Communication content during debriefing in simulation-based medical education: An analytic framework and mixed-methods analysis

Abstract

Background

Debriefing is an indispensable component of simulation-based medical education, and it has great potential for contributions to reflective learning. Little is known about the relevance of communication during debriefings. We developed a category framework to assess the communication content of debriefings, which we used to analyze possible relationships to participant learning outcomes.

Method

We deductively and inductively developed a category framework for qualitative content analysis of debriefings. We coded 20 debriefings using this framework, and correlated debriefing frequency with learning outcomes (i.e. engagement, satisfaction, individual and team learning success).

Results

The category framework comprised 9 main and 81 subcategories (48 debriefers, 27 participants, 6 simulated patients), which yielded good intercoder agreement. Debriefers and participants communicated equally using mostly advocacy, inquiry, illustration, and confirmation. Debriefer questions and participant inputs were positively related to learning outcomes. In contrast, guess-what-I-am-thinking, apologies, observations, use of materials, participant descriptions, simple repetition of statements, and evaluation by other participants were not positively associated with learning outcomes.

Conclusion

This study provides important new information about communication content during debriefings. The association between communication content and learning outcomes appears particularly relevant to further enhance efficacy of debriefings and simulation-based medical education.

Keywords:

• Debriefing
• simulation-based medical education
• communication
• advocacy
• inquiry
• training

Acknowledgements

The authors wish to thank Helen Eigenmann (HE), Peter Hinderberger and Fabian Krebs for their help with data collection and data management, Christopher Berrie for his diligent proofreading of the manuscript, and all participants of the simulations from the Anaesthesia Department at Bern University Hospital, and the staff of the Bern Simulation and CPR-Centre, Bern, Switzerland.

Ethics approval and consent to participate

All participants gave written informed consent, and the Bern Cantonal Ethics Committee (Req-2018-00271, 09.04.2018) waived the need for ethics approval. We used ID numbers to code participants and did not request identifying data. The data were stored in a password secure repository accessible to the investigators only. All procedures from this investigation followed the Helsinki Declaration, and all researchers complied with the Swiss Human Research Act.

Disclosure statement

RG is the Director of Training and Education of the European Resuscitation Council, the Task Force Chair Education, Implementation, and Team of ILCOR, and a member of the Direction of the MME Program of the University of Bern. The remaining authors report no declarations of interest.

Glossary

Advocacy & Inquiry: Advocacy means supporting an idea, plan, or way of doing something. Inquiry is the act of asking for information. Advocacy and inquiry are two key communication behaviors with critical implications for interpersonal, group, and organizational effectiveness. Advocacy & Inquiry is also a known model for debriefing.

Rudolph, Jenny W. PhD; Simon, Robert EdD; Dufresne, Ronald L. MS; Raemer, Daniel B., There's No Such Thing as ‘Nonjudgmental’ Debriefing: a Theory and Method for Debriefing with Good Judgment, Simulation in Healthcare: Spring 2006 - Volume 1 - Issue 1 - p 49–55.

Additional information

Notes on contributors

Joana Berger-Estilita

Joana Berger-Estilita, MD, MMEd (Dundee), is a Consultant in Anaesthesiology and Intensive Care at the Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland. Her research focuses on medical education, simulation, and airway management.

Valérie Lüthi

Valérie Lüthi, MSc, is a Research Assistant in the Department of Health Psychology and Behavioural Medicine at the University of Bern, in Bern, Switzerland. Her research is focused on debriefing in simulation-based medical education.

Robert Greif

Robert Greif, MD, MME, is Professor of Anaesthesiology in the Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland. He is Professor for Medical Education at the School of Medicine, Sigmund Freud University Vienna, Austria. His research focuses on medical education, simulation, resuscitation, and airway management.

Sandra Abegglen

Sandra Abegglen, PhD, is a Senior Researcher in the Department of Health Psychology and Behavioural Medicine at the University of Bern, in Bern, Switzerland and supervisor of the debriefers at Bernese Simulation and CPR Centre (BeSiC). Her research is focused on counselling and coaching interventions, and debriefing in simulation-based medical education.