Background Teams traditionally train in specialty-specific silos, missing opportunities for learning crisis resource management skills based on team interactions. We introduced in-situ whole team training to address this. Debriefing teams brought specific challenges. There is scant literature on debriefing teams. We reviewed the literature and applied it to our practice.
Methodology We ran twelve in-situ simulated trauma scenarios, the debrief involved the whole team. Significant deviations from standard debriefing were identified as we learned from each situation.
Outcomes We changed our debriefing method based on our experiences. The traditional ‘describe, analyse, apply’ (‘DAA’) model did not fit in the short time allowed before the team returned to clinical duties. We facilitated discussions ‘back-to-front’ headlining a non-technical skill, such as communication and encouraged team self-debriefing centred on ‘TEAM’ and T-NOTECHS scales for trauma team working. This allowed discussions to focus on key behaviours in a short time-frame.
Encouraging a flexible debriefing structure ensured all team members contributed to the discussion. Secondly, we found that structuring the debrief around two or three key issues, emerging from how the scenario played out, allowed us to draw in each component of the trauma team, whereas the ‘DAA’ approach had been driven by the leaders and did not encourage the followers to contribute.
Thirdly, these debriefs created a series of action points which have been put into place to improve trauma team interaction and patient outcomes.
Potential impact Adapting a debrief for an entire team is important in reducing the ‘authority gradient’ and has potential to translate into improved patient care. Turning a debrief round highlighting specific non-technical skills first allows whole team involvement and a focused debrief in a short time. In-situ team debriefing requires skill and flexibility different from traditional approaches used in our simulation suites.
Steinemann S, et al. In-situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ 2011;68(6):472–7
Salas E, et al. Debriefing teams: 12 evidence-based practices and tips. Jt Comm J Qual Patient Saf 2008;34(9):518–27
Lyons R, et al. Enhancing the effectiveness of team debriefings in medical simulation: more best practice. Jt Comm J Qual Patient Saf 2015;41(3):115–25
Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25
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