Guided team self-correction, Advocacy-Inquiry, Systemic-constructivist: the integrated approach for structured debriefings
| Step | Instructor's method | Examples of instructor's communication | Sample sources for debriefing step |
|---|---|---|---|
| 1. Reactions | Narrative question | ‘How did you feel?’, ‘How was it for you?’ | 27 36 37 51 55 56 |
| 2. Debriefing the clinical part of the scenario, clarify clinical questions, allow for understanding the appropriate clinical procedures | Narrative question | ‘What happened?’ | 27 36 52 56 |
| Advocacy-inquiry | ‘I would like to talk about intubation procedures. I saw you re-attempting to intubate using the laryngoscope three times in a row, each time it turned out unsuccessful. I think that you could have intubated faster by using another device such as the Laryngeal Mask or Bag Mask Ventilation. So, I am wondering what was on your mind in that moment?’ | ||
| Guided team self-correction | ‘What alternative device could you have used for intubation?’ | ||
| Systemic-constructivist approach: circular question | (to the nurse) ‘If a senior anaesthesiologist had been present at this moment, what would he/she have recommend to the resident?’ | ||
| 3.Transfer from simulation to reality | Narrative question | ‘What aspects of this scenario are familiar to you from your ‘real’ work? What similar situations have you already experienced?’ | 27 36 52 66 |
| 4. Reintroduce the expert model, systematically discuss the behavioural skills and their relationship to clinical outcomes | Guided team self-correction: elicit reflection about positive behaviour | ‘Let's go on to CRM-Principle 5: anticipation and planning. Give me an example of a situation where you anticipated a potential complication. What did you do?’ | 37 50–52 55 56 |
| Systemic question (elicitation meaning of behaviour) | ‘Having anticipated the potential complication—how did this help you later on?’ | ||
| Advocacy-inquiry (using the video) | ‘Let's talk about shared planning. During that situation I saw you working very quietly together and I was concerned whether each of you knew about each other's plan for the next step. What was on your mind?’ (…) (to nurse) ‘What did you know about her plan in that situation?’ | ||
| Circular question | (Turning to resident) How could it have been useful for him to know what you were about to do and what you needed?’(…) | ||
| Guided team self-correction: elicit reflection about positive behaviour | ‘As heard earlier, rising voice when in doubt can be life-saving in anaesthesia. It is also one of the 10 CRM principles. Describe an instance when one of you spoke up’. | ||
| Advocacy-inquiry (using the video) | ‘In that situation my impression is that you are not OK with what he is doing. I was concerned that you would not let him know this and that he would proceed giving the wrong medication dose. What was on your mind?’ | ||
| Observer-perspective, circular questions using the Reflecting Team | (to trainees who have observed the scenario) ‘What do you think she might have needed from him to speak up in that situation?’ | ||
| 5. Summarise learning experience and finish debriefing | Inquiry | ‘Which of the CRM-Principles do you consider most important after that simulation?’ | 27 37 51 55 56 |
| Circular question | ‘Overall, if inexperienced anaesthesia residents and nurses had watched you during the scenario, what could they have learned from you?’ | ||
| 6. If required, improve clinical skills | Practice clinical skills that were not optimally performed during the simulation | Supervised practice of using the defibrillator | 67 68 |
CRM, Crisis Resource Management.