Quality of Structured Debriefing of Simulation by Near-peers versus Faculty Instructors: A Mixed Methods Analysis from a Multicenter Randomized Controlled Non-inferiority Trial
Shyam Bhagat1, Galina Gheihman2, Rameez Merchant3, Sarah Parauda4, Salma Said Elkolaly3, Terry Park4, Sean Thompson5, Zachary Lazzari5, Rose Healy1, Kelly Knolton5, Shalane Morales-Nunez5, Harry Sutherland6, Yara Mikhaeil-Demo7, Nicholas Morris8, Casey Albin5, Daniel Harrison1
1Boston Medical Center, 2Brigham & Women's Hospital, 3Missouri University Hospitals, 4Westchester Medical Center, 5Emory Healthcare, 6Yale University School of Medicine, 7Northwestern University, Feinberg School of Medicine, 8University of Maryland Medical Center
Objective:
To compare the quality of near-peer versus faculty debriefing in simulation-based education.
Background:
Faculty availability limits expansion of simulation-based education. Near-peer facilitators may address this barrier. However, whether residents perceive differences in the quality of near-peer versus faculty debriefing remains unclear.
Design/Methods:
We performed a convergent mixed methods analysis of survey data and semi-structured interview transcripts from the Trial of Peer Leaders in Neurology Education (TOPLINE). We randomized neurology junior residents at four academic centers to a faculty or near-peer (senior resident) simulation debriefer after individually completing a status epilepticus case. Following debriefing, residents completed the Debriefing Assessment for Simulation in Healthcare–Student Version (DASH-SV). The overall score of the DASH-SV and individual elements were tested for non-inferiority (inferiority margin 10% or 0.7 points on a 7-point scale). In parallel, residents were interviewed about their debriefing experience using questions designed to complement the core domains of DASH-SV. Exploratory thematic analysis of transcripts was performed by three blinded coders. Quantitative and qualitative data were analyzed separately but integrated during interpretation.
Results:
32 residents completed the DASH-SV; 19 completed interviews. Overall quality of near-peer debriefing was not perceived to be non-inferior to faculty debriefing (6.24 vs 6.56, difference -0.32, CI -0.76-0.11). Near-peers were perceived non-inferior to faculty for maintaining an engaging learning environment (6.44 vs 6.56, difference -0.12, CI -0.50-0.25) and identifying what participants did well or poorly (6.38 vs 6.44, difference -0.08, CI -0.55-0.43). Preliminary thematic analysis identified debriefer characteristics and actions which promote psychological safety, as well as foster metacognition, identify specific improvements, and reinforce key learning points.
Conclusions:
Near-peer debriefings were overall not non-inferior compared to faculty, though they were non-inferior for creating an engaging learning environment and giving specific feedback. Thematic analysis of residents’ experiences may clarify why near-peers were not non-inferior to faculty debriefers and guide future debriefer training for near-peers.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.