title: Cognitive versus technical debriefing after simulation training.
abstract: BACKGROUND
  Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning.
  
  
  OBJECTIVE
  To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs.
  
  
  METHODS
  Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure." Residents were then block-randomized to a technical/knowledge debriefing covering the medical subject matter or a CDR debriefing covering vertical line failure. They then completed a written survey and were interviewed by an ethnographer. Four investigators blinded to group assignment reviewed the interview transcripts and coded the comments. The comments were qualitatively analyzed and those upon which three out of four raters agreed were quantified. A random sample of 84 comments was assessed for interrater reliability using a kappa statistic.
  
  
  RESULTS
  Sixty-two residents from two EM residencies participated. Survey results were compared by technical (group A, n = 32) or cognitive (group B, n = 30) debriefing. There were 255 group A and 176 group B comments quantified. The kappa statistic for coding the interview comments was 0.42. The CDR debriefing group made more, and qualitatively richer, comments regarding CDR concepts. The technical debriefing group made more comments on the medical subjects of cases. Both groups showed an appreciation for the risk of diagnostic error.
  
  
  CONCLUSIONS
  Survey data indicate that technical debriefing was better received than cognitive debriefing. The authors theorize that an understanding of CDRs can be facilitated through simulation training based on the analysis of interview comments.
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, USA. william.bond@lvh.com
authors.forename: William F
authors.initials: WF
authors.lastname: Bond
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Deitrick
authors.forename: Mary
authors.initials: M
authors.lastname: Eberhardt
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Barr
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Kane
authors.forename: Charles C
authors.initials: CC
authors.lastname: Worrilow
authors.forename: Darryl C
authors.initials: DC
authors.lastname: Arnold
authors.forename: Pat
authors.initials: P
authors.lastname: Croskerry
mesh_terms: D003071:Cognition; D003162:Competency-Based Education / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008348:Manikins; D017145:Models, Educational; D036301:Qualitative Research; D013850:Thinking