Background

Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated.

Methods

In a simulated night shift, seven teams of four to five medical students (n=32) took part in a total of six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool – a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) – or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM).

Results

The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants’ satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions.

Conclusion

The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.

Participaints were asked to fill out a inital and a final survey and to rate ther satisfation with the debriefings (paper pencil); Teamwork was rated by external observers using the TEAM (Team emergency assessment measure); Facilitators were asked to note the topic(s) of each debriefing (wich were mapped to CRM principles by two researchers) and to rate the feasibility of the debriefing / of TeamTAG

Data were analyses with SPSS using Chi-square tests, t-tests, and an analysis of covariance (ANCOVA) and descriptively using a heatmap