Too Anxious to Learn?: Should the Ongoing Debriefing Technique be Amongst the Best Practices in Simulation?

Friday, 25 July 2014

Marc E. Code, CRNA, BS, MSN
Program of Nurse Anesthesia, Samuel Merritt University, Oakland, CA


The aim of this paper is to demonstrate benefit of the Ongoing Simulation Debriefing Technique on lowering anxiety levels amongst those participating in simulation activities.


After IRB approval, the pre-simulation/post-simulation anxiety levels were evaluated in first year nurse anesthesia students (n=26) in three different scenarios using State Trait Anxiety Inventory (STAI). Students were divided into two groups - Control group (End Debriefing) and Experimental group (Ongoing Simulation Debriefing Technique). Both groups were exposed to identical simulations of increasing scenario complexity with the last scenario being the most difficult and complex (pediatric induction). Students were asked to complete a questionnaire both pre/post simulation.  The data were collected from 2012 to 2013.


A quasi-experimental design was used to collect research data and analyzed for validity and significance utilizing SPSS and T–test analysis. The anxiety levels were reduced in both control and experimental groups post simulation as compared to their pre simulation values as evident by STAI scores. The overall mean STAI scores were reduced by 15.21 and 21.81 percentage points, respectively, in control and experimental groups. The difference between means was statistically significant (P < 0.001). Students’ perception of confidence and satisfaction was measured on a 5-point Likert scale. Students demonstrated more confidence and satisfaction in the control group than the experimental group in cardiovascular emergencies while in respiratory and pediatric simulations the experimental group demonstrated more confidence and satisfaction. In the most difficult and complex of the three scenarios, the pediatric emergencies, the experimental group showed the most dramatic increase in confidence and satisfaction while the control group showed a decline.


Ongoing Simulation Debriefing Technique reduces stress and anxiety levels generated by simulation more than when using the End-Debriefing Technique. The Ongoing Simulation Debriefing Technique creates a safer learning environment in which students can maximize their learning potential. This technique should be considered as a best practice for Simulation Based Learning with adults. This method has shown to exhibit more confidence in students but more research is needed to determine its implications on performance in the clinical setting.