More than experience: a post-task reflection intervention among team members enhances performance in student teams confronted with a simulated resuscitation task—a prospective randomised trial

Abstract

BackgroundTeams that regularly step back from action and deliberately reflect on their performance and strategies show higher performance. Ad hoc emergency teams with changing team composition cannot develop such habits but may engage in short postaction reflection to discuss shortcomings of past performance and potential adaptations of their strategies for future similar tasks. This study aimed to test the effect of a short postaction self-led reflective team briefing on resuscitation performance in a simulator setting in terms of three performance parameters: hands-on time, coordination between chest compression and ventilation, and defibrillation.MethodsWe performed a randomised controlled trial including 56 ad hoc formed teams of three fourth-year medical students each. All groups performed a resuscitation task, followed by a self-guided reflective briefing, based on a general instruction (n=28 teams), or an unrelated discussion session (control condition; n=29), followed by a second resuscitation task in the same team composition.ResultsAdjusted for performance in the first task, teams in the reflection condition showed higher performance gain in the second resuscitation than teams in the control condition (6.21 percentage points (95% CI 1.31 to 11.10, p<0.001)) for basic hands-on performance; 15.0 percentage points (95% CI 2 to 28, p<0.001) for coordinative performance but non-significantly lower performance for defibrillation (−9%, 95% CI −27% to –9%, p=0.312).ConclusionEven very short self-led postaction reflective briefings enhance basic resuscitation performance in ad hoc groups but may not influence more complex aspects of the task. We recommend including short self-led team debriefings as part of simulator training.

Exploring in-person self-led debriefings for groups of learners in simulation-based education: an integrative review

“… Did the participants adhere to the assigned intervention? Andrews et al (2019) [ 43 ] Can’t tell Can’t tell Yes No Yes Boet et al (2013) [ 15 ] – RCT component Yes Yes Yes Yes Yes Ha (2020) [ 44 ] No Yes Yes No Yes Ha & Lim (2018) [ 45 ] Can’t tell Can’t tell Yes No Yes Kim & De Gange (2018) [ 46 ] Can’t tell Yes Yes No Yes Kündig et al (2020) [ 47 ] Can’t tell Can’t tell Yes Can’t tell Yes Oikawa et al (2016) [ 48 ] No No Yes Yes Yes Rueda-Medina et al (2020) [ 49 ] No Yes Yes No Yes Rueda-Medina et al (2021) [ 50 ] No Yes Yes No Yes Quantitative non-RCTs Are the representatives of the target population appropriate? Are measurements appropriate regarding both the outcome and intervention (or exposure)?…”

“…The search elicited one qualitative study, eight quantitative RCTs, six quantitative non-RCTs, one quantitative descriptive study and two mixed methods studies. All 18 studies originated from socio-economically developed countries with six studies originating from South Korea [ 44 – 46 , 51 – 53 ], five from the USA [ 42 , 43 , 48 , 54 , 55 ], and the remainder from Canada [ 15 , 16 ], Australia [ 56 , 57 ], Spain [ 49 , 50 ], and Switzerland [ 47 ]. Two studies were multi-site [ 51 , 52 ].…”

“…(3) There were no statistically significant differences in self-confidence ( p =0.686) or knowledge ( p =0.445) between the 2 groups. Kündig et al (2020) [Bern & Basel, Switzerland] [ 47 ] To test the effects of SLDs on resuscitation performance: hands-on time, coordination between chest compressions and ventilation and defibrillation. 2-arm RCT.…”

“Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

“…Such trainings have been shown to be effective in health care settings [68,69]; they therefore might well diminish the triggers of tensions. Furthermore, systematic team reflection on “objectives, strategies, goals, processes and outcomes” [70] could be used as a tool for improving coordination; one of its advantages is that it can be done within very short time frames [71].…”

StOP? II trial: cluster randomized clinical trial to test the implementation of a toolbox for structured communication in the operating room—study protocol

“…Situation awareness requires a shared understanding of the characteristics and requirements of the task in general (often called "shared mental model") [14]. Another interesting focus is on communication practices that aim at team reflexivity [16,17], which includes not only an overt reflection in the team, but also reflective communication about the team's objectives, strategies, and processes [18]. In-action team reflection (reflecting during the process) was related to team performance in simulated medical emergencies [17].…”