Table 2 Recommended changes to the first version of guidelines by design principle
Design principle | Guideline element(s) | Observations | Recommendations |
|---|---|---|---|
• Interprofessional collaborative approach to facilitation | • Assigned roles and scripts for RN and MD facilitators in pre-briefing and debriefing | Works well in pre-briefing, debriefing is still mostly physician-led | • More prominent role for RN facilitators early in debriefing • Ask MD facilitators to review their own videos and reflect on creating space for RN facilitators |
• Expect active participation by all | • Discuss as a ground rule in pre-briefing • Assign participants active roles and observers • Invite participants and observers to speak in debriefing | Variable participation in debriefing, if RN facilitators have a clear presence, RN participants appear to speak more | • Create more space for RN facilitators (see above) • Explicitly invite RN participants to speak |
• Focus on teamwork and collaboration | • Highlight the goal in pre-briefing • Focused questions in debriefing | Most debriefs focus primarily on teamwork and collaboration. Some MD facilitators comment there is a need for discussion of medical content | • Early in the debrief ask for a mental model regarding patient’s medical condition • Develop asynchronous method for in-depth medical content knowledge sharing |
• Encourage perspective taking | • Discuss as a ground rule in pre-briefing • Focused questions in debriefing | Doesn’t happen consistently | • If mental models are incongruent, explore why the team thinks others have a different model • Include example questions in guidelines to promote perspective-taking |
• Make issues of hierarchy and power explicit | • Set expectations in pre-briefing • Focused questions in debriefing | Variable whether this is addressed, participants don’t always seem comfortable and facilitators vary in comfort and skill. Some feel the framing in the pre-briefing is too direct | • Change wording in pre-briefing to explicitly acknowledge the tension between experience versus position/role, without necessarily using words like hierarchy and power • Example questions with open-ended framing • Elicit examples from real life |