Exploring effects of resilience-focused debriefing on reflection and teamwork in interprofessional simulation-based education - a mixed method study

BACKGROUND: Interprofessional simulation-based education (IPSE) holds the potential to prepare healthcare students to handle the complexity of healthcare. However, complexity and resilience are traditionally not addressed deliberately in IPSE. The aim of this study was to explore the effect of resilience-focused debriefing (RFD) that addresses complexity and resilience, on reflection and teamwork in IPSE for pre-graduate healthcare students.

METHODS: In a convergent mixed methods intervention study, 149 nursing and medical students in their last semester participated in a full-day IPSE course with five progressively challenging scenarios. Fifteen facilitators were instructed to use RFD. Qualitative date, comprised of transcripts from nine debriefings, were analysed using topic analysis. An intervention check was performed to assess the use of RFD. Quantitative data comprised pre-post ratings of team performance in videorecorded scenarios (1 and 5) from 18 groups using the Team Emergency Assessment Measure (TEAM). Additionally, a study-specific rating scale was employed to assess the extent of participants' perceived challenges during scenarios.

RESULTS: RFD helped facilitators to guide the students' attention to the complexity of teamwork and how to manage such complex situations successfully by adapting crisis resource management principles and performing resilient actions (e.g., attunement, adaptive leadership), both as individuals and as teams. Applying RFD brought the students' attention to how they were able to succeed despite the difficulties they encountered. Although the assessed team performance was on an acceptable level, students initially had difficulties in recognizing and learning from actions that led to successful outcomes. The significant decrease in the degree of challenges experienced suggests that students developed a greater tolerance for complexity. Nevertheless, the quantitative data showed that there was no pre-post difference in team performance as assessed by TEAM.

CONCLUSIONS: RFD can be used to increase healthcare students' attention to the complexity of interprofessional teamwork in acute dynamic situations and help them recognize and learn from both successful actions and overcoming challenging situations. Although we did not find a significant gain in team performance, the integrated results suggest that RFD may potentially improve interprofessional teamwork. Further research is warranted to develop instruments measuring team performance that are sensitive to various aspects of resilience, as well as to deepen the understanding of RFD in the simulation-based education.