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Looking in the mirror: Self-debriefing versus instructor debriefing for simulated crises*

Boet, Sylvain MD, MEd; Bould, M. Dylan MB ChB, MEd, FRCA; Bruppacher, Heinz R. MD, FMH; Desjardins, François PhD; Chandra, Deven B. MD, FRCPC, MEd; Naik, Viren N. MD, FRCPC, Med

doi: 10.1097/CCM.0b013e31820eb8be
Laboratory Investigations

Objective: To examine the effectiveness of self-debriefing as compared to instructor debriefing in the change of nontechnical skills performance of anesthesiology residents.

Design: Prospective, randomized, controlled study.

Setting: A university hospital simulation center.

Subjects: Fifty anesthesiology residents.

Interventions: Subjects were instructed in the principles of nontechnical skills for crisis management. Subsequently, each resident participated in a high-fidelity simulated anesthesia crisis scenario (pretest). Participants were randomized to either a video-assisted self-debriefing or instructor debriefing. In the self-debriefing group, subjects reviewed their pretest scenario by themselves, guided by the Anesthetists' Non-Technical Skills scale. The instructor debriefing group reviewed their pretest scenario guided by an expert instructor also using the Anesthetists' Non-Technical Skills scale as a framework. Immediately following their respective debriefings, subjects managed a second simulated crisis (post-test).

Measurements and Main Results: After all data were collected, two blinded experts independently rated videos of all performances in a random order using the Anesthetists' Non-Technical Skills scale. Performance significantly improved from pretest to post-test (p < .01) regardless of the type of debriefing received. There was no significant difference in the degree of improvement between self-debriefing and instructor debriefing (p = .58).

Conclusions: Nontechnical skills for crisis resource management improved with training, as measured by the Anesthetists' Non-Technical Skills scale. Crisis resource management can be taught, with measurable improvements. Effective teaching of nontechnical skills can be achieved through formative self-assessment even when instructors are not available.

From the Department of Anesthesiology (SB, HRB, DBC), St. Michael's Hospital, University of Toronto, Toronto, Ontario; Department of Anesthesiology (MDB), Children's Hospital of Eastern Ontario, Ottawa, Ontario; Faculty of Education (FD), University of Ontario Institute of Technology, Oshawa, Ontario; and Department of Anesthesiology (VNN), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.

Supported, in part, by a research grant from the Network of Excellence in Simulation for Clinical Teaching & Learning, Toronto, Canada.

The authors have not disclosed any potential conflicts of interest.

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