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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Rueda-Medina B, Reina-Cabello JC, Buendía-Castro M, Aguilar-Ferrándiz ME, Gil-Gutiérrez R, Tapia-Haro RM, Casas-Barragán A, Correa-Rodríguez M. Effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health professions education: A randomized trial. Nurse Educ Pract 2024; 75:103901. [PMID: 38277804 DOI: 10.1016/j.nepr.2024.103901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
AIM We aimed to compare the debriefing experience, simulation assessment, reflection, anxiety and simulation satisfaction of using oral debriefing versus video-assisted debriefing after a simulated clinical session in an interdisciplinary cohort of health sciences students. BACKGROUND Debriefing is a reflective process that takes place after a clinical simulation and that can be performed either in a traditional way (oral) or using video-assisted debriefing. DESIGN A randomized controlled trial was conducted in 143 health sciences students (35.7% male, 61.5% female). METHODS The simulation scenario was designed to evaluate the procedure for donning and doffing personal protective equipment. Differences in debriefing experience, simulation assessment, reflection, anxiety and satisfaction were assessed. RESULTS Regarding debriefing experience, significant differences were observed for the category "learning" (34.9 (6.13) vs. 36.7 (3.89); p = 0.039). For simulation assessment, significantly higher scores for all categories were identified in video-assisted debriefing compared with oral debriefing (p<0.001). There were also significant differences between the oral debriefing versus video-assisted debriefing for the overall score of reflection ability (86.97 (10.55) vs. 90.74 (9.67); p=0.028) as well as for the category "reflective communication" (24.72 (3.77) vs 26.04 (4.07); p=0.047). Perceived satisfaction was significantly higher in the video-assisted debriefing group compared with oral debriefing group (p <0.001). For anxiety, no significant differences were observed between debriefing groups. CONCLUSION Video-assisted debriefing after a simulated clinical session improves debriefing experience, simulation assessment, reflection and simulation satisfaction, but does not increase anxiety compared with oral debriefing among health sciences students.
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Affiliation(s)
- Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada 18016, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - José Carlos Reina-Cabello
- Functional Area of Health and Social Policy, Subdelegation of the Government of Almería, Almería, Spain
| | - Miriam Buendía-Castro
- Department of Translation and Interpreting, Faculty of Translation and Interpreting, University of Granada, Granada 18003, Spain
| | - María Encarnación Aguilar-Ferrándiz
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada 18016, Spain
| | - Rocío Gil-Gutiérrez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada 18016, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain; Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18016, Spain.
| | - Rosa María Tapia-Haro
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada 18016, Spain
| | - Antonio Casas-Barragán
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada 18016, Spain
| | - María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada 18016, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
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Duff JP, Morse KJ, Seelandt J, Gross IT, Lydston M, Sargeant J, Dieckmann P, Allen JA, Rudolph JW, Kolbe M. Debriefing Methods for Simulation in Healthcare: A Systematic Review. Simul Healthc 2024; 19:S112-S121. [PMID: 38240623 DOI: 10.1097/sih.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Debriefing is a critical component in most simulation experiences. With the growing number of debriefing concepts, approaches, and tools, we need to understand how to debrief most effectively because there is little empiric evidence to guide us in their use. This systematic review explores the current literature on debriefing in healthcare simulation education to understand the evidence behind practice and clarify gaps in the literature. The PICO question for this review was defined as "In healthcare providers [P], does the use of one debriefing or feedback intervention [I], compared to a different debriefing or feedback intervention [C], improve educational and clinical outcomes [O] in simulation-based education?" We included 70 studies in our final review and found that our current debriefing strategies, frameworks, and techniques are not based on robust empirical evidence. Based on this, we highlight future research needs.
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Affiliation(s)
- Jonathan P Duff
- From the Department of Pediatrics (J.P.D.), University of Alberta. Edmonton, Canada; College of Nursing and Health Professions (K.J.M.), Drexel University, Philadelphia, PA; Simulation Centre (J.S., M.K.), University Hospital, Zurich, Switzerland; Department of Pediatrics, Section of Emergency Medicine (I.T.G.), Yale University School of Medicine, New Haven, CT; Treadwell Virtual Library (M.L.), Massachusetts General Hospital, Boston, MA; Faculty of Medicine (J.S.), Dalhousie University, Halifax, Canada; Copenhagen Academy for Medical Education and Simulation (CAMES) (P.D.), Herlev, Denmark; Department of Quality and Health Technology (P.D.), University of Stavanger, Stavanger, Norway; Department of Public Health (P.D.), University of Copenhagen, Denmark; Department of Family and Preventive Medicine (J.A.A.), University of Utah, Salt Lake City, UT; Center for Medical Simulation (J.W.R.), Boston, MA; and ETH Zurich (M.K.), Zurich, Switzerland
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Teles D, Silva M, Berger-Estilita J, Pereira H. Practice of debriefing of critical events: a survey-based cross-sectional study of Portuguese anesthesiologists. Porto Biomed J 2023; 8:215. [PMID: 37362021 PMCID: PMC10289546 DOI: 10.1097/j.pbj.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
Debriefing is an essential procedure for identifying medical errors, improving communication, reviewing team performance, and providing emotional support after a critical event. This study aimed to describe the current practice and limitations of debriefing and gauge opinions on the best timing, effectiveness, need for training, use of established format, and expected goals of debriefing among Portuguese anesthesiologists. Methods We performed a national cross-sectional online survey exploring the practice of anesthesiologists' debriefing practice after critical events in Portuguese hospitals. The questionnaire was distributed using a snowball sampling technique from July to September 2021. Data were descriptively and comparatively analyzed. Results We had replies from 186 anesthesiologists (11.3% of the Portuguese pool). Acute respiratory event was the most reported type of critical event (96%). Debriefing occurred rarely or never in 53% of cases, 59% of respondents needed more training in debriefing, and only 4% reported having specific tools in their institutions to carry it out. There was no statistical association between having a debriefing protocol and the occurrence of critical events (P=.474) or having trained personnel (P=.95). The existence of protocols was associated with lower frequencies of debriefing (P=.017). Conclusions Portuguese anesthesiologists know that debriefing is an essential process that increases patient safety, but among those surveyed, there is a need for an adequate debriefing culture or practice. Trial registration Research registry 7741 (https://www.researchregistry.com/browse-the-registry#home).
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Affiliation(s)
- Daniel Teles
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
| | - Mariana Silva
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
| | - Joana Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland
- CINTESIS—Centre for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
| | - Helder Pereira
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings. BMJ Qual Saf 2023; 32:160-172. [PMID: 35902231 DOI: 10.1136/bmjqs-2021-014393] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings. METHODS In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection. RESULTS The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. CONCLUSION When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland .,ETH Zürich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland.,Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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Paquay M, Dubois N, Diep AN, Graas G, Sassel T, Piazza J, Servotte JC, Ghuysen A. “Debriefing and Organizational Lessons Learned” (DOLL): A Qualitative Study to Develop a Classification Framework for Reporting Clinical Debriefing Results. Front Med (Lausanne) 2022; 9:882326. [PMID: 35814768 PMCID: PMC9263566 DOI: 10.3389/fmed.2022.882326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe COVID-19 crisis has radically affected our healthcare institutions. Debriefings in clinical settings provide a time for the clinicians to reflect on the successes (pluses) and difficulties (deltas) encountered. Debriefings tend to be well-received if included in the broader management of the unit. The goal of this study was to develop a framework to categorize these debriefings and to assess its worthiness.MethodsA qualitative approach based on a grounded theory research method was adopted resulting in the “Debriefing and Organizational Lessons Learned” (DOLL) framework. Debriefings were conducted within two Emergency Departments of a Belgian University Hospital during an 8-week period. In the first step, three researchers used debriefing transcripts to inductively develop a tentative framework. During the second step, these three researchers conducted independent categorizations of the debriefings using the developed framework. In step 3, the team analyzed the data to understand the utility of the framework. Chi-square was conducted to examine the associations between the item types (pluses and deltas) and the framework's dimensions.ResultsThe DOLL is composed of seven dimensions and 13 subdimensions. Applied to 163 debriefings, the model identified 339 items, including 97 pluses and 242 deltas. Results revealed that there was an association between the frequency of pluses and deltas and the dimensions (p < 0.001). The deltas were mainly related to the work environment (equipment and maintenance) (p < 0.001) while the pluses identified tended to be related to the organization of the unit (communication and roles) (p < 0.001). With leadership's support and subsequent actions, clinicians were more enthusiastic about participating and the researchers anecdotally detected a switch toward a more positive organizational learning approach.ConclusionThe framework increases the potential value of clinical debriefings because it organizes results into actionable areas. Indeed, leadership found the DOLL to be a useful management tool. Further research is needed to investigate how DOLL may work in non-crisis circumstances and further apply the DOLL into incident reporting and risk management process of the unit.
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Affiliation(s)
- Méryl Paquay
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
- *Correspondence: Méryl Paquay
| | - Nadège Dubois
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Anh Nguyet Diep
- Biostatistics Unit, Quartier Hôpital, University of Liège, Liège, Belgium
| | - Gwennaëlle Graas
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Tamara Sassel
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Justine Piazza
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | | | - Alexandre Ghuysen
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
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James S, Subedi P, Indrasena BSH, Aylott J. Review DebrIeF: a collaborative distributed leadership approach to "hot debrief" after cardiac arrest in the emergency department - a quality improvement project. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35274508 DOI: 10.1108/lhs-06-2021-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to re-conceptualise the hot debrief process after cardiac arrest as a collaborative and distributed process across the multi-disciplinary team. There are multiple benefits to hot debriefs but there are also barriers to its implementation. Facilitating the hot debrief discussion usually falls within the remit of the physician; however, the American Heart Association suggests "a facilitator, typically a health-care professional, leads a discussion focused on identifying ways to improve performance". Empowering nurses through a distributed leadership approach supports the wider health-care team involvement and facilitation of the hot debrief process, while reducing the cognitive burden of the lead physician. DESIGN/METHODOLOGY/APPROACH A mixed-method approach was taken to evaluate the experiences of staff in the Emergency Department (ED) to identify their experiences of hot debrief after cardiac arrest. There had been some staff dissatisfaction with the process with reports of negative experiences of unresolved issues after cardiac arrest. An audit identified zero hot debriefs occurring in 2019. A quality Improvement project (Model for Healthcare Improvement) used four plan do study act cycles from March 2020 to September 2021, using two questionnaires and semi-structured interviews to engage the team in the design and implementation of a hot debrief tool, using a distributed leadership approach. FINDINGS The first survey (n = 78) provided a consensus to develop a hot debrief in the ED (84% in the ED; 85% in intensive care unit (ICU); and 92% from Acute Medicine). Three months after implementation of the hot debrief tool, 5 out of 12 cardiac arrests had a hot debrief, an increase of 42% in hot debriefs from a baseline of 0%. The hot debrief started to become embedded in the ED; however, six months on, there were still inconsistencies with implementation and barriers remained. Findings from the second survey (n = 58) suggest that doctors may not be convinced of the benefits of the hot debrief process, particularly its benefits to improve team performance and nurses appear more invested in hot debriefs when compared to doctors. RESEARCH LIMITATIONS/IMPLICATIONS There are existing hot debrief tools; for example, STOP 5 and Take STOCK; however, creating a specific tool with QI methods, tailored to the specific ED context, is likely to produce higher levels of multi-disciplinary team engagement and result in distributed roles and responsibilities. Change is accepted when people are involved in the decisions that affect them and when they have the opportunity to influence that change. This approach is more likely to be achieved through distributed leadership rather than from more traditional top-down hierarchical leadership approaches. ORIGINALITY/VALUE To the best of the authors' knowledge, this study is the first of its kind to integrate Royal College Quality Improvement requirements with a collaborative and distributed medical leadership approach, to steer a change project in the implementation of a hot debrief in the ED. EDs need to create a continuous quality improvement culture to support this integration of leadership and QI methods combined, to drive and sustain successful change in distributed leadership to support the implementation of clinical protocols across the multi-disciplinary team in the ED.
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Affiliation(s)
- Shobha James
- Department of Emergency Medicine, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
| | - Prakash Subedi
- Emergency Department, Doncaster Royal Infirmary, Doncaster, UK and QiMET International, Sheffield, UK
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and QiMET International, Sheffield, UK
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