BMJ Qual Saf 22:541-553 doi:10.1136/bmjqs-2012-000917
  • Original research

TeamGAINS: a tool for structured debriefings for simulation-based team trainings

  1. Bastian Grande2
  1. 1Organization, Work, Technology Group, Department of Management, Technology, and Economics, ETH Zurich, Switzerland
  2. 2University Hospital Zurich, Institute of Anaesthesiology, Zurich, Switzerland
  1. Correspondence to Dr Michaela Kolbe, ETH Zurich, Organization, Work, Technology Group, ETH Zurich, Weinbergstrasse 56/58, Zurich CH-8092, Switzerland; mkolbe{at}
  • Received 26 February 2012
  • Revised 22 September 2012
  • Accepted 21 November 2012
  • Published Online First 22 March 2013


Background Improving patient safety by training teams to successfully manage emergencies is a major concern in healthcare. Most current trainings use simulation of emergency situations to practice and reflect on relevant clinical and behavioural skills. We developed TeamGAINS, a hybrid, structured debriefing tool for simulation-based team trainings in healthcare that integrates three different debriefing approaches: guided team self-correction, advocacy-inquiry and systemic-constructivist techniques.

Methods TeamGAINS was administered during simulation-based trainings for clinical and behavioural skills for anaesthesia staff. One of the four daily scenarios involved all trainees, whereas the remaining three scenarios each involved only two trainees with the others observing them. Training instructors were senior anaesthesiologists and psychologists. To determine debriefing quality, we used a post-test-only (debriefing quality) and a pre-post-test (psychological safety, leader inclusiveness), no-control-group design. After each debriefing all trainees completed a self-report debriefing quality scale which we developed based on the Debriefing Assessment for Simulation in Healthcare and the Observational Structured Assessment of Debriefing. Perceived psychological safety and leader inclusiveness were measured before trainees’ first (premeasure) and after their last debriefing (postmeasure) at which time trainees’ reactions to the overall training were measured as well.

Results Four senior anaesthetists, 29 residents and 28 nurses participated in a total of 40 debriefings resulting in 235 evaluations. Utility of debriefings was evaluated as highly positive. Pre-post comparisons revealed that psychological safety and leader inclusiveness significantly increased after the debriefings.

Conclusions The results indicate that TeamGAINS could provide a useful debriefing tool for training anaesthesia staff on all levels of work experience. By combining state-of-the-art debriefing methods and integrating systemic-constructivist techniques, TeamGAINS has the potential to allow for a surfacing, reflecting on and changing of the dynamics of team interactions. Further research is necessary to systematically compare the effects of TeamGAINS’ components on the debriefing itself and on trainees’ changes in attitudes and behaviours.

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