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Helping healthcare teams to debrief effectively: associations of debriefers’ actions and participants’ reflections during team debriefings
  1. Michaela Kolbe1,2,
  2. Bastian Grande1,3,
  3. Nale Lehmann-Willenbrock4,
  4. Julia Carolin Seelandt1
  1. 1 Simulation Centre, University Hospital Zurich, Zurich, Switzerland
  2. 2 ETH Zürich, Zurich, Switzerland
  3. 3 Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
  4. 4 University of Hamburg, Hamburg, Germany
  1. Correspondence to Dr Michaela Kolbe, Simulation Centre, University Hospital Zurich, Zurich 8091, Switzerland; mkolbe{at}


Background Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants’ reflection in debriefings.

Methods In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants’ verbalisation of a mental model as a particular form of reflection.

Results The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers’ observation to debriefers’ opinion (z=9.85, p<0.001), from opinion to debriefers’ open-ended question (z=9.52, p<0.001) and from open-ended question to participants’ mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes.

Conclusion When debriefers pair their observations and opinions with open-ended questions, paraphrase participants’ statements and ask specific questions, they help participants reflect during debriefings.

  • continuous quality improvement
  • crew resource management
  • human factors
  • medical education

Data availability statement

Data are available on reasonable request. Data are available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. Data are available from the corresponding author on reasonable request.

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  • Contributors MK and JCS designed the study. MK, BG and JCS collected the data. MK, NL-W and JCS analysed the data. MK wrote the first draft of the manuscript. All authors approved the final manuscript. MK acted as guarantor.

  • Funding This research was funded by a grant from the Swiss National Science Foundation (grant no. 100014_152822).

  • Competing interests The authors declare the following conflicts of interest: Michaela Kolbe, Bastian Grande and Julia C Seelandt are faculty at the Simulation Centre of the University Hospital Zurich, providing debriefing faculty development training. Michaela Kolbe is faculty for the Debriefing Academy, which runs debriefing courses for healthcare professionals. NL-W has no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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