title: Within-team debriefing versus instructor-led debriefing for simulation-based education: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on team performance during a simulated crisis.
  
  
  BACKGROUND
  Although instructor-led simulation debriefing is considered the "gold standard" in team-based simulation education, cost and logistics are limiting factors for its implementation. Within-team debriefing, led by the individuals of the team itself rather than an external instructor, has the potential to address these limitations.
  
  
  METHODS
  One hundred twenty subjects were grouped into 40 operating room teams consisting of 1 anesthesia trainee, 1 surgical trainee, and 1 staff circulating operating room nurse. All teams managed a simulated crisis scenario (pretest). Teams were then randomized to either a within-team debriefing group or an instructor-led debriefing group. In the within-team debriefing group, the teams reviewed the video of their scenario by themselves. The teams in the instructor-led debriefing group reviewed their scenario guided by a trained instructor. Immediately after debriefing, all teams managed a different intraoperative crisis scenario (posttest). All sessions were videotaped. Blinded expert examiners used the validated Team Emergency Assessment Measure scale to assess crisis resource management performance of all teams in random order.
  
  
  RESULTS
  Team performance significantly improved from pretest to posttest (P = 0.008) regardless of the type of debriefing. There was no significant difference in the degree of improvement between within-team debriefing and instructor-led debriefing (P = 0.52).
  
  
  CONCLUSIONS
  Within-team debriefing results in measurable improvements in team performance in simulated crisis scenarios. This form of debriefing may be as effective as instructor-led team debriefing, which could improve resource utilization and feasibility of team-based simulation (NCT01067378).
authors.affiliation: The University of Ottawa Skills and Simulation Centre & Department of Anesthesiology of The Ottawa Hospital, Ottawa, Ontario, Canada. sboet@toh.on.ca
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.forename: M Dylan
authors.initials: MD
authors.lastname: Bould
authors.forename: Bharat
authors.initials: B
authors.lastname: Sharma
authors.forename: Scott
authors.initials: S
authors.lastname: Revees
authors.forename: Viren N
authors.initials: VN
authors.lastname: Naik
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Triby
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009871:Operating Room Nursing / Q000193:education*; D009873:Operating Rooms; D010348:Patient Care Team / Q000458:organization & administration*; D015203:Reproducibility of Results; D013663:Teaching / Q000379:methods*