title: Looking in the mirror: self-debriefing versus instructor debriefing for simulated crises.
abstract: OBJECTIVE
  To examine the effectiveness of self-debriefing as compared to instructor debriefing in the change of nontechnical skills performance of anesthesiology residents.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  A university hospital simulation center.
  
  
  METHODS
  : Fifty anesthesiology residents.
  
  
  METHODS
  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).
  
  
  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.
authors.affiliation: Department of Anesthesiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. sylvainboet@gmail.com
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.forename: M Dylan
authors.initials: MD
authors.lastname: Bould
authors.forename: Heinz R
authors.initials: HR
authors.lastname: Bruppacher
authors.forename: François
authors.initials: F
authors.lastname: Desjardins
authors.forename: Deven B
authors.initials: DB
authors.lastname: Chandra
authors.forename: Viren N
authors.initials: VN
authors.lastname: Naik
mesh_terms: D000776:Anesthesiology / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007721:Knowledge of Results, Psychological; D008297:Male; D016544:Patient Simulation; D011361:Professional Competence; D024382:Professional Role; D012647:Self-Assessment