title: Cognitive control level of action for analyzing verbal reports in educative clinical simulation situations.
abstract: BACKGROUND
  Several methods and theoretical frameworks have been proposed for efficient debriefing after clinical simulation sessions. In these studies, however, the cognitive processes underlying the debriefing stage are not directly addressed. Cognitive control constitutes a conceptual link between behavior and reflection on behavior to apprehend debriefing cognitively.
  
  
  OBJECTIVE
  Our goal was to analyze cognitive control from verbal reports using the Skill-Rule-Knowledge model. This model considers different cognitive control levels from skill-based to rule-based and knowledge-based control.
  
  
  METHODS
  An experiment was conducted with teams of nursing students who were confronted with emergency scenarios during high-fidelity simulation sessions.
  
  
  METHODS
  Participants' descriptions of their actions were asked in the course of the simulation scenarios or during the debriefing stage.
  
  
  METHODS
  52 nursing students working in 26 pairs participated in this study.
  
  
  METHODS
  Participants were divided into two groups: an "in situ" group in which they had to describe their actions at different moments of a deteriorating patient scenario, and a "debriefing" group, in which, at the same moments, they had to describe their actions displayed on a video recording. In addition to a cognitive analysis, the teams' clinical performance was measured.
  
  
  RESULTS
  The cognitive control level in the debriefing group was generally higher than in the in situ group. Good team performance was associated with a high level of cognitive control after a patient's significant state deterioration.
  
  
  CONCLUSIONS
  These findings are in conformity with the "Skill-Rule-Knowledge" model. The debriefing stage allows a deeper reflection on action compared with the in situ condition. If an abnormal event occurs as an adverse event, then participants' mental processes tend to migrate towards knowledge-based control. This migration particularly concerns students with the best clinical performance. Thus, this cognitive framework can help to strengthen the analysis of verbal reports.
authors.affiliation: Université Bretagne Sud, CRPCC laboratory, Campus de Tohannic, F56000, Vannes, France. Electronic address: thierry.morineau@univ-ubs.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Morineau
authors.affiliation: Université Bretagne Sud, CRPCC laboratory, Campus de Tohannic, F56000, Vannes, France; Social Psychology, Université Bretagne Sud, CRPCC laboratory, Campus de Tohannic, F56000, Vannes, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Meineri
authors.affiliation: Scorff Health Simulation Center (C3S), Centre Hospitalier Bretagne Sud, F56100, Lorient, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Chapelain
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate; D005246:Feedback; D005260:Female; D000070856:High Fidelity Simulation Training; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013338:Students, Nursing
keywords: Cognitive control; Debriefing; Education; Nurse; Simulation