Within-team debriefing versus instructor-led debriefing for simulation-based education: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on team performance during a simulated crisis.

BACKGROUND: Although instructor-led simulation debriefing is considered the "gold standard" in team-based simulation education, cost and logistics are limiting factors for its implementation. Within-team debriefing, led by the individuals of the team itself rather than an external instructor, has the potential to address these limitations.

METHODS: One hundred twenty subjects were grouped into 40 operating room teams consisting of 1 anesthesia trainee, 1 surgical trainee, and 1 staff circulating operating room nurse. All teams managed a simulated crisis scenario (pretest). Teams were then randomized to either a within-team debriefing group or an instructor-led debriefing group. In the within-team debriefing group, the teams reviewed the video of their scenario by themselves. The teams in the instructor-led debriefing group reviewed their scenario guided by a trained instructor. Immediately after debriefing, all teams managed a different intraoperative crisis scenario (posttest). All sessions were videotaped. Blinded expert examiners used the validated Team Emergency Assessment Measure scale to assess crisis resource management performance of all teams in random order.

RESULT: Team performance significantly improved from pretest to posttest (P = 0.008) regardless of the type of debriefing. There was no significant difference in the degree of improvement between within-team debriefing and instructor-led debriefing (P = 0.52).

CONCLUSIONS: Within-team debriefing results in measurable improvements in team performance in simulated crisis scenarios. This form of debriefing may be as effective as instructor-led team debriefing, which could improve resource utilization and feasibility of team-based simulation (NCT01067378).