong Wong
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Tim McCrossin
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Ross Wilson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
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Checklists Improve Team Performance During Simulated Extracorporeal Membrane Oxygenation Emergencies: A Randomized Trial. Crit Care Explor 2021; 3:e0404. [PMID: 33912834 PMCID: PMC8078306 DOI: 10.1097/cce.0000000000000404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Extracorporeal membrane oxygenation–related complications are potentially catastrophic if not addressed quickly. Because complications are rare, high-fidelity simulation is recommended as part of the training regimen for extracorporeal membrane oxygenation specialists. We hypothesized that the use of standardized checklists would improve team performance during simulated extracorporeal membrane oxygenation emergencies. Design: Randomized simulation-based trial. Setting: A quaternary-care academic hospital with a regional extracorporeal membrane oxygenation referral program. Subjects: Extracorporeal membrane oxygenation specialists and other healthcare providers. Interventions: We designed six read-do checklists for use during extracorporeal membrane oxygenation emergencies using a modified Delphi process. Teams of two to three providers were randomized to receive the checklists or not. All teams then completed four simulated extracorporeal membrane oxygenation emergencies. Measurements and Main Results: Simulation sessions were video-recorded, and the number of critical tasks performed and time-to-completion were compared between groups. A survey instrument was administered before and after simulations to assess participants’ attitudes toward the simulations and checklists. We recruited 36 subjects from a single institution, randomly assigned to 15 groups. The groups with checklists completed more critical tasks than participants in the control groups (90% vs 75%; p < 0.001). The groups with checklists performed a higher proportion of both nontechnical tasks (71% vs 44%; p < 0.001) and extracorporeal membrane oxygenation–specific technical tasks (94% vs 86%; p < 0.001). Both groups reported an increase in reported self-efficacy after the simulations (p = 0.003). After adjusting for multiple comparisons, none of the time-to-completion measures achieved statistical significance. Conclusions: The use of checklists resulted in better team performance during simulated extracorporeal membrane oxygenation emergencies. As extracorporeal membrane oxygenation use continues to expand, checklists may be an attractive low-cost intervention for centers looking to reduce errors and improve response to crisis situations.
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Bushuven S, Dettenkofer M, Dietz A, Bushuven S, Dierenbach P, Inthorn J, Beiner M, Langer T. Interprofessional perceptions of emotional, social, and ethical effects of multidrug-resistant organisms: A qualitative study. PLoS One 2021; 16:e0246820. [PMID: 33617529 PMCID: PMC7899372 DOI: 10.1371/journal.pone.0246820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multi-drug-resistant organisms (MDRO) are usually managed by separating the infected patients to protect others from colonization and infection. Isolation precautions are associated with negative experiences by patients and their relatives, while hospital staff experience a heavier workload and their own emotional reactions. METHODS In 2018, 35 participants (nurses, physicians, pharmacists) in an antimicrobial-stewardship program participated in facilitated discussion groups working on the emotional impact of MDRO. Deductive codings were done by four coders focusing on the five basic emotions described by Paul Ekmans. RESULTS All five emotions revealed four to 11 codes forming several subthemes: Anger is expressed because of incompetence, workflow-impairment and lack of knowledge. Anxiety is provoked by inadequate knowledge, guilt, isolation, bad prognoses, and media-related effects. Enjoyment is seldom. Sadness is experienced in terms of helplessness and second-victim effects. Disgust is attributed to shame and bad associations, but on the other hand MDROs seem to be part of everyday life. Deductive coding yielded additional codes for bioethics and the Calgary Family Assessment Method. CONCLUSION MDRO are perceived to have severe impact on emotions and may affect bioethical and family psychological issues. Thus, further work should concentrate on these findings to generate a holistic view of MDRO on human life and social systems.
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Affiliation(s)
- Stefan Bushuven
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital Singen, Healthcare Association Constance (GLKN), Singen, Germany
- Institute for Hospital Hygiene and Infection Prevention, Healthcare Association Constance (GLKN), Radolfzell, Germany
- Institute for Didactics and Educational Research in Medicine, Clinic of the University Munich, LMU Munich, Munich, Germany
- * E-mail:
| | - Markus Dettenkofer
- Institute for Hospital Hygiene and Infection Prevention, Healthcare Association Constance (GLKN), Radolfzell, Germany
| | - Andreas Dietz
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital Singen, Healthcare Association Constance (GLKN), Singen, Germany
| | - Stefanie Bushuven
- Institute for Orthopedics, Handsurgery and Traumatology, Hegau-Bodensee-Hospital Singen, Health Care Association District of Constance (GLKN), Singen, Germany
| | - Petra Dierenbach
- Department of Paediatrics, Neuropaediatrics and Neuro-Rehabilitation Hegau-Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Gailingen, Germany
| | - Julia Inthorn
- Center for Applied Ethics in Health Care, Hannover, Germany
| | - Matthias Beiner
- Department of Paediatrics, Neuropaediatrics and Neuro-Rehabilitation Hegau-Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Gailingen, Germany
| | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disorders, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Ranney SE, Bedrin NG, Roberts NK, Hebert JC, Forgione PM, Nicholas CF. Maximizing Learning in the Operating Room: Residents' Perspectives. J Surg Res 2021; 263:5-13. [PMID: 33618218 DOI: 10.1016/j.jss.2021.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 01/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies examine how residents can optimize their educational experience in the OR on their terms. This study aimed to examine residents' perceptions of how learners can maximize their education in the OR. METHOD Using constructivist grounded theory methodology, the authors conducted focus groups with general surgery residents, PGY1-5, followed by semi-structured interviews with attending surgeons from a single, academic medical center. Constant comparison was used to identify themes and explore their relationships. Theoretical sampling was used until saturation was achieved. RESULTS Residents and attendings participated. Two phases of OR learning were identified, intra-operative and inter-operative. Characters that made optimized learning included control, struggling, and reflection. Residents who practiced self-reflection with their experiences, and were able to articulate this awareness to attendings, felt the OR was an ideal learning environment. Attendings echoed similar findings. CONCLUSIONS Providing residents with a method of maximizing OR learning is critical to postgraduate clinical education. Currently, observation passively morphs into active learning and eventually independent operating in the OR. However, residents who practice self-regulated learning, and are able to discuss their educational goals with attendings, seem to find the OR a better learning environment and progress to independence more quickly. This was echoed by practicing attendings. Providing residents with a generalizable, self-regulated learning framework specific to operative educational experiences could maximize learning potential and expedite resident progression in the OR.
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Affiliation(s)
- Stephen E Ranney
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont.
| | - Nicholas G Bedrin
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - Nicole K Roberts
- The City College of New York, Medical Education and Facultry Development, New York, New York
| | - James C Hebert
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - Patrick M Forgione
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - Cate F Nicholas
- Clinical Simulation Lab, University of Vermont, Burlington, Vermont
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Heimberg E, Daub J, Schmutz JB, Eppich W, Hoffmann F. [Debriefing in pediatric emergency care]. Notf Rett Med 2021; 24:43-51. [PMID: 33551677 PMCID: PMC7853166 DOI: 10.1007/s10049-020-00833-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
Kommunikationsfehler und systembedingte Probleme wirken sich negativ auf Teamarbeit und gemeinsame Entscheidungsfindung aus und können den Patienten Schaden zufügen. Regelmäßige Nachbesprechungen nach kritischen Ereignissen wiederum wirken sich positiv auf die Teamzusammenarbeit und das Patientenoutcome in der Kindernotfallversorgung aus. Das gemeinsame Reflektieren fördert das Lernen, hilft den Teams, sich zu verbessern, und verhindert, dass sich Fehler in Zukunft wiederholen. Dennoch werden Debriefings im präklinischen und klinischen Alltag noch immer qualitativ unzureichend durchgeführt. Gründe dafür sind mangelnde Zeit, Fehlen von erfahrenen Debriefern und fehlende Unterstützung durch Verantwortungsträger. Debriefings können je nach Bedarf zu verschiedenen Zeitpunkten mit unterschiedlicher Dauer stattfinden. Nachbesprechungen können auch rein virtuell oder als sogenannte Hybridveranstaltung durchgeführt werden. Nachbesprechungen sollten sich auf gemeinsames Lernen und das Erarbeiten zukunftsorientierter Verbesserungen konzentrieren. Nicht nur lebensbedrohliche Ereignisse können Nachbesprechungen auslösen, sondern auch potenziell kritische Situationen, wie routinemäßige Intubationen. Debriefing-Skripte fördern eine Strukturierung und ermöglichen selbst unerfahrenen Moderatoren, alle Aspekte zu bearbeiten. Neben der Diskussion schwieriger Abläufe sollten unbedingt positive Leistungen besprochen werden, um diese zu verstärken und das Lernen am Erfolg zu ermöglichen. Dabei sollten die Beweggründe eines Verhaltens erfragt und nicht nur die nach außen sichtbaren Leistungen bewertet werden. Diese Strategie fördert bedarfsgerechtes Lernen und konzentriert sich auf Lösungen. Hilfreich sind dabei spezielle Fragetechniken, echtes Interesse und eine positive Sicherheitskultur.
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Affiliation(s)
- E Heimberg
- Kinderintensivstation, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 1, 72076 Tübingen, Deutschland
| | - J Daub
- Kinderintensivstation, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 1, 72076 Tübingen, Deutschland
| | - J B Schmutz
- Department für Management, Technologie und Ökonomie, ETH Zürich, Zürich, Schweiz
| | - W Eppich
- RCSI Sim: Simulation Education and Research, Royal College of Surgeons of Ireland, Dublin, Irland
| | - F Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU München, München, Deutschland
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Nieboer P, Cnossen F, Stevens M, Huiskes M, Bulstra SK, Jaarsma DA. Residents Think in the "Now" and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons. JOURNAL OF SURGICAL EDUCATION 2021; 78:104-112. [PMID: 32624449 DOI: 10.1016/j.jsurg.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors' preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure. DESIGN In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5. SETTING University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals. PARTICIPANTS Seventeen supervising surgeons and 21 residents. RESULTS Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with "effort." CONCLUSIONS Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the "now" and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training.
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Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Debbie Adc Jaarsma
- Center for Research and Innovation in Medical Education, University Medical Center Groningen, Groningen, the Netherlands
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van Dalen AS, van Haperen M, Swinkels JA, Grantcharov TP, Schijven MP. Development of a Model for Video-Assisted Postoperative Team Debriefing. J Surg Res 2021; 257:625-635. [DOI: 10.1016/j.jss.2020.07.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023]
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Walker CA, McGregor L, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med 2020; 7:259-266. [PMID: 33440103 PMCID: PMC7808839 DOI: 10.15441/ceem.19.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022] Open
Abstract
Objective Team-based resuscitation in emergency departments (EDs) is an excellent opportunity for hot debriefs (HDBs). In creating a bespoke HDB model for emergency medicine resuscitations, we sought to optimize learning from clinical experience, identify team strengths, challenges, encourage honest reflection and focus on ways of improving future performance. Methods Multidisciplinary ED focus groups reviewed existing models, identified benefits/barriers and created new frame works, testing and adapting further using fottage of a simulated complex resuscitation case. The new HDB tool was coined: “STOP5” (STOP for 5 minutes). Cases targeted were prehospital retrievals, major trauma, cardiac arrests, deaths in resuscitation, and staff-triggered. The framework details included a specifically scripted introduction followed by core elements that were S: summarize the case; T: things that went well; O: opportunities to improve; P: points to action and responsibilities. Staffs were surveyed at 1 month prior then 6 and 18 months post-introduction. Data collection forms were used to identify and track hard outcomes/system improvements resulting directly from HDBs. Results Potential benefits identified by respondents included: improved staff morale; team cohesion; improved care for future patients; promoting a culture for learning, patient safety and quality improvement. Ten process and equipment changes resulted directly from STOP5 over 12 months. Conclusion We anticipate the STOP5 framework to be globally generalizable and effective for many ED teams.
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Affiliation(s)
- Craig Andrew Walker
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.,Critical Care Department, St John's Hospital, Livingston, United Kingdom
| | - Laura McGregor
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Forth Valley, United Kingdom
| | - Cameron Taylor
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sara Robinson
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Pritchard SA, Keating JL, Nestel D, Blackstock FC. Physiotherapy students can be educated to portray realistic patient roles in simulation: a pragmatic observational study. BMC MEDICAL EDUCATION 2020; 20:471. [PMID: 33243213 PMCID: PMC7689969 DOI: 10.1186/s12909-020-02382-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Simulation-based education (SBE) has many benefits for learners, but costs can limit embedding SBE in health professional curricula. Peer simulation involves students portraying patient roles, and may reduce costs while still providing the benefits of other SBE experiences. However, the quality of the SBE may be impacted if students cannot portray authentic and realistic patient roles. The aim of this study was to investigate whether targeted education was associated with observable changes to physiotherapy students' abilities to portray patient roles in SBE. METHODS Second year pre-registration physiotherapy students (n = 40) participated. Students completed online and face-to-face education about SBE, patient portrayal skills, and how to portray a specific patient role. Students were video-recorded portraying patient roles in practical exams before and after the program. Three blinded independent assessors rated the overall quality of portrayals using a purpose-developed assessment instrument. RESULTS Twenty-three sets of pre- and post-program videos were analysed. Correlations between assessor scores spanned 0.62 to 0.82 for analyses of interest, which justified using average assessor ratings in analysis. Statistically significant higher scores were seen for post-program assessments for overall portrayal scores (mean difference 6.5, 95%CI [1.51-11.45], p = 0.013), accuracy (mean difference 3.4, 95%CI [0.69-6.13], p = 0.016) and quality (mean difference 3.1, 95%CI [0.64-5.49], p = 0.016). CONCLUSIONS Physiotherapy students appear capable of playing realistic patient roles. Peer simulation can be embedded into health professional programs, and education in patient role portrayal appears to be associated with improvements in portrayal quality and realism. Given these findings, further investigation, including testing program effects in a randomised study, is warranted.
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Affiliation(s)
- Shane A. Pritchard
- Department of Physiotherapy, Monash University, Moorooduc Highway, Frankston, Victoria 3199 Australia
| | - Jennifer L. Keating
- Department of Physiotherapy, Monash University, Moorooduc Highway, Frankston, Victoria 3199 Australia
| | - Debra Nestel
- Monash Institute for Health and Clinical Education (MIHCE), Monash University, Clayton, Victoria Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria Australia
| | - Felicity C. Blackstock
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales Australia
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Pritchard SA, Dalwood N, Keating JL, Nestel D, Te M, Blackstock F. ‘It’s the ultimate observer role…you’re feeling and seeing what’s happening to you’: students’ experiences of peer simulation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:329-337. [DOI: 10.1136/bmjstel-2020-000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/08/2020] [Accepted: 10/15/2020] [Indexed: 11/04/2022]
Abstract
IntroductionSimulation-based education (SBE) benefits learners, but multiple barriers limit curriculum integration. Peer simulation, where students are formally educated to portray patient roles in simulated interactions with their peers, might maintain the educational benefits of SBE, be cost-effective, and enable additional learning. Our research question was: ‘What are the perspectives and experiences of physiotherapy students who participated in peer simulation?’.MethodsSecond-year physiotherapy students (n=16) participated in a blended peer simulation programme that included preparation for patient role portrayal and simulated clinical interactions with peers. Using an interpretivist approach, students’ experiences and perspectives were explored in two focus groups. Inductive thematic analysis was completed by two researchers.ResultsThree primary themes were identified that characterised the experiences and perspectives of physiotherapy students: peer simulation is a valuable learning experience, specific design features enable effective peer simulation, and portraying a patient provides unique insight. Peer simulation was unexpectedly realistic, revealed knowledge and skill deficits, and improved their clinical skills. Specific design features included consistent engagement, repetitive, individualised practice, multiple forms of feedback, and detailed role preparation. Being the patient in peer simulation gave students unique and valuable insight into patients’ experiences of and feelings about health issues and healthcare interactions.ConclusionPhysiotherapy students acquire new insights during peer simulation that may enrich their capabilities for practice through understanding healthcare interactions from patients’ perspectives. Physiotherapy students’ learning in peer simulation appears to align with the powerful learning experiences of health professional students in other immersive simulation modalities.
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Bushuven S, Dettenkofer M, Sippel S, Koenig S, Bushuven S, Schneider-Brachert W. Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students. PLoS One 2020; 15:e0239444. [PMID: 32986726 PMCID: PMC7521694 DOI: 10.1371/journal.pone.0239444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Infection prevention and speaking up on errors are core qualities of health care providers. Heuristic effects (e.g. overconfidence) may impair behavior in daily routine, while speaking up can be inhibited by hierarchical barriers and medical team factors. Aim of this investigation was to determine, how medical students experience these difficulties for hand hygiene in daily routine. Methods On the base of prior investigations we developed a questionnaire with 5-point Likert ordinal scaled items and free text entries. This was tested for validity and reliability (Cronbach’s Alpha 0.89). Accredited German, Swiss and Austrian universities were contacted and medical students asked to participated in the anonymous online survey. Quantitative statistics used parametric and non-parametric tests and effect size calculations according to Lakens. Qualitative data was coded according to Janesick. Results 1042 undergraduates of 12 universities participated. All rated their capabilities in hand hygiene and feedback reception higher than those of fellow students, nurses and physicians (p<0.001). Half of the participants rating themselves to be best educated, realized that faulty hand hygiene can be of lethal effect. Findings were independent from age, sex, academic course and university. Speaking-up in case of omitted hand hygiene was rated to be done seldomly and most rare on persons of higher hierarchic levels. Qualitative results of 164 entries showed four main themes: 1) Education methods in hand hygiene are insufficient, 2) Hierarchy barriers impair constructive work place culture 3) Hygiene and feedback are linked to medical ethics and 4) There is no consequence for breaking hygiene rules. Discussion Although partially limited by the selection bias, this study confirms the overconfidence-effects demonstrated in post-graduates in other settings and different professions. The independence from study progress suggests, that the effect occurs before start of the academic course with need for educational intervention at the very beginning. Qualitative data showed that used methods are insufficient and contradictory work place behavior in hospitals are frustrating. Even 20 years after “To err is human”, work place culture still is far away from the desirable.
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Affiliation(s)
- Stefan Bushuven
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital Singen and Hegau Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Radolfzell, Germany
- Institute for Hospital Hygiene and Infection Prevention, Healthcare Association Constance (GLKN), Radolfzell, Germany
- Institute for Didactics and Educational Research in Medicine, Clinic of the University Munich, LMU Munich, Munich, Germany
- * E-mail:
| | - Markus Dettenkofer
- Institute for Hospital Hygiene and Infection Prevention, Healthcare Association Constance (GLKN), Radolfzell, Germany
| | - Sonia Sippel
- Institute of Medical Teaching and Medical Education Research, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sarah Koenig
- Institute of Medical Teaching and Medical Education Research, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefanie Bushuven
- Clinic for Orthopedics, Hand- and Trauma surgery, Hegau-Bodensee-Hospital Singen, Healthcare Association Constance (GLKN), Radolfzell, Germany
| | - Wulf Schneider-Brachert
- Department of Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Bui AH, Shebeen M, Girdusky C, Leitman IM. Structured Feedback Enhances Compliance with Operating Room Debriefs. J Surg Res 2020; 257:425-432. [PMID: 32892141 DOI: 10.1016/j.jss.2020.07.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical debriefs help reduce preventable errors in the operating room (OR) leading to patient injury. However, compliance with debriefs remains poor. The objective of this study was to evaluate the role of structured feedback to surgeons in improving compliance with and quality of surgical debriefs. MATERIALS AND METHODS Surgical cases at an 875-bed urban teaching hospital from January-June 2019 were audited via audio/video recording to evaluate debrief performance. Debriefs were evaluated for clinical completeness and teamwork quality via two structured forms. Surgeons received an evaluation of their debrief performance at two time points during the study period (February and April). Univariate and mixed-effects regression analyses were used to assess changes in debrief compliance and quality over time. RESULTS A total of 878 surgical cases performed by 61 surgeons were reviewed: 198 (22.6%) cases during Period 1 (P1), 371 (42.3%) P2, and 309 (35.1%) P3. The rate at which a debrief occurred was 62.1% in P1, 73.0% in P2, and 82.2% in P3 (P < 0.001). Debriefs were 1.96 (95% CI 1.31-2.95, P = 0.001) times more likely to be completed during P2 and 3.21 (95% CI 2.07-5.04, P < 0.001) times more likely during P3 compared to P1. The percent of debriefs initiated by the lead surgeon increased from 59.8% in P1, to 80.0% in P2, to 81.5% in P3 (P < 0.001). CONCLUSIONS Providing structured feedback to surgeons on their debrief performance was associated with improvements in compliance and completeness with debriefing protocols, OR teamwork and communication, and leadership and accountability from the lead surgeons.
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Affiliation(s)
- Anthony H Bui
- Department of Surgery, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Minimole Shebeen
- Department of Surgery, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cynthia Girdusky
- Department of Surgery, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - I Michael Leitman
- Department of Surgery, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
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Feasibility of Surgeon-Delivered Audit and Feedback Incorporating Peer Surgical Coaching to Reduce Fistula Incidence following Cleft Palate Repair: A Pilot Trial. Plast Reconstr Surg 2020; 146:144-153. [PMID: 32590658 DOI: 10.1097/prs.0000000000006907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Improving surgeons' technical performance may reduce their frequency of postoperative complications. The authors conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial. METHODS A nonrandomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair. Participants completed a baseline audit of fistula incidence. Participants with a fistula incidence above the median were allocated to an intensive feedback intervention that included selecting a peer surgical coach, observing the coach perform palate repair, reviewing operative video of their own surgical technique with the coach, and proposing and implementing changes in their technique. All others were allocated to simple feedback (receiving audit results). Outcomes assessed were proportion of surgeons completing the baseline audit, disclosing their fistula incidence to peers, and completing the feedback intervention. RESULTS Seven surgeons enrolled in the trial. All seven completed the baseline audit and disclosed their fistula incidence to other participants. The median baseline fistula incidence was 0.4 percent (range, 0 to 10.5 percent). Two surgeons were unable to receive the feedback intervention. Of the five remaining surgeons, two were allocated to intensive feedback and three to simple feedback. All surgeons completed their assigned feedback intervention. Among surgeons receiving intensive feedback, fistula incidence was 5.9 percent at baseline and 0.0 percent following feedback (adjusted OR, 0.98; 95 percent CI, 0.44 to 2.17). CONCLUSION Surgeon-delivered audit and feedback incorporating peer coaching on technical performance was feasible for surgeons.
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Johnson C, Shen E, Winn K, Digiacobbe G, Akinola M. Neonatal Resuscitation: A Blended Learning Curriculum for Medical and Physician Assistant Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10921. [PMID: 32704535 PMCID: PMC7373351 DOI: 10.15766/mep_2374-8265.10921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/23/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Demonstration of competence in neonatal resuscitation is critical for health care providers who provide newborn care because each year, approximately 400,000 (10%) newborns require resuscitation in delivery rooms across the United States. Therefore, neonatal resuscitation skills certification is provided to graduates entering specific specialties at the beginning of residency and renewed biennially through the American Academy of Pediatrics and the American Heart Association. However, there is no formal curriculum to prepare medical (MD) and physician assistant (PA) students prior to graduation. METHODS We developed a neonatal resuscitation curriculum for MD and PA students using a blended learning approach. The curriculum included web-based interactive teaching modules, a demonstration video of a mock neonatal resuscitation, and a neonatal resuscitation simulation. Final-year MD and PA students were evaluated using pre-/posttest, a neonatal resuscitation checklist, and an optional survey on interprofessional communication skills, roles, and responsibility. RESULTS Eighteen health professions learners completed the neonatal resuscitation curriculum. A paired-samples t test was conducted to compare pretest and posttest scores. There was a significant difference in pretest (M = 61.4, SD = 15.3) and posttest (M = 78.6, SD = 8.0) scores, t(17) = -4.7, p < .001. The mean score on the checklist was 79%. Learners strongly agreed/agreed that the simulation improved skills performance (100%), communication skills (92%), and understanding of roles and responsibilities (83%) during a neonatal resuscitation. DISCUSSION There were improvements in knowledge, procedural, and interprofessional skills in learners who received the neonatal resuscitation curriculum.
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Affiliation(s)
- Cassandra Johnson
- Neonatology Fellow, Department of Pediatrics, Wake Forest School of Medicine
| | - E Shen
- Assistant Professor, Department of Internal Medicine, Wake Forest School of Medicine
| | - Kathryn Winn
- Neonatology Fellow, Department of Pediatrics, Wake Forest School of Medicine
| | - Gia Digiacobbe
- Instructional Design Specialist, Kaiser Permanente Bernard J. Tyson School of Medicine
| | - Modupeola Akinola
- Associate Professor of Pediatrics, Department of Pediatrics, Wake Forest School of Medicine
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Mundt AS, Gjeraa K, Spanager L, Petersen SS, Dieckmann P, Østergaard D. Okay, let's talk - short debriefings in the operating room. Heliyon 2020; 6:e04386. [PMID: 32671270 PMCID: PMC7339050 DOI: 10.1016/j.heliyon.2020.e04386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Debriefing is increasingly used to enhance learning and reflection in clinical practice. Nevertheless, barriers to implementing debriefings in the operating room (OR) include lack of time, the availability of trained facilitators, and difficulty gathering the full team after surgery. Spending five minutes on a debriefing during skin closure or between procedures may enhance learning and reflection on practice, generating to improve patient safety. The aim of this study was to explore characteristics, feasibility and content of short debriefings in the OR. METHODS This was a mixed-method study of short debriefings, analyzing audio-recordings, field notes and relevance ratings from multi-professional teams, that conducted short debriefings in the OR at two University Hospitals in Denmark. RESULTS A total of 135 debriefings were conducted, with a median duration of five minutes (range 1:19 min-12:05 min). A total of 477 team members participated in the debriefings. The teams' median rating of relevance was 6 (range 1-10). The rating was higher following challenging events and in debriefings where the surgeon actively participated in the conversation. The teams discussed non-technical skills in all the debriefings and verbalized reflections on practice in 75 percent of the debriefings. CONCLUSION It was feasible to conduct short debriefings in a production-focused, complex work environment. In all the debriefings, the teams discussed various non-technical skills (NTS) and reflected on practice. The majority of team members rated the debriefings as relevant for their task management.
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Affiliation(s)
- Anna Sofie Mundt
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Capital Region of Denmark, Denmark
| | - Kirsten Gjeraa
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Capital Region of Denmark, Denmark
| | - Lene Spanager
- Department of Surgery, Hospital of North Sealand, Hilleroed, Denmark
| | | | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Capital Region of Denmark, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Denmark
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Norway
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Capital Region of Denmark, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Denmark
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van Dalen ASHM, Jansen M, van Haperen M, van Dieren S, Buskens CJ, Nieveen van Dijkum EJM, Bemelman WA, Grantcharov TP, Schijven MP. Implementing structured team debriefing using a Black Box in the operating room: surveying team satisfaction. Surg Endosc 2020; 35:1406-1419. [PMID: 32253558 PMCID: PMC7886753 DOI: 10.1007/s00464-020-07526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating. Electronic supplementary material The online version of this article (10.1007/s00464-020-07526-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Haperen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Grantcharov
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event. Anesthesiology 2020; 130:1039-1048. [PMID: 30829661 DOI: 10.1097/aln.0000000000002649] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. WHAT THIS ARTICLE TELLS US THAT IS NEW Failure to debrief after critical events is common among anesthesia trainees and likely anesthesia teams. Communication breakdowns are associated with a high rate of the failure to debrief. BACKGROUND Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors' objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel. METHODS At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings. RESULTS During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers. CONCLUSIONS Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief.
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Johnston WF, Zelhart MD. Challenges of new surgeon educators: Learning how to lead residents through a case and how much autonomy to give. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2019.100720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Debriefing in der Kindernotfallversorgung. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-019-00831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Secheresse T, Nonglaton S. The "Timeline Debriefing Tool": a tool for structuring the debriefing description phase. Adv Simul (Lond) 2020; 4:29. [PMID: 31890312 PMCID: PMC6923841 DOI: 10.1186/s41077-019-0119-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 11/21/2019] [Indexed: 12/01/2022] Open
Abstract
Several recent literature reviews have been published with the aim to determine how to optimise a debriefing. A main element found in these reviews was the importance of structuring the debriefing. Within the steps usually outlined in the debriefing, the description phase allows participants to describe their recollections and establish a shared mental model of what happened during the simulation. The description phase is used in many debriefing models but how to realise this description remains unclear. We provide an original tool to ensure a highly structured description phase: the “Timeline Debriefing Tool”. The Timeline Debriefing Tool, or TDT, is constructed on visual support such as a whiteboard or a flipchart. It allows for a clear description phase, makes the process more dynamic, promotes exchanges between participants and establishes a clear and shared vision of the simulation in visual support which can be used by the instructor in the analysis phase. Moreover, the timeline allows participants to discover their performance gaps by themselves, thus beginning deeper cognitive processing in the participants’ mind and promoting reflection in the analysis phase.
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Affiliation(s)
- Thierry Secheresse
- CEnSIM Healthcare Simulation Center, Metropole Savoie Hospital, BP 31125, 73011 Chambéry Cedex, France.,2Laboratory of Research on Acquisition in Context (LaRAC), University Grenoble Alpes, CS 40700, 38058 Grenoble Cedex 9, France
| | - Séverine Nonglaton
- CEnSIM Healthcare Simulation Center, Metropole Savoie Hospital, BP 31125, 73011 Chambéry Cedex, France
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Sankaran S, Andrews JP, Chicas M, Wachter RM, Berger MS. Patient safety movement in neurological surgery: the current state and future directions. J Neurosurg 2019; 132:313-323. [PMID: 31585429 DOI: 10.3171/2019.7.jns191505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sujatha Sankaran
- Departments of1Neurological Surgery and
- 2Medicine, University of California, San Francisco, California
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Kolbe M, Eppich W, Rudolph J, Meguerdichian M, Catena H, Cripps A, Grant V, Cheng A. Managing psychological safety in debriefings: a dynamic balancing act. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 6:164-171. [DOI: 10.1136/bmjstel-2019-000470] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety—the perception that it is safe to take interpersonal risks and that one will not be embarrassed, rejected or otherwise punished for speaking their mind, not knowing or asking questions. The role of introductions, learning contracts and prebriefing in establishing psychological safety is well described in the literature. How to maintain psychological safety, while also being able to identify and restore psychological safety during debriefings, is less well understood. This review has several aims. First, we provide a detailed definition of psychological safety and justify its importance for debriefings. Second, we recommend specific strategies debriefers can use throughout the debriefing to build and maintain psychological safety. We base these recommendations on a literature review and on our own experiences as simulation educators. Third, we examine how debriefers might actively address perceived breaches to restore psychological safety. Re-establishing psychological safety after temporary threats or breaches can seem particularly daunting. To demystify this process, we invoke the metaphor of a ‘safe container’ for learning; a space where learners can feel secure enough to work at the edge of expertise without threat of humiliation. We conclude with a discussion of limitations and implications, particularly with respect to faculty development.
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Interprofessional perceptions and emotional impact of multidrug-resistant organisms: A qualitative study. Am J Infect Control 2019; 47:876-882. [PMID: 30850246 DOI: 10.1016/j.ajic.2019.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hospital-acquired infections caused by multidrug-resistant organisms (MDROs) are a threat to patient safety and hospital economy. Training in hygiene precautions is known to limit MDRO spread and patient morbidity. As infection prevention is a collaborative task, we developed an interprofessional educational intervention, including a reflective unit about MDRO. This article reports on the perceptions of professionals for MDRO management. METHODS In 2017, we conducted 8 trainings, including facilitated group discussions focusing on the question how participants think others experience MDRO. Results were analyzed using a socio-constructivist qualitative approach. RESULTS A total of 51 health care workers from 13 professions and 5 hospitals participated, generating 366 items for coding. Three main themes could be identified: (1) significant barriers in educating clinicians and informing lay persons, (2) emotional reactions-especially anxiety and anger-from the perspective of lay persons and professionals evoked by MDRO, and (3) perceived economic burden. CONCLUSIONS MDROs generate psychosocial side effects with an impact on health care management and on professional-patient relationships and interprofessional relationships. Specifically, emotions evoked by insufficient information and transparency play a major role. Therefore, hygiene trainings must not be limited to basic skills. In addition, they should be comprised of communication and educational techniques and evoke attentiveness for emotional stress.
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Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. Recruiting expertise: how surgical trainees engage supervisors for learning in the operating room. MEDICAL EDUCATION 2019; 53:616-627. [PMID: 30900304 DOI: 10.1111/medu.13822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/10/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT For centuries now, the operating room (OR) has been the environment in which surgical trainees come to master procedures. Restricted working hours and insufficient levels of autonomy at the end of their training necessitate a shift towards alternative effective learning strategies. Self-regulated learning is a promising strategy by which surgical trainees can learn more with fewer exposures. However, the challenge is to understand how surgical trainees regulate their learning in the clinical context of the OR. OBJECTIVES The purpose of this study is to identify and understand the strategies of surgical trainees in engaging their supervisors for learning purposes and how these strategies contribute to effective learning. METHODS Total hip replacement procedures performed by four surgical trainees and their supervisors were videotaped. Using the iterative inductive process of conversation analysis, each verbal initiative to engage the supervisor was identified, analysed ('why that now') and categorised. RESULTS Surgical trainees used a range of practices to engage supervisors and recruit expertise, ranging from explicit recruitment to implicit hints. We identified four major categories. Surgical trainees: (i) invite the supervisor to provide an evaluation of the ongoing task; (ii) express an evaluation of the ongoing task and then explicitly invite the supervisor to provide an evaluation; (iii) express an evaluation of the ongoing task and then invite the supervisor to provide confirmation, and (iv) express an evaluation of the ongoing task without engaging the supervisor. CONCLUSIONS Surgical trainees recruit expertise from supervisors using practices of four different categories. Trainees' actions are provoked by the moment at which they experience insufficient expertise and are focused on the task at hand in the immediate present. Supervisors can and do elaborate on these requests to provide explicit teaching. Insight into these practices provides tools for reflection on OR learning, proficiency assessment and deliberation to adapt guidance in the real time of the procedure.
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Affiliation(s)
- Patrick Nieboer
- Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mike Huiskes
- Centre for Language and Cognition, University of Groningen, Groningen, the Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Debbie A D C Jaarsma
- Centre for Research and Innovation in Medical Education, University Medical Centre Groningen, Groningen, the Netherlands
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Sidhu NS, Edwards M. Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity. MEDICAL TEACHER 2019; 41:282-296. [PMID: 29703088 DOI: 10.1080/0142159x.2018.1463087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE AND METHOD We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. RESULTS Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. CONCLUSIONS Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.
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Affiliation(s)
- Navdeep S Sidhu
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
- b Department of Anaesthesiology , University of Auckland , Auckland , New Zealand
| | - Morgan Edwards
- a Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
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Preparing Physiotherapy Students for Clinical Placement: Student Perceptions of Low-Cost Peer Simulation. A Mixed-Methods Study. Simul Healthc 2018; 13:181-187. [PMID: 29346226 DOI: 10.1097/sih.0000000000000276] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Simulation is increasingly used in health care education, yet the organizational and financial costs can be prohibitive. This study aimed to investigate whether peer simulation is perceived by third-year undergraduate physiotherapy students as valuable for clinical placement preparation. METHODS Third-year undergraduate physiotherapy students participated in a 9-week peer simulation program, using each other as patients, and were invited to complete two surveys evaluating perceptions of the program. The program consisted of weekly patient interactions during which students were required to assess and treat a "patient" under strict simulation guidelines and in accordance with stated learning objectives. Items rated included self-perceived skills, confidence, time management, and clinical placement readiness and included collection of qualitative responses. Surveys were released at commencement and completion of the simulation program. RESULTS Of 79 third-year students, 63% completed survey 1 and 66% completed survey 2. Students had high expectations of the program and these were consistently met. Peer simulation rated highly for all items, including identifying knowledge and skill deficits, and improving confidence, clinical reasoning, time management, and communication. Simulation was considered safe, supportive, engaging, and valuable for clinical placement preparation. Students identified some lack of authenticity when working with peers. CONCLUSIONS Peer simulation was perceived by students as valuable in preparing them for clinical placement, despite a perceived lack of realism. These findings support the use of peer simulation as an alternative to the use of more formalized standardized patients in an undergraduate physiotherapy program. Further investigation is required to establish a detailed cost analysis of the program and to determine the amount of realism required to optimize the benefits of this promising educational strategy.
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Gunderson K, Sullivan S, Warner-Hillard C, Thompson R, Greenberg JA, Foley EF, Jung HS. Examining the Impact of Using the SIMPL Application on Feedback in Surgical Education. JOURNAL OF SURGICAL EDUCATION 2018; 75:e246-e254. [PMID: 30213738 DOI: 10.1016/j.jsurg.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The System for Improving and Measuring Procedural Learning (SIMPL) smartphone application allows physicians to provide dictated feedback to surgical residents. The impact of this novel feedback medium on the quality of feedback is unknown. Our objective was to compare the delivery and quality of best-case operative performance feedback given via SIMPL to feedback given in-person. DESIGN We collected operative performance feedback given both in-person and via SIMPL from surgeons to residents over 6 weeks. Feedback transcripts were coded using Verbal Response Modes speech acts taxonomy to compare the delivery of feedback. We evaluated quality of feedback using a validated resident survey and third-party assessment form. SETTING University of Wisconsin School of Medicine and Public Health, a large academic medical institution. PARTICIPANTS Four surgical attendings and 9 general surgery residents. RESULTS Nineteen SIMPL and 18 in-person feedback encounters were evaluated. Feedback via SIMPL was more directive (containing thoughts, perceptions, evaluations of resident behavior, or advice) and contained more presumptuous utterances (in which the physician reflected on and assessed resident performance or offered suggestions for improvement) than in-person feedback (p = 0.01). The resident survey showed no significant difference between the quality of feedback given via SIMPL and in-person (p = 0.07). The mean score was 47.74 (SD = 3.00) for SIMPL feedback and 45.33 (SD = 4.77) for in-person feedback, with a total possible score of 50. Third-party assessment showed no significant difference between the quality of feedback given via SIMPL and in-person (p = 0.486). The mean score was 23.40 (SD = 3.75) for SIMPL feedback and 22.25 (SD = 5.94) for in-person feedback, with a total possible score of 30. CONCLUSIONS Although feedback given via SIMPL was more direct and based on the attendings' perspectives, the quality of the feedback did not differ significantly. Use of the dictation feature of SIMPL to deliver resident operative performance feedback is a reasonable alternative to in-person feedback.
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Affiliation(s)
| | - Sarah Sullivan
- University of Wisconsin, Department of Surgery, Madison, Wisconsin.
| | | | - Ryan Thompson
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin.
| | | | - Eugene F Foley
- University of Wisconsin, Department of Surgery, Madison, Wisconsin.
| | - Hee Soo Jung
- University of Wisconsin, Department of Surgery, Madison, Wisconsin.
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