Evaluating the Briefing,
Intraoperative Teaching, Debriefing
(BID) method for surgical skills
teaching:
a pilot study
Daniel Hoppe MD MEd
Oleg Safir MD FRCS(C) MEd
Adam Dubrowski PhD
What is BID?
Journal of the American College of Surgeons
(2009)
Step
Task
Briefing
Set learning objectives
Intra-operative
Teaching
Teaching during the encounter
Debriefing
Reflection
Rules
Reinforce
Correct
Why the BID?
WHAT LEARNERS
WANT*
WHAT ACTUALLY
HAPPENS**
Instructor “game-plan”
“Opportunistic” teaching
Involvement in the
learning process
Passive transfer of
information
Ongoing and direct
feedback
Limited feedback given
*Vikis et al. (2008), Cox and Swanson (2001), Snyder et al (2012)
**Scallon et al. (1992), Irby (1995), Roberts et al. (2008), Jefree and Clarke (2010)
Objective
✦
To evaluate whether the BID method
is an effective framework for surgical
skills teaching
✦
Learner reactions, satisfaction
Methods
First year orthopaedic residents (n=12)
Allocated to control group
(n=6)
Allocated to BID group
(n=6)
PRE-TEST (OSATS)
Learned Control Skill
(Central Line)
Learned Control Skill
(Central Line)
BID Method Training
Session
First year orthopaedic residents (n=12)
Allocated to control group
(n=6)
Allocated to BID group
(n=6)
PRE-TEST (OSATS)
Learned Control Skill
(Central Line)
Learned Control Skill
(Central Line)
BID Method Training
Session
BID Method Training Session
✦
60 minute session
✦
Interactive - presentation, discussion, roleplay
✦
Given to both instructor and BID group
separately
✦
Learners trained to create synergistic
learning effect*
*Aagaard et al. (2004), Manyon et al. (2003), Vikis et al. (2008)
Learned Control Skill
(Central Line)
Learned Control Skill
(Central Line)
BID Method Training
Session
Learned Test Skill 1
(Bone Wedge)
Learned Test Skill 2
(Bone Plating)
POST-TEST (OSATS)
Learned Test Skill 1
(Bone Wedge)
Learned Test Skill 2
(Bone Plating)
Outcome Measures
✦
Change in individual OSATS scores checklist and GRS
Outcome Measures
✦
Satisfaction Questionnaire, Educational
Practices Questionnaire*
✦
Focus group data
Rizzolo (2006), National League for Nursing (2007)
Standardization of
Instructors
✦
Used a number of measures to try and
ensure approximate instructor equivalency
1. Perception of Preparedness Questionnaire
- no differences
2. “Assessing Teaching Skills” assignment
(adapted from Ramsden et al. 1995)
3. “Control Skill” (Central Line Insertion)
- taught to each group prior to BID training
Results
Assessing Instructor
Equivalency
✦
Perception of Preparedness Questionnaires similar
between both instructors
✦
also had similar teaching ideologies/experience
-no formal educational training
-no familiarity with educational theory
-preferred small-group learning to lectures
-feedback important (but neither knew framework for delivering feedback)
-use questions to confirm understanding
OSATS Pre-test Data
✦
no significant differences in baseline pre-test scores
between groups for checklist and GRS scores
Skill
GRS
Checklist
Central Line
Insertion
P=0.326
P=0.102
Bone Wedge
P=0.478
P=0.536
Bone Plating
P=0.927
P=0.263
Control Skill: Central Line
Insertion
Global Rating Scale
Control
BID
46
53
96
81
PROPORTIONAL CHANGE
P=0.129
100
Proportional Increase
Pre-Test
PostTest
80
84.93
60
55.96
40
20
0
Control Group
BID Group
After BID training
Test Skill 1: Bone Wedge
Cut
Global Rating Scale
P=0.049
PROPORTIONAL CHANGE
Control
BID
59
66
69
94
100
Proportional Increase
Pre-Test
PostTest
80
82.2
60
40
20
13.8
0
Control Group
BID Group
Test Skill 2: Bone
Plating
Global Rating Scale
Control
BID
42
43
56
82
P=0.011
80
Proportional Increase
Pre-Test
PostTest
PROPORTIONAL CHANGE
69
60
40
20
23.7
0
Control Group
BID Group
Checklist Scores
✦
No significant difference in improvement in
checklist scores for any skills
Secondary
Outcome
Measures
Questionnaire Data
✦
After first skill (both groups untrained)
Control Group
(%)
BID Group
(%)
Satisfaction with
Teaching Method
85
85
Objectives/Informa
tion
83
77
Active
Learning/Faculty
Interaction
79
83
Feedback
85
72
Questionnaire Data
✦
After last skill
Control Group
(%)
BID Group
(%)
Satisfaction with
Teaching Method
77
90
Objectives/Informa
tion
74
84
Active
Learning/Faculty
Interaction
72
88
Feedback
69
81
Focus Group Data
✦
Easy to use and remember
✦
For majority, first time setting objectives
✦
Formal time for feedback appreciated
✦
Less time wasted during sim sessions
Conclusions
✦
training both the learners and instructors in the BID
method produced significant improvement in GRS
scores for specific surgical skills
✦
trend towards higher learner satisfaction
✦
BID provides an easy-to-implement framework for
surgical simulation teaching
Limitations
✦
Small sample size
✦
Choice of skills - limited
✦
Retention/transfer not tested
✦
In vivo vs. in vitro effects?
Future Directions
✦
these results are promising enough to
continue with a larger-scale study
✦
more residents, more skills, more
instructors
✦
simulation vs. OR
✦
role in Competency-Based Education?
Quotes from BID
Group
“These sessions seemed a bit like a study group”
“Having an objective to work on focused me on a specific
task”
“I can see this working in the OR but it would need to have staff
buy-in”
“This may not work when I’m on call and it is very busy”
“I think using this approach improved the flow of
teaching”
“I really liked the debriefing part, and I wish this would happen in
real life!”
Thank you
Acknowledgments:
Thanks to Lisa Satterthwaite, Dr. Ranil
Sonnandara, Carween Hui, Polina Mironova,
Dr. Hesham Abdelbary, Dr. Michael Drexler,
and the staff of the Mount Sinai Surgical Skills
Centre
Step
Task
Script
Briefing
Set learning objectives
“What would you like to
focus on?”
Intra-operative
Teaching
Teaching during the
encounter
Focus on stated
objectives
Debriefing
Reflection
Rules
Reinforce
Correct
“How did you think you
did?”
“You did well at...”
“Next time, do...”