The impact of a high fidelity simulation-based debriefing course on the Debriefing Assessment for Simulation in Healthcare (DASH)© score of novice instructors

Abstract

Introduction: Experiential learning, followed by debriefing, is at the heart of Simulation-Based Medical Education (SBME) and has been proven effective to help master several medical skills.<br />We investigated the impact of an educational intervention, based on high-fidelity SBME, on the debriefing competence of novice simulation instructors.<br />Methods: This is a prospective, randomized, quasi-experimental, pre- and post-test study. Sixty physicians without prior formal debriefing expertise attended a 5-day SBME seminar targeted on<br />debriefing. Prior to the start of the seminar, 15 randomly chosen participants had to debrief a spaghetti and tape team exercise. Thereafter, the members of each team assessed their debriefer's<br />performance using the Debriefing Assessment for Simulation in Healthcare (DASH)© score. The debriefing seminar that followed (intervention) consisted of 5 days of teaching that included theoretical and simulation training. Each scenario was followed by a Debriefing of the Debriefing (DOD) session conducted by the expert instructor. At the end of the course, 15 randomly chosen debriefers had to debrief a second tower building exercise and were re-evaluated with the DASH score by their respective team members. The Wilcoxon signed-rank test was used to compare pre- and post-test scores. Statistical tests were performed using GraphPad Prism 6.0c for Mac.<br />Results: A significant improvement in all items of the DASH score was noted following the seminar. The debriefers significantly improved their performance with regard to “maintaining an engaging learning environment" (Median [IQR]) (4[3-5] after the pre-test vs. 5.5[5-6] after the post-test, P<0.001); “structuring the debriefing in an organized way" (5[4-5] after the pre-test vs. 5[5-6] after the post-test, p=0.002); “provoking engaging discussion" (4[3-5.75] after the pre-test vs. 6[5-6]<br />after the post-test, P<0.001); “identifying and exploring performance gaps" (5[4-6] after the pre-test vs. 6[5-6] after the post-test, P=0.014); and “helping trainees to achieve and sustain good future performance" (4[3-5] after the pre-test vs. 6[5-6] after the post-test, P<0.001).<br />Conclusion: A simulation-based debriefing course, based mainly on DOD sessions, allowed novice simulation instructors to improve their overall debriefing skills including, more specifically, the ability<br />to foster engagement in discussions and maintain an engaging learning environment.