Document Type: Original Article

Authors

1 Department of Anesthesiology, Université de Montréal, Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Montréal, Canada

2 Simulation Centre, Faculty of Medicine, Tunis, Tunisia

3 1Department of Anesthesiology, Université de Montréal, Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Montréal, Canada

Abstract

Introduction: Experiential learning, followed by debriefing, is
at the heart of Simulation-Based Medical Education (SBME) and
has been proven effective to help master several medical skills.
We investigated the impact of an educational intervention, based
on high-fidelity SBME, on the debriefing competence of novice
simulation instructors.
Methods: This is a prospective, randomized, quasi-experimental,
pre- and post-test study. Sixty physicians without prior formal
debriefing expertise attended a 5-day SBME seminar targeted on
debriefing. Prior to the start of the seminar, 15 randomly chosen
participants had to debrief a spaghetti and tape team exercise.
Thereafter, the members of each team assessed their debriefer’s
performance using the Debriefing Assessment for Simulation in
Healthcare (DASH)© score. The debriefing seminar that followed
(intervention) consisted of 5 days of teaching that included theoretical
and simulation training. Each scenario was followed by a Debriefing
of the Debriefing (DOD) session conducted by the expert instructor.
At the end of the course, 15 randomly chosen debriefers had to
debrief a second tower building exercise and were re-evaluated with
the DASH score by their respective team members. The Wilcoxon
signed-rank test was used to compare pre- and post-test scores.
Statistical tests were performed using GraphPad Prism 6.0c for Mac.
Results: A significant improvement in all items of the DASH score
was noted following the seminar. The debriefers significantly improved
their performance with regard to “maintaining an engaging learning
environment” (Median [IQR]) (4[3-5] after the pre-test vs. 5.5[5-6]
after the post-test, P<0.001); “structuring the debriefing in an organized
way” (5[4-5] after the pre-test vs. 5[5-6] after the post-test, p=0.002);
“provoking engaging discussion” (4[3-5.75] after the pre-test vs. 6[5-6]
after the post-test, P<0.001); “identifying and exploring performance
gaps” (5[4-6] after the pre-test vs. 6[5-6] after the post-test, P=0.014);
and “helping trainees to achieve and sustain good future performance”
(4[3-5] after the pre-test vs. 6[5-6] after the post-test, P<0.001).
Conclusion: A simulation-based debriefing course, based mainly
on DOD sessions, allowed novice simulation instructors to improve
their overall debriefing skills including, more specifically, the ability
to foster engagement in discussions and maintain an engaging
learning environment.

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