The Trinity Technique: A novel 3-step approach for debriefing interprofessional major incident simulation.
DOI:
https://doi.org/10.18552/ijpblhsc.v13i1.1221Keywords:
acute stress disorders, crisis intervention, high fidelity simulation training, masscasualty incident, simulation trainingAbstract
Debriefing is conducted following serious or unexpected incidents to support well-being, uphold professional standards and help organisations pledge a duty-of-care. Debriefing skills can be honed within Simulation-Based-Learning (SBL) activities and a range of studies have shown this approach effective at transforming experiences into meaningful reflection. Immediately congregating learners after the conclusion of a simulation to identify areas of strength and growth and outlining potential areas to enhance future practice has also been shown to help cement key learning objectives. Despite this, the wider literature lacks a validated tool for interprofessional major incident simulation, highlighting an important research-knowledge gap. As part of a quality improvement initiative to advance teaching and learning practices within this domain, a novel 3-step, interprofessional major incident simulation debriefing strategy titled the Trinity Technique was fashioned and pilot-tested amongst a sample of 436 students studying Paramedic Science, Adult Nursing, Physician Associate Studies and Forensic Science. The Trinity Technique received positive feedback, valuable insight into learner experience was gained and the novel approach had a unique ability to debrief institutions as well as learners. Further research is now required to formally validate this pioneering approach.
References
Allen, J. A., Reiter-Palmon, R., Crowe, J., & Scott, C. (2018). Debriefs: Teams learning from doing in context. American Psychologist, 73(4), 504–516. https://doi.org/10.1037/amp0000246
Arriaga, A. F., Sweeney, R. E., Clapp, J. T., Muralidharan, M., Burson, R. C., Gordon, E. K. B., Falk, S. A., Baranov, D. Y., & Fleisher, L. A. (2019). Failure to debrief after critical events in anaesthesia is associated with failures in communication during the event. Anaesthesiology, 130(6), 1039–1048. https://doi.org/10.1097/ALN.0000000000002649
Barnhill, J.W. (2023). Posttraumatic stress disorder (PTSD). MSD Manual Consumer Version. MSD Manuals. https://www.msdmanuals.com/home/mental-health-disorders/anxiety-and-stress-related-disorders/posttraumatic-stress-disorder-ptsd
Bennett, P., Noble, S., Johnston, S., Jones, D., & Hunter, R. (2020). COVID-19 confessions: a qualitative exploration of healthcare workers experiences of working with COVID-19. BMJ Open, 10(12), e043949. https://doi.org/10.1136/bmjopen-2020-043949
Couper, K., & Perkins, G. D. (2013). Debriefing after resuscitation. Current Opinion in Critical Care, 19(3), 188–194. https://doi.org/10.1097/mcc.0b013e32835f58aa
Dayton, E., & Henriksen, K. (2007). Communication Failure: Basic Components, Contributing Factors, and the Call for Structure. Joint Commission Journal on Quality and Patient Safety, 33(1), 34–47. https://doi.org/10.1016/s1553-7250(07)33005-5
DeCarvalho, R.J. (1991). The humanistic paradigm in education. The Humanistic Psychologist, 19(1), 88–104. https://doi.org/10.1080/08873267.1991.9986754
Department of Health. (2019). Guidelines for Verifying Life Extinct. https://www.health-ni.gov.uk/publications/guidelines-verifying-life-extinct
Edwards, J. J., Wexner, S., & Nichols, A. (2021). Debriefing for clinical learning, Patient Safety Network. https://psnet.ahrq.gov/primer/debriefing-clinical-learning
Eppich, W., & Cheng, A. (2015). Promoting excellence and reflective learning in simulation (PEARLS). Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare, 10(2), 106–115. https://doi.org/10.1097/sih.0000000000000072
Everly, G., & Flynn, B. (2006). Principles and practical procedures for acute psychological first aid training for personnel without mental health experience. International Journal of Emergency Mental Health, 8(2), 93-100.
Gilmartin, S., Martin, L., Kenny, S., Callanan, I., & Salter, N. (2020). Promoting hot debriefing in an emergency department. BMJ Open Quality, 9(3), e000913. https://doi.org/10.1136/bmjoq-2020-000913
Howard, L., Wibberley, C., Crowe, L., & Body, R. (2018). How events in emergency medicine impact doctors’ psychological well-being. Emergency Medicine Journal, 35(10), 595–599. https://doi.org/10.1136/emermed-2017-207218
Joint Emergency Services Interoperability Programme. (2024). JESIP Website. https://www.jesip.org.uk/downloads/joint-doctrine-guide/
Khare, S. R., & Vedel, I. (2019). Recall bias and reduction measures: An example in primary health care service utilization. Family Practice, 36(5), 672–676. https://doi.org/10.1093/fampra/cmz042
Kolbe, M., Schmutz, S., Seelandt, J. C., Eppich, W. J., & Schmutz, J. B. (2021). Team debriefings in healthcare: aligning intention and impact. BMJ, 374, n2042. https://doi.org/10.1136/bmj.n2042
Lawn, S., Roberts, L., Willis, E., Couzner, L., Mohammadi, L., & Goble, E. (2020). The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research. BMC Psychiatry, 20(1), 348. https://doi.org/10.1186/s12888-020-02752-4
Ledbury, K., Glasgow, S., & Tallach, R. (2023). Learning from simulating mass casualty events: A systematic search and a comprehensive qualitative review. Disaster Medicine and Public Health Preparedness, 17, e242. https://doi.org/10.1017/dmp.2022.205
Lightowlers, S. V., Thompson, M. K., & Hunt, S. L. (2017). Not all interventions for burnout cost money: the value of debrief groups. BMJ, 358, j4377. https://doi.org/10.1136/bmj.j4377
Maloney, C. (2012). Critical incident stress debriefing and pediatric nurses: an approach to support the work environment and mitigate negative consequences. Pediatric Nurse, 38(2), 110-113.
Mayville, M. L. (2011). Debriefing: The essential step in simulation. Newborn and Infant Nursing Reviews, 11(1), 35-39. https://doi.org/10.1053/j.nainr.2010.12.012
Musgrave, S. (2013). Understanding Trauma: How Stress and Trauma Cause Chronic Pain, Anxiety, Depression, & PTSD [Video]. Associative Awareness Technique (AAT). https://youtube.com/watch?v=byQBP7fq5vQ
Ngo, M., Skelton, E., Ohene-Botwe, B., Papathanasiou, S., Amedu, C., Mannion, L., Ahmed, S., Vince, C., Stuart, D., Richards, C., Untisz-Sly, L., Brook, J., Hyde, E., O’Sullivan, C., & Malamateniou, C. (2025). The role of debriefing in supporting, retaining, and educating radiography students: An exploratory narrative review. Journal of Medical Imaging and Radiation Sciences, 56(5), 101971. https://doi.org/10.1016/j.jmir.2025.101971
Newton, J., & Smith, A. D. A. C. (2024). Developing emotional preparedness and mental resilience through high-fidelity simulation: a “bridge too far” for institutions teaching major trauma management and mass-casualty medicine? BMC Medical Education, 24, 544. https://doi.org/10.1186/s12909-024-05526-8
Nickson, C. (2021). Clinical debriefing. Life in the Fast Lane. https://litfl.com/clinical-debriefing/
Nikolopoulou, K. (2022). What Is the Pygmalion Effect? | Definition & Examples. Scribbr. https://www.scribbr.co.uk/bias-in-research/pygmalion-effect-explained/
Megnin-Viggars, O., Mavranezouli, I., Greenberg, N., Hajioff, S., & Leach, J. (2019). Post-traumatic stress disorder: what does NICE guidance mean for primary care? British Journal of General Practice, 69(684), 328–329. https://doi.org/10.3399/bjgp19X704189
Mildenhall, J. (2019). Protecting the mental health of UK paramedics. Journal of Paramedic Practice, 11(1), 6-7. https://doi.org/10.12968/jpar.2019.11.1.6
Miller, E. (2021). The prevalence of stress and burnout in UK emergency ambulance service workers and its impact on their mental health and well-being. British Paramedic Journal, 5(4), 62-63. https://doi.org/10.29045/14784726.2021.3.5.4.62
Morris, T. H. (2019). Experiential learning – A systematic review and revision of Kolb’s model. Interactive Learning Environments, 28(8), 1064–1077. https://doi.org/10.1080/10494820.2019.1570279
Petrie, K., Milligan-Saville, J., Gayed, A., Deady, M., Phelps, A., Dell, L., Forbes, D., Bryant, R. A., Calvo, R. A., Glozier, N., & Harvey, S. B. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 53, 897–909. https://doi.org/10.1007/s00127-018-1539-5
Preceptor Education Program. (2015). M5 Kolb’s Experimental Learning Cycle [Video]. https://www.youtube.com/watch?v=Rp-gaV-uSIo
Rose, S. C., Bisson, J., Wessely, S., & Bisson, J. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, CD000560. https://doi.org/10.1002/14651858.CD000560
Rosenthal, R., & Jacobson, L. (1968). Pygmalion in the classroom. The Urban Review, 3, 16–20. https://doi.org/10.1007/BF02322211
Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J. S., Birnbach, D. J., Robinson, D. W., & Upshaw, C. (2008). Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips. Joint Commission Journal on Quality and Patient Safety, 34(9), 518–527. https://doi.org/10.1016/s1553-7250(08)34066-5
Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-Traumatic Stress Disorder. The New England Journal of Medicine, 376(25), 2459-2469. https://doi.org/10.1056/nejmra1612499
Shrehorn, T. (2009). Recognition of life extinct and the processes of death. Journal of Paramedic Practice, 13(1). https://www.paramedicpractice.com/content/features/recognition-of-life-extinct-and-the-processes-of-death-1/
Sugarman, M. (2019) Take stock - hot debrief. RCEM Learning. https://www.rcemlearning.co.uk/foamed/take-stock-hot-debrief/
Sugarman, M., Graham, B., Langston, S., Nelmes, P., & Matthews, J. (2021). Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project. Emergency Medicine Journal, 38, 579–584. https://doi.org/10.1136/emermed-2019-208830
Sweberg, T., Sen, A. I., Mullan, P. C., Cheng, A., Knight, L., del Castillo, J., Ikeyama, T., Seshadri, R., Hazinski, M. F., Raymond, T., Niles, D. E., Nadkarni, V., Wolfe, H., & Pediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators. (2018). Description of hot debriefings after in-hospital cardiac arrests in an international pediatric quality improvement collaborative. Resuscitation, 128, 181–187. https://doi.org/10.1016/j.resuscitation.2018.05.015
Szyld, D., & Arriaga, A. F. (2021). Implementing clinical debriefing programmes. Emergency Medicine Journal, 38(8), 585–586. https://doi.org/10.1136/emermed-2021-211133
Turner, L. (2018). In Harm’s Way: A GMB Union Report. GMB Union. https://www.gmb.org.uk/sites/default/files/IN-HARMS-WAY.pdf
University of Birmingham. (2019). The human brain works backwards to retrieve memories. ScienceDaily. www.sciencedaily.com/releases/2019/01/190114082844.htm
Vaithilingam, N., Jain, S., & Davies, D. (2008). Helping the helpers: debriefing following an adverse incident. The Obstetrician & Gynaecologist, 10(4), 251–256. https://doi.org/10.1576/toag.10.4.251.27442
Watson, A. L., Drake, J., Anderson, M., Heaston, S., Schmutz, P., Reed, C., & Rasmussen, R. (2024). Triage ethics in mass casualty incident simulation: A phenomenological exploration. Nursing Ethics, 32(4), 1313-1326. https://doi.org/10.1177/09697330241299526
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jon Newton
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons License "Attribution-NonCommercial No Derivs 4.0 International" (CC BY-NC-ND 4.0) which permits others to use the publication as long as the authors are appropriately cited.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The Author grants to Coventry University an irrevocable, royalty-free, worldwide, non-exclusive licence to publish this article in this journal in addition to the licence granted at paragraph 1 of this copyright notice.
