Structured vs Unstructured Debriefing: Finding the Right Approach in Cabin Crews' Simulation-Based Resuscitation Training (original) (raw)
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Applied Cognitive Psychology, 2018
Emergency resuscitation in intensive care units (ICUs) requires effective team communication to orchestrate the joint performance of several individuals. Although team simulation training has proven an effective means to improve communication skills in high-risk environments, the influence of debriefing content on simulation-based learning is less clear. In this study, 10 ICU teams completed three consecutive cardiac resuscitation scenarios, followed by a 3-month follow-up. Control teams received a debriefing on the basis of resuscitation technical skills after each of the first three scenarios, whereas the experimental teams' debriefing focused on team communication. Results showed that although information sharing improved for all teams, communication quality improved only for experimental teams, and these training benefits dissipated after 3 months. The study helps develop a methodology for assessing team communication and highlights the importance of frequent team simulation-based training and debriefing in emergency medicine that includes both technical and nontechnical skills.
Basic-SiM train-the-trainer: A resuscitation training module for cabin crew in Malaysia
Songklanakarin Journal of Science & Technology, 2020
We tested the Basic-SiM train-the-trainer simulation-based resuscitation training module among airline instructors to train the cabin crew in Malaysia. Selected airline instructors were asked to attend a Train-The-Trainer course and then use the knowledge to test their airline cabin crews who were divided into 2 different groups (n=65) using different debriefing methods (customary vs DIAMOND) at both the baseline and at 6 weeks post-intervention on resuscitation knowledge and technical and non-technical skills through a MCQ test, TSTC, and CETAM. There were no significant differences in terms of the different debriefing methods on the improvement of all variables except for technical skills in both groups, F(3,123) =0.540, P=0.656, and partial eta squared=0.013 despite retention for all variables. This module is an effective approach to develop trainers for simulated resuscitation training and was proven to be effective in improving the knowledge and skills of cabin crew in Malaysia.
Resuscitation Plus
Aim: Scripted debriefing tools may improve the performance of novices debriefing in resuscitation courses, but this has not previously been measured. The aim of this study was to determine the impact of a script on the quality of debriefs in a statewide paediatric resuscitation course. Methods: This cluster-randomised controlled trial compared scripted debriefing (intervention) versus non-scripted debriefing (control) for participants in a paediatric resuscitation course. The trial was conducted across participating sites in Queensland, Australia, from November 2017 to February 2020. Debriefing quality was measured using the Observational Structured Assessment of Debriefing (OSAD) tool. The OSAD tool rates 8 domains that comprise the elements of an ideal debrief. OSAD scores between scripted and non-scripted groups were compared, overall and after stratification by debriefer experience and site size. Results: Seventy debriefings occurred across 19 sites (intervention, n = 34, control n = 36). There was a statistically significant increase in total OSAD scores in the scripted group, compared to non-scripted (mean difference (MD) = 3.5, 95% confidence interval (CI) 0.7-6.2, p = 0.01). The categories of 'reflection' and 'analysis' had the greatest difference in OSAD scores in the scripted group (MD = 0.8, 95%CI 0.2-1.3, p = 0.005; MD = 0.6, 95%CI 0.2-1.0, p = 0.007). After stratification, overall OSAD scores improved for novices (MD = 4.1, 95%CI 0.5-7.7, p = 0.03) and large centres (MD = 5.2, 95%CI 1.1-9.2, p = 0.01). Conclusion: Providing debriefing scripts to faculty facilitating simulated paediatric resuscitation scenarios improved the quality of debriefing, especially for novices and those at large sites. The development and provision of debriefing scripts for large-scale paediatric resuscitation courses should be considered.
Malaysian Journal of Medicine & Health Sciences, 2019
Introduction: To develop quality cabin crews, trainings involve simulation-based education (SBE) with structured debriefings-a significant component which plays a critical role in optimising learning outcomes. Previous studies have empirically tested the efficacy of the DIAMOND-structured debriefing model and found significant improvement and retention of the cabin crews' knowledge and skills. This study was aimed to explore the elements of the DIAMOND-structured debriefing model that have been known to promote the acquisition and retention of knowledge and skills in basic life support (BLS). Methods: A qualitative study was conducted with a random sample of 16 individual cabin crew members who participated in an in-depth interview with 13 open-ended questions for 45-60 minutes. The interviews were transcribed and independently analysed using inductive thematic analysis. Results: The codes which have emerged during data analysis were clustered into three themes: (1) Cognitive, with three sub-themes: engagement, learning environment, and ability to reflect; (2) Methodology, with three sub-themes: concept of debriefing, techniques of questioning, and additional elements; as well as (3) Psychosocial, with five sub-themes: attitude, self-awareness, relationships, self-confidence, and work culture. Several suggestions have emerged, such as the implementation of the model. Conclusion: The DIAMOND-structured debriefing model was a method to reduce cognitive load, which in turn allowed individuals to organise their knowledge, reflect individually and collectively, as well as structure their ideas. It has showed that the elements has a positive impact on the cabin crews' acquisition and retention of knowledge and skills which will improve the performance and patient safety
Applications of Postresuscitation Debriefing Frameworks in Emergency Settings: A Systematic Review
AEM education and training, 2020
ObjectivesPostresuscitation debriefing (PRD) is a valuable educational tool in emergency medicine. It is recommended by international resuscitation guidelines, has been shown to improve both patient outcomes and resuscitation team performance, and is frequently requested by medical learners. However, there is limited research comparing standardized debriefing frameworks. Not only does this hinder the ability of interested emergency departments (EDs) to adopt PRD, but it limits the quality of future debriefing research. We sought to identify and compare existing PRD frameworks to inform the implementation of effective PRD in emergency medicine.MethodsWe conducted a systematic review following PRISMA standards to identify debriefing frameworks used in the ED and other acute care settings for further analysis. Identified frameworks were analyzed and compared based on a method previously described in the literature.ResultsOur search identified six frameworks, which ranged from simple tools for immediate feedback to complex, hospital‐wide systems engineering–based approaches to quality improvement. Key findings were the importance of ensuring debriefing facilitators are properly selected and trained and of tailoring framework design to specific organizational targets. However, there is limited validation data for these frameworks, and more study is needed to identify and validate true best practices in PRD.ConclusionsAll six identified frameworks seem to be effective methods of debriefing. Given the breadth in debriefing methods and goals identified, this suggests that there may not be a one‐size‐fits‐all approach to PRD and that organizations should instead identify their own unique needs and barriers and adopt the debriefing framework that best addresses those needs. Other findings were the importance of well‐trained debriefing facilitators and the use of clear roles in organizing debriefings. Further research is needed to assess the effectiveness of postresuscitation frameworks with regard to both team performance and patient outcomes.
AEM Education and Training, 2020
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 AC 2 , 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 AC 2 = 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. E ffective debriefing after resuscitations can potentially improve future care. 1-4 The American Heart Association and American Academy of Pediatrics recommend regular postevent debriefings. 3-5 The
BMC Emergency Medicine
Background Post-resuscitation debriefing (PRD) is the process of facilitated, reflective discussion, enabling team-based interpersonal feedback and identification of systems-level barriers to patient care. The importance and benefits of PRD are well recognized; however, numerous barriers exist, preventing its practical implementation. Use of a debriefing tool can aid with facilitating debriefing, creating realistic objectives, and providing feedback. Objectives To assess utility of two PRD tools, Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) and Post-Code Pause (PCP), through user preference. Secondary aims included evaluating differences in quality, subject matter, and types of feedback between tools and implications on quality improvement and patient safety. Methods Prospective, crossover study over a 12-month period from February 2019 to January 2020. Two PDR tools were implemented in 8 week-long blocks in acute care settings at a tertiary care childr...
BMC Medical Education
Background: Debriefing is a critical component to promote effective learning during simulation-based training. Traditionally, debriefing is provided only after the end of a scenario. A possible alternative is to debrief specific portions during an ongoing simulation session (stop-and-go debriefing). While this alternative has theoretical advantages, it is not commonly used due to concerns that interruptions disturb the fidelity and adversely affect learning. However, both approaches have not been rigorously compared, and effects on skill acquisition and learning experience are unknown. Methods: We randomly assigned 50 medical students participating in a simulation-based cardiopulmonary resuscitation training to either a post-scenario debriefing or stop-and-go debriefing. After four weeks, participants performed a repeat scenario, and their performance was assessed using a generic performance score (primary outcome). A difference of 3 or more points was considered meaningful. A 5-item questionnaire was used to assess the subjective learning experience and the perceived stress level (secondary outcomes). Results: There was no significant difference between the groups for the performance score (mean difference:-0.35, 95%CI:-2.46 to 1.77, P = 0.748, n = 48). The confidence limits excluding the specified relevant 3-point difference suggest equivalence of both techniques with respect to the primary outcome. No significant differences were observed for secondary outcomes. Conclusions: Stop-and-go debriefing does not adversely affect skill acquisition compared to the classic post-scenario debriefing strategy. This finding is reassuring when interruptions are deemed necessary and gives simulation instructors the latitude to tailor the timing of the debriefing individually, rather than adhering to the unsupported dogma that scenarios should not be interrupted. Trial registration: As this study is not a clinical trial, it was not registered in a clinical trials register.