Identifying best practice guidelines for debriefing in surgery: a tri-continental study



      Changes in surgical training have decreased opportunities for experiential learning in the operating room (OR). With this decrease, a commensurate increase in debriefing-dependent simulation-based activities has occurred. Effective debriefing could optimize learning from both simulated and real clinical encounters.


      Thirty-three semistructured interviews with surgeons, anesthesiologists, and OR nurses from the United Kingdom, United States, and Australia identified the goals of debriefing, core components of an effective debrief, and solutions to its effective implementation. Interviews were audiotaped, transcribed, and coded using emergent theme analysis.


      Core components of an effective debrief include having the appropriate approach, establishing a learning environment, learner engagement, managing learner reaction, reflection, analysis, diagnosis, and application to real clinical practice. Solutions to enhance practice involve promotion of a debriefing culture within the surgical community with protected time to conduct a structured debriefing.


      A need exists to enhance surgical training through regular structured debriefing. Identifying the key components of an effective debrief is a first step toward improving practice and embedding a debriefing culture within the OR.


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        • Carter B.N.
        The fruition of Halsted's concept of surgical training.
        Surgery. 1952; 32: 518-527
        • Tooke J.
        Aspiring to excellence: final report of the independent inquiry into modernising medical careers.
        MMC Inquiry, London2008
        • Reznick R.K.
        • MacRae H.
        Teaching surgical skills—changes in the wind.
        N Engl J Med. 2006; 355: 2664-2669
        • Collins J.P.
        • Civil I.D.
        • Sugrue M.
        • et al.
        Surgical education and training in Australia and New Zealand.
        World J Surg. 2008; 32: 2138-2144
        • Arora S.
        • Hull L.
        • Sevdalis N.
        • et al.
        Factors compromising safety in surgery: stressful events in the operating room.
        Am J Surg. 2010; 199: 60-65
        • Scallon S.E.
        • Fairholm D.J.
        • Cochrane D.D.
        • et al.
        Evaluation of the operating room as a surgical teaching venue.
        Can J Surg. 1992; 35: 173-176
        • Kneebone R.L.
        • Nestel D.
        • Vincent C.
        • et al.
        Complexity, risk and simulation in learning procedural skills.
        Med Educ. 2007; 41: 808-814
        • Aggarwal R.
        • Darzi A.
        Technical-skills training in the 21st century.
        N Engl J Med. 2006; 355: 2695-2696
        • van de Ridder J.M.
        • Stokking K.M.
        • McGaghie W.C.
        • et al.
        What is feedback in clinical education?.
        Med Educ. 2008; 42: 189-197
        • Rudolph J.W.
        • Simon R.
        • Raemer D.B.
        • et al.
        Debriefing as formative assessment: closing performance gaps in medical education.
        Acad Emerg Med. 2008; 15: 1010-1016
        • Fanning R.M.
        • Gaba D.M.
        The role of debriefing in simulation-based learning.
        Simul Healthc. 2007; 2: 115-125
        • Rogers D.A.
        • Regehr G.
        • Howdieshell T.R.
        • et al.
        The impact of external feedback on computer-assisted learning for surgical technical skill training.
        Am J Surg. 2000; 179: 341-343
        • Mahmood T.
        • Darzi A.
        The learning curve for a colonoscopy simulator in the absence of any feedback: no feedback, no learning.
        Surg Endosc. 2004; 18: 1224-1230
        • Hamad G.G.
        • Brown M.T.
        • Clavijo-Alvarez J.A.
        Postoperative video debriefing reduces technical errors in laparoscopic surgery.
        Am J Surg. 2007; 194: 110-114
        • McGaghie W.C.
        • Issenberg S.B.
        • Petrusa E.R.
        • et al.
        A critical review of simulation-based medical education research: 2003-2009.
        Med Educ. 2010; 44: 50-63
        • Dieckmann P.
        • Molin Friis S.
        • Lippert A.
        • et al.
        The art and science of debriefing in simulation: ideal and practice.
        Med Teach. 2009; 31: e287-e294
        • Steinwachs B.
        How to facilitate a debrief.
        Simul Gaming. 1992; 23: 186-195
        • Rudolph J.W.
        • Simon R.
        • Dufresne R.L.
        • et al.
        There's no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment.
        Simul Healthc. 2006; 1: 49-55
        • Rudolph J.W.
        • Simon R.
        • Rivard P.
        • et al.
        Debriefing with good judgment: combining rigorous feedback with genuine inquiry.
        Anesthesiol Clin. 2007; 25: 361-376
        • Dreifuerst K.T.
        The essentials of debriefing in simulation learning: a concept analysis.
        Nurs Educ Perspect. 2009; 30: 109-114
        • Porter T.
        Beyond metaphor: applying a new paradigm of change to experiential debriefing.
        J Exp Educ. 1999; 22: 85-90
        • Petranek C.F.
        Written debriefing: the next vital step in learning with simulations.
        Simul Gaming. 2000; 31: 108-118
        • Lederman L.C.
        Debriefing: toward a systematic assessment of theory and practice.
        Simul Gaming. 1992; 2: 145-159
        • Salas E.
        • Klein C.
        • King H.
        • et al.
        Debriefing medical teams: 12 evidence-based best practices and tips.
        Joint Comm J Qual Patient Saf. 2008; 34: 518-527
        • Pearson M.
        • Smith D.
        Debriefing in experience-based learning.
        Simul Games. 1986; 16: 155-172
        • Arora S.
        • Sevdalis N.
        • Nestel D.
        • et al.
        Managing intraoperative stress: what do surgeons want from a crisis training program?.
        Am J Surg. 2009; 197: 537-543
        • Arora S.
        • Aggarwal R.
        • Moran A.
        • et al.
        Mental practice: effective stress management training for novice surgeons.
        J Am Coll Surg. 2011; 212: 225-233