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Abstract
Aims Simulation offers paediatric trainees the opportunity of practised experience in a safe learning environment. Performance debriefing (facilitated or guided reflection in the cycle of experiential learning) is essential to maximise the learning experience, but there is currently little evidence-based guidance on effective paediatric debriefings. This study aimed to develop a debriefing assessment tool in order to assess the quality of feedback in paediatric simulation debriefings, and to evaluate its validity, inter-rater reliability, and feasibility.
Methods A literature review (phase 1) and semi-structured interviews with 16 paediatricians (phase 2) were used to identify key elements of a paediatric debriefing. Emergent theme analysis of these key elements was used to identify dimensions for inclusion in a novel “Objective Structured Assessment of Debriefing” for Paediatrics tool (OSAD). Expert input on the tool was sought from ten experienced paediatric simulation debriefing facilitators to provide further input to OSAD (content validation; feasibility). Evidence for inter-rater reliability was sought from video ratings of 35 debriefings after simulation scenarios of a seriously ill child. Concurrent validity was assessed via correlations of OSAD scores with trainees’ self-ratings of the quality of debriefings they received.
Results The literature review identified 34 relevant studies on debriefing. 307 key elements were identified from the literature review and 16 interviews. Key elements were thematically grouped into eight dimensions representing the desired features of a paediatric debriefing, which make up OSAD (Figure 1). The simulation experts significantly agreed with the elements of debriefing included in OSAD (content validity) and found its instructions clear and intuitive (feasibility). Inter-rater reliability was demonstrated with intra-class correlations of 0.60–0.70 for 6 of the 8 dimensions of the tool. The internal consistency of OSAD (Cronbach alpha) was 0.79. OSAD also demonstrated concurrent validity in the form of high correlations with trainees’ assessment of debriefings (Pearson r = 0.71, p < 0.01).
Conclusion The OSAD tool provides a structured approach to debriefing for paediatricians, which is evidence-based, reliable and valid and relevant to users. OSAD can be used to improve the quality of debriefing after paediatric simulation or after managing a seriously ill child in clinical practise.
Objective Structured Assessment of Debriefi ng (OSAD) in Paediatrics