Advertisement

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

  • John T. Paige
Chapter
Part of the Comprehensive Healthcare Simulation book series (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.

Keywords

Debriefing Feedback Simulation-based training Experiential learning Faculty development 

References

  1. 1.
    Kerr B, O’Leary JP. The training of the surgeon: Dr. Halsted’s greatest legacy. Am Surgeon. 1999;65(11):1101–2.PubMedGoogle Scholar
  2. 2.
    Tan SY, Uyehara P. William Stewart Halsted (1852–1922): father of American surgery. Singap Med J. 2010;51(7):530–1.Google Scholar
  3. 3.
    Rutkow IM. Moments in surgical history: William Steward Halsted. Arch Surg. 2000;135(12):1478.CrossRefGoogle Scholar
  4. 4.
    Paige JT. Surgical team training: promoting high reliability with nontechnical skills. Surg Clin North Am. 2010;90(3):569–81.CrossRefGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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. 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. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 16.
    Etymonline. “feedback.”http://www.etymonline.com/index.php?term=feedback. Accessed 12 Dec 2016.
  17. 17.
    Merriam-Webster Dictionary. “feedback.” https://www.merriam-webster.com/dictionary/feedback. Accessed 12 Dec 2016.
  18. 18.
    Etymonline. “debrief.” http://www.etymonline.com/index.php?allowed_in_frame=0&search=debrief. Accessed 17 Dec 2016.
  19. 19.
    Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25.CrossRefGoogle Scholar
  20. 20.
    Merriam-Webster Dictionary. “debriefing.” https://www.merriam-webster.com/dictionary/debriefing. Accessed 17 Dec 2016.
  21. 21.
    Freeman R, Lewis R. Planning and implementing assessment. London: Routledge; 1998.Google Scholar
  22. 22.
    Sugden C, Aggarwal R. Assessment and feedback in the skills laboratory and operating room. Surg Clin North Am. 2010;90:519–33.CrossRefGoogle Scholar
  23. 23.
    Chauvin S. Assessment in simulation. In: Bok LR, et al., editors. Simulation in radiology. New York: Oxford University Press; 2012.Google Scholar
  24. 24.
    Shute VJ. Focus on Formative Feedback. RR-07-11. Educational Testing Service. Princeton, 2007.Google Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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. 27.
  28. 28.
    Kulhavy RW, Stock W. Feedback in written instruction: the place of response certitude. Educ Psychol Rev. 1989;1(4):279–308.CrossRefGoogle Scholar
  29. 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. 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.CrossRefGoogle Scholar
  31. 31.
    Schön D. The reflective practitioner: how professionals think in action. London: Temple Smith; 1983.Google Scholar
  32. 32.
    Lederman LC. Debriefing: toward a systematic assessment of theory and practice. Simul Gaming. 1992;2:145–59.CrossRefGoogle Scholar
  33. 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. 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.CrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 36.
    Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing: defusing, discovering, and deepening. Semin Perinatol. 2011;35(2):52–8.CrossRefGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 38.
    Jaye P, Thomas L, Reedy G. ‘The Diamond’: a structure for simulation debrief. Clin Teach. 2015;12(3):171–5.CrossRefGoogle Scholar
  39. 39.
    Paige JT. Principles of simulation. In: Bok LR, et al., editors. Simulation in radiology. New York: Oxford University Press; 2012.Google Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 42.
    Petranek C. Maturation in experiential learning: principles of simulation and gaming. Simul Gaming. 1994;25:513–22.CrossRefGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.CrossRefGoogle Scholar
  45. 45.
    Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ. 2012;51:326–33.CrossRefGoogle Scholar
  46. 46.
    Wiggins G. Seven keys to effective feedback. Feedback for Learning. 2012;70(1):10–6.Google Scholar
  47. 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.CrossRefGoogle Scholar
  48. 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.CrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. 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.CrossRefGoogle Scholar
  51. 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.CrossRefGoogle Scholar
  52. 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. 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.CrossRefGoogle Scholar
  54. 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.CrossRefGoogle Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 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. 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.CrossRefPubMedGoogle Scholar
  59. 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.PubMedPubMedCentralGoogle Scholar
  60. 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. 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. 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.CrossRefGoogle Scholar
  63. 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.CrossRefGoogle Scholar
  64. 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.CrossRefGoogle Scholar
  65. 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.CrossRefGoogle Scholar
  66. 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.CrossRefGoogle Scholar
  67. 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.CrossRefGoogle Scholar
  68. 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.CrossRefGoogle Scholar
  69. 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.CrossRefGoogle Scholar
  70. 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.CrossRefGoogle Scholar
  71. 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.CrossRefGoogle Scholar
  72. 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.CrossRefGoogle Scholar
  73. 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.CrossRefGoogle Scholar
  74. 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.CrossRefGoogle Scholar
  75. 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.CrossRefGoogle Scholar
  76. 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.CrossRefGoogle Scholar
  77. 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.CrossRefGoogle Scholar
  78. 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.CrossRefGoogle Scholar
  79. 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.CrossRefGoogle Scholar
  80. 80.
    Flin R, Patey R. Improving patient safety through training in non-technical skills. BMJ. 2009;339:b3595.CrossRefGoogle Scholar
  81. 81.
    Center for Medical Simulation. Comprehensive instructor workshop in medical simulation. http://www.harvardmedsim.org/ims-comprehensive-workshop.php. Accessed 31 Dec 2016.
  82. 82.
  83. 83.
    Dieckmann P. Debriefing Olympics – a workshop concept to stimulate the adaptation of debriefings to learning contexts. Simul Healthc. 2012;7:176–82.CrossRefGoogle Scholar
  84. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryLSU Health New Orleans School of MedicineNew OrleansUSA

Personalised recommendations