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Smith LE, McBride ME, Henschen B, Bierman J, Uchida T, Eppich W. Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study. Acad Med 2024:00001888-990000000-00817. [PMID: 38527027 DOI: 10.1097/acm.0000000000005715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships. METHOD The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. RESULTS Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterwards. These practices strengthened learning relationships and supported students' developmental trajectories. CONCLUSIONS Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.
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Fadous M, Chen-Tournoux AA, Eppich W. Current Use of Simulation in Canadian Cardiology Residency Programs: Painting the Landscape to Better Visualize the Future. Can J Cardiol 2024:S0828-282X(24)00199-5. [PMID: 38460613 DOI: 10.1016/j.cjca.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024] Open
Abstract
Simulation-based medical education (SBME) has been proposed as a method to expose cardiology residents to common and uncommon clinical scenarios. This approach aims to develop the core clinical competencies required for practice amidst many constraints, such as reduced training hours, limited patient encounters, and increased healthcare complexity. SBME fits particularly well in the Canadian Competency-by-Design framework, where the emphasis is on measurable competencies and achievement of milestones. This survey-based study aims to outline the current uses of SBME in Canadian cardiology residency programs, explore opportunities for SBME to enhance current approaches and identify barriers to its integration into the curriculum.
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Affiliation(s)
- Maria Fadous
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada;; Notre-Dame Hospital, Montreal, Quebec, Canada;.
| | - Annabel A Chen-Tournoux
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter Eppich
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia
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Ryan JM, Simiceva A, Eppich W, Kavanagh DO, McNamara DA. End-of-shift surgical handover: mixed-methods, multicentre evaluation and recommendations for improvement. BJS Open 2024; 8:zrae023. [PMID: 38568851 PMCID: PMC10989866 DOI: 10.1093/bjsopen/zrae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Jessica M Ryan
- RCSI SIM Centre for Simulation Education and Research, 123 St. Stephen’s Green, RCSI, Co. Dublin, Ireland
- RCSI StAR MD programme, St. Stephen’s Green, RCSI, Co. Dublin, Ireland
- Department of Surgery, The Bon Secours Hospital, Glasnevin Hill, Glasnevin, Co. Dublin, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, 123 St. Stephen’s Green, RCSI, Co. Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, 123 St. Stephen’s Green, RCSI, Co. Dublin, Ireland
- Department of Medical Education and Collaboratory Practice Centre, The University of Melbourne, Melbourne, Australia
| | - Dara O Kavanagh
- RCSI Department of Surgical Affairs, 121 St. Stephen’s Green, RCSI, Co. Dublin, Ireland
- Department of Surgery, Tallaght University Hospital, Tallaght, Co. Dublin, Ireland
| | - Deborah A McNamara
- Office of the President, RCSI, 123 St. Stephen’s Green, Co. Dublin, Ireland
- National Clinical Programme in Surgery, RCSI, 2 Proud’s Lane, Co. Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Beaumont, Co. Dublin, Ireland
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Ryan JM, McHugh F, Simiceva A, Eppich W, Kavanagh DO, McNamara DA. Daily handover in surgery: systematic review and a novel taxonomy of interventions and outcomes. BJS Open 2024; 8:zrae011. [PMID: 38426257 PMCID: PMC10905088 DOI: 10.1093/bjsopen/zrae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Poor-quality handovers lead to adverse outcomes for patients; however, there is a lack of evidence to support safe surgical handovers. This systematic review aims to summarize the interventions available to improve end-of-shift surgical handover. A novel taxonomy of interventions and outcomes and a modified quality assessment tool are also described. METHODS Ovid MEDLINE®, PubMed, Embase, and Cochrane databases were searched for articles up to April 2023. Comparative studies describing interventions for daily in-hospital surgical handovers between doctors were included. Studies were grouped according to their interventions and outcomes. RESULTS In total, 6139 citations were retrieved, and 41 studies met the inclusion criteria. The total patient sample sizes in the control and intervention groups were 11 946 and 11 563 patients, respectively. Most studies were pre-/post-intervention cohort studies (92.7%), and most (73.2%) represented level V evidence. The mean quality assessment score was 53.4% (17.1). A taxonomy of handover interventions and outcomes was developed, with interventions including handover tools, process standardization measures, staff education, and the use of mnemonics. More than 25% of studies used a document as the only intervention. Overall, 55 discrete outcomes were assessed in four categories including process (n = 27), staff (n = 14), patient (n = 12) and system-level (n = 2) outcomes. Significant improvements were seen in 51.8%, 78.5%, 58.3% (n = 9761 versus 9312 patients) and 100% of these outcomes, respectively. CONCLUSIONS Most publications demonstrate that good-quality surgical handover improves outcomes and many interventions appear to be effective; however, studies are methodologically heterogeneous. These novel taxonomies and quality assessment tool will help standardize future studies.
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Affiliation(s)
- Jessica M Ryan
- RCSI SIM Centre for Simulation Education and Research, RCSI, Dublin, Ireland
- StAR MD Programme, School of Postgraduate Studies, RCSI, Dublin, Ireland
- Department of Surgery, The Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | - Fiachra McHugh
- Department of Surgery, Mayo University Hospital, Mayo, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, RCSI, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, RCSI, Dublin, Ireland
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Deborah A McNamara
- Office of the President, RCSI, Dublin, Ireland
- National Clinical Programme in Surgery, RCSI, Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
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O'Toole M, Doyle A, Collins N, Sullivan C, Mulhall C, Condron C, Doherty E, Eppich W. 'They mirror what they see': A constructivist grounded theory study of simulation culture in four professional domains in Ireland. Med Teach 2024:1-8. [PMID: 38340311 DOI: 10.1080/0142159x.2024.2311863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine. METHODS Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships. RESULTS Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice. CONCLUSION The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.
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Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrea Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Visual and Human Computing, Dundalk Institute of Technology, Dundalk, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eva Doherty
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Doyle AJ, Sullivan C, O'Toole M, Tjin A, Simiceva A, Collins N, Murphy P, Anderson MJ, Mulhall C, Condron C, Nestel D, MacAulay R, McNaughton N, Coffey F, Eppich W. Training simulated participants for role portrayal and feedback practices in communication skills training: A BEME scoping review: BEME Guide No. 86. Med Teach 2024; 46:162-178. [PMID: 37552799 DOI: 10.1080/0142159x.2023.2241621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. METHODS The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). RESULTS From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. CONCLUSIONS The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.
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Affiliation(s)
- Andrea J Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- Department of Visual & Human Centred Computing, Dundalk Institute of Technology, Co. Louth
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin Ireland
| | - Michael J Anderson
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Debra Nestel
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
- Department of Surgery, University of Melbourne, Australia
| | - Robert MacAulay
- School of Medicine, University of California San Diego, United States of America
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Frank Coffey
- DREEAM (Department of Research and Education in Emergency and Acute medicine, Nottingham University Hospitals' NHS Trust)
- School of Health Sciences, University of Nottingham, UK
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Sullivan C, Doyle AJ, O'Toole M, Mulhall C, McNaughton N, Eppich W. 'How can we help the students learn?' A grounded theory study of simulated participants as educators. Med Teach 2023; 45:1047-1053. [PMID: 36726233 DOI: 10.1080/0142159x.2023.2171857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Despite the demonstrated value of simulated participant (SP) feedback, we are only beginning to understand how to optimize SPs' feedback practices for communication skills and strengthen their role as educators. SPs portray roles and engage in feedback practices to support simulated-based learning for communication skills training. SPs come to their role with diverse experiences, knowledge, and training, such as (a) professional actors, (b) lay people, and (c) health professions educators. This study explored what factors influenced SPs' role as educators, including their preparation, training, and approach to role portrayal and feedback practices and how these aspects were influenced by SPs' backgrounds. METHODS Using grounded theory methodology, we collected and analysed data iteratively from 16 semi-structured in-depth interviews. We identified key concepts, using constant comparison and by exploring how concepts were related , to develop a conceptual model of SPs as educators. RESULTS The SP role as educator was shaped by several interrelated dualities which spanned both the SP and learner roles and contributed to the identity formation of both SP and learner: (a) building competence (SP competence as educator and learner competence as healthcare professional), (b) engaging in reflective practice (SPs prompting learner reflection and SPs reflecting on their own role), and (c) establishing a safe space (SP needing to feel safe in their role to create safety to support learner engagement). SPs' backgrounds influenced how they learned to portray roles and how they engaged in feedback practices, both in-action, through in-role prompts and cues, and on-action, through post-scenario feedback discussions. CONCLUSION Our conceptual model about SPs as educators informs SP selection and training. Further, this model enables practical suggestions for SP educators and faculty who involve SPs in teaching. Enhanced feedback practices have the potential to improve learning from simulated encounters.
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Affiliation(s)
- Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrea Jane Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Rock LK, Morse KJ, Eppich W, Rudolph JW. Transforming Team Culture: A Case Study From Critical Care. Chest 2023; 163:1448-1457. [PMID: 36642367 DOI: 10.1016/j.chest.2022.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
Interprofessional team conflict amplifies division and impedes patient care. Normal differences of opinion escalate to frank conflicts when members respond with indignation or resentment. These behaviors engender a workplace culture that degrades collaborative clinical management and patient safety. We describe the impacts of dysfunctional team culture along with interventions that can lead to more productive teams. In our case study, an interprofessional group of critical care clinicians recognized that their interactions impaired collaborative care and requested support. Two experts, a nurse and a physician, facilitated two 2-h workshops with 18 critical care physicians, nurses, and fellows to begin transforming their dysfunctional unit culture. After establishing psychological safety, facilitators introduced the learning pathways grid to explore (1) how faulty assumptions lead to dysfunctional interactions and suboptimal results and (2) how new assumptions informed by new insights enable teams to redesign their interactions. Through reflection and analysis, clinicians concluded that understanding other clinicians' goals and perspectives benefits patients and families, helps clinicians feel valued, and fosters mutual trust. This exercise supports interprofessional teams to transform dysfunctional interactions by helping team members to develop a mindset of humility and inquiry and to remind themselves about the good intentions in others. To address conflict, we offer a conversational approach grounded in curiosity, respect, and transparency. Ultimately, the most important communication strategy for effective critical care is caring about the perspectives and experiences of other members of the interprofessional team.
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Affiliation(s)
- Laura K Rock
- Beth Israel Deaconess Medical Center, Harvard Medical School, Center for Medical Simulation, Boston, MA.
| | - Kate J Morse
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jenny W Rudolph
- Center for Medical Simulation, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Daly M, Condron C, Mulhall C, Eppich W, O'Neill J. IMPROVING DIAGNOSTIC CLINICAL SKILLS IN CARDIOLOGY: CAN HYBRID SIMULATION WITH SCRIPTED HISTORIES, WEARABLE TECHNOLOGY AND QUANTITATIVE GRADING IMPROVE LEARNING AND PERFORMANCE? - THE ASSIMILATE EXCELLENCE STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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11
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Frerejean J, van Merriënboer JJG, Condron C, Strauch U, Eppich W. Critical design choices in healthcare simulation education: a 4C/ID perspective on design that leads to transfer. Adv Simul (Lond) 2023; 8:5. [PMID: 36823641 PMCID: PMC9951482 DOI: 10.1186/s41077-023-00242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Healthcare simulation education often aims to promote transfer of learning: the application of knowledge, skills, and attitudes acquired during simulations to new situations in the workplace. Although achieving transfer is challenging, existing theories and models can provide guidance. RECOMMENDATIONS This paper provides five general recommendations to design simulations that foster transfer: (1) emphasize whole-task practice, (2) consider a cognitive task analysis, (3) embed simulations within more comprehensive programs, (4) strategically combine and align simulation formats, and (5) optimize cognitive load. We illustrate the application of these five recommendations with a blueprint for an educational program focusing on simulation activities. CONCLUSIONS More evidence-informed approaches to healthcare simulation might require a paradigm shift. We must accept that a limited number of simulations is not enough to develop complex skills. It requires comprehensive programs that combine simulation sessions with workplace learning.
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Affiliation(s)
- Jimmy Frerejean
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Jeroen J. G. van Merriënboer
- grid.5012.60000 0001 0481 6099School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Claire Condron
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ulrich Strauch
- grid.412966.e0000 0004 0480 1382Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands ,grid.412966.e0000 0004 0480 1382Department of Intensive Care, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Walter Eppich
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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12
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Tjin A, Traynor A, Doyle B, Mulhall C, Eppich W, O’Toole M. Turning to 'Trusted Others': A Narrative Review of Providing Social Support to First Responders. Int J Environ Res Public Health 2022; 19:16492. [PMID: 36554368 PMCID: PMC9778548 DOI: 10.3390/ijerph192416492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
First responders, such as paramedics and firefighters, encounter duty-related traumatic exposures, which can lead to post-traumatic stress (PTS). Although social support protects against PTS, we know little about how first responders' families, spouses/partners, friends, and care-partners (i.e., 'trusted others') provide social support. This narrative review explores support behaviors, coping strategies, and resources trusted others use to support first responders. A structured literature search yielded 24 articles. We used House's (1981) conceptual framework to inform our analysis. We identified three main themes: providing support, finding support, and support needs. Additionally, we describe trusted others' self-reported preparedness, coping strategies, and barriers to providing social support. We found that trusted others provided different types of support: (a) emotional (fostering a safe space, giving autonomy over recovery, facilitating coping mechanisms, prioritizing first responders' emotional needs); (b) instrumental (prioritizing first responders' practical needs, handling household tasks, supporting recovery); (c) appraisal (active monitoring, verbal reassurance, positive reframing), and (d) informational (seeking informal learning). In their role, trusted others sought formal (organizational) and informal (peer and personal) support and resources, alongside intrapersonal and interpersonal coping strategies. Identified barriers include inadequate communication skills, maladaptive coping, and disempowering beliefs. Thus, we offer practical, treatment, and social support recommendations.
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13
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Roze des Ordons AL, Ellaway RH, Eppich W. The many spaces of psychological safety in health professions education. Med Educ 2022; 56:1060-1063. [PMID: 35981976 DOI: 10.1111/medu.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine; Division of Palliative Medicine, Department of Oncology; Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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14
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Roze des Ordons AL, Eppich W, Lockyer J, Wilkie RD, Grant V, Cheng A. Guiding, Intermediating, Facilitating, and Teaching (GIFT): A Conceptual Framework for Simulation Educator Roles in Healthcare Debriefing. Simul Healthc 2022; 17:283-292. [PMID: 34839303 DOI: 10.1097/sih.0000000000000619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Use of frameworks for simulation debriefing represents best practice, although available frameworks provide only general guidance. Debriefers may experience difficulties implementing broad recommendations, especially in challenging debriefing situations that require more specific strategies. This study describes how debriefers approach challenges in postsimulation debriefing. METHODS Ten experienced simulation educators participated in 3 simulated debriefings. Think-aloud interviews before and after the simulations were used to explore roles that debriefers adopted and the associated strategies they used to achieve specific goals. All data were audio recorded and transcribed, and a constructivist grounded theory approach was used for analysis. RESULTS 4 roles in debriefing were identified: guiding, (inter)mediating, facilitating integration, and teaching. Each role was associated with specific goals and strategies that were adopted to achieve these goals. The goal of creating and maintaining a psychologically safe learning environment was common across all roles. These findings were conceptualized as the GIFT debriefing framework. CONCLUSIONS Our findings highlight the multiple roles debriefers play and how these roles are enacted in postsimulation debriefing. These results may inform future professional development and mentorship programs for debriefing in both simulation-based education and healthcare settings.
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Affiliation(s)
- Amanda L Roze des Ordons
- From the Division of Palliative Medicine, Departments of Critical Care Medicine, Oncology, and Anesthesiology (A.L.R.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Royal College of Surgeons of Ireland (RCSI) SIM Centre for Simulation Education and Research (W.E.), RCSI University of Medicine and Health Sciences, Dublin, Ireland; and Departments of Community Health Sciences (J.L.), Emergency Medicine (R.D.W., V.G., A.C.), and Pediatrics (V.G.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Jain PG, McBride ME, Caliendo A, Eppich W. Effects of Longitudinal Coaching on Relationships and Feedback Processes in Pediatric Subspecialty Fellowships-An Interpretive Description Study. J Grad Med Educ 2022; 14:458-465. [PMID: 35991102 PMCID: PMC9380628 DOI: 10.4300/jgme-d-21-00936.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Coaching in graduate medical education provides a facilitative approach to feedback as well as opportunities for residents and fellows to engage with feedback and develop individualized improvement goals. OBJECTIVE To explore the roles and actions of successful coaches in longitudinal coaching relationships and how they enable feedback processes. METHODS Using interpretive description methodology, we performed semi-structured interviews with pediatrics fellows (n=11), faculty coaches (n=9), and program directors (n=2) from 2 pediatric subspecialty fellowship training programs at Ann and Robert H. Lurie Children's Hospital of Chicago. Both training programs had previously implemented longitudinal clinical coaching programs. Interview questions aimed to explore the roles and impacts of coaches within a longitudinal coaching program. Interviews took place in 2019 and 2020. RESULTS We identified 4 major actions to the coaching role in longitudinal coaching relationships: (1) establish the coach-fellow relationship; (2) prepare for the coaching conversation; (3) facilitate feedback dialogue; and (4) serve as the go-to person to raise uncomfortable issues. Additionally, nearly all participants expressed support for a longitudinal coaching program to support fellows' growth and development of personalized learning goals. CONCLUSIONS By fulfilling these 4 key aspects to the coaching role, coaches in longitudinal relationships with coachees enable feedback processes.
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Affiliation(s)
- Priya G. Jain
- Priya G. Jain, MD, MEd, is Assistant Professor, Department of Pediatrics and Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine
| | - Mary E. McBride
- Mary E. McBride, MD, MEd, is Associate Professor, Departments of Pediatrics and Medical Education, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine
| | - Anne Caliendo
- Anne Caliendo, MSEd, is a Researcher, Scientific Careers Research and Development Group, Northwestern University Feinberg School of Medicine
| | - Walter Eppich
- Walter Eppich, MD, PhD, is a Professor, RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Science, Dublin, Ireland
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16
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Affiliation(s)
- Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, Waterloo Bridge Wing G7, London, UK
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17
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O'Toole M, Eppich W. In support of appropriate psychological debriefing. Med Educ 2022; 56:229. [PMID: 34541708 DOI: 10.1111/medu.14588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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18
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O'Toole M, Mulhall C, Eppich W. Breaking down barriers to help-seeking: preparing first responders' families for psychological first aid. Eur J Psychotraumatol 2022; 13:2065430. [PMID: 35572389 PMCID: PMC9103391 DOI: 10.1080/20008198.2022.2065430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND First responders regularly encounter both operational stressors and potentially traumatic events, increasing their risk of mental health issues (Declercq et al., 2011). Due to unique cultural complexities, they turn mostly to peers for early psychosocial support (Isaac & Buchanan, 2021). However, peer support and/or mental health assistance may not always be available or easy to access and first responders' mental health suffers. OBJECTIVE We need more accessible routes to crisis intervention to ensure first responder resilience and wellbeing, so they may continue to function in the service of public safety. Family members and close friends may be ideally placed to provide this immediate care. This article outlines the protective role of social support as an early intervention strategy to mitigate the effects of first responder trauma, exploring the potential opportunity for family members and friends to play an increasingly supportive role in their loved one's wellbeing. This paper serves as a call to action for practical educational interventions that will prepare family members for these critical conversations. CONCLUSION We see potential in combining early intervention theory, psychoeducation, and a strengths-based gender specific positive psychology approach. Further study should investigate how best to help first responders break down barriers to support, by bolstering their existing social supports and ultimately reducing the stigma associated with experiencing traumatic stress. HIGHLIGHTS By training family members in psychological first aid, we may strengthen existing social support for first responders, providing more options for, and potentially breaking down stigma associated with help-seeking.
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Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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19
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Sullivan C, Condron C, Mulhall C, Almulla M, Kelly M, O'Leary D, Eppich W. Preparing for Pediatrics: Experiential Learning Helps Medical Students Prepare for Their Clinical Placement. Front Pediatr 2022; 10:834825. [PMID: 35311060 PMCID: PMC8931532 DOI: 10.3389/fped.2022.834825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the importance of effective communication skills in pediatrics, clinical placements may inadequately prepare undergraduate students to communicate with children. The integration of non-clinical interactions with healthy children within a pediatric curriculum has the potential to enhance learning. We designed and implemented a novel course involving experiential learning, including video-recorded consultations with simulated parents (SPs), team-based scenarios with a pediatric mannequin, interactions with healthy children through a pre-school visit and medical student led health workshops for primary school children. Medical students at the RCSI University of Medicine and Health Sciences took part in the course. We used a mixed methods approach to assess the impact of the course. We investigated medical students' perspectives through a pre- and post-intervention questionnaire and post-intervention focus group discussions (FGDs). We assessed participating children's health literacy at the start of the course. 144/279 (51.6%) of the fourth year medical student cohort on their pediatric rotation, consented to participate in the study. All 144 (100%) of consenting students completed the pre-intervention questionnaire. 59/144 (40.1%) of consenting students completed the post-intervention questionnaire. Results showed a statistically significant improvement in ratings (p < 0.05) for items related to managing a confrontational situation involving family members, completing a psychosocial assessment with an adolescent and effectiveness using evidence-based medicine (EBM) when motivating patients. There was a statistically significant decrease in how students rated their comfort at using EBM when motivating patients. Four themes relating to how students experienced the intervention were identified from eight FGDs (n = 35 students): Shaping Student Learning; Supporting Student Learning; Developing New Skills and Feeling More Prepared. 39/49 (79.6%) children completed a health literacy assessment. All questions had a high percentage of positive responses. Question 7, understanding your doctor, had the highest proportion of negative responses (27%). Ours is one of the first studies to design an educational intervention to enhance pediatrics teaching by combining interactions with healthy children outside of a clinical setting with more traditional simulation-based approaches. We conclude that this type of intervention supports students' learning of pediatric communication skills and enhances students' perceived preparation for clinical placement.
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Affiliation(s)
- Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mohammad Almulla
- RCSI School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maria Kelly
- REACH RCSI, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daire O'Leary
- Department of Pediatrics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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20
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Roze des Ordons AL, Cheng A, Lockyer J, Wilkie RD, Grant V, Eppich W. Approaches to interpersonal conflict in simulation debriefings: A qualitative study. Med Educ 2021; 55:1284-1296. [PMID: 34291487 DOI: 10.1111/medu.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Conflict during simulation debriefing can interfere with learning when psychological safety is threatened. Debriefers often feel unprepared to address conflict between learners and the literature does not provide evidence-based guidance within the simulation setting. The purpose of this study was to describe debriefers' approach to mediating interpersonal conflict and explore when, why and how they adopt mediation strategies. METHODS We performed a secondary analysis of qualitative data collected as part of a larger study examining simulation debriefers' approaches to debriefing scenarios with different learner characteristics. For this study, we applied thematic analysis to transcripts from simulated debriefings (n = 10) and the associated pre-simulation (n = 11) and post-simulation (n = 10) interviews that focused on interpersonal conflict between learners. RESULTS Debriefers described struggling with mediating conflict and the importance of self-awareness. Specific mediation strategies included intervening, addressing power relations, reconciling unproductive differences, leveraging different perspectives, circumventing the conflict, and shifting beyond the conflict; each of these strategies encompassed a number of particular skills. Situations that triggered a mediation approach were related to psychological safety, emotional intensity, and opportunities for shared understanding and productive learning. Debriefers applied mediation strategies and skills in a flexible and creative way. CONCLUSIONS The strategies we have described for mediating interpersonal conflict between learners in simulation debriefing align with notions of psychological safety and may be useful in guiding future professional development for simulation educators.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adam Cheng
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jocelyn Lockyer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ryan D Wilkie
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vincent Grant
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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21
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Cheng A, Eppich W, Epps C, Kolbe M, Meguerdichian M, Grant V. Embracing informed learner self-assessment during debriefing: the art of plus-delta. Adv Simul (Lond) 2021; 6:22. [PMID: 34090514 PMCID: PMC8180042 DOI: 10.1186/s41077-021-00173-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
The healthcare simulation field has no shortage of debriefing options. Some demand considerable skill which serves as a barrier to more widespread implementation. The plus-delta approach to debriefing offers the advantages of conceptual simplicity and ease of implementation. Importantly, plus-delta promotes learners' capacity for a self-assessment, a skill vital for safe clinical practice and yet a notorious deficiency in professional practice. The plus-delta approach confers the benefits of promoting uptake of debriefing in time-limited settings by educators with both fundamental but also advanced skills, and enhancing essential capacity for critical self-assessment informed by objective performance feedback. In this paper, we describe the role of plus-delta in debriefing, provide guidance for incorporating informed learner self-assessment into debriefings, and highlight four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.
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Affiliation(s)
- A. Cheng
- KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8 Canada
| | - W. Eppich
- RSCI SIM Centre for Simulation Education and Research RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C. Epps
- Departments of Anesthesiology and Interprofessional Education, University of Tennessee Health Science Center, Memphis, USA
| | - M. Kolbe
- Simulation Center, UniversitatsSpital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - M. Meguerdichian
- Department of Emergency Medicine, NYC Health + Hospitals/Harlem, NYC Health + Hospitals/Simulation Center, Columbia University, New York, USA
| | - V. Grant
- KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8 Canada
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22
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Coggins A, Zaklama R, Szabo RA, Diaz-Navarro C, Scalese RJ, Krogh K, Eppich W. Twelve tips for facilitating and implementing clinical debriefing programmes. Med Teach 2021; 43:509-517. [PMID: 33032476 DOI: 10.1080/0142159x.2020.1817349] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.
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Affiliation(s)
- Andrew Coggins
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ramez Zaklama
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca A Szabo
- Department of Obstetrics and Gynaecology and Department of Medical Education, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Cristina Diaz-Navarro
- Department of Perioperative Care, Cardiff and Vale University Health Board, Cardiff, UK
| | - Ross J Scalese
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristian Krogh
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Walter Eppich
- Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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23
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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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Cheng A, Kolbe M, Grant V, Eller S, Hales R, Symon B, Griswold S, Eppich W. A practical guide to virtual debriefings: communities of inquiry perspective. Adv Simul (Lond) 2020; 5:18. [PMID: 32817805 PMCID: PMC7422458 DOI: 10.1186/s41077-020-00141-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022] Open
Abstract
Many simulation programs have recently shifted towards providing remote simulations with virtual debriefings. Virtual debriefings involve educators facilitating conversations through web-based videoconferencing platforms. Facilitating debriefings through a computer interface introduces a unique set of challenges. Educators require practical guidance to support meaningful virtual learning in the transition from in-person to virtual debriefings. The communities of inquiry conceptual framework offer a useful structure to organize practical guidance for conducting virtual debriefings. The communities of inquiry framework describe the three key elements-social presence, teaching presence, and cognitive presence-all of which contribute to the overall learning experience. In this paper, we (1) define the CoI framework and describe its three core elements, (2) highlight how virtual debriefings align with CoI, (3) anticipate barriers to effective virtual debriefings, and (4) share practical strategies to overcome these hurdles.
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Affiliation(s)
- Adam Cheng
- KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Canada
| | - Michaela Kolbe
- Simulation Center, UniversitatsSpital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Vincent Grant
- KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Canada
| | - Susan Eller
- Center for Immersive And Simulation-based Learning, Stanford University, Stanford, USA
| | - Roberta Hales
- Center for Simulation, Advanced Education and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Benjamin Symon
- Simulation Training Optimising Resuscitation for Kids (STORK), Queensland Children’s Hospital, School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Sharon Griswold
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, M.C. H043, P.O. Box 850, Hershey, PA USA
| | - Walter Eppich
- Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
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Tavares W, Eppich W, Cheng A, Miller S, Teunissen PW, Watling CJ, Sargeant J. Learning Conversations: An Analysis of the Theoretical Roots and Their Manifestations of Feedback and Debriefing in Medical Education. Acad Med 2020; 95:1020-1025. [PMID: 31365391 DOI: 10.1097/acm.0000000000002932] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Feedback and debriefing are experience-informed dialogues upon which experiential models of learning often depend. Efforts to understand each have largely been independent of each other, thus splitting them into potentially problematic and less productive factions. Given their shared purpose of improving future performance, the authors asked whether efforts to understand these dialogues are, for theoretical and pragmatic reasons, best advanced by keeping these concepts unique or whether some unifying conceptual framework could better support educational contributions and advancements in medical education.The authors identified seminal works and foundational concepts to formulate a purposeful review and analysis exploring these dialogues' theoretical roots and their manifestations. They considered conceptual and theoretical details within and across feedback and debriefing literatures and traced developmental paths to discover underlying and foundational conceptual approaches and theoretical similarities and differences.Findings suggest that each of these strategies was derived from distinct theoretical roots, leading to variations in how they have been studied, advanced, and enacted; both now draw on multiple (often similar) educational theories, also positioning themselves as ways of operationalizing similar educational frameworks. Considerable commonality now exists; those studying and advancing feedback and debriefing are leveraging similar cognitive and social theories to refine and structure their approaches. As such, there may be room to merge these educational strategies as learning conversations because of their conceptual and theoretical consistency. Future scholarly work should further delineate the theoretical, educational, and practical relevance of integrating feedback and debriefing.
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Affiliation(s)
- Walter Tavares
- W. Tavares is assistant professor and scientist at both The Wilson Centre and the Post-MD Education Office, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and scientist, Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario, Canada; ORCID: http://orcid.org/0000-0001-8267-9448. W. Eppich is associate professor of pediatrics-emergency medicine and medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. A. Cheng is associate professor of pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. S. Miller is associate professor of emergency medicine and medical education, Department of Emergency Medicine, and assistant dean, undergraduate medical education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. P.W. Teunissen is professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands, and maternal fetal medicine specialist, VU University Medical Center, Amsterdam, the Netherlands. C.J. Watling is professor, Departments of Clinical Neurological Sciences and Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. J. Sargeant is professor, Continuing Professional Development Program and Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e82-e122. [PMID: 29930020 DOI: 10.1161/cir.0000000000000583] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
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Kolbe M, Eppich W, Rudolph J, Meguerdichian M, Catena H, Cripps A, Grant V, Cheng A. Managing psychological safety in debriefings: a dynamic balancing act. BMJ STEL 2019; 6:164-171. [DOI: 10.1136/bmjstel-2019-000470] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety—the perception that it is safe to take interpersonal risks and that one will not be embarrassed, rejected or otherwise punished for speaking their mind, not knowing or asking questions. The role of introductions, learning contracts and prebriefing in establishing psychological safety is well described in the literature. How to maintain psychological safety, while also being able to identify and restore psychological safety during debriefings, is less well understood. This review has several aims. First, we provide a detailed definition of psychological safety and justify its importance for debriefings. Second, we recommend specific strategies debriefers can use throughout the debriefing to build and maintain psychological safety. We base these recommendations on a literature review and on our own experiences as simulation educators. Third, we examine how debriefers might actively address perceived breaches to restore psychological safety. Re-establishing psychological safety after temporary threats or breaches can seem particularly daunting. To demystify this process, we invoke the metaphor of a ‘safe container’ for learning; a space where learners can feel secure enough to work at the edge of expertise without threat of humiliation. We conclude with a discussion of limitations and implications, particularly with respect to faculty development.
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Abstract
BACKGROUND Simulation-based education (SBE) has emerged as an essential modality for health professions education. One of the central tenants of effective SBE is reflective practice, typically guided by a facilitated debriefing. The debriefing conversation has the possibility of becoming a difficult conversation based on learner and situation-related factors. Difficult debriefing situations may threaten the learning environment, thus requiring an appreciation and understanding of the various ways that learners may react adversely to simulation and debriefing. AIM This article provides a review of the various phenotypes of difficult debriefing situations and a toolbox of proactive and reactive strategies to help guide the simulation educator to manage these situations, with the ultimate goal of achieving learning objectives.
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Affiliation(s)
- V J Grant
- a Department of Pediatrics and Emergency Medicine, Cumming School of Medicine , University of Calgary , Calgary , Canada
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
| | - T Robinson
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
| | - H Catena
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
| | - W Eppich
- c Departments of Pediatrics and Medical Education , Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - A Cheng
- a Department of Pediatrics and Emergency Medicine, Cumming School of Medicine , University of Calgary , Calgary , Canada
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
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Affiliation(s)
- Komal Bajaj
- New York City Health + Hospitals NYC Health + Hospitals University of Saskatchewan College of Medicine University of Saskatchewan College of Medicine Ann & Robert H. Lurie Children's Hospital of Chicago; and Alberta Children's Hospital, University of Calgary
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Eppich W, Rethans JJ, Teunissen PW, Dornan T. Learning to Work Together Through Talk: Continuing Professional Development in Medicine. Professional and Practice-based Learning 2016. [DOI: 10.1007/978-3-319-29019-5_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Mangold KA, Jeffers JM, Burns RA, Trainor JL, Unti SM, Eppich W, Adler MD. An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents. J Grad Med Educ 2015; 7:470-4. [PMID: 26457159 PMCID: PMC4597964 DOI: 10.4300/jgme-d-14-00777.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residency programs are developing new methods to assess resident competence and to improve the quality of formative assessment and feedback to trainees. Simulation is a valuable tool for giving formative feedback to residents. OBJECTIVE To develop an objective structured clinical examination (OSCE) to improve formative assessment of senior pediatrics residents. METHODS We developed a multistation examination using various simulation formats to assess the skills of senior pediatrics residents in communication and acute resuscitation. We measured several logistical factors (staffing and program costs) to determine the feasibility of such a program. RESULTS Thirty-one residents participated in the assessment program over a 3-month period. Residents received formative feedback comparing their performance to both a standard task checklist and to peers' performance. The program required 16 faculty members per session, and had a cost of $624 per resident. CONCLUSIONS A concentrated assessment program using simulation can be a valuable tool to assess residents' skills in communication and acute resuscitation and provide directed formative feedback. However, such a program requires considerable financial and staffing resources.
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Affiliation(s)
- Karen A. Mangold
- Corresponding author: Karen A. Mangold, MD, MEd, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 62, Chicago, IL 60611, 312.227.6080, fax 312.227.9475,
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Sandhu N, Eppich W, Mikrogianakis A, Grant V, Robinson T, Cheng A. Postresuscitation debriefing in the pediatric emergency department: a national needs assessment. CAN J EMERG MED 2015. [DOI: 10.2310/8000.2013.131136] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACTObjectives:The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement.Methods:A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported.Results:Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment.Conclusion:PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.
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Eppich W, Cheng A. Competency-based simulation education: should competency standards apply for simulation educators? BMJ STEL 2015; 1:3-4. [DOI: 10.1136/bmjstel-2014-000013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/23/2014] [Indexed: 11/04/2022]
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Eppich W, Nannicelli AP, Seivert NP, Sohn MW, Rozenfeld R, Woods DM, Holl JL. A rater training protocol to assess team performance. J Contin Educ Health Prof 2015; 35:83-90. [PMID: 26115107 DOI: 10.1002/chp.21270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Simulation-based methodologies are increasingly used to assess teamwork and communication skills and provide team training. Formative feedback regarding team performance is an essential component. While effective use of simulation for assessment or training requires accurate rating of team performance, examples of rater-training programs in health care are scarce. We describe our rater training program and report interrater reliability during phases of training and independent rating. METHODS We selected an assessment tool shown to yield valid and reliable results and developed a rater training protocol with an accompanying rater training handbook. The rater training program was modeled after previously described high-stakes assessments in the setting of 3 facilitated training sessions. Adjacent agreement was used to measure interrater reliability between raters. RESULTS Nine raters with a background in health care and/or patient safety evaluated team performance of 42 in-situ simulations using post-hoc video review. Adjacent agreement increased from the second training session (83.6%) to the third training session (85.6%) when evaluating the same video segments. Adjacent agreement for the rating of overall team performance was 78.3%, which was added for the third training session. Adjacent agreement was 97% 4 weeks posttraining and 90.6% at the end of independent rating of all simulation videos. DISCUSSION Rater training is an important element in team performance assessment, and providing examples of rater training programs is essential. Articulating key rating anchors promotes adequate interrater reliability. In addition, using adjacent agreement as a measure allows differentiation between high- and low-performing teams on video review.
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Sandhu N, Eppich W, Mikrogianakis A, Grant V, Robinson T, Cheng A. Postresuscitation debriefing in the pediatric emergency department: a national needs assessment. CAN J EMERG MED 2014; 16:383-392. [PMID: 25227647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. METHODS A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported. RESULTS Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. CONCLUSION PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.
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Cheng A, Eppich W, Grant V, Sherbino J, Zendejas B, Cook DA. Debriefing for technology-enhanced simulation: a systematic review and meta-analysis. Med Educ 2014; 48:657-666. [PMID: 24909527 DOI: 10.1111/medu.12432] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Debriefing is a common feature of technology-enhanced simulation (TES) education. However, evidence for its effectiveness remains unclear. We sought to characterise how debriefing is reported in the TES literature, identify debriefing features that are associated with improved outcomes, and evaluate the effectiveness of debriefing when combined with TES. METHODS We systematically searched databases, including MEDLINE, EMBASE and Scopus, and reviewed previous bibliographies for original comparative studies investigating the use of TES with debriefing in training health care providers. Reviewers, in duplicate, evaluated study quality and abstracted information on instructional design, debriefing and outcomes. Effect sizes (ES) were pooled using random-effects meta-analysis. RESULTS From 10 903 potentially eligible studies, we identified 177 studies (11 511 learners) that employed debriefing as part of TES. Key characteristics of debriefing (e.g. duration, educator presence and characteristics, content, structure/method, timing, use of video) were usually incompletely reported. A meta-analysis of four studies demonstrated that video-assisted debriefing has negligible and non-significant effects for time skills (ES = 0.10) compared with non-video-assisted debriefing. Meta-analysis demonstrated non-significant effects in favour of expert modelling with short debriefing in comparison with long debriefing (ES range = 0.21-0.74). Among studies comparing terminal with concurrent debriefing, results were variable depending on outcome measures and the context of training (e.g. medical resuscitation versus technical skills). Eight additional studies revealed insight into the roles of other debriefing-related factors (e.g. multimedia debriefing, learner-led debriefing, debriefing duration, content of debriefing). Among studies that compared simulation plus debriefing with no intervention, pooled ESs were favourable for all outcomes (ES range = 0.28-2.16). CONCLUSIONS Limited evidence suggests that video-assisted debriefing yields outcomes similar to those of non-video-assisted debriefing. Other debriefing design features show mixed or non-significant results. As debriefing characteristics are usually incompletely reported, future debriefing research should describe all the key debriefing characteristics along with their associated descriptors.
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Affiliation(s)
- Adam Cheng
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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Cheng A, Hunt EA, Donoghue A, Nelson-McMillan K, Nishisaki A, Leflore J, Eppich W, Moyer M, Brett-Fleegler M, Kleinman M, Anderson J, Adler M, Braga M, Kost S, Stryjewski G, Min S, Podraza J, Lopreiato J, Hamilton MF, Stone K, Reid J, Hopkins J, Manos J, Duff J, Richard M, Nadkarni VM. Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr 2013; 167:528-36. [PMID: 23608924 DOI: 10.1001/jamapediatrics.2013.1389] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. OBJECTIVE To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. DESIGN Prospective, randomized, factorial study design. SETTING The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. PARTICIPANTS We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. INTERVENTION Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. MAIN OUTCOMES AND MEASURES Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). RESULTS There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. CONCLUSIONS AND RELEVANCE The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.
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Riddell A, Eppich W. Should tympanic temperature measurement be trusted? Arch Dis Child 2001; 85:433-4. [PMID: 12035818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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