Department of Surgery and Cancer, Imperial College, London, UK.
Ann Surg. 2012 Dec;256(6):982-8. doi: 10.1097/SLA.0b013e3182610c91.
: To identify the features of effective debriefing and to use this to develop and validate a tool for assessing such debriefings.
: Simulation-based training has become an accepted means of surgical skill acquisition. A key component of this is debriefing-yet there is a paucity of research to guide best practice.
: Phase 1-Identification of best practice and tool development. A search of the Medline, Embase, PsycINFO, and ERIC databases identified current evidence on debriefing. End-user input was obtained through 33 semistructured interviews conducted with surgeons (n = 18) and other operating room personnel (n = 15) from 3 continents (UK, USA, Australia) using standardized qualitative methodology. An expert panel (n = 7) combined the data to create the Objective Structured Assessment of Debriefing (OSAD) tool. Phase 2-Psychometric testing. OSAD was tested for feasibility, reliability, and validity by 2 independent assessors who rated 20 debriefings following high-fidelity simulations.
: Phase 1: 28 reports on debriefing were retrieved from the literature. Key components of an effective debriefing identified from these reports and the 33 interviews included: approach to debriefing, learning environment, learner engagement, reaction, reflection, analysis, diagnosis of strengths and areas for improvement, and application to clinical practice. Phase 2: OSAD was feasible, reliable [inter-rater ICC (intraclass correlation coefficient) = 0.88, test-retest ICC = 0.90], and face and content valid (content validity index = 0.94).
: OSAD provides an evidence-based, end-user informed approach to debriefing in surgery. By quantifying the quality of a debriefing, OSAD has the potential to identify areas for improving practice and to optimize learning during simulation-based training.
确定有效的反馈特点，并以此为依据开发和验证一种评估此类反馈的工具。
基于模拟的培训已成为一种公认的获取手术技能的手段。其中一个关键组成部分是反馈——但目前缺乏指导最佳实践的研究。
第一阶段——确定最佳实践和工具开发。通过对 Medline、Embase、PsycINFO 和 ERIC 数据库的检索，确定了目前关于反馈的最佳实践和工具开发的证据。通过使用标准化的定性方法，对来自三个大洲（英国、美国、澳大利亚）的 33 名外科医生（n=18）和其他手术室人员（n=15）进行了 33 次半结构化访谈，获取了最终用户的输入。一个专家小组（n=7）将这些数据结合起来创建了客观结构化的反馈评估（OSAD）工具。第二阶段——心理测量测试。由两位独立评估者对 20 次高保真模拟后的反馈进行评估，以测试 OSAD 的可行性、可靠性和有效性。
第一阶段：从文献中检索到 28 篇关于反馈的报告。从这些报告和 33 次访谈中确定了有效的反馈的关键组成部分包括：反馈方法、学习环境、学习者参与、反应、反思、分析、优势和改进领域的诊断，以及对临床实践的应用。第二阶段：OSAD 是可行的、可靠的（组内相关系数（ICC）=0.88，测试-再测试 ICC=0.90），并且具有面部和内容有效性（内容有效性指数=0.94）。
OSAD 为手术中的反馈提供了一种基于证据、最终用户知情的方法。通过量化反馈的质量，OSAD 有可能识别需要改进的领域，并优化基于模拟培训的学习。
