Individual Debriefing Research Articles

Performing versus observing: Investigating the effectiveness of group debriefing in a VR-based safety education program

How can students in a large classroom benefit from virtual reality (VR)-based instruction despite limited equipment? Group debriefing based on observed VR experiences provides a potential solution. This study employed a two-by-two factorial design to empirically investigate the feasibility and effectiveness of debriefing and types of VR experiences on enhancing VR learning outcomes. Second and third graders (n = 150) were randomly assigned to one of the four VR learning conditions: (1) performing individually with individual debriefing, (2) performing individually with no debriefing, (3) observing in a group with group debriefing, and (4) observing in a group with no debriefing. Study results reported moderate effect sizes of debriefing on increasing knowledge test as well as performance scores of the VR learners but revealed no significant difference between direct and observed VR learning experiences. The findings reveal that students can benefit from vicarious VR learning experiences if an instructional component of debriefing is provided in educational practice.

Le « débriefing francophone » : origines, définitions, évolutions, efficacité. Trois décennies de discours spécialisé vers la thérapie du trauma

Le « débriefing francophone » : origines, définitions, évolutions, efficacité. Trois décennies de discours spécialisé vers la thérapie du trauma

Using virtual reality to identify and modify risky pedestrian behaviors amongst Chinese children

Objective: China has a high fatality rate for child pedestrians, which highlights the necessity of implementing more effective pedestrian safety training programs in elementary schools. We thus investigated the efficacy of using virtual reality (VR) as an instructional technology to identify and modify risky pedestrian behaviors among Chinese children.Methods: Seventy-nine children (grades 1 through 3) from three elementary schools in Hubei province participated and were categorized into urban (n = 20), migrant (n = 29), or rural (n = 30) students based on the schools’ locations. They completed a VR program comprising three street-crossing challenges to measure five pedestrian behaviors. The participants first attempted to complete the challenges by themselves in the first-time trial (T1) and then engaged in a personalized debriefing session before undertaking the challenges a second time (T2). Pedestrian performance for the two trials was compared by school location and grade level as between-subjects factors, and the rationale behind risky pedestrian behaviors was inductively analyzed.Results: Three risky pedestrian behaviors were observed in the program: dashing into the street, crossing on a blinking green light, and failing to check for traffic. Potential reasons for these behaviors included a lack of knowledge of road signs and traffic rules and the absence of daily adult supervision. The overall pedestrian performance increased from T1 to T2 with a moderate effect size (Ƞp2 = 0.59, p < .001). A significant main effect of the trials was found for the three pedestrian behaviors (for all values, p < .001); however, interactions of trial by location and trial by grade were nonsignificant in all univariate tests (for all values, p ≥ .05).Conclusions: VR is an effective technology to diagnose and correct risky pedestrian behaviors among Chinese children when accompanied with individual debriefing and repetitive practices. School location and grade level had no significant influence on children’s pedestrian performance and learning outcomes, indicating the ubiquity of the pedestrian safety problem and the need for more effective instructional interventions.

Pulseless Electrical Activity Cardiac Arrest.

This simulation-based scenario is appropriate for senior level emergency medicine residents. Pulseless electrical activity (PEA) accounts for up to 25% of sudden cardiac arrest;1 therefore the ability to recognize and care for this condition is an essential skill of emergency medicine physicians. Management of PEA arrest in the emergency department centers on Advanced Cardiac Life Support (ACLS) algorithms and the identification and treatment of potentially reversible causes. Massive pulmonary embolism (PE) is one of several causes of PEA cardiac arrest.2 However, diagnosis by CT-angiographic or nuclear imaging may not be obtainable in the hemodynamically unstable patient, requiring physicians to have a high index of suspicion. Systemic thrombolytic therapy is indicated in cardiac arrest due to known or presumed massive pulmonary embolism.3,4,5. After competing this simulation-based session, the learner will be able to:Identify PEA arrestReview the ACLS commonly recognized PEA arrest etiologies via the H &T mnemonicReview and discuss the risks and benefits of tissue plasminogen activator (tPA) for massive PE. This is a high-fidelity simulation that allows learners to evaluate and treat a PEA arrest secondary to massive PE in a safe environment. The learners will demonstrate their ability to recognize a PEA arrest, sort through possible etiologies, and demonstrate treatment of a massive PE with tPA. Debriefing will focus on diagnosis and management of the PEA arrest. This case was piloted with 12 PGY-2 and PGY-3 residents. Group and individual debriefing occurred post-case. Post-simulation feedback from the faculty suggested two potential issues. First was fidelity, which we increased by using our ultrasound simulator. Second, the elevated presenting glucose with lactic acidosis could be a poor cue, leading some towards diabetic ketoacidosis (DKA). Learners felt more confident about running a PEA arrest. The simulation improved resident awareness of the value of point of care ultrasound (POCUS) in cardiac arrest. It also clarified the dosing of tPA in massive PE. Faculty felt simulating the actual US without breaking simulation would be more challenging without our US simulator. Although there was concern about results pointing towards possible DKA, this did not occur in any of the pilot simulations. The presenting glucose was reduced to make this less likely in future simulations. Pulseless electrical activity (PEA), syncope, cardiac arrest, Hs and Ts from ACLS PEA instruction, tPA for massive PE, critical care medicine, simulation.

Piloting for the Multidimensional Job Satisfaction Instrument in the Offshore Work Setting

This article draws upon pilot study to test the developed job satisfaction questionnaire with offshore catering employees. Changing the attention from a hypothetical work setting where job satisfaction is usually studied, this study investigated employees’ satisfaction with the offshore catering job as the employees perform their job in an isolated and confined work environment. The pilot study was employed as an impetus for a scale development dissertation in validating a bespoke job satisfaction instrument in the offshore catering context. In this small-scale study, the researchers investigated job satisfaction with a purposive sample of 37 (n=37) offshore catering employees using electronic-based survey. Subsequently, an individual debriefing was conducted with four respondents to improve the questionnaire items. The objectives of the pilot study were to evaluate the quality of the items and to identify potential challenges that might occur in the main study. The study findings are not extensively discussed; however, adequate information about the study background and sample characteristics are included. The study about job satisfaction among offshore catering employees was used to demonstrate the process. The key aspects of the pilot study including the amendment of items, challenges encountered during data collection, and modifications made to the actual study are discussed.

Pediatric Disaster Triage: Multiple Simulation Curriculum Improves Prehospital Care Providers' Assessment Skills

ABSTRACTObjective: Paramedics and emergency medical technicians (EMTs) triage pediatric disaster victims infrequently. The objective of this study was to measure the effect of a multiple-patient, multiple-simulation curriculum on accuracy of pediatric disaster triage (PDT). Methods: Paramedics, paramedic students, and EMTs from three sites were enrolled. Triage accuracy was measured three times (Time 0, Time 1 [two weeks later], and Time 2 [6 months later]) during a disaster simulation, in which high and low fidelity manikins and actors portrayed 10 victims. Accuracy was determined by participant triage decision concordance with predetermined expected triage level (RED [Immediate], YELLOW [Delayed], GREEN [Ambulatory], BLACK [Deceased]) for each victim. Between Time 0 and Time 1, participants completed an interactive online module, and after each simulation there was an individual debriefing. Associations between participant level of training, years of experience, and enrollment site were determined, as were instances of the most dangerous mistriage, when RED and YELLOW victims were triaged BLACK. Results: The study enrolled 331 participants, and the analysis included 261 (78.9%) participants who completed the study, 123 from the Connecticut site, 83 from Rhode Island, and 55 from Massachusetts. Triage accuracy improved significantly from Time 0 to Time 1, after the educational interventions (first simulation with debriefing, and an interactive online module), with a median 10% overall improvement (p < 0.001). Subgroup analyses showed between Time 0 and Time 1, paramedics and paramedic students improved more than EMTs (p = 0.002). Analysis of triage accuracy showed greatest improvement in overall accuracy for YELLOW triage patients (Time 0 50% accurate, Time1 100%), followed by RED patients (Time 0 80%, Time 1 100%). There was no significant difference in accuracy between Time 1 and Time 2 (p = 0.073). Conclusion: This study shows that the multiple-victim, multiple-simulation curriculum yields a durable 10% improvement in simulated triage accuracy. Future iterations of the curriculum can target greater improvements in EMT triage accuracy.

The Use of Debriefing With Children.

The debate over the use of psychological debriefing in the early aftermath of a traumatic event has raged for decades, yet little attention has been paid to its use with perhaps the most vulnerable of victims, children and adolescents. While recommendations against the use of group debriefing with adults seem to have been made based on research of individual debriefing, recommendations regarding its use with children have been made based on the adult literature. In this review, we outline the possible mechanisms of harm and benefit of debriefing with a discussion of developmental concerns. The available empirical and nonempirical literature on the use of debriefing with youth is summarized. While research does not currently evidence harm in the use of debriefing with children, there is no strong support for its use either. We present both clinical considerations and research implications as they relate to debriefing as well as what this debate has taught us about the challenges to disseminating and evaluating early crisis interventions in general.

Teaching evaluations and reflective practice: Strategies for improving teaching skills in adventure education

There is a shortage of evidence-based research on evaluation of teaching skills of adventure educators. Although program and instructor assessments are regularly used, there is limited documentation as to the methods employed to design them. Incomplete theoretical conceptions about the role of the instructor and how students learn may account for the lack of research on instructional evaluation in adventure education. The authors suggest that adventure education assessments put more focus on evaluation of teaching strategies by incorporating theories of reflective practice. The goal is to improve outdoor pedagogy using a mutually supportive debriefing format. The authors provide a summary of four themes (evaluation methods, opportunities for individual and shared debriefing as reflective practice, the role of feedback in student learning, and adaptive expertise), based on recent research, which can contribute to a future model of reflective practice for adventure education.

Board 282 - Program Innovations Abstract Simultaneous Simulation

Introduction/Background As interns across all specialties graduate from internship into their more senior post graduate years, there is an inherent transformation in their duties and the expectations placed upon them. These shifts include moving from the role of reporter to one of interpreter and intervener and this coincides with responsibility for significantly more patients at any given time. Along with this, new residents inherently lose their "safety net". This opportunity to seek guidance from senior resident dissipates as they assume the role of advisor. This transition, although occurring every July since the conception graduate medical education, has little to no standardization or regulation and potentially poses a significant risk to patient safety. As we migrate to competency based assessment and milestone development, high fidelity simulation offers a unique opportunity for standardized evaluation and just-in-time education as necessary. Methods We developed a series of unstable patient scenarios (acute hypoxemia, atrial fibrillation with RVR, GIB, and septic shock) that were designed to be run simultaneously. All categorical internal medicine residents transitioning from PGY1 to PGY2 at our institution participated in the educational project. Through a random number generator, scenarios were randomly ordered for each resident. All residents were provided a prebrief and orientation on arrival to the scenario. The first group of two scenarios were run simultaneously, requiring the resident to travel between rooms, triage duties depending on severity of illness of the patient and escalate intervention on patients as necessary. Residents were scored on a multitude of previously agreed upon key interventions (both diagnostic and therapeutic) for each scenario on a scale of zero to two. At the Conclusion of the first set of scenarios, the second set was run in the same manner. Scoring was done real time by agreement of two experienced critical care physicians. Following Conclusion of the second set of scenarios, the residents were provided an individual debriefing and reeducation as necessary. Feedback was also sought from the learners regarding utility of the project and opportunities for improvement. Results: Conclusion All residents completed the scenarios. Although they performed well overall, there was a wide variance in performance between them and several common educational gaps were identified. It allowed for identification of specific learning opportunities and provided a venue for real-time remediation as necessary. All residents found this to be of benefit in preparation for their transition to their second year of residency. As competency-based milestone assessment becomes further integrated into ACGME, simulation will inherently need to take a more prominent role in both the assessment and education of residents. This project serves not only as a pilot that can be expanded to better reflect milestone assessments across specialties but also provides a venue to better evaluate educational opportunities for either individual residents or an entire program. It also provides an objective benchmark of performance for residents in the management of multiple coinciding and competing issues, which is a skill set of paramount importance as these learners progress through their residency.

Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial

Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.

DEVELOPMENT MONOPOLY

DEVELOPMENT MONOPOLY is a simulation game that allows players to experience how power relations influence the agency of different socioeconomic groups, and how this can induce poverty and inequality. Players alter the original rules of the MONOPOLY board game so that they more accurately reflect social stratification and inequalities in the context of developing countries. After the game, the players reflect on how they could be made more inclusive and pro-poor. In an individual debriefing, they are invited to think about the connections between game dynamics and contemporary evolutions in developing countries. In a final collective debriefing phase, participants discuss the ways in which the simulation experience enhanced their understandings of poverty and inequality.

Firefighter preferences regarding post-incident intervention

The effectiveness of Critical Incident Stress Debriefing (CISD) as a tool remains, at best, inconclusive. Yet in many locales CISD is mandatory for emergency services workers, including firefighters. To our knowledge, to date no study has investigated firefighters’ preferences for psychological intervention following traumatic events. To examine this, a survey was conducted with 142 members (54%) of an urban fire and rescue service in south-western Ontario, Canada. Firefighters were provided with five scenarios of varying traumatic intensity, for which they rated desirability of four voluntary post-incident interventions: CISD, individual debriefing, informal discussion, and no intervention. Firefighters expressed interest in working with post-event reactions within their peer group for all events, and an increasing interest in formal intervention as event severity increased. Individual debriefing was preferred to CISD in scenarios of low to moderate intensity. For scenarios of high intensity, ratings for all interventions were high. Expected relationships with prior CISD experience and years of service were not upheld. The essential role of informal peer-support, and the desire for meaningful intervention in severe situations, are discussed.

Durability of Non-Technical Skills Following Crisis Resource Management Training.

BACKGROUND: Non-technical skills, such as task management, team working, situation awareness and decision making, are vital to anesthesia crisis resource management.(1) These skills are often taught using a high fidelity patient simulator. Previous studies have demonstrated improvement in non-technical skills following a debriefing of a simulated crisis, and sustained skills two months after the training session. This same study showed these skills are not learned through clinical duties exclusively.(2) We conducted this study to examine the durability of teaching non-technical skills over time. METHODS: After institutional ethics approval, 8 junior anesthesia residents were recruited as subjects. Each had one individual debriefing of their management of a crisis prior to a pre-test. The pre-test was the management of a simulated intraoperative cardiopulmonary arrest, followed by a videotape-assisted debriefing focused on their non-technical skills. No subjects participated in a simulator session for eight months. Eight months after their pre-test, each subject returned to manage a post-test, consisting of the management of a similar intraoperative cardiopulmonary arrest. Videotaped performances were reviewed by two expert blinded independent assessors who rated each subject’s non-technical skills, using a previously validated and reliable marking system.(1) RESULTS: A significant improvement in non-technical skills was observed eight months after a simulated crisis resource management training session (p<0.001)(see Figure).FigureCONCLUSIONS: Not only are measurements of residents’ non-technical skills sustained with respect to simulated crisis management eight months following a training session - they are improved. Residents’ reflection on their simulated crisis experience and debriefing may have lead to improvement. Improvement may also be secondary to non-technical skills that were practiced clinically, after simulator sessions. Educators should be reassured that the non-technical skills learned during simulated crisis management training sessions are durable.

A Randomized Controlled Trial of an Adapted Form of Individual Critical Incident Stress Debriefing for Victims of an Armed Robbery

Victims of an armed robbery are at great risk of psychological distress. This research is a prospective randomized controlled clinical trial of an adapted form of Critical Incident Stress Debriefing (CISD-A) with victims of an armed robbery. The specific goals are to examine whether the CISD-A is superior to the control group in both preventing the development of a posttraumatic stress disorder (PTSD) and attenuating the frequency and severity of posttraumatic stress symptoms. Following pretest, 75 participants were randomly assigned to individual debriefing or to a control group. Results revealed no differences between the CISD-A and the control group in preventing PTSD or attenuating posttraumatic symptoms 1 and 3 months later.

Individual Debriefing vs. Computer Based Multimedia Instruction After Patient Crisis Simulation

BACKGROUND: Several advantages of simulation over didactic and patient dependent teaching have lead to a proliferation of patient simulators in academic centers. Although simulation experience alone seems insufficient for learning, research evaluating different modes of instruction following simulation is lacking (1). Standardized multimedia has shown to be useful in teaching surgical skills, but has not been evaluated for use as an adjunct in crises management training. The primary purpose of this study is to determine whether standardized computer-based multimedia instruction is effective for learning in patient crises scenarios. The secondary purpose is to compare multimedia debriefing to personal oral debriefing with an expert. METHODS: Thirty anesthesia residents were recruited to manage three different simulated resuscitation crises using a high-fidelity patient simulator. Following the first scenario, subjects were randomized to either a computer-based multimedia tutorial or a personal debriefing with an expert followed by a posttest and retention test five weeks later. To date, the performances of 20 residents were independently rated by two expert blinded assessors using the previously validated Anesthesia Non Technical Skills (ANTS) marking system (2). RESULTS: Resident performance of non-technical skills improved significantly in both groups compared to pretest p<0.05). The improvement was sustained after five weeks for both groups (p<0.05)(see Figure). No significant difference in the performance of residents receiving either type of debriefing was demonstrated in any of the tests.FigureCONCLUSION: Computer based multimedia instruction is an effective method of teaching non-technical skills in simulated crisis scenarios and may be as effective as oral personalized debriefing. Multimedia may be a valuable adjunct to centers when debriefing expertise is not available. Multimedia may also improve simulation utilization by reducing anxiety of peer evaluation in continuing medical education. (1) Savodelli GL et al., submitted 2005. (2) Fletcher G et al., Br J Anaesth 2003; 90 (5) 580–588. Conflict of Interest: Authors indicated they have nothing to disclose.

Traumatic birth: understanding predictors, triggers, and counseling process is essential to treatment.

Traumatic birth: understanding predictors, triggers, and counseling process is essential to treatment.

Brief psychological interventions ("debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder.

To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder. Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ.Safety and Health, CDSR and the Trials Register of the Depression, Anxiety and Neurosis group. Hand search of Journal of Traumatic Stress. Contact with leading researchers. The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event. 8 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (pooled odds ratio 1.0, 95% ci 0.6-1.8). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.9, 95% ci 1.1-7.5). The pooled odds ratio for the two trials with follow ups just included unity (odds ratio 2.0, 95% ci 0.9-4.5). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety. There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.