医学模拟教育中复盘教学方法的发展和应用综述

doi:10.3760/cma.j.cn115259-20210826-01080

摘要/Abstract

摘要： 复盘教学方法是模拟医学领域中医学模拟教育的重要环节。为了提高对复盘教学法的认识和保障医学模拟教育的质量,本文回顾了医学模拟教育中复盘的相关重要文献,对复盘的内涵与发展现状、复盘教学的实施模型和分析工具、复盘教学的国内外研究现状与进展做了梳理。复盘模型多种多样,开诚布公地复盘策略更有助于学员提升,复盘过程中可以合理运用学员指令性反馈、自我评价、重点引导等复盘分析工具,复盘教学的文化差异及其如何在我国具体落地实施仍然是值得关注的研究方向。

关键词: 复盘, 医学模拟教育, 教学方法

Abstract: Debriefing is an foundamental instructional approach of simulation-based medical education in the field of healthcare simulation. In order to improve the understanding of debriefing as an instructional approach and ensure the quality of simulation-based medical education, this paper reviews the relevant critical literatures of debriefing in simulation-based medical education, and outlined the essential elements and current development status of debriefing, debriefing models, different methods used in analyze phase of debriefing, as well as the research progress of debriefing in China and abroad. Despite various debriefing models, “debriefing with good judgment” would be more likely to assure better learner improvement. In the process of debriefing, directive feedback, students' self-assessment, and focused facilitation can be reasonably used. However, there are still room for future research on how these practices could be translated and better applied in China.

Key words: Debriefing, Simulation-based medical education, Instruction method

中图分类号:

龙晓焕, 王西富, 关天悦, 伍军华, 李力. 医学模拟教育中复盘教学方法的发展和应用综述[J]. 中华医学教育杂志, 2022, 42(3): 241-245.

Long Xiaohuan, Wang Xifu, Guan Tianyue, Wu Junhua, Li Li. A literature review on development and implementation of debriefing as an instructional approach in simulation-based medical education[J]. Chinese Journal of Medical Education, 2022, 42(3): 241-245.

参考文献

[1] Cheng A, Eppich W, Grant V,et al. Debriefing for technology-enhanced simulation: a systematic review and meta-analysis[J]. Med Educ, 2014, 48(7):657-666. DOI:10.1111/medu.12432.
[2]Lioce L. Healthcare simulation dictionary [M/OL].2nd. Rockvill:Agency for Healthcare Research and Quality, 2020:13 [2022-01-14]. https://www.ahrq.gov/patient-safety/resources/simulation/terms.html.
[3]Kolb DA. Experiential learning: experience as the source of learning and development, second edition [M]. New Jersey:Pearson FT Press, 2014:31-64.
[4]Schön DA. Educating the reflective practitioner: Toward a new design for teaching and learning in the professions[M]. San Francisco: Jossey-Bass, 1987:305-326.
[5]Witherspoon R. Double-loop coaching for leadership development[J]. J Appl Behav Sci, 2014, 50(3):261-283. DOI:10.1177/0021886313510032.
[6]Rudolph JW, Simon R, Raemer DB, et al. Debriefing as formative assessment: closing performance gaps in medical education[J]. Acad Emerg Med, 2008, 15(11):1010-1016. DOI: 10.1111/j.1553-2712.2008.00248.x.
[7]Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation the role of the presimulation briefing[J].Simul Healthc, 2014;9(6):339-349. DOI:10.1097/SIH.00000
00000000047.
[8]Kolbe M, Eppich W, Rudolph J, et al. Managing psychological safety in debriefings:a dynamic balancing act[J]. BMJ Simul Technol Enhanc Learn, 2020, 6(3):164-171. DOI:10.1136/bmjstel-2019-000470.
[9]Center for Medical Simulation. The Basic Assumption^TM[EB/OL]. [2022-01-14]. https://harvardmedsim.org/resources/the-basic-assumption/.
[10]Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice[J]. Simul Healthc, 2007, 2(3):183-193. DOI:10.1097/SIH.0b013e3180f637f5.
[11]Everly GS Jr, Boyle SH. Critical incident stress debriefing (CISD): a meta-analysis[J]. Int J Emerg Ment Health, 1999,1(3):165-168.
[12]Boud D, Keogh R,Walker D. Reflection: Turning experience into learning[M]. New York, Routledge, 1985:69-84.
[13]Fanning RM, Gaba DM. The role of debriefing in simulation-based learning[J].Simul Healthc, 2007, 2(2):115-125. DOI:10.1097/SIH.0b013e3180315539.
[14]Cantrell MA. The importance of debriefing in clinical simulations[J].Clin Simul Nurs, 2008;4(2). DOI:10.1016/j.ecns.2008.06.006.
[15]Boud D, Falchikov N. Rethinking assessment in higher education: learning for the longer term[M]. New York:Routledge,2007:144-155.
[16]Rudolph JW, Simon R, Dufresne RL,et al. There's no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment[J]. Simul Healthc, 2006,1(1):49-55. DOI:10.1097/01266021-200600110-00006.
[17]Rudolph JW, Simon R, Rivard P, et al. Debriefing with good judgment: combining rigorous feedback with genuine inquiry[J]. Anesthesiol Clin, 2007, 25(2):361-376. DOI: 10.1016/j.anclin.2007.03.007.
[18] Sawyer T, Eppich W, Brett-Fleegler M,et al. More than one way to debrief: a critical review of healthcare simulation debriefing methods[J]. Simul Healthc, 2016,11(3):209-217. DOI:10.1097/SIH.0000000000000148.
[19] PhrampusPE, O'Donnell JM. “Debriefing using a structured and supported approach.” the comprehensive textbook of healthcare simulation [M]. New York: Springer US, 2013: 73-84.
[20] Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing: defusing, discovering, and deepening [J]. Semin Perinatol, 2011, 35(2):52-58. DOI:10.1053/j.semperi.2011.01.003.
[21] Jaye P, Thomas L, Reedy G. “The diamond”: a structure for simulation debrief[J]. Clin Teach, 2015, 12(3):171-175. DOI:10.1111/tct.12300.
[22] Eppich W, Cheng A. Promoting excellence and reflective learning in simulation (PEARLS):development and rationale for a blended approach to health care simulation debriefing[J]. Simul Healthc, 2015, 10(2):106-115. DOI:10.1097/SIH.0000000000000072.
[23] Sawyer TL, Deering S. Adaptation of the US army's after-action review for simulation debriefing in healthcare[J].Simul Healthc, 2013, 8(6):388-397. DOI:10.1097/SIH.0b013e31829ac85c.
[24] Kolbe M, Weiss M, Grote G, et al. TeamGAINS:a tool for structured debriefings for simulation-based team trainings[J]. BMJ Qual Saf, 2013, 22(7):541-553. DOI:10.1136/bmjqs-2012-000917.
[25] Cheng A, Eppich W, Epps C, et al. Embracing informed learner self-assessment during debriefing: the art of plus-delta[J]. Adv Simul (Lond), 2021,6(1):22. DOI: 10.1186/s41077-021-00173-1.
[26] Kolbe M, Marty A, Seelandt J, et al. How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns[J]. Adv Simul (Lond), 2016,1:29. DOI: 10.1186/s41077-016-0029-7.
[27] Karam VY, Barakat H, Aouad M, et al. Effect of a simulation-based workshop on breaking bad news for anesthesiology residents: an intervention study[J]. BMC Anesthesiol, 2017,17(1):77. DOI: 10.1186/s12871-017-0374-7.
[28] Sawyer T, Sierocka-Castaneda A, Chan D,et al. The effectiveness of video-assisted debriefing versus oral debriefing alone at improving neonatal resuscitation performance a randomized trial[J]. Simul Healthc, 2012, 7(4):213-221. DOI:10.1097/SIH.0b013e318
2578eae.
[29] Rudolph JW, Palaganas J, Fey MK, et al. A DASH to thetop: educator debriefing standards as a path to practice readiness for nursing students[J]. Clin Simul Nurs, 2016, 12(9):412-417. DOI:10.1016/j.ecns.2016.05.003.
[30] Cheng A, Grant V, Huffman J, et al. Coaching the debriefer: peer coaching to improve debriefing quality in simulation programs[J]. Simul Healthc, 2017,12(5):319-325. DOI: 10.1097/SIH.0000000000000232.
[31] Ahmed M, Arora S, Russ S, et al. Operation debrief: a SHARP improvement in performance feedback in the operating room[J]. Ann Surg, 2013,258(6):958-963. DOI: 10.1097/SLA.0b013
e31828c88fc.
[32] Arora S, Ahmed M, Paige J, et al. Objective structured assessment of debriefing:bringing science to the art of debriefing in surgery[J]. Ann Surg, 2012,256(6):982-988. DOI:10.1097/SLA.0b013e
3182610c91.
[33] O'shea CI, Schnieke-Kind C, Pugh D,et al. The Meta-Debrief club: an effective method for debriefing your debrief[J]. BMJ Simul Technol Enhanc Learn, 2020, 6(2):118-120. DOI:10.1136/bmjstel-2018-000419.
[34] 王诗蕊,陈适,潘周娴,等.反馈性任务报告在医学模拟教学中的应用[J].基础医学与临床,2019,39(3):458-460.DOI:10.3969/j.issn.1001-6325.2019.03.035.
[35] 耿志超,史霆.在医学模拟教学中开展反馈性任务报告的重要性分析[J].中华医学教育探索杂志,2014, 39(3):260-263.DOI:10.3760/cma.j.issn.2095-1485.2014.03.014.
[36] 童斌,朱滨海,占伊扬,等.医学模拟教学中Debriefing的认识与实践[J].中国毕业后医学教育,2020,4(3):258-261.DOI:10.3969/j.issn.2096-4293.2020.03.016.
[37] Cheng A, Eppich W, Kolbe M,et al. A conceptual framework for the development of debriefing skills: a journey of discovery, growth, and maturity[J]. Simul Healthc, 2020, 15(1):55-60. DOI:10.1097/SIH.0000000000000398.
[38] Wong NL, Peng C, Park CW, et al. DebriefLive:a pilot study of a virtual faculty development tool for debriefing[J]. Simul Healthc, 2020,15(5):363-369. DOI: 10.1097/SIH.00000000
00000436.
[39] Ray JM, Wong AH, Yang TJ, et al. Virtual Telesimulation for Medical Students during the COVID-19 Pandemic[J]. Acad Med, 2021, 96(10):1431-1435. DOI:10.1097/ACM.0000000
000004129.
[40] Twigg S. Clinical event debriefing: a review of approaches and objectives[J]. Curr Opin Pediatr, 2020,32(3):337-342. DOI: 10.1097/MOP.0000000000000890.
[41] Welch-Horan TB, Lemke DS, Bastero P, et al. Feedback, reflection and team learning for COVID-19:development of a novel clinical event debriefing tool[J]. BMJ Simul Technol Enhanc Learn, 2021, 7(1):54-57. DOI:10.1136/bmjstel-2020-000638.
[42] 杨闻,李力,季湘年,等.复盘教学方式在临床基本技能教学中的应用[J].中华医学教育杂志,2020,40(1):30-33.DOI:10.3760/cma.j.issn.1673-677X.2020.01.016.
[43] 顾海涛,王敏,吴珺艺,等.视频辅助Debriefing教学法在外科住院医师腹腔镜技能培训中的应用与评价[J].腹腔镜外科杂志,2020,25(4):307-312.DOI:10.13499/j.cnki.fqjwkzz.2020.04.307.
[44] 罗先武,商丽,喻惠丹.标准化引导性反馈在高仿真模拟教学中的应用[J].中华护理教育,2020,17(2):113-116.DOI:10.3761/j.issn.1672-9234.2020.02.003.