Training and evaluating simulation debriefers in low-resource settings: lessons learned from Bihar, India

Abstract

Background: To develop effective and sustainable simulation training programs in low-resource settings, it is critical that facilitators are thoroughly trained in debriefing, a critical component of simulation learning. However, large knowledge gaps exist regarding the best way to train and evaluate debrief facilitators in low-resource settings. Methods: Using a mixed methods approach, this study explored the feasibility of evaluating the debriefing skills of nurse mentors in Bihar, India. Videos of obstetric and neonatal post-simulation debriefs were assessed using two known tools: the Center for Advanced Pediatric and Perinatal Education (CAPE) tool and Debriefing Assessment for Simulation in Healthcare (DASH). Video data was used to evaluate interrater reliability and changes in debriefing performance over time. Additionally, twenty semi-structured interviews with nurse mentors explored perceived barriers and enablers of debriefing in Bihar. Results: A total of 73 debriefing videos, averaging 18 min each, were analyzed by two raters. The CAPE tool demonstrated higher interrater reliability than the DASH; 13 of 16 CAPE indicators and two of six DASH indicators were judged reliable (ICC > 0.6 or kappa > 0.40). All indicators remained stable or improved over time. The number of 'instructors questions,' the amount of 'trainee responses,' and the ability to 'organize the debrief' improved significantly over time (p < 0.01, p < 0.01, p = 0.04). Barriers included fear of making mistakes, time constraints, and technical challenges. Enablers included creating a safe learning environment, using contextually appropriate debriefing strategies, and team building. Overall, nurse mentors believed that debriefing was a vital aspect of simulation-based training. Conclusion: Simulation debriefing and evaluation was feasible among nurse mentors in Bihar. Results demonstrated that the CAPE demonstrated higher interrater reliability than the DASH and that nurse mentors were able to maintain or improve their debriefing skills overtime. Further, debriefing was considered to be critical to the success of the simulation training. However, fear of making mistakes and logistical challenges must be addressed to maximize learning. Teamwork, adaptability, and building a safe learning environment enhanced the quality enhanced the quality of simulation-based training, which could ultimately help to improve maternal and neonatal health outcomes in Bihar.

Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings

“…22,38 Key points of difference from this study are the requirements for facilitators in resource-limited settings to be highly flexible and to explore the contextual, cultural, and communication factors that may impact learners' performance. Existing facilitatorassessment tools may not be reliable when applied in resource-limited environments 11 and are likely to overlook the full complement of skills required for delivery of SBE in these settings. A tool for assessing facilitator competency in this environment allows for refinement of facilitator training methods, thus enhancing faculty development.…”

Improving Newborn Resuscitation by Making Every Birth a Learning Event

“…These barriers can be addressed by (1) limiting debriefing time, using a structured approach, and postponing discussion of systems issues that require deep-dives with leadership; (2) identifying individuals with training in post-event debriefing and investing in the development of new facilitators; (3) identifying a “debriefing room” that is convenient, available at all times, and considered a safe and confidential place; (4) protecting debriefing records and discussions; and (5) developing procedures to disclose medical errors that arise during debriefings. In LMICs, barriers to debriefing often include (1) lack of prior exposure to debriefing [ 103 , 104 ], (2) lack of knowledge and skills to conduct debriefing [ 105 ], and (3) a culture of blame [ 104 , 106 , 107 , 108 , 109 ]. These barriers can be addressed through targeted training in debriefing, support for less-experienced facilitators, including a video review to objectively establish the sequence of events and emphasize learning points, and interventions that focus on developing a culture of improvement [ 104 , 105 , 106 ].…”

“…In LMICs, barriers to debriefing often include (1) lack of prior exposure to debriefing [ 103 , 104 ], (2) lack of knowledge and skills to conduct debriefing [ 105 ], and (3) a culture of blame [ 104 , 106 , 107 , 108 , 109 ]. These barriers can be addressed through targeted training in debriefing, support for less-experienced facilitators, including a video review to objectively establish the sequence of events and emphasize learning points, and interventions that focus on developing a culture of improvement [ 104 , 105 , 106 ]. For example, Sim for Life Foundations is a two-day course in debriefing developed for new faculty in simulation education in Uganda [ 110 ].…”

Health sciences educator's simulation debriefing practice needs: A mixed methods study

“…The literature on simulation debriefing practices of health sciences educators in low- and middle-income countries is limited. [ 15 ] In this article, we describe the simulation debriefing practices of educators across a faculty of health sciences in Africa. We argue that insight into the simulation debriefing practices for health science educators provides valuable understanding of the needs of health sciences educators which are essential inputs toward developing contextually appropriate faculty development interventions specifically in a low- and middle-income context.…”

“…[ 17 ] Considering the high volume of students participating in simulation as part of their training at the University of the Free State, the limited reporting on simulation debriefing practices of health sciences educators in low- and middle-income countries is worrisome and thus the current study aimed to explore the aforementioned debriefing practices of health science educators. [ 15 ]…”