Three-phase video-assisted multidisciplinary team debriefing (VAMTD) 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 assisting the debriefers to structure the session. Currently, however, no consensus exists on how to optimally perform a team debriefing. In our study, we aim to 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 non-technical skills (NTS). After Institutional Review Board (IRB) approval, we performed a study with 50 residents who were randomly assigned to two groups. Group 1 (control, or "no VAD", n=25) consisted of residents who received oral debriefing by one 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 one week after their debrief. Every resident was assessed on the primary and secondary survey, as well as the NTS, based on the integrated skills (IS) score. The "VAD" group presented significantly higher values for the IS score (p<0.001) compared to the "no VAD'' group. Our demonstration of three-phase VAD emphasizes important aspects of coherent simulation-based training: psychological safety, A&I, reflection, cognitive frames, pre-brief, main debrief, summary, and translation of new discoveries to real-life patient care. The unique audio-visual aspect of the VAD enhanced residents' performance in simulation.