Table 1 The integrated approach for structured debriefing TeamGAINS as a six-step approach, developed from Guided team self-correction, Advocacy-Inquire, Systemic-constructivist the integrated approach for structured debriefing
Six Steps of the TeamGAINS debriefing approach [10] | ||
|---|---|---|
Step | Topics | Instuctor’s method and examples of communicaiton |
1 | Reactions | Narrative question (e.g. “How did you feel?”). |
2 | Debriefing the clinical part of the scenario, clarify questions, allow for understanding the appropriate clinical procedures | Narrative question, Advocay-inquiry (“What happened?”, “I saw you re-attempting to intubate using the laryngoscope three times”) Guided team self-correction (“What alternative device could you have used for intubation?”) Systemic constructivist approach: circular question (“What would he have recommended to the colleague?”) |
3 | Transfer from simulation to reality | Narrative question (“What aspects of this scenario are familiar to you from the real world?”) |
4 | Reintroduce the expert model, systematically discuss the behavioral skills and their relationship to clinical outcomes | Guided team self-correction: elicit reflection about positive behaviour (“Give me an example of a situation where you anticipated a potential complication.”) Systemic question (“Having anticipated the potential complication— how did this help you later on?”) Advocacy-inquiry -using the video (“Let’s talk about shared planning. During that situation, I saw you working very quietly together, and I was concerned whether each of you knew about each other’s plan for the next step. What was on your mind?“) Circular question (“How could it have been useful for him to know what you were about to do and what you needed?”) Observer-perspective, circular questions using the Reflecting Team (“What do you think she might have needed from him to speak up in that situation?”) |
5 | Summaries learning experience and finish debriefing | Inquiry (“Which of the CRM-principles do you consider most important after that situation?”) Circular question (“Overall, if inexperienced anaesthesia residents and nurses had watched you during the scenario, what could they have learned from you?”) |
6 | If required, improve clinical skills | Practice clinical skills, that were not optimally performed during the scenario (example: practice using the defibrillator) |