Debriefing Techniques Research Articles

Focusing on explicit debriefing for novice learners in healthcare simulations: A randomized prospective study

IntroductionDebriefing is essential in simulation-based training, but it is not clear what exactly constitutes a successful debriefing session. Research in educational sciences shows that a structured, explicit and trainer-directed approach is systematically more effective than an implicit, reflective approach with minimal guidance, particularly for novice or intermediate learners. The aim of this study is to compare explicit strongly trainer-guided debriefing with implicit and weakly guided debriefing in nursing training. MethodSingle-centre randomized prospective study comparing effectiveness of explicit and implicit debriefing techniques. We focused on the description and the analysis phases of the debriefing. Our main aim was to assess the effectiveness of debriefing in terms of knowledge improvement. We also assessed its effectiveness for self-efficacy and self-confidence. Results136 nursing students participated in 46 simulation sessions. Knowledge, self-efficacy and self-confidence increased in all conditions. The results also showed that debriefing with explicit analysis improved learning significantly when compared to the control session. ConclusionAlthough the results revealed a beneficial effect of simulation training on self-efficacy, the explicit debriefing technique was shown to produce greater knowledge improvement than the implicit debriefing method in novice learners. Consequently, debriefing technique should be adapted to the objectives of the training and learners.

Does a Written Tool to Guide Structured Debriefing Improve Discourse? Implications for Interprofessional Team Simulation

Timely debriefing following a simulated event supports learners in critically reflecting on their performance and areas for improvement. Content of debriefing has been shown to affect learner skill acquisition and retention. The use of good judgment statements from debriefing facilitators is considered superior to judgmental or nonjudgmental statements. Ideally, the majority of the conversation will consist of learner self-reflection and focused facilitation rather than directive performance feedback. We hypothesized that the introduction of a written tool to help facilitate high-quality debriefing techniques could improve the ratio of judgmental, nonjudgmental, and good judgment statements from facilitators, as well as shift the percentage of talk in the debrief away from directive performance feedback and toward self-assessment and focused facilitation. The University of Wisconsin Joint Trauma Simulation Program is an interdisciplinary project to improve quality of trauma care through simulation. Simulations use teams of five trauma trainees: two surgery residents, an emergency medicine resident, and two nurses. Three faculty members conducted the scenarios and debriefings. Debriefings were video recorded. Videos were transcribed and dialogue analyzed according to the teaching/learning strategy used in each turn of talk. Discourse was coded into three categories: (1) learner self-assessment; (2) focused facilitation; and (3) directive performance feedback. Each facilitation statement was coded as either (1) judgmental; (2) nonjudgmental, or (3) good judgment. The TEAM Debrief Tool is a written guide designed to help facilitators adhere to best practices, with example structure and phrasing, similar to the Promoting Excellence and Reflective Learning in Simulation tool. Pre- and post-implementation analysis was completed to assess for efficacy of the tool. Seven videos before the implementation of the tool and seven videos after implementation were analyzed. The percentage of learner self-assessment increased significantly with tool use (7.23% vs 24.99%, p=0.00004), and directive performance feedback decreased significantly (56.13% vs 32.75%, p=0.0042). There was no significant change in the percentage of talk using focused facilitation. After implementation of the tool, there was a significant decrease in use of the nonjudgmental debriefing style (60.63% vs 37.31%, p=0.00017), and a significant increase in the use of good judgment debriefing (38.77% vs 59.82%, p=0.00038). There was also a slight increase in judgmental debriefing (0.60% vs 2.87%, p=0.0027). The discourse in our interprofessional trauma simulation debriefings unaided by a written debriefing tool skewed heavily toward direct performance feedback, with a preponderance of nonjudgmental statements. After introduction of the tool, dialogue shifted significantly toward learner self-assessment, and there was a large increase in utilization of debriefing with good judgment. This shift toward higher quality debriefing styles demonstrates the utility of such a tool in the debriefing of interprofessional simulations.

Qualitative Research to Explore the Patient Experience of X-Linked Hypophosphatemia and Evaluate the Suitability of the BPI-SF and WOMAC® as Clinical Trial End Points

BackgroundX-linked hypophosphatemia (XLH) is a rare genetic disorder characterized by renal phosphate wasting and defective bone mineralization. Symptoms include bone pain, joint pain, stiffness, and fatigue. Published evidence regarding the patient experience of XLH is sparse and no XLH-specific outcome measures have been validated. ObjectivesTo understand the symptoms, impacts, and patient experience of XLH and to evaluate the face and content validity of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC®) and the Brief Pain Inventory Short Form (BPI-SF) for use as end points in XLH clinical trials. MethodsFace-to-face, qualitative, semistructured interviews were conducted with 18 adults with XLH in the United States using concept elicitation and cognitive debriefing techniques. Open-ended questioning elicited spontaneous concepts focusing on XLH-associated symptoms and functional limitations. Cognitive debriefing of the WOMAC® and BPI-SF assessed the relevance and patient understanding of item wording, recall period, and response options. ResultsVarious distinct symptom concepts were elicited including pain symptoms, dental symptoms, sensory symptoms, tiredness/fatigue symptoms, and musculoskeletal symptoms. Participants reported experiencing significant bone and joint pain, stiffness, mobility limitations, and an impact on their ability to work. Cognitive interviewing found both instruments to be relevant and well understood by most patients. ConclusionsThe interviews generated rich, qualitative insights into the patient experience of XLH. Cognitive debriefing of the BPI-SF and WOMAC® supported their value as XLH clinical trial end points. Future research will assess the psychometric properties of these instruments for use in the XLH population.

Construção de uma escala de capacidade para cuidar em paliativos: processo de validação de conteúdo

In palliative care it is important to promote the wellbeing. The aim of this study is to present the creation/validation process of the scale for Capacity to Care in Palliative Care (ECCP). 58 items were created and then discussed and measured by a group of experts and caregivers of PC, using the Content Validity Index and Cognitive Debriefing techniques. The peer‐test reached an agreement on 47 items, none of which obtained a value <3. This study shows that the instrument is endowed with content validity, which allows us to conclude that it is a consistent instrument liable to be applied to the target population.

Developing situation awareness amongst nursing and paramedicine students utilizing eye tracking technology and video debriefing techniques: A proof of concept paper

ObjectiveThe aims of this quasi-experimental before-and-after study were to first determine whether the use of eye tracking technology combined with video debriefing techniques has the potential to improve the quality of feedback and enhance situation awareness (SA) in simulated settings and second to determine students' satisfaction towards simulated learning. MethodsNursing and paramedicine students from three universities participated in three 8-minute simulation scenarios of acutely deteriorating patients. Eye tracking glasses video recorded the scenarios and tracked right eye movement. On completion, participants were questioned using the Situation Awareness Global Assessment Technique, completed the Satisfaction with Simulation Experience Scale (SSES), and provided textual feedback and received video-based verbal feedback. ResultsParticipants lacked awareness of presenting medical conditions and patient environments and had poor recall of patient vital signs. Significant improvements in SA scores were demonstrated between the first and third scenarios (P = 0.04). Participants reported greater insight into their performance and were satisfied with simulated learning. ConclusionsUse of visual field review techniques appears to enhance the use of realistic simulated practice as a means of addressing significant performance deficits. Eye tracking and point of view recording techniques are feasible and with applicable debriefing techniques could enhance clinical and situated performance.

Kerentanan perempuan terhadap penularan IMS dan HIV: gambaran perilaku seksual berisiko di Kota Denpasar

Abstrak: Sero-survei tahun 2010 di Bali melaporkan angka 1% HIV positif pada ibu hamil. Angka HIV dan AIDS yang dilaporkan ke Dinkes Propinsi Bali juga menunjukkan peningkatan laporan kasus HIV yang terjadi pada perempuan. Salah satu alasan yang menyebabkan perempuan menjadi terlibat dalam kelompok rentan tertular IMS dan HIV adalah karena suami atau pasangan seksual mereka memiliki perilaku seksual yang tidak aman diluar pernikahannya dan atau menggunakan narkoba suntik yang tidak steril. Kerentanan perempuan terhadap penularan penyakit seperti HIV ini didasarkan pada beberapa faktor yang terjadi pada level individu, rumah tangga dan masyarakat serta level makro yang sering membuat perempuan tidak menyadari bahaya HIV dan AIDS. Belum banyak penelitian yang menggambarkan bagaimana kerentanan perempuan dapat mempengaruhi risikonya untuk tertular HIV dan AIDS serta IMS. Penelitian ini bertujuan untuk menggali kerentanan perempuan terhadap penularan IMS dan HIV dikaitkan dengan perilaku seksual berisiko. Penelitian kualitatif ini menggunakan metode wawancara mendalam dengan pedoman wawancara semi terstruktur pada 21 informan yang terdiri dari informan perempuan, laki-laki, konselor dan penyedia layanan kesehatan di tiga tempat layanan di Denpasar. Data divalidasi menggunakan teknik member checking dan peer debriefing, kemudian dianalisis secara tematik. Gambaran perilaku berisiko yang menyebabkan kerentanan perempuan terhadap penularan IMS dan HIV adalah perilaku laki-laki yaitu hubungan seksual dengan lebih dari satu pasangan seksual, biseksual, membeli seks, IDU, serta tidak konsisten menggunakan kondom. Sedangkan perilaku berisiko perempuan diantaranya memiliki lebih dari satu pasangan seksual, posisi tawar rendah dalam negosiasi kondom, melacur dan hubungan seks dalam keadaan terpaksa.

A Qualitative Description of Self-Regulatory Behaviors of Male Expert and Novice Athletic Trainers in Collegiate Settings

Context: Understanding the transition from a novice to an expert has the potential to provide valuable information for young professionals and athletic training educators to aid in the development of tools necessary for lifetime professional learning. Objective: The purpose of this study was to identify and describe the self-regulated learning behaviors of male athletic trainers used to develop expertise in clinical evaluation and diagnosis domain knowledge in athletic training. Design: Descriptive qualitative study using a phenomenological approach. Setting: NCAA Division I and II colleges in NATA District 3 (DC, MD, NC, SC, VA, and WV.) Participants: A total of 20 male n = 10 novice (limited experiences) and n = 10 expert (at least 10 years of experience) athletic trainers in the college setting participated in the study. Data Collection and Analysis: Data were collected using an interview and questionnaire. Data were transcribed and analyzed using interpretive thematic analysis procedures. Member checks, triangulation of data, audit trail, and peer debriefing techniques were utilized to ensure trustworthiness of the data. Results: Three major themes of (1) environment, (2) experiences and goals, and (3) sources of feedback were identified and appear to describe different ways of self-regulating learning behaviors in the clinical evaluation and diagnosis domain. Conclusions: Awareness of the types of experiences needed to develop in the clinical evaluation and diagnosis domain is important to the athletic training profession. The findings of this descriptive study raise questions regarding future study of self-regulated behaviors. Post-professional education might benefit from a better understanding of self-regulated learning but research is needed.

Development of the PedsQL™ sickle cell disease module items: qualitative methods

The objective of this qualitative study was to develop the items and support the content validity of the PedsQL™ Sickle Cell Disease Module for pediatric patients with sickle cell disease (SCD). The iterative process included multiphase qualitative methodology. A literature review on SCD was conducted to generate domains of interest for the individual in-depth interviews. Ten healthcare experts with clinical experience in SCD participated in the development of the conceptual framework. A total of 13 pediatric patients with SCD ages 5-18 and 18 parents of patients ages 2-18 participated in the individual in-depth interviews. A total of 33 pediatric patients with SCD ages 5-18 and 39 parents of patients ages 2-18 participated in individually conducted cognitive interviews that included both think aloud and cognitive debriefing techniques to assess the interpretability and readability of the item stems. Six domains were derived from the qualitative methods involving patient/parent interviews and expert opinion, with content saturation achieved, resulting in 48 items. The six domains consisted of items measuring Pain Intensity/Location (9 items), Pain Interference (11 items), Worry (7 items), Emotions (3 items), Disease Symptoms/Treatment, (12 items), and Communication (6 items). Qualitative methods involving pediatric patients and parents in the item development process support the content validity for the PedsQL™ SCD Module. The PedsQL™ SCD Module is now undergoing national multisite field testing for the psychometric validation phase of instrument development.

Facilitative Debriefing Techniques for Simulation-based Learning

Facilitative Debriefing Techniques for Simulation-based Learning

Student Retention in Athletic Training Education Programs

The success of any academic program, including athletic training, depends upon attracting and keeping quality students. The nature of persistent students versus students who prematurely leave the athletic training major is not known. Understanding the profiles of athletic training students who persist or leave is important. To (1) explore the relationships among the following variables: anticipatory factors, academic integration, clinical integration, social integration, and motivation; (2) determine which of the aforementioned variables discriminate between senior athletic training students and major changers; and (3) identify which variable is the strongest predictor of persistence in athletic training education programs. Descriptive study using a qualitative and quantitative mixed-methods approach. Thirteen athletic training education programs located in District 3 of the National Athletic Trainers' Association. Ninety-four senior-level athletic training students and 31 college students who changed majors from athletic training to another degree option. Data were collected with the Athletic Training Education Program Student Retention Questionnaire (ATEPSRQ). Data from the ATEPSRQ were analyzed via Pearson correlations, multivariate analysis of variance, univariate analysis of variance, and a stepwise discriminant analysis. Open-ended questions were transcribed and analyzed using open, axial, and selective coding procedures. Member checks and peer debriefing techniques ensured trustworthiness of the study. Pearson correlations identified moderate relationships among motivation and clinical integration (r = 0.515, P < .01) and motivation and academic integration (r = 0.509, P < .01). Univariate analyses of variance showed that academic integration (F(1,122) = 8.483, P < .004), clinical integration (F(1,119) = 30.214, P < .001), and motivation (F(1,121) = 68.887, P < .001) discriminated between seniors and major changers. Discriminant analysis indicated that motivation was the strongest predictor of persistence in athletic training education, accounting for 37.2% of the variance between groups. The theoretic model accurately classified 95.7% of the seniors and 53.8% of the major changers. A common theme emerging from the qualitative data was the presence of a strong peer-support group that surrounded many of the senior-level students. Understanding student retention in athletic training is important for our profession. Results from this study suggest 3 key factors associated with student persistence in athletic training education programs: (1) student motivation, (2) clinical and academic integration, and (3) the presence of a peer-support system. Educators and program directors must create comprehensive recruitment and retention strategies that address factors influencing students' decisions to stay in the athletic training profession.

Making Your Point: The Impact of Processing Techniques on Classroom Activities

Many teachers would readily acknowledge that their words can have a tremendous impact on students' learning. When activity is used as a teaching tool in the classroom, these words can take the form of “processing,” or intentional actions taken by a facilitator [educator] to influence the outcomes of that activity and, as a result, the learning that takes place. Much of the literature about processing is theoretical in nature. Therefore, the purpose of this study was to investigate the impact of two processing techniques (frontloading and debriefing) on activity outcomes. Frontloading (intentionally focusing students' attention to a particular issue or topic prior to an event) and debriefing (facilitating student reflection after an event) techniques were used in different combinations to target divergent outcomes in undergraduate college courses. The results of this study supported the necessity of using structured debriefing for classroom activities and did not support the use of frontloading as a standalone processing technique. Implications for classroom instructors are discussed.

Adolescents' perspectives on living and growing up with Treacher Collins syndrome: a qualitative study.

This study explored the experiences and essences of growing up and living with Treacher Collins syndrome (TCS) from an adolescent perspective. A qualitative approach using the long interview method was used to explore the adolescents' experiences. Semistructured interviews and peer debriefing techniques were used to gather and verify data with each participant. A purposive sampling technique was used to recruit a sample of six adolescents with TCS, ranging in age from 12 to 18 years, who received care from a craniofacial center in a large pediatric hospital. The themes central to the adolescents' experiences were balancing sameness and difference and the journey toward social and self-acceptance. Five subthemes further described this experience: reconstructing perceptions of others; making meaning of the difference; forming friendships and fitting in; handling staring and teasing; and excelling. The study group described good psychosocial adjustment, experienced an increasing acceptance of self, TCS, and social acceptance over time and demonstrated resilient adaptive strategies (optimism, motivation, and positive meaning making). They were, however, also challenged by the social stigma associated with difference and by the challenges of finding a good fit in their school environments in meeting unique needs, particularly in their early grades. This study highlights the value of using a qualitative research approach in furthering our understanding of the experiences of children and youth with facial differences.

Book Review: Psychological Debriefing: Theory, Practice and Evidence

The use of Psychological Debriefing has come under fire in recent psychological debate. This debate concerns the wide spread general use of psychological debriefing techniques in varying clinical settings and concerns about its efficacy. Recently the process of debriefing has become so widely utilised that large companies have implemented compulsory debriefing procedures for staff following traumatic events. These industries include emergency services, military groups and some large scale corporations.

The solution-focused debriefing group: An integrated postviolence group intervention for adults

A solution-focused debriefing group model for adult survivors of violence is described. This model integrates Critical Incident Stress Debriefing and solution-focused counseling techniques.

Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of post-traumatic stress disorder.

The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed. This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally. A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment. Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.