Self-Debriefing Leads to Similar Improvements as Facilitated Debriefing When Used in Medical Simulation

Abstract

Background: Simulation has gained popularity in recent years as an adjunct to clinical exposure. Optimal learning from simulation occurs with good debriefing. Current practice usually involves one or more clinical experts, trained in debriefing techniques, to facilitate the debrief, which often takes longer than the simulation. With the cost of simulation already high, it would be advantageous if the debrief could be accomplished by the learners directly, without the experts. Also, finding leaders for debriefing can be challenging for some institutions. Self-debriefing, a type of debriefing where the learners debrief by themselves without the help of a facilitator, might be an answer to this problem. Only one large study so far has evaluated self-debriefing as compared with faculty-led debriefing. This study showed promising results, but had some limitations. Methods: We have developed a new self-debriefing approach, using a self-debriefing tool that can be used by learners to self-debrief, without the need for a facilitator. We have compared this self- debriefing approach to debriefing done by second- and third-year residents in a randomized trial with 50 interns. The primary outcome of the study was overall performance of the interns in a second simulated case after a first case and debriefing, as rated by three blinded senior internal medicine residents. Secondary objectives included performance on seven other subscales of the evaluation tool as well as the opinion of interns on the self-debriefing tool, as recorded by questionnaires. Results: The overall performance of interns in the self-debriefing group increased by 0.28 point on an 8-point scale, while the overall performance in the resident-led debriefing group increased by 0.37 point, for a difference between groups of -0.09 point, which was not statistically significant (95% CI -0.38 to 0.21, p=0.5289). There was no statistically significant differences between the improvement in both randomization groups for the other seven subscales of the evaluation tool. Overall, there was a statistically significant improvement in the overall performance from case 1 to case 2 in the overall cohort of 0.33 point (95% CI 0.18 to 0.47, p=0.0002). There was also a statistically significant improvement from case 1 to case 2 for five of the seven other subscales evaluated. Interns rated the resident-led debriefing as superior to self-debriefing on five of six subscales in a questionnaire. Conclusion: Self-debriefing using a new self-debriefing tool was as efficient as resident-led debriefing in improving the performance of interns in a simulated environment, but the interns had a more positive view of the resident-led debriefing.