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Objective Structured Assessment of Debriefing: Bringing Science to the Art of Debriefing in Surgery

Arora, Sonal PhD*; Ahmed, Maria MPH*; Paige, John MD; Nestel, Debra PhD; Runnacles, Jane MBBS*; Hull, Louise MSc*; Darzi, Ara MD, FACS*; Sevdalis, Nick PhD*

doi: 10.1097/SLA.0b013e3182610c91
Original Articles

Objective: To identify the features of effective debriefing and to use this to develop and validate a tool for assessing such debriefings.

Introduction: Simulation-based training has become an accepted means of surgical skill acquisition. A key component of this is debriefing—yet there is a paucity of research to guide best practice.

Methods: Phase 1—Identification of best practice and tool development. A search of the Medline, Embase, PsycINFO, and ERIC databases identified current evidence on debriefing. End-user input was obtained through 33 semistructured interviews conducted with surgeons (n = 18) and other operating room personnel (n = 15) from 3 continents (UK, USA, Australia) using standardized qualitative methodology. An expert panel (n = 7) combined the data to create the Objective Structured Assessment of Debriefing (OSAD) tool. Phase 2—Psychometric testing. OSAD was tested for feasibility, reliability, and validity by 2 independent assessors who rated 20 debriefings following high-fidelity simulations.

Results: Phase 1: 28 reports on debriefing were retrieved from the literature. Key components of an effective debriefing identified from these reports and the 33 interviews included: approach to debriefing, learning environment, learner engagement, reaction, reflection, analysis, diagnosis of strengths and areas for improvement, and application to clinical practice. Phase 2: OSAD was feasible, reliable [inter-rater ICC (intraclass correlation coefficient) = 0.88, test–retest ICC = 0.90], and face and content valid (content validity index = 0.94).

Conclusions: OSAD provides an evidence-based, end-user informed approach to debriefing in surgery. By quantifying the quality of a debriefing, OSAD has the potential to identify areas for improving practice and to optimize learning during simulation-based training.

This study reports the identification of scientifically robust guidelines for debriefing in surgery, incorporating the best evidence and end-user opinion. Using this information, the Objective Structured Assessment of Debriefing (OSAD) tool was created and demonstrated to be feasible, reliable, and valid to assess the quality of surgical debriefings.

*Department of Surgery and Cancer, Imperial College, London, UK

Louisiana State University Health Sciences Center, USA

Gippsland Medical School, School of Rural Health, Faculty of Medicine, Monash University, Australia.

Reprints: Sonal Arora, PhD, Department of Surgery and Cancer, 10th Floor, QEQM Building, St Marys Hospital, Praed Street, London W2 1NY, UK. E-mail:

Disclosure: This study was funded by the London Deanery STeLI initiative and by the Association of Surgical Education CESERT grant. S.A., M.A., L.H., and N.S. are also affiliated with the Imperial Centre for Patient Safety and Service Quality, which is funded by the National Institute for Health Research (NIHR).

© 2012 Lippincott Williams & Wilkins, Inc.