Video Review Using a Reliable Evaluation Metric Improves Team Function in High-Fidelity Simulated Trauma Resuscitation

Abstract

To demonstrate that instruction of proper team function can occur using high-fidelity simulated trauma resuscitation with video-assisted debriefing and that this process can be integrated rapidly into a standard general surgery curriculum. The rater reliability of our team metric was assessed by having physicians and nonphysicians rate the same video-recorded trauma simulations at intervals in time. To assess the effectiveness of video debriefing, subjects participated in a 3-week trauma team training course that consisted of 2 video-recorded simulation sessions, each approximately 2 hours in length separated by a 90-minute debriefing session. To assess the impact of the debriefing session, video recordings of participants performing resuscitations before and after the debriefing were reviewed by a panel of blinded traumatologists and graded using our team evaluation instrument. The study took place at the high-fidelity simulation center at a large, urban academic training hospital. All 11 PGY-2 general surgery and combined general surgery and plastic surgery residents at our institution. Our instrument was found to have high interrater correlation (interclass correlation coefficient [ICC], 0.926; 95% confidence interval, 0.893-0.953). Initially, residents were either unsure as to their competency to serve as team leader (70%) or felt they were not competent to serve as team leader (30%). Ninety percent of residents found the video debriefing very to extremely helpful in improving team function and clinical competency. All participants felt more competent as both team leaders and team members because of the video debriefing. The mean team function score improved significantly after video debriefing (4.39 [±0.3] vs 5.45 [±0.4] prevideo vs postvideo review, p < 0.05). Video review with debriefing is an effective means of teaching team competencies and improving team function in simulated trauma resuscitation. This strategy can be integrated readily into the surgical curriculum analogous to other applications of simulation technology.