by J. Biggs and C. Tang, Maidenhead, England,
Open University Press, 2007, 360 pp., £29.99, ISBN-13: 978-0-335-22126-4

Teaching for quality learning at university

Introducing Focus Groups

Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. Debriefing occurs either after (postevent) or during (within-event) the simulation. The debriefing conversation can be guided by either a facilitator (facilitator-guided) or the simulation participants themselves (self-guided). Postevent facilitator-guided debriefing may incorporate several conversational structures. These conversational structures break the debriefing discussion into a series of 3 or more phases to help organize the debriefing and ensure the conversation proceeds in an orderly manner. Debriefing process elements are an array of techniques to optimize reflective experience and maximize the impact of debriefing. These are divided here into the following 3 categories: essential elements, conversational techniques/educational strategies, and debriefing adjuncts. This review provides both novice and advanced simulation educators with an overview of various methods of conducting healthcare simulation debriefing. Future research will investigate which debriefing methods are best for which contexts and for whom, and also explore how lessons from simulation debriefing translate to debriefing in clinical practice.

More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods.

A Comparative Study of the Purchase, Management and Use of Large-scale Research Equipment in the UK and US Universities (report for Evidence Ltd on behalf of the Higher Education Funding Council for England)

A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the “evidence base” levels of the research. Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.

/pdf/interventions-to-improve-team-effectiveness-within-health-3yn9dvno5m.pdf

Interventions to improve team effectiveness within health care: a systematic review of the past decade

Summary
Background

Despite debriefing being found to be the most important element in providing effective learning in simulation-based medical education reviews, there are only a few examples in the literature to help guide a debriefer. The diamond debriefing method is based on the technique of description, analysis and application, along with aspects of the advocacy-inquiry approach and of debriefing with good judgement. It is specifically designed to allow an exploration of the non-technical aspects of a simulated scenario.



Context

The debrief diamond, a structured visual reminder of the debrief process, was developed through teaching simulation debriefing to hundreds of faculty members over several years. The diamond shape visually represents the idealised process of a debrief: opening out a facilitated discussion about the scenario, before bringing the learning back into sharp focus with specific learning points.



Debriefing is the most important element in providing effective learning in simulation-based medical education reviews



Innovation

The Diamond is a two-sided prompt sheet: the first contains the scaffolding, with a series of specifically constructed questions for each phase of the debrief; the second lays out the theory behind the questions and the process.



Implication

The Diamond encourages a standardised approach to high-quality debriefing on non-technical skills. Feedback from learners and from debriefing faculty members has indicated that the Diamond is useful and valuable as a debriefing tool, benefiting both participants and faculty members. It can be used by junior and senior faculty members debriefing in pairs, allowing the junior faculty member to conduct the description phase, while the more experienced faculty member leads the later and more challenging phases. The Diamond gives an easy but pedagogically sound structure to follow and specific prompts to use in the moment.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/tct.12300

'The Diamond': a structure for simulation debrief.

Objectives In this work, we have compared uniprofessional and interprofessional versions of a simulation education intervention, in an attempt to understand more about whether it improves trainees’ self-efficacy Background Interprofessionalism has been climbing the healthcare agenda for over 50 years Simulation education attempts to create an environment for healthcare professionals to learn, without potential safety risks for patients Integrating simulation and interprofessional education can provide benefits to individual learners Setting The intervention took place in a high-fidelity simulation facility located on the campus of a large urban hospital The centre provides educational activities for an Academic Health Sciences Centre Approximately 2500 staff are trained at the centre each year Participants One hundred and fifteen nurses and midwives along with 156 doctors, all within the early years of their postgraduate experience participated All were included on the basis of their ongoing postgraduate education Methods Each course was a one-day simulation course incorporating five clinical and one communication scenarios After each a facilitated debriefing took place A mixed methods approach utilised precourse and postcourse questionnaires measuring self-efficacy in managing emergency situations, communication, teamwork and leadership Results Thematic analysis of qualitative data showed improvements in communication/teamwork and leadership, for doctors and nurses undergoing simulation training These findings were confirmed by statistical analysis showing that confidence ratings improved in nurses and doctors overall (p Conclusions This study provides evidence that simulation training enhances participants’ self-efficacy in clinical situations It also leads to increases in their perceived abilities relating to communication/teamwork and leadership/management of clinical scenarios Interprofessional training showed increased positive effects on self-efficacy for nurses and doctors

https://bmjopen.bmj.com/content/bmjopen/5/1/e005472.full.pdf

Does interprofessional simulation increase self-efficacy: a comparative study.

https://www.nursingsimulation.org/article/S1876-1399(15)00043-2/pdf

Using Cognitive Load Theory to Inform Simulation Design and Practice

Emergency exercises involving the health community are considered an important and integral part of emergency preparedness activities. However, little is known about whether these exercises are effective at improving individual and/or organisational preparedness for responding to emergencies. This paper reviews and summarises published evidence on the effectiveness and benefits of exercises to prepare health emergency professionals for responding to emergencies and disasters. A literature search strategy was designed to identify the relevant publications from four major medical databases (Medline, Embase, Global Health and CINAHL). Studies meeting our inclusion criteria were analysed in detail (N=86). Both qualitative and quantitative data were reviewed. Data analysis involved a descriptive summary and a thematic analysis. Health emergency preparedness exercises were found to be effective (post exercise) at improving participants’ knowledge of emergency activities, policies and procedures and improving overall competence and confidence. Other immediate individual benefits included improved perceptions of preparedness and improved understanding of individual roles and roles of partners. Whether these improvements persist over time and translate into improved emergency response is not clear. The most commonly reported post-exercise organisational benefits were: identifying gaps or limitations in plans, protocols or procedures and providing opportunities to share lessons. Only a few identified studies reported the long-term impact of exercises on job practices and on real emergency response. Published evidence of exercises impact on individual and organisational levels of emergency preparedness and response over the long term is very limited. The majority of the studies included (n=65, 76%) were US-based.

Gabriel Reedy

Papers

'The Diamond': a structure for simulation debrief.

Does interprofessional simulation increase self-efficacy: a comparative study.

Using Cognitive Load Theory to Inform Simulation Design and Practice

What is the value of health emergency preparedness exercises? A scoping review study

Using the mind as a simulator: a randomized controlled trial of mental training.