Student Performance During a Simulated Patient Encounter Has No Impact on Debriefer Adherence to PEARLS Debriefing Model

Abstract

Purpose: Debriefing is necessary for effective simulation education. The PEARLS (Promoting Excellence and Reflective Learning in Simulations) is a scripted debriefing model that incorporates debriefing best practices. It was hypothesized that student simulation performance might impact facilitator adherence to the PEARLS debriefing model. There are no published findings on the effect of student performance on debriefer behavior.

Methods: Third-year medical students participated in a video-recorded, formative simulation to treat a high-fidelity mannequin for an asthma exacerbation. A faculty debriefer trained in the PEARLS model evaluated student performance with a standardized rubric and conducted a recorded debriefing. Debriefing recordings were analyzed for debriefer adherence to the PEARLS model. Debriefers were assigned a debriefing score (DS) from 0 to 13; 13 was perfect adherence to the model. Definitive intervention (DI) for asthma exacerbation was defined as bronchodilator therapy. Critical actions were as follows: a focused history, heart/lung exam, giving oxygen, and giving a bronchodilator.

Results: Mean DS for the debriefers of students who provided DI was 8.57; 9.14 for those students who did not (P = 0.25). Mean DS for debriefers of students who completed all critical actions was 8.68; 8.52 for those students who did not (P = 0.62). Analysis of elapsed time to DI showed no relationship between the time DI was provided and DS.

Conclusions: Student performance had no impact on debriefer performance, suggesting the PEARLS model is an effective aid for debriefers, regardless of learner performance. These findings suggest student performance may not bias facilitators' ability to conduct quality debriefings.

Keywords: Asthma exacerbation; Debriefing; Emergency medicine; PEARLS; Simulation.

Fig. 1

Time to definitive intervention vs debriefing score. This graph compares the time when the learner gave a bronchodilator, to the debriefing score assigned to the learner. The time intervals were recorded by debriefers at 1-min intervals. A time score of 0 indicates the student administered a bronchodilator at a time less than 1 min after case start. The data was derived from the simulation performance and subsequent debriefing of 187 3rd year medical students at Augusta University in 2019

Fig. 2

Time distance from mean TTDI vs debriefing score. This graph compares debriefing score to the time difference (sooner or later) between the time at which the learner gave a bronchodilator and the mean time of bronchodilator administration. The mean time was calculated using only the 180 learners who gave a bronchodilator. The data was derived from the simulation performance and subsequent debriefing of 187 3rd year medical students at Augusta University in 2019