The impact of a high fidelity simulation-based debriefing course on the Debriefing Assessment for Simulation in Healthcare (DASH)© score of novice instructors

Impact of simulation debriefing structure on knowledge and skill acquisition for postgraduate critical care nursing students: three-phase vs. multiphase

BACKGROUND

Simulation is part of the training provided to nurses enrolled in the master's degree for critical care nursing programmes at our institution. Although the students are practicing nurses, many still make mistakes when performing nursing procedures related to critical care during simulation sessions, and these mistakes must be addressed during the debriefing session. The aim of the study is to compare the knowledge and skills acquired by groups of postgraduate critical care nursing students who were exposed to high-fidelity simulation (HFS) by using different debriefing structures.

METHODS

A quasi-experimental crossover design was utilised during the post-tests and objective structured clinical examinations (OSCEs). The students were divided into two groups: one was exposed to HFS with a 3-phase debriefing, and the other was exposed to HFS with a multiphase debriefing. Both groups involved facilitator-guided and video-assisted debriefings.

RESULTS

Overall, the post-test scores (p-value: Phase 1 = 0.001 and Phase 2 = 0.000) and post-OSCE scores (p-value: Phase 1 = 0.002 and Phase 2 = 0.002) support that the group of postgraduate students who underwent HFS with a multiphase debriefing structure gained significantly higher scores compared to the group who underwent HFS with a 3-phase debriefing structure.

CONCLUSION

Debriefing is a critical component of successful simulation. Learning requires assessment that creates constructive criticism based on feedback and reflection. A multiphase debriefing structure, specifically the healthcare simulation after-action review, provides a significant advantage for knowledge and skills acquisition.

Psychometric Testing of the Debriefing Assessment for Simulation in Healthcare (DASH) for Trainee-led, In Situ Simulations in the Pediatric Emergency Department Context

OBJECTIVES

Effective trainee-led debriefing after critical events in the pediatric emergency department has potential to improve patient care, but debriefing assessments for this context have not been developed. This study gathers preliminary validity and reliability evidence for the Debriefing Assessment for Simulation in Healthcare (DASH) as an assessment of trainee-led post-critical event debriefing.

METHODS

Eight fellows led teams in three simulated critical events, each followed by a video-recorded discussion of performance mimicking impromptu debriefings occurring after real clinical events. Three raters assessed the recorded debriefings using the DASH, and their feedback was collated. Data were analyzed using generalizability theory, Gwet's AC2, intraclass correlation coefficient (ICC), and coefficient alpha. Validity was examined using Messick's framework.

RESULTS

The DASH instrument had relatively low traditional inter-rater reliability (Gwet's AC2 = 0.24, single-rater ICC range = 0.16-0.35), with 30% fellow, 19% rater, and 23% rater by fellow variance. DASH generalizability (G) coefficient was 0.72, confirming inadequate reliability for research purposes. Decision (D) study results suggest the DASH can attain a G coefficient of 0.8 with five or more raters. Coefficient alpha was 0.95 for the DASH. A total of 90 and 40% of items from Elements 1 and 4, respectively, were deemed "not applicable" or left blank.

CONCLUSIONS

Our results suggest that the DASH does not have sufficient validity and reliability to rigorously assess debriefing in the post-critical event environment but may be amenable to modification. Further development of the tool will be needed for optimal use in this context.

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

Background

Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance.

Methods

Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD.

Results

During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD.

Conclusions

Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care.