title: Debriefing in the intensive care unit: a feedback tool to facilitate bedside teaching.
abstract: OBJECTIVE
  To develop an assessment tool for bedside teaching in the intensive care unit (ICU) that provides feedback to residents about their performance compared with clinical best practices.
  
  
  METHODS
  We reviewed the literature on the assessment of resident clinical performance in critical care medicine and summarized the strengths and weaknesses of these assessments. Using debriefing after simulation as a model, we created five checklists for different situations encountered in the ICU--areas that encompass different Accreditation Council for Graduate Medical Education core competencies. Checklists were designed to incorporate clinical best practices as defined by the literature and institutional practices as defined by the critical care professionals working in our ICUs. Checklists were used at the beginning of the rotation to explicitly define our expectations to residents and were used during the rotation after a clinical encounter by the resident and supervising physician to review a resident's performance and to provide feedback to the resident on the accuracy of the resident's self-assessment of his or her performance.
  
  
  RESULTS
  Five "best practice" checklists were developed: central catheter placement, consultation, family discussions, resuscitation of hemorrhagic shock, and resuscitation of septic shock. On average, residents completed 2.6 checklists per rotation. Use of the cards was fairly evenly distributed, with the exception of resuscitation of hemorrhagic shock, which occurs less frequently than the other encounters in the medical ICU. Those who used more debriefing cards had higher fellow and faculty evaluations. Residents felt that debriefing cards were a useful learning tool in the ICU.
  
  
  CONCLUSIONS
  Debriefing sessions using checklists can be successfully implemented in ICU rotations. Checklists can be used to assess both resident performance and consistency of practice with respect to published standards of care in critical care medicine.
authors.affiliation: Critical Care Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Alison S
authors.initials: AS
authors.lastname: Clay
authors.forename: Loretta
authors.initials: L
authors.lastname: Que
authors.forename: Emil R
authors.initials: ER
authors.lastname: Petrusa
authors.forename: Mark
authors.initials: M
authors.lastname: Sebastian
authors.forename: Joseph
authors.initials: J
authors.lastname: Govert
mesh_terms: D000068:Accreditation; D001291:Attitude of Health Personnel; D019985:Benchmarking; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D030141:Feedback, Psychological; D006801:Humans; D007362:Intensive Care Units; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D017145:Models, Educational; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic