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Within-Team Debriefing Versus Instructor-Led Debriefing for Simulation-Based Education: A Randomized Controlled Trial

Boet, Sylvain MD, MEd*; Bould, M. Dylan MB ChB, MEd; Sharma, Bharat MD, MEd*,‡; Revees, Scott PhD§; Naik, Viren N. MD, MEd, FRCPC*; Triby, Emmanuel PhD; Grantcharov, Teodor MD, PhD‡,§

doi: 10.1097/SLA.0b013e31829659e4
Randomized Controlled Trials

Objective: To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on team performance during a simulated crisis.

Background: Although instructor-led simulation debriefing is considered the “gold standard” in team-based simulation education, cost and logistics are limiting factors for its implementation. Within-team debriefing, led by the individuals of the team itself rather than an external instructor, has the potential to address these limitations.

Methods: One hundred twenty subjects were grouped into 40 operating room teams consisting of 1 anesthesia trainee, 1 surgical trainee, and 1 staff circulating operating room nurse. All teams managed a simulated crisis scenario (pretest). Teams were then randomized to either a within-team debriefing group or an instructor-led debriefing group. In the within-team debriefing group, the teams reviewed the video of their scenario by themselves. The teams in the instructor-led debriefing group reviewed their scenario guided by a trained instructor. Immediately after debriefing, all teams managed a different intraoperative crisis scenario (posttest). All sessions were videotaped. Blinded expert examiners used the validated Team Emergency Assessment Measure scale to assess crisis resource management performance of all teams in random order.

Result: Team performance significantly improved from pretest to posttest (P = 0.008) regardless of the type of debriefing. There was no significant difference in the degree of improvement between within-team debriefing and instructor-led debriefing (P = 0.52).

Conclusions: Within-team debriefing results in measurable improvements in team performance in simulated crisis scenarios. This form of debriefing may be as effective as instructor-led team debriefing, which could improve resource utilization and feasibility of team-based simulation (NCT01067378).

Supplemental Digital Content is Available in the Text.Crisis resource management can be taught to teams, resulting in measurable improvement in team performance. Within-team debriefing—with no instructor—is effective in improving crisis resource management performance of teams during simulated scenarios and may be as effective as an instructor-led team debriefing.

*The University of Ottawa Skills and Simulation Centre & Department of Anesthesiology of The Ottawa Hospital, Ottawa

The University of Ottawa Skills and Simulation Centre & Department of Anesthesiology, Children's Hospital of Eastern Ontario, Ottawa

Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto

§Li Ka Shing International Healthcare Education Centre & Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; and

Faculté de Sciences de l'Education, Université de Strasbourg, Strasbourg, France.

Reprints: Sylvain Boet, MD, MEd, The University of Ottawa Skills and Simulation Centre & Department of Anesthesiology of The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. E-mail:

Disclosure: The virtual reality laparoscopic simulator (LapSim, Surgical Science, Gothenberg Sweden) used in this study was provided in kind by Surgical Science, Inc. The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 by Lippincott Williams & Wilkins.