Abstract
BackgroundDefined 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.MethodsPrior 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.ResultsDuring 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.ConclusionsTopics 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.
Highlights
Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training
A total of 76 study forms were submitted by healthcare staff during a 9-month pre-defined window. 5 forms were excluded from the final analysis (3 for debriefing >60mins after event and 2 due to forms being left blank)
Domains discussed were divided into plus and delta. 232 ‘plus’ learning points were recorded of which 195 (84.1%) were coded to one of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) simulation debriefing domains [19]. 164 ‘delta’ learning points were observed of which 107 entries (61.5%) were coded to a PEARLS simulation-based debriefing domain [19]
Summary
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. [1, 2] When taken from its familiar use for simulation based medical education (SBME) to clinical environments such as an Emergency Department (ED), it has been associated with observed improvements in team performance [3,4,5]. The Cochrane review suggested there is an association between debriefing and a risk of posttraumatic stress disorder (PTSD) [13]. While these concerns should be acknowledged, recent studies of CD for healthcare providers did not report harm in over 300 debriefings [14]. Many of these programs build in approaches to ensure provider wellbeing and foster individual resilience [15,16,17]
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