Simulation is an effective method for learning and demonstrating competency in the clinical setting. Like protocols used by nurses in the practice setting, simulation educators have standards of best practice to guide their use of simulation for teaching and learning. By using the Healthcare Simulation Standard of Best Practice: Prebriefing, the simulation educators and nurse preceptors can create safe learning and working environments. Incorporating a standard prebriefing method and plan that carries throughout the clinical environment may be one way to decrease stress and anxiety of the nursing team and promote a psychologically safe working environment.

While healthcare should not be compared to other high reliability organisations (HROs), many lessons, attitudes, and transferable practices can be applied and adapted from them to improve patient safety and team morale. Despite briefings improving both patient safety and effective team working, some in healthcare have not valued or actively engaged with them, deeming them to be irrelevant. In this pilot study we explored the experiences of, and attitudes to, briefings using a 10-question Survey Monkey. This was promoted during a human factors session at the 2023 Association of Surgeons in Training Conference (ASiT) and at a large NHS trust. Questions were asked about the number of briefings per day, attitudes, engagement, and respondents\' attitudes to them. In total, 109 responses were received. A total of 85% reported at least one briefing on a normal operating day, 65% felt them to be interactive, 67% reported that briefings were led by the most senior surgical team member, and 58% lasted four minutes or more. Eighteen per cent of respondents felt they were of little benefit, and 56% did not routinely de-brief at the end of the day. This study has highlighted variable attitudes to team briefings, with some colleagues still seeing them as a \'tick box\' exercise. While culture has changed following the introduction of the WHO checklist, the importance of active engagement and education to improve the delivery and value of effective briefings cannot be overestimated. It is also an opportunity to create a \'safe space\' for team members and to confirm zero tolerance for any inappropriate behaviour, including sexual misconduct.

Globally, at least one adverse event occurs in 10% of patients using emergency, inpatient, outpatient, surgical and primary care services. Particularly in emergency health care, this problem is exacerbated by additional variables such as patient criticality, high-risk diagnostic and therapeutic interventions and varying levels of healthcare provider training. In relation to the last point, briefing and debriefing activities during an emergency reinforce staff training and support them in managing work resources, planning interventions and improving future performance. The aim of the scoping review is to explore the state of the art in human factors applied to emergency situations and to develop a new tool to support healthcare professionals in conducting evidence-based briefings and debriefings. This review was developed using a search strategy based on the Arksey and O\'Malley\'s six-step framework for scoping reviews. The literature analysed and the data identified, which are heterogeneous due to different study methodologies, objectives and types of interventions, suggest that human factors applied to emergency situations are still under-researched. At the end of the data extraction, analysis process, authors\' reviews, discussion rounds and comparison with the multidisciplinary team of healthcare providers, 42 behaviours, 33 elements and 8 domains were considered relevant and included in the Emergency Team Comptencies (ETC) briefing and debriefing tool, ranked in order of priority as follows: communication, decision-making, clinical skills, situational awareness, leadership, task management, collaboration and stress and fatigue management. Further research is needed to investigate human factors applied to emergency situations and to generate new evidence to improve clinical practice and reduce the risk of error. In the near future, further studies will be conducted by the authors to test the validity of the Emergency Team Competencies tool in objectively measuring the performance of professionals and multidisciplinary teams.

BACKGROUND: Surgical care, which is performed by intensely interacting multidisciplinary teams of surgeons, anesthetists, and nurses, remains associated with significant morbidity and mortality. Intraoperative communication has been shown to be associated with surgical outcomes, but tools ensuring efficient intraoperative communication are lacking. In a previous study, we developed the StOP?-protocol that fosters structured intraoperative communication. Before the critical phases of the operation, the responsible surgeon initiates and leads one or several StOP?s. During a StOP?, the surgeon informs about the progress of the operation (status), next steps and proximal goals (objectives), and possible problems (problems) and encourages all team members to voice their observations and ask questions (?). In a before-after study performed mainly in visceral surgery, we found effects of the StOP?-protocol on mortality, length of hospital stay, and reoperation. We intend to assess the impact of the StOP?-protocol in a cluster randomized trial, in a wider variety of surgical specialties (i.e., general, visceral, thoracic, vascular surgery, surgical urology, and gynecology). The primary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces patient mortality within 30 days after the operation. The secondary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces unplanned reoperations, length of hospital stay, and unplanned hospital readmissions.
METHODS: This study is designed as a multicenter, cluster-randomized parallel-group trial. Board-certified surgeons of participating clinical departments will be randomized 1:1 to the StOP? intervention group or to the standard of care (control) group. The intervention group will undergo a training to use the StOP?-protocol and receive regular feedback on their compliance with the protocol. The surgeons in the control group will communicate as usual during their operations. The unit of observation will be operations performed by cluster surgeons. Consecutive patients will be enrolled over 4 months per cluster. A total of 400 surgeons will be recruited, and we expect to collect patient outcome data for 14,000 surgical procedures.
CONCLUSIONS: The StOP?-protocol was designed as a tool to structure communication during surgical procedures. Testing its effects on patient outcomes will contribute to implementing evidenced-based interventions to reduce surgical complications.
BACKGROUND: ClinicalTrials.gov NCT05356962. Registered on May 2, 2022.

Although numerous efforts have been made to promote age-friendly communities (AFCs) in urban China, challenges such as the engagement and management of stakeholders, budget constraints, and policy issues remain. This article describes the work of designing a multi-agent platform (MAP) for the briefing stage of AFC projects.
The process to design the MAP is first described, and the components and variables are identified. Then, a case study of a stakeholder consensus formation process is conducted using an agent-based simulation. Next, according to the simulation results, strategies to handle the conflicts arising among the stakeholders of AFC projects are proposed.
According to the agent-based simulation conducted, both the initial approval rate and the outside connection rate will affect the stakeholder consensus formation process. Although a higher initial approval rate and a lower outside connection rate may reduce the average convergence time, the results show that 3-5 rounds of information exchange are still needed before a consensus or dissent is formed.
Investors are suggested to communicate with residents and alleviate their concerns regarding AFC projects to facilitate the consensus formation process during the briefing stage of AFC projects; they can also organize activities for residents to exchange information and ideas. The simulation conducted, together with the MAP built in this research, will serve as a reference to help researchers and practitioners further understand the briefing stage and explore efficient strategies for the successful implementation of AFC projects in urban China.

Miscommunication and poor coordination among surgical teams are known causes of preventable medical harms and operating room inefficiencies and inhibit surgical training. Technology may help overcome these challenges. This study used the personal experience of one of the authors as a former Air Force F-15 pilot to design a combat aviation pre- and postoperative communication workflow in the neurosurgery department and tested its effect on safety, efficiency, and education. The authors hypothesized that the adoption of this workflow through a tailored technological platform will increase compliance and improve the chances of sustainability.
Data were prospectively collected from neurosurgery cases before (January-May 2020) and after (June-October 2020) implementation of this workflow. Briefing and debriefing were executed using a custom mobile platform and were defined as nonmandatory for all participants. All faculty and residents who operated at NYU Langone Medical Center (Tisch campus) during the intervention period were enrolled on the platform. Primary outcomes were morbidity and mortality per the department\'s criteria, and intraoperative last-minute requests as reported by operating room staff in a double-blinded fashion. Secondary outcomes were user responses on the subjective questionnaires.
Data were collected from 637 and 893 cases during the preintervention and intervention periods, respectively. The average briefing rates for residents and surgeons were 71% and 81%, respectively, and the average debriefing rates for residents and surgeons were 67% and 88%. There was no significant difference in preoperative risk score between the preintervention and intervention patient populations (p = 0.24). The rate of intraoperative last-minute requests significantly decreased from 16.6% (35/211) to 10.5% (35/334, p = 0.048). There was no significant change in morbidity and mortality between the preintervention and intervention periods. On subjective questionnaires there was a statistically significant improvement in safety, efficiency, and educational aspects of the cases during the intervention period.
Implementation of aviation-like structured team communication practices in the neurosurgery department through a technological platform improved education and communication between surgical teams and led to a reduction in last-minute surgical requests that could impact costs.

To implement the use of standardized preoperative briefings and postoperative debriefings for surgical cases involving residents in an effort to improve resident autonomy and skill acquisition.
Prospective longitudinal study.
Johns Hopkins Department of Otolaryngology-Head and Neck Surgery.
Resident and attending physicians.
Joint Huddles for Improving Resident Education (JHFIRE) tool was created and successfully implemented by 19 residents and 17 faculty members. Over the course of three data collection periods spanning an academic year, overall scores improved though not statistically significantly in the metrics of Zwisch autonomy, Resident Performance, and Objective Structured Assessment of Technical Skills (OSATS) scores. Female residents were scored significantly higher by attendings than their male counterparts in the assessment of baseline Resident Performance.
(1) JHFIRE tool implemented a standardized preoperative briefing and postoperative debriefing to improve communication and resident skill acquisition; (2) The tool was accepted and utilized throughout an academic year; (3) Zwisch, Resident Performance, and OSATS scores improved though not significantly.

To study the impact of a new preoperative briefing and postoperative debriefing tool on the perceived quality of surgical education and to assess attitudes of residents and attendings regarding this tool.
Surrounding introduction and use of the tool (JHFIRE: Joint Huddles for Improving Resident Education), perceived quality of surgical education was assessed with pre- and postintervention System for Evaluation of Teaching Qualities (SETQ) surveys. Additionally, a postintervention Likert survey regarding the JHFIRE tool itself was completed by residents and faculty.
Johns Hopkins University Department of Otolaryngology-Head and Neck Surgery, a tertiary care academic institution.
All residents and attendings who used the tool were invited to participate. 40 participants (13 residents, 27 attendings) completed the preintervention SETQ. 11 participants (3 residents, 7 attendings, 1 unspecified) completed the postintervention SETQ. For postintervention qualitative assessment of the tool itself, 12 participants (3 residents, 7 attendings, 2 unspecified) provided feedback.
The tool was well-received with large subjective benefit in improving resident surgical education. A total of 88% thought that the time spent on the debriefings was \"just right\" and 91% planned to make the debriefings a regular part of operative performance assessments. Despite this overwhelmingly positive feedback, there was no overall difference in pre- and postintervention SETQ scores for climate of surgical education in the Department (4.25 ± 0.55 vs. 4.10 ± 0.88, p = 0.63).
Introduction of 4 item preoperative briefing and 4 item postoperative debriefing checklists was welcomed by both residents and faculty for its ability to shape surgical education in the operating room into a guided discovery model of hands-on education. Overall SETQ scores did not change, but most participants found value in the tool and plan to continue its use.

BACKGROUND: This paper explores a novel pedagogy surrounding students\' clinical practice sessions. Before each clinical session, student clinical groups meet and each student presents their treatment planned for that session. The teachers question their understanding and explore \"what-if\" and other management scenarios. Peers in the clinical group observe the presentation and learning dialogue. After the clinical session, students gather on the clinic to debrief their performance with the tutor. Peers observe this dialogue, the shared clinical experience. This paper explores students\' perceptions of reflection before action and reflection on action surrounding their clinical practice.
METHODS: Focus groups were conducted to explore this phenomenon and to create a questionnaire, which was administered to the whole class. Transcriptions of the focus groups and open-ended response in the questionnaire were subjected to a thematic analysis to identify emerging themes and supported by closed-ended question responses.
RESULTS: Briefing sessions before clinical sessions helped students identify problems and clear doubts before entering clinics. Students were able to recall and rehearse the clinical procedural knowledge and felt well prepared and confident for patient care. Student sharing of knowledge with peers provided a broader learning experience and helped gain confidence. Students also reported to learn from the teacher facilitating their preparation for the session. Debriefing sessions after the clinical session allowed reflection and learning including error correction on their own and peer experiences. Students learnt personally, from peers and from the teacher, and emphasised the importance of the student-teacher relation.
CONCLUSIONS: Briefing and debriefing sessions were highly valued by students for preparation and learning on clinics and in learning from peers. Briefing sessions cleared misunderstanding, prevented errors, broadened procedural knowledge and improved both confidence and clinical experience. Debriefing sessions facilitated reflective practice, error correction and prevention, and helped gain insights from teachers\' own experience and perspectives.

UNASSIGNED: Facilitators plays a key role in nursing student\'s learning when briefing them for simulation scenarios. However, few studies have explored the importance of the facilitator\'s role in preparing students from the students\' perspective. The aim of this study was to explore undergraduate nursing students\' perspectives of the facilitator\'s role in briefing.
UNASSIGNED: An explorative, qualitative approach was used. Four focus group interviews with a total of 30 nursing students constituted the data source. Data collection took place in December 2017 and in May 2018. The data was analysed using systematic text condensation.
UNASSIGNED: Two main categories were identified: \"The importance of framing the subsequent scenario\" and \"The importance of instructing students how to execute nursing actions in the subsequent scenario\". The first category consisted of three subcategories: providing predictability, providing emotional support and providing challenges. The second main category also consisted of three subcategories: providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin.
UNASSIGNED: A briefing is more than a general introduction to a simulation scenario, learning objectives, roles, simulation environment and medical equipment. The information provided in a briefing is important for nursing students\' understanding of what they will encounter in the simulation scenario and what is being simulated, as well as possibly being a prerequisite for mastery. The facilitator\'s role in the briefing is complex and requires a high level of educational expertise to balance the diversity of students\' learning approaches. Students have to learn how to simulate before the briefing. Therefore, we suggest separating the concepts of prebriefing and presimulation from the concept of briefing, introducing prebriefing and presimulation preparation before briefing, and possibly dividing students into groups based on their learning approach. Such interventions will make it possible for facilitators to balance between students\' needs and the time available for briefing.
UNASSIGNED: Supplementary information accompanies this paper at 10.1186/s12912-020-00493-z.