Eficacia del co-debriefing para desarrollo de habilidades clínicas en soporte vital básico: estudio piloto aleatorizado

Nascimento, Juliana da Silva Garcia; Nascimento, Kleiton Gonçalves do; Alves, Mateus Goulart; Braga, Fernanda Titareli Merizio Martins; Regino, Daniela da Silva Garcia; Dalri, Maria Celia Barcellos

Juliana da Silva Garcia Nascimento

Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, São Paulo, Brasil.

http://orcid.org/0000-0003-1118-2738

Kleiton Gonçalves do Nascimento

Universidade Federal do Triângulo Mineiro (UFTM). Uberaba, Minas Gerais, Brasil.

http://orcid.org/0000-0002-2717-6837

Mateus Goulart Alves

Faculdade Atenas (UniAtenas). Passos, Minas Gerais, Brasil.

http://orcid.org/0000-0003-0680-6817

Fernanda Titareli Merizio Martins Braga

Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, São Paulo, Brasil.

http://orcid.org/0000-0001-8089-788X

Daniela da Silva Garcia Regino

Universidade Brasil (UB). Fernandópolis, São Paulo, Brasil.

http://orcid.org/0000-0003-0045-7783

Maria Celia Barcellos Dalri

Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, São Paulo, Brasil.

http://orcid.org/0000-0002-8173-8642

Corresponding author
Juliana da Silva Garcia Nascimento E-mail: mestradounesp28@yahoo.com.br

Authorship contribution

Conceptualization: Juliana da Silva Garcia Nascimento, Maria Celia Barcellos Dalri. Investigation: Juliana da Silva Garcia Nascimento, Kleiton Gonçalves do Nascimento, Mateus Goulart Alves, Daniela da Silva Garcia Regino. Methodology: Juliana da Silva Garcia Nascimento, Kleiton Gonçalves do Nascimento, Maria Celia Barcellos Dalri, Fernanda Titareli Merizio Martins Braga. Supervision: Maria Celia Barcellos Dalri, Fernanda Titareli Merizio Martins Braga. Writing-original draft: Juliana da Silva Garcia Nascimento. Writing-review & editing: Juliana da Silva Garcia Nascimento, Maria Celia Barcellos Dalri, Fernanda Titareli Merizio Martins Braga.

The authors declare that there is no conflict of interest.

Associate editor

João Lucas Campos de Oliveira

Editor-in-chief

Maria da Graça Oliveira Crossetti

Phases and stages	Activity and period
Non face-to-face phase
Stage 1: Planning, dissemination and registration	The three stages of the clinical simulation were planned: preparation, participation and debriefing. The dissemination and registration were made via e-mail, sending the schedule and registration form with a deadline of 15 days for the student to return.
Stage 2: Consent and characterization of the participant	Made available through electronic submission of a Google Forms-type instrument within a period of 15 days prior to the execution of the workshop, containing: the explanation about the research, the FICF*, Term for authorization to capture the image and voice and a questionnaire to characterize the participants’ profile.
Stage 3: Pre-simulation.	Based on a validated script1313. Almeida RGS, Mazzo A, Martins JCA, Coutinho VRD, Jorge BM, Mendes IAC. Validation to Portuguese of the debriefing experience scale. Rev Bras Enferm. 2016;69(4):658-64. doi: https://doi.org/10.1590/0034-7167.2016690413i. https://doi.org/10.1590/0034-7167.201669... ^), which describes the study materials made available to participants in a period of 15 days, prior to the execution of the clinical scenario, by e-mail.
Face-to-face phase: in August 2021.
Stage 4: Presentation and pre-test	Welcomed in classroom, the students, divided into groups, were introduced to the facilitators and answered the pre-test1010. Alves MG, Pereira VOS, Batista DFG, Cordeiro ALPC, Nascimento JSG, Darli MCB. Construction and validation of a questionnaire for cardiopulmonary resuscitation knowledge assessment. Cogitare Enferm. 2019;24:e64560. doi: https://doi.org/10.5380/ce.v24i0.64560. https://doi.org/10.5380/ce.v24i0.64560... .
Stage 5: Skills training	A skills training was performed for the BLS^\|\| using the AED^¶, using the Little Anne QCPR mannequin and a feedback device, based on an application via Bluetooth, for smartphone. After this stage, a coffee break was offered with a 15-minute interval.
Stage 6: Pre-briefing/briefing	Explanation of the participants regarding the environment and proposed simulation scenario1414. Alves MG. Objetos contemporâneos de aprendizagem para ensino-aprendizagem da ressuscitação cardiopulmonar [dissertação]. São Paulo: Universidade de São Paulo. [Internet]. 2018 [ cited 2021 Aug 12]. Available from: https://www.teses.usp.br/teses/disponiveis/22/22132/tde-31072018-105443/publico/MATEUSGOULARTALVES.pdf . https://www.teses.usp.br/teses/disponive... .
Stage 7: First execution of the scenario	Development of the proposed scenario lasting approximately 10 minutes. This moment represented the first scene, performed before the debriefing, duly filmed for later evaluation by the main researcher, through the OSCE^**.
Stage 8: Debriefing	After the scenario execution phase, similar for both groups, the participants sat in a circle. The CG^†† was submitted to the oral debriefing guided by a facilitator1414. Alves MG. Objetos contemporâneos de aprendizagem para ensino-aprendizagem da ressuscitação cardiopulmonar [dissertação]. São Paulo: Universidade de São Paulo. [Internet]. 2018 [ cited 2021 Aug 12]. Available from: https://www.teses.usp.br/teses/disponiveis/22/22132/tde-31072018-105443/publico/MATEUSGOULARTALVES.pdf . https://www.teses.usp.br/teses/disponive... and the IG^‡‡ to the co-debriefing1515. Nascimento JSG, Nascimento KG, Regino DSG, Alves MG, Oliveira JLG, Dalri MCB. Clinical simulation: construction and validation of script for Basic Life Support in adults. Rev Enferm UFSM. 2021;11:1-19. doi: https://doi.org/10.5902/2179769254578. https://doi.org/10.5902/2179769254578... ⁾ lasting approximately 20 minutes. The debriefing techniques used were detailed in Chart 2.
Stage 9 - Second execution of the scenario	The same scenario1414. Alves MG. Objetos contemporâneos de aprendizagem para ensino-aprendizagem da ressuscitação cardiopulmonar [dissertação]. São Paulo: Universidade de São Paulo. [Internet]. 2018 [ cited 2021 Aug 12]. Available from: https://www.teses.usp.br/teses/disponiveis/22/22132/tde-31072018-105443/publico/MATEUSGOULARTALVES.pdf . https://www.teses.usp.br/teses/disponive... was performed again, in order to compare the psychomotor skills related to CPA^‡ care, before and after the debriefing, and the necessary final feedbacks were given to the learners. After this stage, the students completed the post-test1010. Alves MG, Pereira VOS, Batista DFG, Cordeiro ALPC, Nascimento JSG, Darli MCB. Construction and validation of a questionnaire for cardiopulmonary resuscitation knowledge assessment. Cogitare Enferm. 2019;24:e64560. doi: https://doi.org/10.5380/ce.v24i0.64560. https://doi.org/10.5380/ce.v24i0.64560... , the satisfaction and self-confidence in learning scale1212. Almeida RGS, Mazzo A, Martins JCA, Baptista RCN, Girão FB, Mendes IAC. Validation to Portuguese of the scale of student satisfactionand self-confidence in learning. Rev Latinoam Enferm. 2015;23(6):1007-13. doi: https://doi.org/10.1590/0104-1169.0472.2643. https://doi.org/10.1590/0104-1169.0472.2... and the experience with debriefing scale1313. Almeida RGS, Mazzo A, Martins JCA, Coutinho VRD, Jorge BM, Mendes IAC. Validation to Portuguese of the debriefing experience scale. Rev Bras Enferm. 2016;69(4):658-64. doi: https://doi.org/10.1590/0034-7167.2016690413i. https://doi.org/10.1590/0034-7167.201669... , ending the workshop. It is important to highlight that: (1) retention of skill was not evaluated over time; (2) the scenario was filmed before and after the debriefing so that the main researcher could compare the psychomotor skills, adopting the OSCE^; (3) due to its extension, the OSCE^(1111. Alves MG, Carvalho MTM, Nascimento JSG, Oliveira JLG, Cyrillo RMZ, Braga FTMM, Fonseca LMM, et al. Construction and validation of Objective Structured Clinical Examination (OSCE) on cardiopulmonary resuscitation. Rev Min Enferm. 2019;23:e-1257. doi: https://doi.org/10.5935/1415-2762.20190105. https://doi.org/10.5935/1415-2762.201901... was not filled out concomitantly with the execution of the simulated scenario, but later, through the filming, established before and after the debriefing.

Control Group

Intervention Group

(1) Technique: oral debriefing guided by a facilitator55. Brown DK, Wong AH, Ahmed RA. Evaluation of simulation debriefing methods with interprofessional learning. J Interprof Care. 2018;19:1-3. doi: https://doi.org/10.1080/135618 20.2018.1500451.
https://doi.org/10.1080/135618 20.2018.1... ⁾ (2) Location: classroom; (3) facilitator: expert 1 (expert in CPR^* and trained to perform clinical simulation); (4) Debriefing method: G.A.S^† debriefing; (5) Time: until reaching the learning objectives; (6) Procedure: After the first scenario execution: the participants sat in a circle and the facilitator made the questions: G: Gather - Gathering information and calming feelings: “How are you feeling after the experience? A: Analyze - Analyze the experience and articulate it to the theoretical framework: “describe how did you cared for Mr. Alfredo”, “What are the positive points in this service?”, “What points need improvement?” S: Summarize - Summarize the experience and articulate it to the learning objectives: “What caught your attention in this experience?”, “What do you take from this experience to your professional life?” After the debriefing, the proposed scene was performed again.

(1) Technique: co-debriefing77. Cheng A, Palaganas J, Eppich W, Rudolph J, Robinson T, Grant V. Co-debriefing for simulation-based education: a primer for facilitators. Simul Healthc. 2015;10(2):69-75. doi: https://doi.org/10.1097/SIH.0000000000000077.
https://doi.org/10.1097/SIH.000000000000... ⁾ (2) Location: classroom; (3) Facilitators: Expert 1 and Expert 2 (both are CPR^* experts and trained to perform clinical simulation); (4) Debriefing method: G.A.S^† debriefing; (5) Time: until reaching the learning objectives; (6) Procedure: Pre-debriefing: prior meeting between facilitators to plan the debriefing. It was adopted the co-debriefing type to “divide and conquer”, in which the co-debriefing stages are divided according to the expertise of the facilitators55. Brown DK, Wong AH, Ahmed RA. Evaluation of simulation debriefing methods with interprofessional learning. J Interprof Care. 2018;19:1-3. doi: https://doi.org/10.1080/135618 20.2018.1500451.
https://doi.org/10.1080/135618 20.2018.1... . Expert 1 assumed the “G” and “S” phases of the G.A.S^† debriefing and expert 2, the “A” phase. Debriefing: After the first scenario: the participants sat in a circle and the facilitators made the questions: 1^st facilitator: G: Gather - Gather information and calm feelings: “How are you feeling after the experience? 2^nd facilitator: A: Analyze - Facilitator 2 wrote down all the points to be discussed. Analyze the experience and articulate it to the reference: “Describe how did you cared for Mr. Alfredo”, “What are the positive points in this service?”, “What are the points in which you need to improve?” 1^st facilitator: S - Summarize: Summarize the experience, and articulate it to the learning objectives: “What caught your attention in this experience?”, “What do you take from this experience to your professional life?” After the debriefing, the proposed scene was performed again. Post-debriefing: the facilitators met after the clinical simulation to organize their perceptions and improve their actions.

Intragroup Groups assessment^*				Intergroup assessment^†
	Mean of correct answers		p-value	Mean of correct answers	p-value
	Pre-test	Post-test	p-value	Mean of correct answers	p-value
Control-Group oral debriefing with a facilitator	12.63 ± 3.54	17.00 ± 2.39	p=0.011	17.00 ± 2.39	p=0.021
Intervention Group Co-debriefing	12.33 ± 2.44	19.22 ± 0.66	p=0.007	19.22 ± 0.66	p=0.021

Intra-group Groups assessment^*				Inter-group assessment^†
	Mean value of points obtained in the OSCE^*		p-value	Mean value of points obtained in the OSCE^†	p-value
	OSCE before debriefing	OSCE after debriefing	p-value	Mean value of points obtained in the OSCE^†	p-value
Control Group Debriefing with a facilitator (N=8)	7.06± 0.11	8.12±0.13	p=0.008	8.12 ± 0.13	p<0.001
Intervention Group Co-debriefing (N=9)	6.55±1.21	8.50±0.00	p=0.006	8.50 ± 0.001	p<0.001

[1] Corresponding author
Juliana da Silva Garcia Nascimento E-mail: mestradounesp28@yahoo.com.br

Brasil

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Eficacia del co-debriefing para desarrollo de habilidades clínicas en soporte vital básico: estudio piloto aleatorizado

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