Learning from Experience : The Use of Structured Video-Assisted Debriefing Among Nursing Students

Abstract: Background: Simulation enhances experiential learning through creating experience to form the basis of learning, and it has been recognized as an effective pedagogy in current health professions education. As an integral element of simulation, debriefing contributes to transforming the created experience to new knowledge. Video-assisted debriefing (VAD) refers to adding audio-visual capture and review to traditional verbal debriefing (VD). Despite being regarded as ‘gold standard’ for simulation, evidence reporting educational effects of VAD is mixed and its best practice remains absent.Aims: The aims of this thesis were to develop a framework for VAD, to test and compare its effects on prelicensure nursing students’ debriefing experiences, reflective abilities and nursing competencies with VD without video, as well as to explore its potential impact on facilitators’ perceptions and practices following high-fidelity simulation.Design and methods: This thesis comprised of four studies with different research designs. Study I was a systematic review which synthesized the characteristics of existing VAD practices in health professions education and evaluated its effectiveness on learners’ reactions, learning and behaviors. Study II was a proof-of-concept study which developed of a three-phase framework for VAD and tested its preliminary effects on nursing students’ debriefing experiences, reflective abilities, and nursing competencies using a pretest-posttest design. Study III adopted a qualitative method to explore nursing students’ experiences and perspectives of a structured VAD using focus groups. Data were analyzed using thematic analysis approach. Study IV employed a mixed-method research design to investigate the impact of a three-phase VAD on nursing students’ debriefing experiences, perceived stress, as well as facilitators’ perceptions and debriefing practices.Results: Study I showed that existing VAD offered comparable educational effects as VD in terms of learners’ experiences, attitudes, and performance, except on knowledge acquisition. Video did not demonstrate its continuous advantage in debriefing, which informed the absence of best practice. The preliminary results of Study II reported that a three-phase VAD significantly improved students’ debriefing experiences (p<0.001), reflective abilities (p<0.01), and nursing competencies (p<0.001). Study III disclosed an emotional roller coaster experienced by nursing students in VAD, from unwillingness and fear of being judged, followed by stress and defensiveness, to sense of appreciation and satisfaction. Most students agreed that VAD provided a good learning experience with few preferred not to receive peer feedback after video review. Study IV demonstrated that VAD improved nursing students’ debriefing experiences (p=0.01) and caused comparable stress as VD. Repeated exposure to VAD significantly reduced stress levels. VAD also enhanced facilitators’ perceptions and debriefing practices.Conclusions: This project developed a three-phase framework for VAD, and affirmed its educational effects on improving nursing students’ debriefing experiences, reflective abilities, and competencies following high fidelity simulation, with comparable stress experienced as in VD. The finding of an emotional roller coaster experienced by nursing students in VAD challenged the snapshot of negative emotions reported in other studies, offering some clarity to the inconsistent evidence regarding learners’ experiences of VAD and contributing to its best practice. This thesis also proved that this three-phase VAD held the potential to enhance facilitators’ debriefing practices towards student-centered learning.