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Making It Stick: Keys to Effective Feedback and Debriefing in Surgical Education

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Comprehensive Healthcare Simulation: Surgery and Surgical Subspecialties

Part of the book series: Comprehensive Healthcare Simulation ((CHS))

Abstract

Although founded on evidence-based principles using established scientific frameworks and methods, the practice of surgery, in which the surgeon must combine both technical skills with medical knowledge, continues to a large degree rely on intuition, experience, and “feel,” the so-called art of healing. In much the same way, surgical training applies evidence-based educational principles with the “art of teaching.” Nowhere is this intangible aspect of education more important than in providing feedback to learners or facilitating debriefs after educational interventions. These moments are the points in time where learning occurs for the trainee/student. If done properly, it can transpire via a eureka-like epiphany, helping to embed the newfound information into the memory of the learner. Unfortunately, feedback and debriefing are often neglected subjects, especially in the field of simulation-based education and training where an inordinate amount of attention is placed on simulators, scenarios, and how to use them. This chapter will elucidate key practices and principles related to giving effective feedback and debriefing in surgical education. First, it will provide definitions for both terms and provide a theoretical framework related to their use. Next, it will attempt to identify key best practices for optimizing trainee/student learning using either technique. Finally, it will delineate several concrete examples of their use in current health educations training.

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References

  1. Kerr B, O’Leary JP. The training of the surgeon: Dr. Halsted’s greatest legacy. Am Surgeon. 1999;65(11):1101–2.

    CAS  PubMed  Google Scholar 

  2. Tan SY, Uyehara P. William Stewart Halsted (1852–1922): father of American surgery. Singap Med J. 2010;51(7):530–1.

    CAS  Google Scholar 

  3. Rutkow IM. Moments in surgical history: William Steward Halsted. Arch Surg. 2000;135(12):1478.

    Article  CAS  Google Scholar 

  4. Paige JT. Surgical team training: promoting high reliability with nontechnical skills. Surg Clin North Am. 2010;90(3):569–81.

    Article  Google Scholar 

  5. Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, Hoyt DB, Yang AD, Tarpley JL, Mellinger JD, Mahvi DM, Kelz RR, Ko CY, Odell DD, Stulberg JJ, Lewis FR. National Cluster-Randomized Trial of duty-hour flexibility in surgical training. N Engl J Med. 2016;374(8):713–27. https://doi.org/10.1056/NEJMoa1515724. Epub 2016 Feb 2.

    Article  CAS  PubMed  Google Scholar 

  6. Bolster L, Rourke L. The effect of restricting residents’ duty hours on patient safety, resident well-being, and resident education: an updated systematic review. J Grad Med Educ. 2015;7(3):349–63.

    Article  Google Scholar 

  7. Kohn LT, Corrigan J, Donaldson MS, editors, Institute of Medicine. To Err is human: building a safer health system. Washington D.C.: National Academies Press; 2000.

    Google Scholar 

  8. Aspden P, Corrigan JM, Wolcott J, Erickson SM, editors, Institute of Medicine. Patient safety: achieving a new standard for care. Washington D.C.: National Academies Press; 2004.

    Google Scholar 

  9. Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458–63; discussion 463–4.

    Article  Google Scholar 

  10. Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248:166–79.

    Article  Google Scholar 

  11. Arriaga AF, Gawande AA, Raemer DB, Jones DB, Smink DS, Weinstock P, Dwyer K, Lipsitz SR, Peyre S, Pawlowski JB, Muret-Wagstaff S, Gee D, Gordon JA, Cooper JB, Berry WR, Harvard Surgical Safety Collaborative. Pilot testing of a model for insurer-driven, large-scale multicenter simulation training for operating room teams. Ann Surg. 2014;259(3):403–10.

    Article  Google Scholar 

  12. Paull DE, Deleeuw LD, Wolk S, Paige JT, Neily J, Mills PD. The effect of simulation-based crew resource management training on measurable teamwork and communication among interprofessional teams caring for postoperative patients. J Contin Educ Nurs. 2013;44(11):516–24.

    Article  Google Scholar 

  13. Paige JT, Garbee DD, Kozmenko V, Yu Q, Kozmenko L, Yang T, Bonanno L, Swartz W. Getting a head start: high-fidelity, simulation-based operating room team training of interprofessional students. J Am Coll Surg. 2014;218(1):140–9.

    Article  Google Scholar 

  14. Issenberg SB, McGaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10–28.

    Article  Google Scholar 

  15. McGaghie WC, Issenberg SB, Petrusa ER, et al. A critical review of simulation-based medical education research: 2003–2009. Med Educ. 2010;44(1):50–63.

    Article  Google Scholar 

  16. Etymonline. “feedback.”http://www.etymonline.com/index.php?term=feedback. Accessed 12 Dec 2016.

  17. Merriam-Webster Dictionary. “feedback.” https://www.merriam-webster.com/dictionary/feedback. Accessed 12 Dec 2016.

  18. Etymonline. “debrief.” http://www.etymonline.com/index.php?allowed_in_frame=0&search=debrief. Accessed 17 Dec 2016.

  19. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25.

    Article  Google Scholar 

  20. Merriam-Webster Dictionary. “debriefing.” https://www.merriam-webster.com/dictionary/debriefing. Accessed 17 Dec 2016.

  21. Freeman R, Lewis R. Planning and implementing assessment. London: Routledge; 1998.

    Google Scholar 

  22. Sugden C, Aggarwal R. Assessment and feedback in the skills laboratory and operating room. Surg Clin North Am. 2010;90:519–33.

    Article  Google Scholar 

  23. Chauvin S. Assessment in simulation. In: Bok LR, et al., editors. Simulation in radiology. New York: Oxford University Press; 2012.

    Google Scholar 

  24. Shute VJ. Focus on Formative Feedback. RR-07-11. Educational Testing Service. Princeton, 2007.

    Google Scholar 

  25. Bangert-Drowns RL, Kulik CC, Kulik JA, Morgan MT. The instructional effect of feedback in test-like events. Rev Educ Res. 1991;61(2):213–38.

    Article  Google Scholar 

  26. Kolb D, Fry R. Toward an applied theory of experiential learning. In: Cooper C, editor. Theories of group process. London: Wiley; 1975.

    Google Scholar 

  27. Welker A. Essentials of feedback. http://www48.homepage.villanova.edu/andrea.welker/Teams/Essentials%20of%20Feedback.pdf. Accessed 25 Dec 2016.

  28. Kulhavy RW, Stock W. Feedback in written instruction: the place of response certitude. Educ Psychol Rev. 1989;1(4):279–308.

    Article  Google Scholar 

  29. Narciss S, Huth K. How to design informative tutoring feedback for multimedia learning. In: Niegemann HM, Leutner D, Brunken R, editors. Instructional design for multimedia learning. Munster/New York: Waxmann; 2004. p. 181–95.

    Google Scholar 

  30. Sawyer T, Eppich W, Brett-Flegger M, Grant V, Cheng A. More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11:209–17.

    Article  Google Scholar 

  31. Schön D. The reflective practitioner: how professionals think in action. London: Temple Smith; 1983.

    Google Scholar 

  32. Lederman LC. Debriefing: toward a systematic assessment of theory and practice. Simul Gaming. 1992;2:145–59.

    Article  Google Scholar 

  33. Paragi R, Yang T, Paige JT, Chauvin S. Examining the effectiveness of debriefing at the point of care in simulation-based operating room team training. Advances in Patient Safety: New Directions and Alternative Approaches. Volume 3. Performance and Tools. AHRQ Publication Nos. 08-0034 (1-4). August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/advances2/.

  34. Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good judgement: combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007;25:361–76.

    Article  Google Scholar 

  35. Rudolph J, Simon R, Dufresne R, Raemer D. There’s no such thing as a “nonjudgemental” debriefing: a theory and method for debriefing with good judgement. Simul Healthc. 2006;1(1):49–55.

    Article  Google Scholar 

  36. Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing: defusing, discovering, and deepening. Semin Perinatol. 2011;35(2):52–8.

    Article  Google Scholar 

  37. Phrampus P, O’Donnell J. Debriefing using a structured and supported approach. In: Levine A, DeMaria S, Schwartz A, Sim A, editors. The comprehensive textbook of healthcare simulation. 1st ed. New York: Springer; 2013. p. 73–85.

    Chapter  Google Scholar 

  38. Jaye P, Thomas L, Reedy G. ‘The Diamond’: a structure for simulation debrief. Clin Teach. 2015;12(3):171–5.

    Article  Google Scholar 

  39. Paige JT. Principles of simulation. In: Bok LR, et al., editors. Simulation in radiology. New York: Oxford University Press; 2012.

    Google Scholar 

  40. Paige JT, Arora S, Fernandez G, Seymour N. Debriefing 101: training faculty to promote learning in simulation-based training. Am J Surg. 2015;209(1):126–31. Epub 2014 Oct. 16.

    Article  Google Scholar 

  41. Sawyer T, Deering S. Adaptation of the U.S. Army’s after-action review (AAR) to simulation debriefing in healthcare. Simul Healthc. 2013;8(6):388–97.

    Article  Google Scholar 

  42. Petranek C. Maturation in experiential learning: principles of simulation and gaming. Simul Gaming. 1994;25:513–22.

    Article  Google Scholar 

  43. Fernandez R, Vozenilek JA, Hegarty CB, Motola I, Reznek M, Phrampus PE, Kozlowski SWJ. Developing expert medical teams: toward an evidence-based approach. Acad Emerg Med. 2008;15:1025–36.

    Article  Google Scholar 

  44. Rudolph JW, Simon R, Raemer DB, et al. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med. 2008;15:1–7.

    Article  Google Scholar 

  45. Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ. 2012;51:326–33.

    Article  Google Scholar 

  46. Wiggins G. Seven keys to effective feedback. Feedback for Learning. 2012;70(1):10–6.

    Google Scholar 

  47. Nicol DJ, Macfarlane-Dick D. Formative assessment and self-regulated learning: a model and seven principles of good feedback practice. Stud High Educ. 2006;31(2):199–218.

    Article  Google Scholar 

  48. Jensen AR, Wright AS, Kim S, Horvath KD, Calhoun KE. Educational feedback in the operating room: a gap between resident and faculty perceptions. Am J Surg. 2012;204(2):248–55.

    Article  Google Scholar 

  49. Kannappan A, Yip DT, Lodhia NA, Morton J, Lau JN. The effect of positive and negative verbal feedback on surgical skills performance and motivation. J Surg Educ. 2013;70(4):514–21.

    Article  Google Scholar 

  50. Porte MC, Xeroulis G, Reznick RK, Dubrowski A. Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. Am J Surg. 2007;193(1):105–10.

    Article  Google Scholar 

  51. Boyle E, Al-Akash M, Gallagher AG, Traynor O, Hill AD, Neary PC. Optimising surgical training: use of feedback to reduce errors during a simulated surgical procedure. Postgrad Med J. 2011;87(1030):524–8.

    Article  Google Scholar 

  52. Soucisse ML, Boulva K, Sideris L, Drolet P, Morin M, Dubé P. Video coaching as an efficient teaching method for surgical residents-A randomized controlled trial. J Surg Educ. 2016. pii: S1931-7204(16)30156-8. https://doi.org/10.1016/j.jsurg.2016.09.002. [Epub ahead of print].

  53. Garner MS, Gusberg RJ, Kim AW. The positive effect of immediate feedback on medical student education during the surgical clerkship. J Surg Educ. 2014;71(3):391–7.

    Article  Google Scholar 

  54. Yule S, Parker SH, Wilkinson J, McKinley A, MacDonald J, Neill A, McAdam T. Coaching non-technical skills improves surgical residents’ performance in a simulated operating room. J Surg Educ. 2015;72(6):1124–30.

    Article  Google Scholar 

  55. Ahmed M, Sevdalis N, Paige J, Paragi-Gururaja R, Nestel D, Arora S. Identifying best practice guidelines for debriefing in surgery: a tri-continental study. Am J Surg. 2012;203(4):523–9.

    Article  Google Scholar 

  56. Arora S, Ahmed M, Paige J, Nestel D, Runnacles J, Hull L, Darzi A, Sevdalis N. Objective structured assessment of debriefing: bringing science to the art of debriefing in surgery. Ann Surg. 2012;256(12):982–8. Epub 2012 Aug 14.

    Article  Google Scholar 

  57. Arora S, Runnacles J, Ahmed M, Sevdalis N, Nestel D, Paige J, Hull L, Thomas L, Russ S, Wheelock A, Miskovic D, Darzi A, Vincent C. The London handbook for debriefing: enhancing performance debriefing in clinical and simulated settings. London: London Deanery; 2012.

    Google Scholar 

  58. Brett-Fleegler M, Rudolph J, Eppich W, Monuteaux M, Fleegler E, Cheng A, Simon R. Debriefing assessment for simulation in healthcare: development and psychometric properties. Simul Healthc. 2012;7(5):288–94. https://doi.org/10.1097/SIH.0b013e3182620228.

    Article  PubMed  Google Scholar 

  59. Saylor JL, Wainwright SF, Herge EA, Pohlig RT. Development of an instrument to assess the clinical effectiveness of the debriefer in simulation education. J Allied Health. 2016;45(3):191–8.

    PubMed  PubMed Central  Google Scholar 

  60. Saylor J. Using Delphi technique to develop a peer-review debriefing instrument for simulation in healthcare. http://hdl.handle.net/10755/602986. Accessed 25 Dec 2016.

  61. Saylor JL, Wainwright SF, Herge EA, Pohlig RT. Peer-assessment debriefing instrument (PADI): assessing faculty effectiveness in simulation education. J Allied Health. 2016;45(3):27E–30E(4).

    Google Scholar 

  62. Levett-Jones T, Lapkin S. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Educ Today. 2014;34:e58–63.

    Article  Google Scholar 

  63. Sawyer T, Sierocka-Castaneda A, Chan D, Berg B, Lustik M, Thompson M. The effectiveness of video-assisted debriefing versus oral debriefing alone at improving neonatal resuscitation performance: a randomized trial. Simul Healthc. 2012;7(4):213–21.

    Article  Google Scholar 

  64. Smith-Jentsch KA, Canon-Bowers JA, Tannenbaum SI, Salas E. Guided team self-correction: impacts on team mental models, processes, and effectiveness. Small Group Res. 2008;39(3):303–27.

    Article  Google Scholar 

  65. Kolbe M, Weiss M, Grote G, Knauth A, Dambach M, Spahn DR, Grande B. TeamGAINS: a tool for structured debriefings for simulation-based team trainings. BMJ Qual Saf. 2013;22(7):541–53.

    Article  Google Scholar 

  66. Kolbe M, Grande B, Spahn DR. Briefing and debriefing during simulation-based training and beyond: content, structure, attitude and setting. Best Pract Res Clin Anaesthesiol. 2015;29(1):87–96.

    Article  Google Scholar 

  67. Cheng A, Morse KJ, Rudolph J, Arab AA, Runnacles J, Eppich W. Learner-centered debriefing for health care simulation education: lessons for faculty development. Simul Healthc. 2016;11(1):32–40.

    Article  Google Scholar 

  68. Boet S, Bould MD, Sharma B, Revees S, Naik VN, Triby E, Grantcharov T. Within-team debriefing versus instructor-led debriefing for simulation-based education: a randomized controlled trial. Ann Surg. 2013;258(1):53–8.

    Article  Google Scholar 

  69. Boet S, Pigford AA, Fitzsimmons A, Reeves S, Triby E, Bould MD. Interprofessional team debriefings with or without an instructor after a simulated crisis scenario: an exploratory case study. J Interprof Care. 2016;30(6):717–25.

    Article  Google Scholar 

  70. Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Dubrowski A. Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery. 2007;141(4):442–9. Epub 2007 Jan 25.

    Article  Google Scholar 

  71. Eppich WJ, Hunt EA, Duval-Arnould JM, Siddall VJ, Cheng A. Structuring feedback and debriefing to achieve mastery learning goals. Acad Med. 2015;90(11):1501–8.

    Article  Google Scholar 

  72. Ahmed M, Arora S, Russ S, Darzi A, Vincent C, Sevdalis N. Operation debrief: a SHARP improvement in performance feedback in the operating room. Ann Surg. 2013;258(6):958–63.

    Article  Google Scholar 

  73. Mackenzie H, Cuming T, Miskovic D, Wyles SM, Langsford L, Anderson J, Thomas-Gibson S, Valori R, Hanna GB, Coleman MG, Francis N. Design, delivery, and validation of a trainer curriculum for the national laparoscopic colorectal training program in England. Ann Surg. 2015;261(1):149–56.

    Article  Google Scholar 

  74. Dort J, Trickey A, Paige J, Schwarz E, Dunkin B. Hands-On 2.0: improving transfer of training via the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) Program. Surg Endosc. 2017;31:3326–32.

    Article  Google Scholar 

  75. Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc. 2015;10(2):106–15.

    Article  Google Scholar 

  76. Khamis NN, Satava RM, Alnassar SA, Kern DE. A stepwise model for simulation-based curriculum development for clinical skills, a modification of the six-step approach. Surg Endosc. 2016;30(1):279–87.

    Article  Google Scholar 

  77. Stefanidis D, Arora S, Parrack DM, Hamad GG, Capella J, Grantcharov T, Urbach DR, Scott DJ, Jones DB, Association for Surgical Education Simulation Committee. Research priorities in surgical simulation for the 21st century. Am J Surg. 2012;203(1):49–53.

    Article  Google Scholar 

  78. Johnston MJ, Paige JT, Aggarwal R, Stefanidis D, Tsuda S, Khajuria A, Arora S, Association for Surgical Education Simulation Committee. An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains. Am J Surg. 2016;211(1):214–25. Epub 2015 Aug 12.

    Article  Google Scholar 

  79. Cheng A, Grant V, Dieckmann P, Arora S, Robinson T, Eppich W. Faculty development for simulation programs: five issues for the future of debriefing training. Simul Healthc. 2015;10(4):217–22.

    Article  Google Scholar 

  80. Flin R, Patey R. Improving patient safety through training in non-technical skills. BMJ. 2009;339:b3595.

    Article  Google Scholar 

  81. Center for Medical Simulation. Comprehensive instructor workshop in medical simulation. http://www.harvardmedsim.org/ims-comprehensive-workshop.php. Accessed 31 Dec 2016.

  82. American Heart Association. Structured and supported debriefing course. http://www.heart.org/HEARTORG/CPRAndECC/InstructorNetwork/InstructorResources/Structured-and-Supported-Debriefing-Course_UCM_304285_Article.jsp. Accessed 31 Dec 2016.

  83. Dieckmann P. Debriefing Olympics – a workshop concept to stimulate the adaptation of debriefings to learning contexts. Simul Healthc. 2012;7:176–82.

    Article  Google Scholar 

  84. Seymour NE, Paige JT, Arora S, Fernandez GL, Aggarwal R, Tsuda ST, Powers KA, Langlois G, Stefanidis D. Putting the MeaT into TeaM training: development, delivery, and evaluation of a surgical team-training workshop. J Surg Educ. 2016;73(1):136–42.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, LSU Health New Orleans School of Medicine, New Orleans, LA, USA

    John T. Paige

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Editors and Affiliations

  1. Vice Chair of Education, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Dimitrios Stefanidis

  2. Vice Chair of Education, Department of Surgery, Stanford University, Stanford, CA, USA

    James R. Korndorffer Jr.

  3. Executive Director WISH and CREST, Department of Urology, University of Washington, Seattle, WA, USA

    Robert Sweet

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Paige, J.T. (2019). Making It Stick: Keys to Effective Feedback and Debriefing in Surgical Education. In: Stefanidis, D., Korndorffer Jr., J., Sweet, R. (eds) Comprehensive Healthcare Simulation: Surgery and Surgical Subspecialties. Comprehensive Healthcare Simulation. Springer, Cham. https://doi.org/10.1007/978-3-319-98276-2_12

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