Anne van Dalen

2 Development of a model for video-assisted postoperative team debriefing I 65 time, space, and use of equipment. 5,67,68,69 Previous research has shown that there was a sense that VAD also had benefits of removing the debriefer from the position of the critic who told the learners how to improve. By showing the team a video (‘‘a picture paints thousand words”), the debriefer may present the team an objective view of the situation. This may help the moderator in taking the role of facilitator instead of feedback provider. 5 Furthermore, participants may feel that video presents a more unbiased way of conveying feedback than from the participant’s memory. 5 The value of video to debrief important skills such as communication, teamwork, and situational awareness has been highlighted as well. 5,70 However, the problem is that the team may first need a method to analyze the complete video recordings objectively. Otherwise, valuable time is lost “searching” for relevant feedback moments to discuss during debriefing. 55,71,72 Several models have been developed to objectively assess the nontechnical skills of the team. The Nontechnical Skills for Surgeons (NOTSS), Scrub Practitioners’ List of Intraoperative Nontechnical Skills (SPLINTS), and Anesthesia Nontechnical Skills rating systems have been proven to be effective tools that may be used to rate the nontechnical skills of the operating team when assessing the video recordings. 73,74,75 The Systems Engineering Initiative for Patient Safety model provides a framework for understanding the structures, processes, and outcomes of the work system in health care and patient safety. It combines the human factor with the system aspects, such as environment (e.g., distraction in the OR) and organization (e.g., schedules, safety culture, or coordination), all influencing team performance. 76 It is also important to realize that it may neither be realistic nor useful to look back on entire video recording of the surgical case. Both the team and debriefer could be overloaded with a multitude of not very informative data. Debriefing may not be one- way conveyance of information, but rather an active multiway discussion. The benefit of using a video or MDR is that aggregated and condensed information may be obtained, resulting from actual use. Hence, an output report containing summarized video clips of positive and negative events deemed relevant, rated with the use of validated and objective nontechnical rating scales such as the NOTSS, SPLINTS, and Anesthesia Nontechnical Skills, may be of much help structuring the team debriefing. 77,78