From the Department of Surgery and Cancer, Imperial College London, United Kingdom.
Ann Surg. 2013 Dec;258(6):958-63. doi: 10.1097/SLA.0b013e31828c88fc.
To explore the current status of performance feedback (debriefing) in the operating room and to develop and evaluate an evidence-based, user-informed intervention termed "SHARP" to improve debriefing in surgery.
Effective debriefing is a key educational technique for optimizing learning in surgical settings. However, there is a lack of a debriefing culture within surgery. Few studies have prospectively evaluated educational interventions to improve the quality and quantity of performance feedback in surgery.
This was a prospective pre- and post-study of 100 cases involving 22 trainers (attendings) and 30 surgical residents (postgraduate years 3-8). A trained researcher assessed the quality of debriefings provided to the trainee using the validated Objective Structured Assessment of Debriefing (OSAD) tool alongside ethnographic observation. Following the first 50 cases, an educational intervention termed "SHARP" was introduced and measures repeated for a further 50 cases. User satisfaction with SHARP was assessed via questionnaire. Twenty percent of the cases were observed independently by a second researcher to test interrater reliability.
Interrater reliability for OSAD was excellent (ICC = 0.994). Objective scores of debriefing (OSAD) improved significantly after the SHARP intervention: median pre = 19 (range, 8-31); median post = 33 (range, 26-40), P < 0.001. Strong correlations between observer (OSAD) and trainee rating of debriefing were obtained (median ρ = 0.566, P < 0.01). Ethnographic observations also supported a significant improvement in both quality and style of debriefings. Users reported high levels of satisfaction in terms of usefulness, feasibility, and comprehensiveness of the SHARP tool.
SHARP is an effective and efficient means of improving performance feedback in the operating room. Its routine use should be promoted to optimize workplace-based learning and foster a positive culture of debriefing and performance improvement within surgery.
探讨手术室绩效反馈（反馈）的现状，并开发和评估一种基于证据、用户知情的干预措施，称为“SHARP”，以改善手术中的反馈。
有效的反馈是优化手术环境中学习的关键教学技术。然而，手术中缺乏反馈文化。很少有研究前瞻性评估教育干预措施，以提高手术中绩效反馈的质量和数量。
这是一项前瞻性的预-后研究，涉及 100 例手术，涉及 22 名培训师（主治医生）和 30 名外科住院医师（住院医师 3-8 年）。一名经过培训的研究人员使用经过验证的客观结构化评估反馈（OSAD）工具以及人种学观察，评估培训师提供的反馈质量。在进行了前 50 例手术后，引入了一种名为“SHARP”的教育干预措施，并对另外 50 例进行了重复测量。通过问卷调查评估用户对 SHARP 的满意度。有 20%的病例由第二位研究人员进行独立观察，以测试评分者间的可靠性。
OSAD 的评分者间可靠性极好（ICC=0.994）。在 SHARP 干预后，反馈的客观评分（OSAD）显著提高：中位数预=19（范围 8-31）；中位数后=33（范围 26-40），P<0.001。观察者（OSAD）和学员对反馈的评分之间存在较强的相关性（中位数ρ=0.566，P<0.01）。人种学观察也支持反馈的质量和风格有显著改善。用户对 SHARP 工具的有用性、可行性和全面性报告了高度满意。
SHARP 是改善手术室绩效反馈的有效且高效的方法。应推广其常规使用，以优化基于工作场所的学习，并在手术中培养积极的反馈和绩效改进文化。
