Embracing informed learner self-assessment during debriefing: the art of plus-delta

Advances in Simulation - 2021
Adam Cheng1, Walter Eppich2, Chad Epps3, Michaela Kolbe4, Michael Meguerdichian5, Vincent Grant1
1KidSIM Simulation Program, Alberta Children’s Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
2RSCI SIM Centre for Simulation Education and Research RCSI University of Medicine and Health Sciences, Dublin, Ireland
3Departments of Anesthesiology and Interprofessional Education, University of Tennessee Health Science Center, Memphis, USA
4Simulation Center, UniversitatsSpital Zurich, Zurich, Switzerland
5Department of Emergency Medicine, NYC Health + Hospitals/Harlem, NYC Health + Hospitals/Simulation Center, Columbia University, New York, USA

Tóm tắt

AbstractThe healthcare simulation field has no shortage of debriefing options. Some demand considerable skill which serves as a barrier to more widespread implementation. The plus-delta approach to debriefing offers the advantages of conceptual simplicity and ease of implementation. Importantly, plus-delta promotes learners’ capacity for a self-assessment, a skill vital for safe clinical practice and yet a notorious deficiency in professional practice. The plus-delta approach confers the benefits of promoting uptake of debriefing in time-limited settings by educators with both fundamental but also advanced skills, and enhancing essential capacity for critical self-assessment informed by objective performance feedback. In this paper, we describe the role of plus-delta in debriefing, provide guidance for incorporating informed learner self-assessment into debriefings, and highlight four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.

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Tài liệu tham khảo

Kolbe M, Grande B, Spahn DR. Briefing and debriefing during simulation-based training and beyond: content, structure, attitude and setting. Best Pract Res Clin Anaesthesiol. 2015;29(1):87–96. https://doi.org/10.1016/j.bpa.2015.01.002.

Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More than one way to debrief a critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11(3):209–17. https://doi.org/10.1097/SIH.0000000000000148.

Cheng A, Eppich W, Grant V, Sherbino J, Zendejas B, Cook DA. Debriefing for technology-enhanced simulation: a systematic review and meta-analysis. Med Educ. 2014;48(7):657–66. https://doi.org/10.1111/medu.12432.

Arafeh JM, Hansen SS, Nichols A. Debriefing in simulated-based learning: facilitating a reflective discussion. J Perinat Neonatal Nurs. 2010;24(4):302–9. https://doi.org/10.1097/JPN.0b013e3181f6b5ec.

Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25. https://doi.org/10.1097/SIH.0b013e3180315539.

Levett-Jones T, Lapkin S. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Educ Today. 2014;34(6):e58–63. https://doi.org/10.1016/j.nedt.2013.09.020.

Mullan PC, Wuestner E, Kerr TD, Christopher DP, Patel B. Implementation of an in situ qualitative debriefing tool for resuscitations. Resuscitation. 2013;84(7):946–51. https://doi.org/10.1016/j.resuscitation.2012.12.005.

Sweberg T, Sen AI, Mullan PC, Cheng A, Knight L, del Castillo J, et al. Description of hot debriefings after in-hospital cardiac arrests in an international pediatric quality improvement collaborative. Resuscitation. 2018;128:181–7. https://doi.org/10.1016/j.resuscitation.2018.05.015.

Zinns LE, Mullan PC, O'Connell KJ, Ryan LM, Wratney AT. An evaluation of a new debriefing framework: REFLECT. Pediatric Emergency Care. 2017;Publish Ahead of Print. https://doi.org/10.1097/PEC.0000000000001111.

Ahmed M, Arora S, Russ S, Darzi A, Vincent C, Sevdalis N. Operation debrief: a SHARP improvement in performance feedback in the operating room. Ann Surg. 2013;258(6):958–63. https://doi.org/10.1097/SLA.0b013e31828c88fc.

Rose S, Cheng A. Charge nurse facilitated clinical debriefing in the emergency department. CJEM. 2018:1–5.

Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc. 2015;10(2):106–15. https://doi.org/10.1097/SIH.0000000000000072.

Schmutz J, Eppich W. When I say ... team reflexivity. Medical Education. 2019;53(6):545-6, When I say … team reflexivity, DOI: https://doi.org/10.1111/medu.13768.

Schmutz J, Eppich WJ. Promoting learning and patient care through shared reflection: a conceptual framework for team reflexivity in health care. Acad Med. 2017;92(11):1555–63. https://doi.org/10.1097/ACM.0000000000001688.

Ross JA, Rolheiser C, Hogaboam-Gray A. Student evaluation in co-operative learning: teacher cognitions. Teachers and Teaching. 2006;4(2):299–316.

Sawyer TL, Deering S. Adaptation of the US Army’s After-Action Review for simulation debriefing in healthcare. Simul Healthc. 2013;8(6):388–97. https://doi.org/10.1097/SIH.0b013e31829ac85c.

Morrison J, Meliza L. Foundations of the After Action Review Process. Special Report #42. US Army Research Institute for the Behavioral and: Social Sciences; 1999.

Cheng A, Morse KJ, Rudolph J, Arab AA, Runnacles J, Eppich W. Learner-centered debriefing for health care simulation education: lessons for faculty development. Simul Healthc. 2016;11(1):32–40. https://doi.org/10.1097/SIH.0000000000000136.

Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102. https://doi.org/10.1001/jama.296.9.1094.

Andrade HL. A critical review of research on student self-assessment. Frontiers in Education. 2019;4. https://doi.org/10.3389/feduc.2019.00087.

Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77(6):1121–34. https://doi.org/10.1037/0022-3514.77.6.1121.

Hodges B, Regehr G, Martin DR. Difficulties in recognizing one’s own incompetence: novice physicians who are unskilled and unaware of it. Acad Med. 2001;76(Supplement):S87–9. https://doi.org/10.1097/00001888-200110001-00029.

Abadel FT, Hattab AS. How does the medical graduates' self-assessment of their clinical competency differ from experts’ assessment? BMC Medical Education. 2013;13(1):24. https://doi.org/10.1186/1472-6920-13-24.

Gordon MJ. A review of the validity and accuracy of self-assessments in health professions training. Acad Med. 1991;66(12):762–9. https://doi.org/10.1097/00001888-199112000-00012.

Cheng A, Overly F, Kessler D, Nadkarni VM, Lin Y, Doan Q, et al. Perception of CPR quality: influence of CPR feedback, Just-in-Time CPR training and provider role. Resuscitation. 2015;87:44–50. https://doi.org/10.1016/j.resuscitation.2014.11.015.

Pisklakov S, Rimal J, McGuirt S. Role of self-evaluation and self-assessment in medical student and resident education. British J Educ, Soc Behav Sci. 2014;4(1):1–9. https://doi.org/10.9734/BJESBS/2014/5066.

Arnold L, Willoughby T, Calkins E. Self-evaluation in undergraduate medical education: a longitudinal perspective. J Med Educ. 1985;60(1):21–8. https://doi.org/10.1097/00001888-198501000-00004.

Leaf D, Neighbor W, Schaad D, Scott C. A comparison of self-report and chart audit in studying resident physician assessment of cardiac risk factors. J Gen Intern Med . 1995;10(4):194–8. https://doi.org/10.1007/BF02600254.

Hawkins SC, Osborne A, Schofield SJ, Pournaras DJ, Chester JF. Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks. Med Teach. 2012;34(4):279–84. https://doi.org/10.3109/0142159X.2012.658897.

Sargeant J. How external performance standards inform self-assessment. Med Teach. 2012;34(4):267–8. https://doi.org/10.3109/0142159X.2012.658898.

Sargeant J, Lockyer J, Mann K, Holmboe E, Silver I, Armson H, et al. Facilitated reflective performance feedback: developing an evidence- and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Acad Med. 2015;90(12):1698–706. https://doi.org/10.1097/ACM.0000000000000809.

Mann K, van der Vleuten C, Eva K, Armson H, Chesluk B, Dornan T, et al. Tensions in informed self-assessment: how the desire for feedback and reticence to collect and use it can conflict. Acad Med. 2011;86(9):1120–7. https://doi.org/10.1097/ACM.0b013e318226abdd.

Sargeant J, Eva KW, Armson H, Chesluk B, Dornan T, Holmboe E, et al. Features of assessment learners use to make informed self-assessments of clinical performance. Med Educ. 2011;45(6):636–47. https://doi.org/10.1111/j.1365-2923.2010.03888.x.

Colthart I, Bagnall G, Evans A, et al. The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice: BEME Guide no. 10. Med Teach. 2009;30(2):124-145.

Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, et al. Resuscitation education science: educational strategies to improve outcomes from cardiac arrest: a scientific statement from the American Heart Association. Circulation. 2018;138(6):e82–e122. https://doi.org/10.1161/CIR.0000000000000583.

West MA. Reflexivity, revolution and innovation in work teams. In: Beyerlein MM, Johnson DA, Beyerlein ST, editors. Product Development Teams. Stamford, CT: JAI Press; 2000. p. 1–29.

Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007;25(2):361–76. https://doi.org/10.1016/j.anclin.2007.03.007.

Cheng A, Grant V, Robinson T, Catena H, Lachapelle K, Kim J, et al. The Promoting Excellence and Reflective Learning in Simulation (PEARLS) approach to health care debriefing: a faculty development guide. Clin Simul Nurs. 2016;12(10):419–28. https://doi.org/10.1016/j.ecns.2016.05.002.

Baumeister RF, Bratslavsky E, Finkenauer C, Vohs KD. Bad is stronger than good. Rev Gen Psychol. 2001;5(4):323–70. https://doi.org/10.1037/1089-2680.5.4.323.

Vaish A, Grossmann T, Woodward A. Not all emotions are created equal: The negativity bias in social-emotional development. Psychol Bull. 2008;134(3):383–403. https://doi.org/10.1037/0033-2909.134.3.383.

Muller-Pinzler L, Czekalla N, Mayer AV, et al. Negativity-bias in forming beliefs about own abilities. Scientific reports. 2019;9(1):14416. https://doi.org/10.1038/s41598-019-50821-w.

Hollnagel E. Safety-I and Safety-II. The past and future of safety management. Farnham, UK.: Ashgate; 2014.

Dieckmann P, Patterson M, Lahlou S, Mesman J, Nyström P, Krage R. Variation and adaptation: learning from success in patient safety-oriented simulation training. Advances in Simulation. Adv Simul. 2017;2(1):1–14.

Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2006;1(1):49–55. https://doi.org/10.1097/01266021-200600110-00006.

Kolbe M, Marty A, Seelandt J, Grande B. How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns. Adv Simul. 2016;1(1):1–8.

Gordon MJ. A review of the validity and accuracy of self-assessments in health professions training. Acad Med. 1992;66:762–9.

Ross L, Greene D, House P. The “false consensus effect”: an egocentric bias in social perception and attribution processes. J Exp Soc Psychol. 1977;13(3):279–301. https://doi.org/10.1016/0022-1031(77)90049-X.

Mohammed S, Ferzandi L, Hamilton K. Metaphor no more: a 15-year review of the team mental model construct. J Manag. 2010;36(4):876–910. https://doi.org/10.1177/0149206309356804.

Kolbe M, Eppich W, Rudolph J, Meguerdichian M, Catena H, Cripps A, et al. Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simulation and Technology Enhanced Learning. 2020;6(3):164–71. https://doi.org/10.1136/bmjstel-2019-000470.

Myers DG, Lamm H. The group polarization phenomenon. Psychol Bull. 1976;83(4):602–27. https://doi.org/10.1037/0033-2909.83.4.602.

Epstein RM, Siegel DJ, Silberman J. Self-monitoring in clinical practice: a challenge for medical educators. J Contin Educ Health Prof. 2008;28(1):5–13. https://doi.org/10.1002/chp.149.

Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham B, Blewer AL, et al. Part 6: Resuscitation Education Science. 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S551–S79.

Boud D. Enhancing learning through self-assessment. London: Kogan Page Limited; 1995.

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