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Lim SY, Bae MJ. Comparative analysis of nursing students' reflection levels before and after debriefing in simulation training in South Korea: qualitative analysis design. CHILD HEALTH NURSING RESEARCH 2024; 30:167-175. [PMID: 39081182 PMCID: PMC11294900 DOI: 10.4094/chnr.2024.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/17/2024] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE To measure the level of reflection, this study analyzes diaries written by third-year nursing students before and after the debriefing stage in simulation training. A qualitative study using diary entries from 15 nursing students to explore reflection depth. METHODS Students engaged in simulation training and the debriefing stage, documenting their reflections in diaries. Before and after debriefing, reflections were rated from Level 1 (reflectivity) to Level 7 (theoretical reflectivity). RESULTS The total number of reflection levels rose significantly from 545 to 829 post-debriefing, enhancing higher-order reflection.The shift signifies a move from superficial to deep reflection, highlighting debriefing's role in fostering critical thinking. CONCLUSION The findings underscore the critical role of debriefing in enhancing reflective thinking in nursing education. There is a demonstrated need for further research into the specific elements of debriefing that are most effective at promoting deep reflection. Future studies should conduct comparative analyses of different debriefing methods and approaches across various educational settings. This research could lay the foundation for designing more effective debriefing strategies that foster critical thinking and improve learning outcomes in nursing education.
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Affiliation(s)
- Sun-Young Lim
- Lecturer, College of Nursing, Seoil University, Seoul, Korea
| | - Mi-Jeong Bae
- PhD Student, Department of Nursing Science, Korea University, Seoul, Korea
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Saeed S, Hegazy NN, Malik MGR, Abbas Q, Atiq H, Ali MM, Aslam A, Hashwani Y, Ahmed FB. Transforming the delivery of care from "I" to "We" by developing the crisis resource management skills in pediatric interprofessional teams to handle common emergencies through simulation. BMC MEDICAL EDUCATION 2024; 24:649. [PMID: 38862911 PMCID: PMC11167930 DOI: 10.1186/s12909-024-05459-2] [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: 11/29/2023] [Accepted: 04/23/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The healthcare system is highly complex, and adverse events often result from a combination of human factors and system failures, especially in crisis situations. Crisis resource management skills are crucial to optimize team performance and patient outcomes in such situations. Simulation-based training offers a promising approach to developing such skills in a controlled and realistic environment. METHODS This study employed a mixed-methods (quantitative-qualitative) design and aimed to assess the effectiveness of a simulation-based training workshop in developing crisis resource management skills in pediatric interprofessional teams at a tertiary care hospital. The effectiveness of the intervention was evaluated using Kirkpatrick's Model, focusing on reaction and learning levels, employing the Collaboration and Satisfaction about Care Decisions scale, Clinical Teamwork Scale, and Ottawa Global Rating Scale for pre- and post-intervention assessments. Focused group discussions were conducted with the participants to explore their experiences and perceptions of the training. RESULTS Thirty-nine participants, including medical students, nurses, and residents, participated in the study. Compared to the participants' pre-workshop performance, significant improvements were observed across all measured teamwork and performance components after the workshop, including improvement in scores in team communication (3.16 ± 1.20 to 7.61 ± 1.0, p < 0.001), decision-making (3.50 ± 1.54 to 7.16 ± 1.42, p < 0.001), leadership skills (2.50 ± 1.04 to 5.44 ± 0.6, p < 0.001), and situation awareness (2.61 ± 1.13 to 5.22 ± 0.80, p < 0.001). No significant variations were observed post-intervention among the different teams. Additionally, participants reported high levels of satisfaction, perceived the training to be highly valuable in improving their crisis resource management skills, and emphasized the importance of role allocation and debriefing. CONCLUSIONS The study underscores the effectiveness of simulation-based training in developing crisis resource management skills in pediatric interprofessional teams. The findings suggest that such training can impact learning transfer to the workplace and ultimately improve patient outcomes. The insights from our study offer additional valuable considerations for the ongoing refinement of simulation-based training programs. There is a need to develop more comprehensive clinical skills evaluation methods to better assess the transferability of these skills in real-world settings. The potential challenges unveiled in our study, such as physical exhaustion during training, must be considered when refining and designing such interventions.
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Affiliation(s)
- Sana Saeed
- Department of Pediatrics and Child Health, and Department of Educational Development, The Aga Khan University, Karachi, Pakistan.
| | - Nagwa Nashat Hegazy
- Family Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Qalab Abbas
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Huba Atiq
- Department of Anesthesiology, Department of Emergency Medicine, and Center of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Pakistan
| | | | - Aashir Aslam
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Yasmin Hashwani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Farzana Bashir Ahmed
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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Berger DJ, Lum L, Shercliffe R, Sinz E. Use of High-Fidelity Simulation as an Adjunct to Basic Life Support Training To Promote Team-Based Resuscitation Skills: A Mixed-Methods Pilot Study. Cureus 2024; 16:e62719. [PMID: 39036194 PMCID: PMC11259406 DOI: 10.7759/cureus.62719] [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] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction The 2020 American Heart Association's (AHA) Basic Life Support (BLS) curriculum focuses on cardiac arrest resuscitation with one or two rescuers, providing only limited opportunities to develop higher-level skills such as leadership, communication, and debriefing. This mixed-methods pilot study evaluated whether supplementing the traditional Heartcode BLS course with a high-fidelity teamwork simulation session improved mastery of these higher-level skills. Methods Twenty-four first-year medical students completed the pilot training during sessions offered in February and May of 2023. The program included the traditional AHA Heartcode BLS course, which ranges from two to four hours, and includes both online and in-person skills components. This was followed by a 90-minute high-fidelity simulation session consisting of two simulated resuscitations separated by a student-led plus/delta debriefing. Facilitators then debriefed the entire activity. Students completed an anonymous online survey that used a 0-10 slider scale to attribute their perceived proficiency for specific skills to the initial BLS course or the teamwork simulations and provided qualitative feedback. Results Twenty-one students (87.5%) completed the follow-up survey. Students credited their proficiency in technical skills (e.g., "Chest Compressions") to both sessions equally, but proficiency in higher-level skills, such as leadership, communication, and teamwork, was predominantly credited to the simulation. Additionally, students reported that the teamwork simulation promoted realism and increased self-efficacy. Conclusion Team-based resuscitation simulations using high-fidelity equipment augmented the AHA BLS course by promoting perceived competence in team dynamics domains and increasing students' self-efficacy for participating in real hospital-based resuscitations. Studies with larger sample sizes and objective data should be performed, and the use of similar resuscitation simulations or the development of a formal team-based BLS certification course should be considered.
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Affiliation(s)
- Daniel J Berger
- Emergency & Internal Medicine, Virginia Commonwealth University Health System, Richmond, USA
| | - Lauren Lum
- Resuscitation Sciences Training Center, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Ryan Shercliffe
- Resuscitation Sciences Training Center, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elizabeth Sinz
- Anesthesiology and Critical Care, West Virginia University, Morgantown, USA
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Hrdy M, Tarver EM, Lei C, Moss HC, Wong AH, Moadel T, Beattie LK, Lamberta M, Cohen SB, Cassara M, Hughes MD, De Castro A, Sahi N, Chen TH. Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education. AEM EDUCATION AND TRAINING 2024; 8:S56-S69. [PMID: 38774828 PMCID: PMC11102949 DOI: 10.1002/aet2.10981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 05/24/2024]
Abstract
Introduction Generation Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape. Methodology The Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG-EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation-based education (SBE) and actively involved in EM residency education. Unique treatment/analysis Through primary and secondary literature searches, the SLANG-EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self-paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments. Implications for educators Instructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small-group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner-centered debriefing, rapid-cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner-centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student-centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, "Delivering Effective Education to the Next Generation," at the 2023 SAEM Annual Meeting.
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Affiliation(s)
- Michael Hrdy
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Emily M. Tarver
- University of Mississippi Medical CenterJacksonMississippiUSA
| | - Charles Lei
- Hennepin County Medical CenterMinneapolisMinnesotaUSA
| | | | | | - Tiffany Moadel
- Donald and Barbara Zucker School of Medicine at Hofstra NorthwellHempsteadNew YorkUSA
| | - Lars K. Beattie
- University of Florida College of MedicineGainesvilleFloridaUSA
| | | | | | - Michael Cassara
- Donald and Barbara Zucker School of Medicine at Hofstra NorthwellHempsteadNew YorkUSA
- Northwell Health Center for Learning and InnovationLake SuccessNew YorkUSA
| | | | - Aga De Castro
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
- Hartford HospitalHartfordConnecticutUSA
| | - Nidhi Sahi
- University of TorontoTorontoOntarioCanada
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Phua GLG, Owyong JLJ, Leong ITY, Goh S, Somasundaram N, Poon EYL, Chowdhury AR, Ong SYK, Lim C, Murugam V, Ong EK, Mason S, Hill R, Krishna LKR. A systematic scoping review of group reflection in medical education. BMC MEDICAL EDUCATION 2024; 24:398. [PMID: 38600515 PMCID: PMC11007913 DOI: 10.1186/s12909-024-05203-w] [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: 01/20/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. METHODS A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. RESULTS 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. CONCLUSIONS Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.
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Affiliation(s)
- Gillian Li Gek Phua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, 463 Clementi Road, Singapore, Singapore
| | - Ian Tze Yong Leong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Suzanne Goh
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- KK Women's and Children Hospital, 100 Bukit Timah Rd, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Vengadasalam Murugam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, Singapore
- Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, 31 Third Hospital Ave, Singapore, 168753, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Ruaridh Hill
- Health Data Science, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, Singapore, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [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] [Indexed: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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Jaffrelot M, Boet S, Floch Y, Garg N, Dubois D, Laparra V, Touffet L, Bould MD. Learning with our peers: peer-led versus instructor-led debriefing for simulated crises, a randomized controlled trial. Korean J Anesthesiol 2024; 77:265-272. [PMID: 38556779 PMCID: PMC10982526 DOI: 10.4097/kja.23317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 01/16/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Although peer-assisted learning is known to be effective for reciprocal learning in medical education, it has been understudied in simulation. We aimed to assess the effectiveness of peer-led compared to instructor-led debriefing for non-technical skill development in simulated crisis scenarios. METHODS Sixty-one undergraduate medical students were randomized into the control group (instructor-led debriefing) or an intervention group (peer debriefer or peer debriefee group). After the pre-test simulation, the participants underwent two more simulation scenarios, each followed by a debriefing session. After the second debriefing session, the participants underwent an immediate post-test simulation on the same day and a retention post-test simulation two months later. Non-technical skills for the pre-test, immediate post-test, and retention tests were assessed by two blinded raters using the Ottawa Global Rating Scale (OGRS). RESULTS The participants' non-technical skill performance significantly improved in all groups from the pre-test to the immediate post-test, with changes in the OGRS scores of 15.0 (95% CI [11.4, 18.7]) in the instructor-led group, 15.3 (11.5, 19.0) in the peer-debriefer group, and 17.6 (13.9, 21.4) in the peer-debriefee group. No significant differences in performance were found, after adjusting for the year of medical school training, among debriefing modalities (P = 0.147) or between the immediate post-test and retention test (P = 0.358). CONCLUSIONS Peer-led debriefing was as effective as instructor-led debriefing at improving undergraduate medical students' non-technical skill performance in simulated crisis situations. Peer debriefers also improved their simulated clinical skills. The peer debriefing model is a feasible alternative to the traditional, costlier instructor model.
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Affiliation(s)
- Morgan Jaffrelot
- University of Ottawa Skills and Simulation Center and Academy for Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Simulation Center, University of Western Brittany and University Hospital of Brest, Brest, France
- Education and Health Promotion Laboratory EA 3412, Paris 13-Sorbonne Paris Cité University, France
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Yolande Floch
- Simulation Center, University of Western Brittany and University Hospital of Brest, Brest, France
| | - Nitan Garg
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Violaine Laparra
- Simulation Center, University of Western Brittany and University Hospital of Brest, Brest, France
| | - Lionel Touffet
- Simulation Center, University of Western Brittany and University Hospital of Brest, Brest, France
| | - M. Dylan Bould
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatric Anesthesia, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Saragih ID, Suarilah I, Hsiao CT, Fann WC, Lee BO. Interdisciplinary simulation-based teaching and learning for healthcare professionals: A systematic review and meta-analysis of randomized controlled trials. Nurse Educ Pract 2024; 76:103920. [PMID: 38382335 DOI: 10.1016/j.nepr.2024.103920] [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: 11/08/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
AIM This study aimed to investigate the effects of interdisciplinary simulation-based teaching and learning on the interprofessional knowledge of healthcare professionals. BACKGROUND Interdisciplinary simulation-based teaching and learning have been employed to prepare learners to collaborate in clinical settings. This strategy could help healthcare professionals to better understand each other, develop interdisciplinary shared values and promote mutual respect between professions, while reducing errors and adverse events in hospital. A meta-analysis was performed to investigate the effects of interdisciplinary simulation-based teaching and learning on healthcare professionals. DESIGN A systematic review and meta-analysis. METHODS A systematic search was conducted of databases including Academic Search Complete, CINAHL Plus with full text, Cochrane Library, Embase, Medline Complete, PubMed and Web of Science from their inception to September 5, 2023. The study included randomized controlled trials that provided interdisciplinary simulation-based education to healthcare professionals. Protocol trials or studies that did not include median or mean and standard deviation were excluded. The pooled standardized mean differences of outcomes were analyzed using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using I2. Egger's regression test was used to examine publication bias indicated in forest plots. RESULTS Ten randomized control trials with a total of 766 participants were included in the pooled analyses. Interdisciplinary simulation-based teaching and learning positively enhanced the interprofessional knowledge of healthcare professionals (pooled SMD = 0.30; 95% CI = 0.10-0.50; p < 0.001). Egger's regression test results were non-significant, indicating that publication bias had little impact on the pooled SMDs. CONCLUSION Interdisciplinary simulation-based teaching and learning for health professionals appear to be significantly beneficial for increasing their interprofessional knowledge. This strategy highlights the importance of providing a well-developed scenario with relevant properties, which applies valid and rigorous instruments, to measure behavioral changes induced by interdisciplinary simulation-based teaching and learning.
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Affiliation(s)
| | - Ira Suarilah
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Taiwan, ROC.
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Senette CL, Dingley C, Doolen J, Gordon H. Fluctuating cohesion: A grounded theory study of nursing students engaged in a combined debriefing format. Nurse Educ Pract 2024; 76:103943. [PMID: 38554617 DOI: 10.1016/j.nepr.2024.103943] [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: 12/20/2023] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
AIM This study explored the social processes enacted by nursing students when they engage in a combined format of structured peer debriefing followed by instructor-led debriefing after in-person simulation. The aim was to gain insight into nursing students' perceptions and how peer processes influenced reflection and learning. BACKGROUND Debriefing, a key component of clinical simulation, promotes development of nursing students' reflective processes and enhances learning. In-person group-debriefing led by faculty/instructors is the most used debriefing format in healthcare simulation education. Yet, recent studies indicate instructor-led formats may increase students' anxiety and limit their capacity for reflection, a crucial step in clinical reasoning and decision making. Investigations into learner-centered formats support peer debriefing as a reasonable alternative to traditional instructor-led debriefing. However, current peer debriefing studies provide little insight into the social interactions and processes supporting reflection and learning; and little theoretical basis exists for the integration of alternatives to instructor-led debriefing formats (such as peer debriefing) into simulation-based education. DESIGN This qualitative study used a Straussian grounded theory design. METHODS Senior-level baccalaureate and associate degree nursing students from an U.S. public university with first-hand experience using the combined format of peer debriefing followed by instructor-led debriefing were recruited to participate in focus-group interviews. Data gathered from semi structured interviews were analysed using the iterative process of constant comparison. Theory building was aided using memoing, theoretical sampling and conceptual diagramming. RESULTS The sample consisted of 34 students. Study findings revealed the core category of the constructed theory, 'Fluctuating cohesion', involved students' pervasive sense of going back and forth between a sense of unity (we-ness) and separatism (me-ness) while engaged in the combined debriefing format. The theory integrated five related categories: discovering the process, normalizing experiences, developing mutuality, dynamic balancing and engaging informal social connections. Findings illustrated the processes students enacted to take ownership for learning and proactively discuss their clinical decision-making with the instructor. In turn, reflection was enhanced by increased receptiveness to subsequent expert feedback. CONCLUSIONS The study findings demonstrated that augmenting instructor-led debriefing with peer debriefing leveraged the beneficial nature of peer interactions, promoted psychological safety, facilitated nascent team behaviors and enhanced reflective thinking. The resultant theory that was generated from the findings and grounded in participants' experience, provides a meaningful framework that may inform future learner-centered debriefing formats aimed at optimizing debriefing effectiveness.
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Affiliation(s)
- Carol Lynn Senette
- University of Nevada, Las Vegas School of Nursing, 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA; University of Alaska Anchorage School of Nursing, Health Sciences Building, 3795 Piper St, Anchorage, AK 99508, USA.
| | - Catherine Dingley
- University of Nevada, Las Vegas School of Nursing, 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Jessica Doolen
- University of Nevada, Las Vegas School of Nursing, 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA.
| | - Howard Gordon
- University of Nevada, Las Vegas School of Nursing, 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
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Pang M, Dong Y, Zhao X, Wan J, Jiang L, Song J, Ji P, Jiang L. Virtual and Interprofessional Objective Structured Clinical Examination in Dentistry and Dental Technology: Development and User Evaluations. JMIR Form Res 2024; 8:e44653. [PMID: 38231556 PMCID: PMC10831592 DOI: 10.2196/44653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/26/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Interprofessional education (IPE) facilitates interprofessional collaborative practice (IPCP) to encourage teamwork among dental care professionals and is increasingly becoming a part of training programs for dental and dental technology students. However, the focus of previous IPE and IPCP studies has largely been on subjective student and instructor perceptions without including objective assessments of collaborative practice as an outcome measure. OBJECTIVE The purposes of this study were to develop the framework for a novel virtual and interprofessional objective structured clinical examination (viOSCE) applicable to dental and dental technology students, to assess the effectiveness of the framework as a tool for measuring the outcomes of IPE, and to promote IPCP among dental and dental technology students. METHODS The framework of the proposed novel viOSCE was developed using the modified Delphi method and then piloted. The lead researcher and a group of experts determined the content and scoring system. Subjective data were collected using the Readiness for Interprofessional Learning Scale and a self-made scale, and objective data were collected using examiner ratings. Data were analyzed using nonparametric tests. RESULTS We successfully developed a viOSCE framework applicable to dental and dental technology students. Of 50 students, 32 (64%) participated in the pilot study and completed the questionnaires. On the basis of the Readiness for Interprofessional Learning Scale, the subjective evaluation indicated that teamwork skills were improved, and the only statistically significant difference in participant motivation between the 2 professional groups was in the mutual evaluation scale (P=.004). For the viOSCE evaluation scale, the difference between the professional groups in removable prosthodontics was statistically significant, and a trend for negative correlation between subjective and objective scores was noted, but it was not statistically significant. CONCLUSIONS The results confirm that viOSCE can be used as an objective evaluation tool to assess the outcomes of IPE and IPCP. This study also revealed an interesting relationship between mutual evaluation and IPCP results, further demonstrating that the IPE and IPCP results urgently need to be supplemented with objective evaluation tools. Therefore, the implementation of viOSCE as part of a large and more complete objective structured clinical examination to test the ability of students to meet undergraduate graduation requirements will be the focus of our future studies.
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Affiliation(s)
- MengWei Pang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- College of Stomatology, Chongqing Medical University, Chongqing, China
| | - YanLing Dong
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- College of Stomatology, Chongqing Medical University, Chongqing, China
| | - XiaoHan Zhao
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - JiaWu Wan
- Beijing Unidraw Virtual Reality Technology Research Institute Co Ltd, Beijing, China
| | - Li Jiang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- College of Stomatology, Chongqing Medical University, Chongqing, China
| | - JinLin Song
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Ping Ji
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Lin Jiang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- College of Stomatology, Chongqing Medical University, Chongqing, China
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Kumar P, Somerville S. Exploring in-person self-led debriefings for groups of learners in simulation-based education: an integrative review. Adv Simul (Lond) 2024; 9:5. [PMID: 38229166 PMCID: PMC10790376 DOI: 10.1186/s41077-023-00274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/10/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Facilitator-led debriefings are well-established for debriefing groups of learners in immersive simulation-based education. However, there has been emerging interest in self-led debriefings whereby individuals or groups of learners conduct a debriefing themselves, without the presence of a facilitator. How and why self-led debriefings influence debriefing outcomes remains undetermined. RESEARCH AIM The aim of this study was to explore how and why in-person self-led debriefings influence debriefing outcomes for groups of learners in immersive simulation-based education. METHODS An integrative review was conducted, searching seven electronic databases (PubMed, Cochrane, Embase, ERIC, SCOPUS, CINAHL Plus, PsychINFO) for peer-reviewed empirical studies investigating in-person self-led debriefings for groups of learners. Data were extracted, synthesised, and underwent reflexive thematic analysis. RESULTS Eighteen empirical studies identified through the search strategy were included in this review. There was significant heterogeneity in respect to study designs, aims, contexts, debriefing formats, learner characteristics, and data collection instruments. The synthesised findings of this review suggest that, across a range of debriefing outcome measures, in-person self-led debriefings for groups of learners following immersive simulation-based education are preferable to conducting no debriefing at all. In certain cultural and professional contexts, such as postgraduate learners and those with previous debriefing experience, self-led debriefings can support effective learning and may provide equivalent educational outcomes to facilitator-led debriefings or self-led and facilitator-led combination strategies. Furthermore, there is some evidence to suggest that self-led and facilitator-led combination approaches may optimise participant learning, with this approach warranting further research. Reflexive thematic analysis of the data revealed four themes, promoting self-reflective practice, experience and background of learners, challenges of conducting self-led debriefings and facilitation and leadership. Similar to facilitator-led debriefings, promoting self-reflective practice within groups of learners is fundamental to how and why self-led debriefings influence debriefing outcomes. CONCLUSIONS In circumstances where simulation resources for facilitator-led debriefings are limited, self-led debriefings can provide an alternative opportunity to safeguard effective learning. However, their true value within the scope of immersive simulation-based education may lie as an adjunctive method alongside facilitator-led debriefings. Further research is needed to explore how to best enable the process of reflective practice within self-led debriefings to understand how, and in which contexts, self-led debriefings are best employed and thus maximise their potential use.
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Affiliation(s)
- Prashant Kumar
- Department of Medical Education, NHS Greater Glasgow & Clyde, Glasgow, Scotland, UK.
- School of Medicine, Dentistry & Nursing, University of Glasgow, University Avenue, Glasgow, G12 8QQ, Scotland, UK.
| | - Susan Somerville
- Centre for Medical Education & Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland, UK
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Christiansen CR, Andersen JV, Dieckmann P. Comparing reflection levels between facilitator-led and student-led debriefing in simulation training for paramedic students. Adv Simul (Lond) 2023; 8:30. [PMID: 38098131 PMCID: PMC10722852 DOI: 10.1186/s41077-023-00273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Simulation in healthcare attempts to create relevant representations of patient encounters. It provides experiential learning, bridging typical classroom activities and clinical practice. This study aims to investigate whether the principle of Peer-Assisted Learning can be used in simulation by letting simulation-experienced paramedic students prepare, deliver, and debrief their own simulations, with minimal faculty assistance. This could be a way to support student learning by being involved in teaching, and it might at the same time optimise the cost-effectiveness of simulation-based training. METHODS This observational non-inferiority study compared reflection levels between facilitator-led and student-led simulation and debriefing, between scenario types, and compared the number of turns in which students are involved in both settings. Third-year Bachelor in Paramedic Science students' debriefings were filmed and transcribed. The degree of reflection in students' statements was rated according to a modified version of Fleck's analytical framework of reflection levels, assigning scores from lowest (R0 description) to highest (R4 critical reflection). Facilitator-led and student-led debriefings were compared using chi-square tests. Scenarios were also analysed according to type (paediatric emergencies and complex assessments) regardless of who led the simulation. RESULTS Ten facilitator-led and 12 student-led debriefings were analysed. Students gave 682 (49%) contributions in the facilitator-led debriefings, and 702 (51%) contributions in student-led debriefings. Comparison of reflection levels between facilitator-led and student-led debriefings was respectively: R0-level 32.7% vs 33.8%, R1-level 44.0% vs 44.3%, R2-level 14.7% vs 17.1%, R3-level 0.1% vs 1.3%, and R4-level 0.1% vs 0.1%. There were no statistically significant differences in reflection levels between facilitator-led and student-led debriefings (p = 0.178). Comparing the reflection levels between the scenarios on "paediatric emergencies" and "complex assessments", the results were respectively: R0-level 35.4% vs. 31.7%-level, R1-level 45.3% vs. 43.3%-level, R2-level 13.4% vs. 17.8%, R3-level 0.5% vs. 0.9%, and R4-level 0.0% vs. 0.3%. These differences were statistically significant (p = 0.010). No significant differences in engagement were found between debriefings led by a student or a facilitator, when measuring the number of turns in the conversations. CONCLUSIONS Facilitator-led and student-led debriefings resulted in equivalent reflection levels amongst students. Student-led simulation is potentially a cost-effective supplement to regular simulation within a healthcare degree program. Since complex scenarios provided higher reflection levels than paediatric, scenario design might influence reflection levels.
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Affiliation(s)
- Carl Robert Christiansen
- Department for Prehospital Education and Research, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Jeanette Viggen Andersen
- Department for Prehospital Education and Research, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Peter Dieckmann
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
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Pađen L, Pajnič M, Vettorazzi R, Pérez-Perdomo A, Stefaniak M, Claes N, Franco H, Vandervoort A, Ravljen M. "Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries. Healthcare (Basel) 2023; 11:2969. [PMID: 37998462 PMCID: PMC10671496 DOI: 10.3390/healthcare11222969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.
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Affiliation(s)
- Ljubiša Pađen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | - Manca Pajnič
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | - Renata Vettorazzi
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | | | - Małgorzata Stefaniak
- Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Nele Claes
- HBO Verpleegkunde Genk, 3600 Genk, Belgium;
| | - Hugo Franco
- School of Health Setúbal, Setúbal Polytechnic University, 2910-761 Setúbal, Portugal;
| | | | - Mirjam Ravljen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
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Daya S, Illangasekare T, Tahir P, Bochatay N, Essakow J, Ju M, van Schaik S. Using Simulation to Teach Learners in Health Care Behavioral Skills Related to Diversity, Equity, and Inclusion: A Scoping Review. Simul Healthc 2023; 18:312-320. [PMID: 36194859 DOI: 10.1097/sih.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SUMMARY STATEMENT Bias is commonplace in the health care environment and can negatively impact patients and their health outcomes. Simulation has long been shown to be an effective teaching tool for communication skills in health care, but it has rarely been used to deliver concrete behavioral skills that address issues of diversity, equity, and inclusion (DEI). This scoping review examines 23 published articles surrounding the use of simulation in health care education to impart behavioral skills that reduce bias and promote DEI. Included articles described various behavioral skills including communication, history-taking, and system/community-level advocacy. The most commonly used simulation modality to teach these skills included the use of simulated participants (16 articles, 70%). The main DEI topics addressed in the trainings included sexual orientation/gender identity, language, and culture/ethnicity. Based on findings from this review, the authors suggest recommendations for educators who are considering teaching DEI-related skills through simulation.
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Affiliation(s)
- Sneha Daya
- From the Department of Internal Medicine and Pediatrics (S.D.), Department of Obstetrics & Gynecology (T.I.), Department of Pediatrics (J.E. M.J., S.v.S.), University of California San Francisco (P.T., N.B.), San Francisco, CA
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Boet S, Burns JK, Brehaut J, Britton M, Grantcharov T, Grimshaw J, McConnell M, Posner G, Raiche I, Singh S, Trbovich P, Etherington C. Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches. J Interprof Care 2023; 37:715-724. [PMID: 36739535 DOI: 10.1080/13561820.2023.2171373] [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: 08/31/2021] [Revised: 10/26/2022] [Accepted: 01/07/2023] [Indexed: 02/06/2023]
Abstract
Intraoperative teamwork is vital for patient safety. Conventional tools for studying intraoperative teamwork typically rely on behaviorally anchored rating scales applied at the individual or team level, while others capture narrative information across several units of analysis. This prospective observational study characterizes teamwork using two conventional tools (Operating Theatre Team Non-Technical Skills Assessment Tool [NOTECHS]; Team Emergency Assessment Measure [TEAM]), and one alternative approach (modified-Systems Engineering Initiative for Patient Safety [SEIPS] model). We aimed to explore the advantages and disadvantages of each for providing feedback to improve teamwork practice. Fifty consecutive surgical cases at a Canadian academic hospital were recorded with the OR Black Box®, analyzed by trained raters, and summarized descriptively. Teamwork performance was consistently high within and across cases rated with NOTECHS and TEAMS. For cases analyzed with the modified-SEIPS tool, both optimal and suboptimal teamwork behaviors were identified, and team resilience was frequently observed. NOTECHS and TEAM provided summative assessments and overall pattern descriptions, while SEIPS facilitated a deeper understanding of teamwork processes. As healthcare organizations continue to prioritize teamwork improvement, SEIPS may provide valuable insights regarding teamwork behavior and the broader context influencing performance. This may ultimately enhance the development and effectiveness of multi-level teamwork interventions.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort, Montfort Hospital & Faculty of Education, University of Ottawa, Ottawa, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Joseph K Burns
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital (General Campus), Ottawa, Canada
| | - Teodor Grantcharov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of General Surgery, University of Toronto, Toronto, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Meghan McConnell
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Glenn Posner
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Isabelle Raiche
- Department of General Surgery, University of Ottawa, Ottawa, Canada
| | - Sukhbir Singh
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Patricia Trbovich
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cole Etherington
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Allison A, Weerahandi A, Johnson T, Koshan J, Bagstad G, Ferreira C, Jenney A, Krut BA, Wollny K. A Scoping Review on the Use of Experiential Learning in Professional Education on Intimate Partner Violence. JOURNAL OF FAMILY VIOLENCE 2023:1-20. [PMID: 37358988 PMCID: PMC10157572 DOI: 10.1007/s10896-023-00552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Purpose Intimate partner violence (IPV) involves any form of emotional, physical, and sexual abuse including controlling behaviors by an intimate partner. Front line service workers such as social workers, nurses, lawyers, and physicians are often the first professionals to come into contact with individuals experiencing IPV but are often inadequately prepared to respond appropriately as IPV education is highly variable. Experiential learning (EL), also known as learning by doing, has gained much attention from educators; however, the extent and type of EL strategies used to teach IPV competencies has not yet been explored. Our aim was to extract what is known from the literature about the use of EL strategies to teach IPV competencies to front line service providers. Methods We conducted a search from May 2021 through November 2021. Reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data collected included study demographics (publication year, country, etc.), study participants, and information about the IPV EL. Results Of 5216 identified studies, 61 were included. Medicine and nursing represented the majority of learners in the included literature. Graduate students were the targeted learners in 48% of articles. Low fidelity EL was used most frequently in 48% of the articles; and role play was the EL mode most frequently utilized (39%) overall. Conclusions This scoping review provides a comprehensive overview of the limited literature on how EL is used to teach IPV competencies and identifies significant gaps related to the lack of intersectional analysis within educational interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s10896-023-00552-4.
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Affiliation(s)
- Aurora Allison
- Faculty of Law, University of Calgary, Calgary, AB Canada
| | - Ambereen Weerahandi
- Faculty of Nursing, University of Calgary, Drive NW, PF 3239, Calgary, AB T2N 1N4 Canada
| | - Torri Johnson
- Faculty of Nursing, University of Calgary, Drive NW, PF 3239, Calgary, AB T2N 1N4 Canada
| | | | - Georgina Bagstad
- Faculty of Nursing, University of Calgary, Drive NW, PF 3239, Calgary, AB T2N 1N4 Canada
| | - Carla Ferreira
- School of Nursing, University of British Columbia, Vancouver, BC Canada
| | - Angelique Jenney
- Faculty of Social Work, University of Calgary, Calgary, AB Canada
| | - Breanne A. Krut
- Faculty of Nursing, University of Calgary, Drive NW, PF 3239, Calgary, AB T2N 1N4 Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Drive NW, PF 3239, Calgary, AB T2N 1N4 Canada
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:214-226.e1. [PMID: 37055148 DOI: 10.1016/j.jogc.2023.02.006] [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] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates. TARGET POPULATION Providers working to improve health care for Canadian women and their families; patients and their families. OUTCOMES Simulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition. BENEFITS, HARMS, AND COSTS This modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time. EVIDENCE Articles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords "simulation" and "simulator." The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care professionals working to improve Canadian women's health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs. RECOMMENDATIONS
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Déclaration de consensus n o 434 : Simulation en obstétrique et gynécologie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:227-240.e1. [PMID: 37055149 DOI: 10.1016/j.jogc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Lee J, Lee JH. Effects of simulation-based education for neonatal resuscitation on medical students' technical and non-technical skills. PLoS One 2022; 17:e0278575. [PMID: 36454959 PMCID: PMC9714940 DOI: 10.1371/journal.pone.0278575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 11/20/2022] [Indexed: 12/03/2022] Open
Abstract
Simulation is a learner-centered practice that helps develop and maintain knowledge, skills, and competencies. This study evaluated the effect of neonatal resuscitation simulation-based education for medical students in the fifth year (part of the regular clinical clerkship program) on the perceived performance of their technical and non-technical skills. In addition, we analyzed the difference between instructor's and learners' evaluations of technical skills after the simulation. A one-group pretest-posttest design was adopted. The simulation-based education of the neonatal resuscitation program (NRP) was conducted for 40 medical students from July to November 2020 at a medical school in South Korea. The simulation-based education comprised 5 minutes of pre-briefing, 10 minutes of running the simulation, and 30 minutes of debriefing (using a recorded video). The perceived performance of students' technical and non-technical skills before and after the simulation was compared by collecting and analyzing the pre- and post-questionnaires. The perceived performance of technical (p = .001) and non-technical skills (p < .001) was found to have significantly increased after the simulation. Particularly, the performance of technical skills, such as diagnostic (p = .007) and therapeutic actions (p < .001) and non-technical skills, such as leadership (p < .001), teamwork (p = .001), and task management (p = .020) improved significantly. There was no significant difference in the evaluations of the technical performance of the instructor and learners after the simulation (p = .953). Simulation-based education can improve technical skills, such as diagnostic and therapeutic actions for neonatal resuscitation. It is also effective in enhancing non-technical skills, such as leadership, teamwork, and task management. Further, after the simulation-based education, students can fully self-evaluate through objective reflection and improve their clinical competency.
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Affiliation(s)
- Jiwon Lee
- Office of Medical Education, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
- * E-mail:
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Traoré J, Balen F, Geeraerts T, Charpentier S, Dubucs X, Houzé-Cerfon CH. Is it valid to assess an individual's performance in team training simulation when the supporting team are confederates? A controlled and randomized clinical trial. BMC MEDICAL EDUCATION 2022; 22:685. [PMID: 36123654 PMCID: PMC9487079 DOI: 10.1186/s12909-022-03747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants' performance during full-scale simulation of crisis medical situations. METHODS This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes. RESULTS A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 ± 0.8 in the Control group and 4.0 ± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization) CONCLUSION: In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents. TRIAL REGISTRATION This study does not need to be registered on Clintrial as it does not report a health care intervention on human participants.
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Affiliation(s)
- Jérémie Traoré
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France
| | - Frédéric Balen
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Intensive Care Medicine, Toulouse University Hospital, Toulouse, France
- Toulouse Institute of Simulation Healthcare (Institut Toulousain de Simulation en Santé, ItSimS), University Hospital Toulouse, Toulouse, France
- University Toulouse III Paul Sabatier, Toulouse, France
| | - Sandrine Charpentier
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France
- University Toulouse III Paul Sabatier, Toulouse, France
| | - Xavier Dubucs
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France
| | - Charles-Henri Houzé-Cerfon
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France.
- Toulouse Institute of Simulation Healthcare (Institut Toulousain de Simulation en Santé, ItSimS), University Hospital Toulouse, Toulouse, France.
- UMR EFTS (Education, Formation, University of Toulouse 2 Jean Jaurès, Savoirs), Toulouse, Travail, France.
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Holmes C, Mellanby E. Debriefing strategies for interprofessional simulation-a qualitative study. Adv Simul (Lond) 2022; 7:18. [PMID: 35717254 PMCID: PMC9206121 DOI: 10.1186/s41077-022-00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Interprofessional education is becoming more common worldwide. Simulation is one format in which this can effectively take place. The debriefing after the simulation is a critical part of the simulation process as it allows reflection and discussion of concepts that arose during the simulation. Debriefing has been noted to be challenging in the literature. Debriefing after interprofessional simulation (IPS) is likely to have even more challenges, many related to the different backgrounds (profession, specialty) of the learners. This study was designed to investigate: ‘How do differing learner professions impact on delivery of post simulation debriefing after team based interprofessional simulation—what are the challenges and what strategies can be used to overcome them?’ Methods An initial review of the literature was used to identify current understanding and potential themes requiring further exploration. Using the results from the literature as a starting point for topics and questions to be asked, semi-structured interviews were planned, with those who are experienced in debriefing after IPS. The interviews were transcribed then analysed using a framework analysis. Results The literature search resulted in twenty relevant papers. Four dimensions were drawn out from these papers that were directly related to debriefing after IPS: ‘the debriefer’, ‘method of debriefing’, ‘the learner’ and ‘psychological safety’. Sixteen interviews occurred between June and August 2020. Ten themes were extracted from the analysis of the transcripts of these interviews: number and specialty of debriefers, credibility, assumptions/preconceptions, nurses vs doctors, method of debriefing, the learner, hierarchy, safe learning environment, inclusion of all learners, and number of debriefers. These themes were fitted in the four dimensions identified in the literature search, and discussed as so. Conclusion Several challenges and strategies were identified during this study. ‘It depends’ was a common answer received in the interviews suggesting that there is very little advice that can be given that applies to every situation. The main recommendation from this study is the support for an interprofessional group of debriefers in IPS although this does introduce its own challenges. Further research is suggested around the hierarchy found in IPS debriefing and how this translates to and from clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-022-00214-3.
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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rajendran G, Mahalingam S, Balaraman N, Kumaran A, Ganessane E. Designing a universal tool for developing content of debriefing: The how and what questions. AEM EDUCATION AND TRAINING 2022; 6:e10739. [PMID: 35479186 PMCID: PMC9024152 DOI: 10.1002/aet2.10739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Clear and specific content for debriefing promotes learning and reflection for the learner. Currently, there is no universal tool for developing the content for debriefing. METHODS We developed a tool for debriefing that can be applied for developing content for debriefing, which can be used for instructor-led and within-team debriefing. These tools include two sets of eight questions, namely, the how and the what questions. RESULTS We used these tools in our monthly simulation activities and got a favorable response from the residents who used them. CONCLUSIONS The how question deals with human factors, and the what questions deal with educational factors.
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Affiliation(s)
- Gunaseelan Rajendran
- Department of Emergency Medicine & TraumaJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Sasikumar Mahalingam
- Department of Emergency Medicine & TraumaJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Nithya Balaraman
- Department of Emergency Medicine & TraumaJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Aswin Kumaran
- Department of Emergency Medicine & TraumaJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Ezhilkugan Ganessane
- Department of Emergency Medicine & TraumaJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
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Morgan S, Jones B. Developing pre-registration nurses' resilience to mass casualty situations through the pedagogy of simulation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:136-141. [PMID: 35152742 DOI: 10.12968/bjon.2022.31.3.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Simulation has become a core component of nursing curricular worldwide. Within a three-year, pre-registration degree typically students would not be exposed to disaster type situations and it was believed that a well-coordinated simulation exercise could replicate this. It was hoped that the simulation would require students to think quickly on their feet and transfer acquired skills. Worldwide disasters including the current novel coronavirus have, heightened the need for well-prepared resilient health professionals capable of responding to many different types of emergencies including mass casualty situations. The simulated event involved 80 adult field student nurses, 19 probationer police officers, 6 photojournalism students, 2 Welsh Ambulance paramedics, 5 staff from 203 Field Hospital, 2 St John Cymru Wales Officers, 1 community first responder and 6 Fire and Rescue personnel. All these individuals came together to undertake a simulated emergency response to a mass casualty incident. Behaviours and clinical skills were observed throughout the event along with interprofessional interactions.
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Affiliation(s)
- Sara Morgan
- Senior Lecturer Advanced Practice, University of South Wales, Pontypriddd
| | - Bridie Jones
- Academic Subject Manager, Head of Professional Practice and Development, University of South Wales, Pontypriddd
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Niu Y, Liu T, Li K, Sun M, Sun Y, Wang X, Yang X. Effectiveness of simulation debriefing methods in nursing education: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2021; 107:105113. [PMID: 34492539 DOI: 10.1016/j.nedt.2021.105113] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate debriefing methods' effectiveness on learning outcomes for nursing students. DESIGN A systematic review and meta-analysis were applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. DATA SOURCES Publications were searched in PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, and WANFANG (China) databases from inception to 2020. REVIEW METHODS Two researchers independently retrieved articles and evaluated their quality. Review Manager version 5.3 software was used to conduct the meta-analysis, following the PRISMA guidelines. Bias risk was assessed using the Joanna Briggs Institute manual. Heterogeneity was assessed by I2 statistics. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were used for effect size analysis based on learning outcomes. RESULTS Sixteen studies were selected in the systematic review and 13 studies with 1637 nursing students were included in the meta-analysis. Five debriefing methods were used in the intervention group. The analysis showed that Debriefing for Meaningful Learning was more effective on the debriefing quality (SMD = 0.52, 95%CI [0.32, 0.72]), and that video-assisted debriefing was more effective on nursing students' experiences (SMD = 0.30, 95%CI [0.02, 0.58]) and critical thinking (SMD = 0.90, 95%CI [0.65, 1.15]) compared with the usual debriefing. However, written debriefing did not show better effects on students' experiences (SMD = -0.22, 95%CI [-0.51, 0.07]), and peer-led debriefing did not show better effects on the debriefing quality compared with the usual debriefing (SMD = -0.15, 95%CI [-1.43, -0.67]). CONCLUSIONS The study indicated that Debriefing for Meaningful Learning and video-assisted debriefing showed a positive impact on nursing education. Future studies that have larger sample sizes, high-quality debriefing methods, robust study designs, and other learning outcomes are required.
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Affiliation(s)
- Yushuo Niu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Ting Liu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Kuinan Li
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Mengke Sun
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Yaru Sun
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xin Wang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xiuling Yang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China.
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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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Arriaga AF, Chen YYK, Pimentel MPT, Bader AM, Szyld D. Critical event debriefing: a checklist for the aftermath. Curr Opin Anaesthesiol 2021; 34:744-751. [PMID: 34817451 DOI: 10.1097/aco.0000000000001061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Millions of perioperative crises (e.g. anaphylaxis, cardiac arrest) may occur annually. Critical event debriefing can offer benefits to the individual, team, and system, yet only a fraction of perioperative critical events are debriefed in real-time. This publication aims to review evidence-based best practices for proximal critical event debriefing. RECENT FINDINGS Evidence-based key processes to consider for proximal critical event debriefing can be summarized by the WATER mnemonic: Welfare check (assessing team members' emotional and physical wellbeing to continue providing care); Acute/short-term corrections (matters to be addressed before the next case); Team reactions and reflections (summarizing case; listening to team member reactions; plus/delta conversation); Education (lessons learned from the event and debriefing); Resource awareness and longer term needs [follow-up (e.g. safety/quality improvement report), local peer-support and employee assistance resources]. A cognitive aid to accompany this mnemonic is provided with the publication. SUMMARY There is growing literature on how to conduct proximal perioperative critical event debriefing. Evidence-based best practices, as well as a cognitive aid to apply them, may help bridge the gap between theory and clinical practice. In this era of increased attention to burnout and wellness, the consideration of interventions to improve the quality and frequency of critical event debriefing is paramount.
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Affiliation(s)
- Alexander F Arriaga
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
- Center for Surgery and Public Health
- Ariadne Labs
| | - Yun-Yun K Chen
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
| | - Marc Philip T Pimentel
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
| | - Angela M Bader
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
- Center for Surgery and Public Health
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital
- Center for Medical Simulation, Boston, Massachusetts, USA
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Teaming in the ambulatory surgical space and crisis management strategies. Fertil Steril 2021; 117:22-26. [PMID: 34809973 DOI: 10.1016/j.fertnstert.2021.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022]
Abstract
Outpatient procedures and flexible staffing models have become prevalent within the ambulatory surgical and procedural spaces of reproductive endocrinology and infertility practice. High volumes of outpatients are treated daily by rotating nurses, surgeons, and anesthesia staff, often with the added layer of trainees present. "Teaming" can allow stable units and ad hoc groups to partner better for enhanced efficiency, effectiveness, and patient experience in routine procedural activities. These skills then can be parlayed into the rare moments of crisis to improve safety outcomes. Teaming concepts, applied in routine and acute scenarios, can optimize clinical operations, patient experience, and outcomes in our reproductive endocrinology and infertility ambulatory procedural and surgical spaces.
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Dewolf P, Vanneste M, Desruelles D, Wauters L. Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study. Resusc Plus 2021; 8:100171. [PMID: 34693380 PMCID: PMC8517196 DOI: 10.1016/j.resplu.2021.100171] [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] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aim To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). Conclusion The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,KULeuven, University, Faculty of Medicine, Belgium
| | - Maïté Vanneste
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Dewolf P, Clarebout G, Wauters L, Van Kerkhoven J, Verelst S. The Effect of Teaching Nontechnical Skills in Advanced Life Support: A Systematic Review. AEM EDUCATION AND TRAINING 2021; 5:e10522. [PMID: 34041431 PMCID: PMC8138104 DOI: 10.1002/aet2.10522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing. METHODS A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence. RESULTS Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n = 25), retention (n = 8), and feedback (n = 10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing. CONCLUSION Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6 months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
- Faculty of MedicineKU LeuvenLeuvenFlandersBelgium
| | - Geraldine Clarebout
- Faculty of Psychology and Pedagogical SciencesCentre for Instructional Psychology and TechnologyKU LeuvenLeuvenFlandersBelgium
| | - Lina Wauters
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
| | - Joke Van Kerkhoven
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
| | - Sandra Verelst
- Department of Emergency MedicineUniversity Hospitals LeuvenLeuvenFlandersBelgium
- Faculty of MedicineKU LeuvenLeuvenFlandersBelgium
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A Combination of Self-debriefing and Instructor-led Debriefing Improves Team Effectiveness in Health Science Students. Nurse Educ 2021; 46:E7-E11. [PMID: 32433378 DOI: 10.1097/nne.0000000000000845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Debriefing is considered a critical component of simulation-based learning, but the differences between different debriefing methods remain unclear. PURPOSE The purpose of the study was to investigate the effectiveness of the debriefing assessment, problem-solving process, and team effectiveness among students who received instructor-led debriefing, self-debriefing, and combined debriefing. METHODS An experimental design was conducted with 250 students (nursing, physiotherapy, and occupational therapy). Differences in the Debriefing Experience Scale (DES), Problem Solving Inventory (PSI), and Communication and Teamwork Skills (CATS) assessment between the groups were measured. RESULTS In nursing students, the combined debriefing group had the highest scores for the CATS assessment (P < .001) and for the coordination (P < .001), cooperation (P = .012), and communication (P = .002) categories. No significant differences were observed between debriefing groups for DES or PSI. CONCLUSIONS Combined debriefing improves communication and team skills in students. Educators might promote combined debriefing after simulation sessions as it seems to improve team effectiveness.
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Na YH, Roh YS. Effects of Peer-led Debriefing on Cognitive Load, Achievement Emotions, and Nursing Performance. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makkink AW, Dreyer DJ. Simulation debriefing: a perspective from emergency medical care students at three South African Higher Education Institutions. Pan Afr Med J 2021; 38:97. [PMID: 33889263 PMCID: PMC8035690 DOI: 10.11604/pamj.2021.38.97.23009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/15/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction simulation-based learning (SBL) is an educational technique that is used to create lifelike experiences within a controlled setting. Feedback and debriefing have been described as most important components in healthcare simulation. Providing feedback or debriefing loses its efficacy if it is not performed correctly. The results of poor feedback or debriefing practice may negatively affect future student performance. It is important to identify both positive and negative current practice so as to better understand the potential effects on student learning. There is a paucity of evidence relating to debriefing within the resource-constrained environment. Methods a cross-sectional design collected data using a purpose-designed, paper-based questionnaire that was validated using a pilot study. We collected data from three South African higher education institutions (HEI) offering emergency medical care qualifications. Questionnaires were distributed on-site at each HEI by an academic staff member and were returned to the researchers via courier. Participants were recruited from the second, third and fourth academic years of study. Responses were captured manually and imported into Microsoft Excel for analysis. Results we collected 153 completed questionnaires from three South African Higher Education Institutions (HEIs). Student perceptions of debriefing practices were generally positive. There were general feelings of psychological safety and an understanding between students and facilitator related to why debriefing took place. Linking debrief and learning outcomes was perceived as making debriefing meaningful to students. Question-asking techniques by facilitators were mixed, but were generally asked in a manner that encouraged self-reflection. Peer-led debriefing was perceived as good practice and a single facilitator was preferred to multiple facilitators. Conclusion several strategies related to effective feedback and debriefing were identified by the student participants as already being employed by facilitators. The potentially negative effect of multiple facilitators was highlighted by participants who indicated that they preferred a single debriefer for the entire academic year. Peer-led debriefing was perceived as a positive practice and has a number of advantages and disadvantages that should be considered and mitigated by the facilitator.
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Affiliation(s)
- Andrew William Makkink
- Department of Emergency Medical Care, University of Johannesburg, Doornfontein, Johannesburg, South Africa
| | - Devin John Dreyer
- Department of Emergency Medical Care, University of Johannesburg, Doornfontein, Johannesburg, South Africa
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Przednowek T, Stacey C, Baird K, Nolan R, Kellar J, Corser WD. Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting. Spartan Med Res J 2021; 6:21376. [PMID: 33870002 PMCID: PMC8043908 DOI: 10.51894/001c.21376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Regular debriefing has been associated with improved resource utilization and measurable improvements in team performance in crisis situations. While Emergency Department (ED) staff have often stated that they would like to be provided a formal debriefing model after "code blue" and similar events, few EDs have such protocols in place. METHODS The study consisted of two data collection processes: (1) completion of a 7-item survey distributed pre-intervention, 6-months post-intervention, and 1-year post-intervention, and (2) completion of a Rapid Post-Code Debriefing form. Overall responses were measured on a possible 0-10 scale and individual responses were tracked. The debrief process was triggered by one of four criteria and followed a standard format using a readily available form. RESULTS A total of 178 pre- and post-debriefing protocol implementation survey responses were collected throughout the duration of the study. Of those, 79 (44.4%) were pre-protocol response surveys. The post-protocol responses were comprised of 51 (51.5%) six month and 48 (48.5%) 12-month surveys. The average overall satisfaction with code-response performance increased significantly following the implementation of the debriefing protocol, from M=6.661, SD=2.028 to M=7.90, SD=1.359 (independent t-test = 5.069, p<0.001). There was a statistically significant decrease regarding how respondents felt emotionally supported after a code by their staff, (Pearson Chi Square 14.977, df 4, p = 0.005). CONCLUSION During this study, implementation of a post-code debriefing resulted in increased overall satisfaction with how codes had been conducted and there was a significant change in how staff felt in regards to code team leaders and an expectation of "returning to work." However, there a noted overall decrease in perceptions of feeling supported by other staff involved during the code. Further studies in both community and academic-based ED settings are needed to further explore these complex relationships.
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Connolly F, De Brún A, McAuliffe E. A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation. J Interprof Care 2021; 36:222-233. [PMID: 33818255 DOI: 10.1080/13561820.2021.1880381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Interprofessional simulation has been linked to improved self-efficacy, communication, knowledge and teamwork skills in healthcare teams. However, there are few studies that synthesize learners' perceptions of interprofessional simulation-based approaches and barriers or facilitators they encounter in such learning approaches. The aim of this review was to explore these issues through synthesis of the published literature on healthcare staff engaging in interprofessional simulation to inform enhancement of instructional design processes. Searches of four major databases resulted in the retrieval of 2,727 studies. Following screening and full-text review, a total of 13 studies were included in the final review and deductive content analysis was used to collate the findings, which were then synthesized using a narrative approach. Three categories of barriers and facilitators were identified: characteristics of the simulation learning process, outcomes of interprofessional simulation, and interprofessional dynamics. Related to the latter, the findings indicate the instructional design of interprofessional simulation-based approaches may benefit from a greater focus on the context of healthcare teams that prioritizes teamwork. Furthermore, greater emphasis on designing realistic clinical situations promotes effectiveness of simulation. It is important to recognize the perspectives of healthcare team members engaging in these learning approaches and how they may affect clinical performance and influence patient outcomes.
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Affiliation(s)
- Fergal Connolly
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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Ciceron F, Besch G, Benkhadra M, Rouge JA, Dupont G, Avena C, Laithier C, Girard C, Samain E, Pili-Floury S. Individual versus collective debriefing after interprofessional training course simulation: The randomised DEBRIEF-SIM trial. Anaesth Crit Care Pain Med 2021; 40:100828. [PMID: 33741514 DOI: 10.1016/j.accpm.2021.100828] [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: 06/19/2020] [Revised: 09/23/2020] [Accepted: 10/24/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Debriefing is a critical phase in simulation-based education that is extremely time-consuming for the instructors. The aim of the study was to assess whether a collective debriefing was non-inferior to an individual debriefing to improve learning outcomes after a simulation session. METHODS This randomised controlled multicentre non-inferiority study included pairs comprising one resident and one student nurse in anaesthesia. Each pair underwent two sessions of a simulated life-threatening emergency held at a 6-week interval. Six participant pairs underwent simulation sessions every half-day of training. The debriefing performed after the first session was either individual (1 debriefing by pair; individual group) or collective (1 debriefing by 6 pairs; collective group). The primary outcome was the evolution of a 34-parameter technical skill score (Delta-TSS-34) between the two simulation sessions. The non-inferiority margin was 5. The change in the Anaesthetists' Non-Technical Skills score (Delta-ANTS), and the debriefing duration per participant pair were secondary endpoint measures. RESULTS Respectively 23 and 21 pairs were included in the collective and individual groups. Delta-TSS-34 was non-inferior in the collective group compared to the individual group (mean intergroup difference [95% confidence interval]: 2.71 [0.44-4.98]). Delta-ANTS did not significantly differ between the two groups (median [interquartile range]: 22 [10-37] versus 25 [17-35], p = 0.57; respectively in the collective and individual groups). The debriefing duration per participant pair was significantly lower in the collective group (10 [10-11] min versus 27 [25-28] min; p < 0.001). CONCLUSION Collective debriefing was non-inferior to individual debriefing to improve learning outcomes after simulation of medical emergencies and allows a significant reduction in the time dedicated to the debriefing.
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Affiliation(s)
- Floriane Ciceron
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France
| | - Guillaume Besch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; SFR FED 4234, EA 3920, University of Franche-Comté, F-25000 Besancon, France.
| | - Medhi Benkhadra
- U-Seem Institute and Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Dijon, F-21000 Dijon, France
| | - Jeanne-Antide Rouge
- Nurses School Anaesthetist, Healthcare Professionals Training Institute, University Hospital of Besancon, F-25000 Besancon, France
| | - Gregory Dupont
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France
| | - Christophe Avena
- U-Seem Institute and Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Dijon, F-21000 Dijon, France
| | - Christophe Laithier
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France
| | - Claude Girard
- U-Seem Institute and Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Dijon, F-21000 Dijon, France
| | - Emmanuel Samain
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; SFR FED 4234, EA 3920, University of Franche-Comté, F-25000 Besancon, France
| | - Sébastien Pili-Floury
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France; SFR FED 4234, EA 3920, University of Franche-Comté, F-25000 Besancon, France
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Goodwin CDG, Velasquez E, Ross J, Kueffer AM, Molefe AC, Modali L, Bell G, Delisle M, Hannenberg AA. Development of a Novel and Scalable Simulation-Based Teamwork Training Model Using Within-Group Debriefing of Observed Video Simulation. Jt Comm J Qual Patient Saf 2021; 47:385-391. [PMID: 33785261 DOI: 10.1016/j.jcjq.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
THE CHALLENGE Effective teamwork and communication skills are essential for safe and reliable health care. These skills require training and practice. Experiential learning is optimal for training adults, and the industry has recognized simulation training as an exemplar of this approach. Yet despite decades of investment, this training is inaccessible and underutilized for most of the more than 12 million health care professionals in the United States. DESIGNING A SOLUTION This report describes the design process of an adapted simulation training created to overcome the key barriers to scaling simulation-based teamwork training: access to technology, time away from clinical work, and availability of trained simulation educators. The prototype training is designed for delivery in one-hour segments and relies on observation of video simulation scenarios and within-group debriefing, which are promising variations on traditional simulation training. To our knowledge, these two simulation approaches have not been previously combined. The resulting prototype minimizes the need for an on-site trained simulation educator. This report details the development of a training model, its subsequent modification based on pilot testing, and the evaluation of the resulting redesigned prototype. PRELIMINARY EVALUATION Participant evaluations of the redesigned prototype were highly positive, with 92% reporting that they would like to participate in additional, similar training sessions. Positive results were also found in assessment of feasibility, acceptability, psychological safety, and behavioral intention (reported intention to alter behavior).
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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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Rueda-Medina B, Schmidt-RíoValle J, González-Jiménez E, Fernández-Aparicio Á, Encarnación Aguilar-Ferrándiz M, Correa-Rodríguez M. Peer Debriefing Versus Instructor-Led Debriefing for Nursing Simulation. J Nurs Educ 2021; 60:90-95. [PMID: 33528579 DOI: 10.3928/01484834-20210120-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Debriefing is the reflective process following the simulation experience. We aimed to compare the debriefing assessment and debriefing satisfaction perceived by nursing students who underwent different debriefing methods. METHOD An experimental study conducted on three groups (instructor-led debriefing, peer debriefing, and combined debriefing) was performed for 177 nursing students. Differences in the debriefing satisfaction were assessed using the Clinical Experience Simulation scale, the Visual Analogue scale, and the Debriefing Assessment for Simulation in Healthcare (DASH). RESULTS VAS scores for satisfaction differed significantly between the instructor-led debriefing, peer debriefing, and combined debriefing groups. In the Clinical Experience Simulation scale, the combined debriefing group was significantly higher compared with instructor-led debriefing. The total score for DASH was significantly higher in the combined debriefing group compared with instructor-led debriefing, and in instructor-led debriefing compared with peer debriefing. CONCLUSION Combining debriefing after a simulation session improves the debriefing satisfaction and the perceived debriefing assessment among nursing students. [J Nurs Educ. 2021;60(2):90-95.].
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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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Abstract
Simulation-based education improves health care professionals' performance in managing critical events. Limitations to widespread uptake of high-fidelity simulation include barriers related to training, technology, and time. Alternatives to high-fidelity simulation that overcome these barriers include in situ simulation, classroom-based simulation, telesimulation, observed simulation, screen-based simulation, and game-based simulation. Some settings have limited access to onsite expert facilitation to design, implement, and guide participants through simulation-based education. Alternatives to onsite expert debriefing in these settings include teledebriefing, scripted debriefing, and within-group debriefing. A combination of these alternatives promotes successful implementation and maintenance of simulation-based education for managing critical health care events.
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Affiliation(s)
- Megan Delisle
- Department of Surgery, University of Manitoba, 347-825 Sherbrook Street, Winnipeg, Manitoba R3T 2N2, Canada
| | - Alexander A Hannenberg
- Ariadne Labs, Tufts University School of Medicine, 401 Park Drive, 3 West, Boston, MA 02115, USA.
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Sweeney RE, Clapp JT, Arriaga AF, Muralidharan M, Burson RC, Gordon EKB, Falk SA, Baranov DY, Fleisher LA. Understanding Debriefing: A Qualitative Study of Event Reconstruction at an Academic Medical Center. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1089-1097. [PMID: 31567173 DOI: 10.1097/acm.0000000000002999] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This qualitative study sought to characterize the role of debriefing after real critical events among anesthesia residents at the Hospital of the University of Pennsylvania. METHOD From October 2016 to June 2017 and February to April 2018, the authors conducted 25 semistructured interviews with 24 anesthesia residents after they were involved in 25 unique critical events. Interviews focused on the experience of the event and the interactions that occurred thereafter. A codebook was generated through annotation, then used by 3 researchers in an iterative process to code interview transcripts. An explanatory model was developed using an abductive approach. RESULTS In the aftermath of events, residents underwent a multistage process by which the nature of critical events and the role of residents in them were continuously reconstructed. Debriefing-if it occurred-was 1 stage in this process, which also included stages of internal dialogue, event documentation, and lessons learned. Negotiated in each stage were residents' culpability, reputation, and the appropriateness of their affective response to events. CONCLUSIONS Debriefing is one of several stages of interaction that occur after a critical event; all stages play a role in shaping how the event is interpreted and remembered. Because of its dynamic role in constituting the nature of events and residents' role in them, debriefing can be a high-stakes interaction for residents, which can contribute to their reluctance to engage in it. The function and quality of debriefing can be assessed in more insightful fashion by understanding its relation to the other stages of event reconstruction.
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Affiliation(s)
- Rachel E Sweeney
- R.E. Sweeney is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. J.T. Clapp is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. A.F. Arriaga is assistant professor of anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. M. Muralidharan is research assistant, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. R.C. Burson II is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. E.K.B. Gordon is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. S.A. Falk is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. D.Y. Baranov is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. L.A. Fleisher is chair and Robert Dunning Dripps Professor of Anesthesia, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Lee M, Kim S, Kang K, Kim S. Comparing the learning effects of debriefing modalities for the care of premature infants. Nurs Health Sci 2020; 22:243-253. [DOI: 10.1111/nhs.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/14/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Myung‐Nam Lee
- Department of NursingKangwon National University Samcheok Korea
| | | | | | - Sunghee Kim
- Red Cross College of NursingChung‐Ang University Seoul Korea
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Walshe NC, Crowley CM, OʼBrien S, Browne JP, Hegarty JM. Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-Analysis. Simul Healthc 2020; 14:398-408. [PMID: 31116171 DOI: 10.1097/sih.0000000000000376] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
STATEMENT We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.
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Affiliation(s)
- Nuala C Walshe
- From the Clinical Skills Simulation Resource Centre (N.C.W., C.M.C., SO'B), School of Nursing and Midwifery (J.M.H.); and School of Public Health (J.P.B.), University College Cork, Cork, Ireland
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Kündig P, Tschan F, Semmer NK, Morgenthaler C, Zimmermann J, Holzer E, Huber SA, Hunziker S, Marsch S. More than experience: a post-task reflection intervention among team members enhances performance in student teams confronted with a simulated resuscitation task-a prospective randomised trial. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:81-86. [PMID: 35516080 PMCID: PMC8936849 DOI: 10.1136/bmjstel-2018-000395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 11/04/2022]
Abstract
Background Teams that regularly step back from action and deliberately reflect on their performance and strategies show higher performance. Ad hoc emergency teams with changing team composition cannot develop such habits but may engage in short postaction reflection to discuss shortcomings of past performance and potential adaptations of their strategies for future similar tasks. This study aimed to test the effect of a short postaction self-led reflective team briefing on resuscitation performance in a simulator setting in terms of three performance parameters: hands-on time, coordination between chest compression and ventilation, and defibrillation. Methods We performed a randomised controlled trial including 56 ad hoc formed teams of three fourth-year medical students each. All groups performed a resuscitation task, followed by a self-guided reflective briefing, based on a general instruction (n=28 teams), or an unrelated discussion session (control condition; n=29), followed by a second resuscitation task in the same team composition. Results Adjusted for performance in the first task, teams in the reflection condition showed higher performance gain in the second resuscitation than teams in the control condition (6.21 percentage points (95% CI 1.31 to 11.10, p<0.001)) for basic hands-on performance; 15.0 percentage points (95% CI 2 to 28, p<0.001) for coordinative performance but non-significantly lower performance for defibrillation (-9%, 95% CI -27% to -9%, p=0.312). Conclusion Even very short self-led postaction reflective briefings enhance basic resuscitation performance in ad hoc groups but may not influence more complex aspects of the task. We recommend including short self-led team debriefings as part of simulator training.
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Affiliation(s)
- Patrizia Kündig
- Department of Anesthesiology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Franziska Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Camille Morgenthaler
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Eliane Holzer
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon Andreas Huber
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital of Basel, Basel, Switzerland
| | - Stephan Marsch
- Medical Intensive Care, University Hospital of Basel, Basel, Switzerland
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Madson L, Burns CM. Jumpstarting Team Cohesion with Team Activity Debriefings. MEDICAL SCIENCE EDUCATOR 2020; 30:609-615. [PMID: 34457712 PMCID: PMC8368505 DOI: 10.1007/s40670-019-00843-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although peer evaluations are essential to team-based learning, they can be problematic. Team activity debriefings (TAD) are advantageous because they focus on the team's problem-solving strategies and teamwork skills. Students (N = 100) who used both tools reported that TADs were more helpful in developing team cohesion, helping students understand the characteristics of well-functioning teams, and helping students work better as a team. Peer evaluations were more helpful in evaluating and improving their own contributions to the team. Using both tools may be the best way to foster teamwork skills and hold students accountable for making positive contributions to the team.
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Affiliation(s)
- Laura Madson
- Department of Psychology, New Mexico State University, Box 30001/MSC 3452, Las Cruces, NM 88003 USA
| | - Christopher M. Burns
- Biomedical Education Department, College of Osteopathic Medicine, California Health Sciences University, Clovis, CA 93612 USA
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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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