The effectiveness of debriefing in simulation-based learning for health professionals: A systematic review.

Abstract

Simulation is defined as a technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner. The use of simulation for educational purposes began decades ago with the use of low-fidelity simulations and has evolved at an unprecedented pace. Debriefing is considered by many to be an integral and critical part of the simulation process. However, different debriefing approaches have developed with little objective evidence of their effectiveness. The aim of this review was to identify, appraise and synthesise the best available evidence for the effectiveness of debriefing as it relates to simulation-based learning for health professionals. This review included any health professional participants regardless of gender, age or profession.Studies that evaluated the use of debriefing for the purpose of simulation-based learning were included.The review included randomised controlled trials.Outcome measures included objectively measured outcomes such as situational awareness, communication skills, teamwork, knowledge acquisition, and performance of psychomotor skills as assessed by validated instruments such the Anaesthesia Non-Technical Skills Scale, the Emergency Response Performance Tool, and the Clinical Simulation Tool. A three-stage comprehensive search strategy was utilised to search across ten electronic databases. English language studies published between January 2000 and September 2011 were considered for inclusion. Two independent reviewers assessed the methodological quality of each study selected for retrieval using standardised Joanna Briggs Institute critical appraisal tools. Data were extracted from studies using the standardised data extraction tool from the Joanna Briggs Institute DATA SYNTHESIS: Meta-analysis was not possible because of the different outcomes, control groups and interventions in the selected studies. Findings are therefore presented in narrative form. Ten randomised controlled trials involving various debriefing methods were eligible for inclusion in this review. The methods of debriefing included: post simulation debriefing, in-simulation debriefing, instructor facilitated debriefing and video-assisted instructor debriefing. In the included studies there was a statistically significant improvement pre-test to post-test in the performance of technical and nontechnical skills such as: vital signs assessment; psychomotor skills; cardiopulmonary resuscitation; task management; team working; and situational awareness, regardless of the type of debriefing conducted. Additionally, four of the studies reported improvement in these outcomes without the use of video playback during debriefing. In one study the effect of the educational intervention was evident 6-9 months after the initial simulation experience. The results of this systematic review support the widely held assumption that debriefing is an important component of simulation. It is recommended therefore that debriefing remain an integral component of all simulation-based learning experiences. However, the fact that there were no clinical or practical differences in outcomes when instructor facilitated debriefing was enhanced by video playback is an important finding since this approach is currently considered to be the 'gold standard' for debriefing.