DE-CODE: a coding scheme for assessing debriefing interactions

Correspondence to Dr Michaela Kolbe; [email protected]

What this paper adds

What is already known on this subject

• Debriefings are crucial for learning during simulation-based training.

• Although the quality of debriefings is very important for SBT, few studies have examined actual debriefing conversations.

• More knowledge on debriefing interactions is important for addressing research gaps and targeting faculty development.

What this study adds

• This study aims to contribute to debriefing science by providing DE-CODE, a coding scheme for assessing debriefers’ and learners’ communication in debriefings.

• DE-CODE may be used in full version (47 codes) for research purpose and in reduced version (selected codes) for faculty development and other purposes.

• DE-CODE is reliable for direct, on-site observations as well as for video-based coding.

Introduction

Debriefing is a core element of team learning and simulation-based training (SBT).^1–3 It is an instructor-guided conversation among trainees that aims to explore and understand the relationships among events, actions, thought and feeling processes and performance outcomes of the simulation.^{1 2 4 5} In effective debriefings, learners are encouraged to transfer learning from the simulated setting to the patient care context through reflection.^{6 7}

There are various debriefing approaches available providing advice on how to promote learners’ reflection, for example, the Debriefing with Good Judgment,¹ PEARLS,⁸ The Diamond⁹ and TeamGAINS.¹⁰ In addition, there are techniques available for creating a psychologically safe and engaging setting,¹¹ codebriefing⁷ and debriefer communication such as advocacy inquiry¹ and circular questions.¹² Though evidence on the effectiveness of debriefings is growing,^{5 13–15} empirical research evaluating debriefings during SBT is rare, as are studies comparing different debriefing approaches in SBT.⁶ Even more, a recent meta-analysis on team training in healthcare concluded that training programmes that involved feedback were less effective than programmes without feedback.¹⁶ Although debriefing includes much more than giving feedback, this finding is unsettling and calls for further and more detailed research.

Tools have been developed to assess the quality of debriefings, for example, the Debriefing Assessment for Simulation in Healthcare (DASH)¹⁷ and the Objective Structured Assessment of Debriefing (OSAD).^{18 19} These are behavioural marker systems. When using behavioural marker methodology, users rate the overall quality of different behavioural classes (eg, teamwork and...