A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada.

PurposeHigh-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.MethodsThis study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.ResultsSelf-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can300, instructor debriefing was the preferred alternative.ConclusionWith a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education

Pocket Book for Simulation Debriefing in Healthcare

© 2018 Springer International Publishing AG. This is a post-peer-review, pre-copyedit sample portion of 'Pocket Book for Simulation Debriefing in Healthcare'. The final authenticated version is available online at: http://dx.doi.org/10.1007/978-3-319-59882-6This book is a concise manual on debriefing techniques in a clinical educational context. It presents the most popular debriefing techniques and, hence, can be used as a reference manual by educators to help them achieve their intended debriefing objectives. The overarching objective of debriefing is to promote reflection and improve patient safety awareness at an individual and a team level. This book provides clear explanations of what constitutes a valuable and effective debriefing, and presents the various approaches that can be used and how debriefing differs from feedback. It includes key recommendations on aspects that directly or indirectly impact debriefing with different populations of learners such as students or qualified healthcare professionals of various levels of seniority. This book can also be used as a survival guide for both simulation educators and clinicians during debriefings. It includes several useful sections explaining the different phases of a debriefing session, which help learners develop and consolidate their knowledge, and identify potential knowledge or performance gaps and near misses. The underlying philosophy of this book is to also promote profound respect for the trainee by using a non-offensive debriefing approach. Debriefing facilitators will appreciate the several key sentences that will help them lead and engage their learners in the various phases of expressing their emotions and analyzing their experience and actions

Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use

Early interventions following exposure to traumatic events: psychological debriefing and the law

Defines Post Traumatic Stress Disorder (PTSD) and discusses the advantages of providing "Critical Incident Stress Debriefing" (CISD) to those who have witnessed traumatic events to prevent them developing PTSD. Outlines the development of CISD, the procedure itself and concerns arising from medical studies into its effectiveness. Examines the legal implications, including the existence of a duty of care to provide CISD or liability for debriefings which are negligently provided. Sets out briefly the status of psychological debriefing amongst support organisations

How Debriefing Strategies Can Improve Student Motivation and Self-Efficacy in Game-Based Learning

Debriefing is an important step in game-based learning environments. In the present study, the effect of different debriefing strategies in terms of two factors, grouping (self vs. team) and timing (in-game vs. post-game), was investigated on the motivation and self-efficacy levels of students. In a 2x2 ANOVA design, 62 sixth grade students were randomly assigned into two debriefing groups: self-debriefing and team debriefing. About half of members in each group performed either one of the two debriefing: in-game debriefing or post-game debriefing. Students in the self-debriefing as well as in the team-briefing group played the game three days a week over nine weeks. As students finished the task, motivation and self-efficacy scales were administered and semi-structured interviews were conducted. Findings indicate that students showed higher motivation and self-efficacy scores in the team debriefing than in the self-debriefing. Moreover, the in-game debriefing group outperformed the post-game debriefing group in terms of self-efficacy and motivation levels. Semi-structured interviews supported the quantitative results that students benefited more from collaborative debriefing sessions

Effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health professions education: A randomized trial

* Corresponding author at: Department of Nursing, Faculty of Health Sciences, University of Granada, Granada 18016, Spain. E-mail address: [email protected] (R. Gil-Gutiérrez).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.*Funding for open access charge: Univeresidad de Granada/CBUA

Using Debriefing for Meaningful Learning to Foster Development of Clinical Reasoning in Simulation

Debriefing is critical to learning from simulation experiences, yet the literature reports little research describing best practices within nursing. Debriefing for Meaningful Learning (DML) is a systematic process for debriefing in which teachers and students explicate different aspects of reflection and generate new meanings from simulation experiences. The purpose of this exploratory, quasi-experimental, pretest–posttest study was to test the relationship of DML on the development of clinical reasoning skills in prelicensure nursing students when compared with customary debriefing strategies and on students’ perception of quality of the debriefing experience. Analysis of data demonstrated a greater change in clinical reasoning skills and identification of higher-quality debriefing and a positive correlation between clinical reasoning and perception of quality. Findings demonstrate that DML is an effective debriefing method. It contributes to the body of knowledge supporting the use of debriefing in simulation learning and supports the development of best teaching practices

Redesigning Simulation Debriefing Practices of a Pre-licensure Baccalaureate Nursing Program

The practice of the nursing department demonstrates a lack of a common, standardized, evidence-based approach to simulation debriefing. Simulation debriefing is known to enhance students’ learning opportunity. Offered an evidence-based practice approach following professional recommendations of simulation debriefing practice. The purpose of this project is to create a simulation debriefing program that enhances the faculty debriefing. Three tools were introduced to the faculty. Utilization of all three tools and evaluation of each simulation debrief was done. Findings support the use of the tools and effective debriefing evaluations was achieved by all facuty.D.N.P