Three-Phase Video-Assisted Multidisciplinary Team Debriefing in High-Fidelity Blast Simulation through the Advocacy and Inquiry Method.

Abstract

Video-assisted debriefing (VAD) combined with the advocacy and inquiry (A&I) technique is a tool that allows video playback of selected segments of a simulation, thereby helping the debriefers structure the session. However, no consensus exists on how to optimally perform a team debriefing. The authors demonstrate and describe the methodology of A&I debriefing in an instructional simulated blast scenario and assess the impact of VAD on residents' technical and nontechnical skills. After institutional review board approval, the authors performed a study with 50 residents who were randomly assigned to 2 groups. Group 1 (control, or no VAD; n = 25) consisted of residents who received oral debriefing by 1 independent faculty member without the recorded video of the simulation. Group 2 (intervention, or VAD; n = 25) consisted of residents who received VAD from the second independent faculty member. These residents repeated the same simulation scenario 1 week after their debrief. Every resident was assessed on the primary and secondary survey, as well as the nontechnical skills, based on the integrated skills score. The VAD group presented significantly higher values for the integrated skills score ( P < 0.001) compared with the no-VAD group. This demonstration of 3-phase VAD emphasizes important aspects of coherent simulation-based training: psychologic safety, A&I, reflection, cognitive frames, prebrief, main debrief, summary, and translation of new discoveries to real-life patient care. The unique audiovisual aspect of the VAD enhanced residents' performance in simulation.