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Background. Debriefing is a fundamental step in simulation, particularly in the medical field. Simulation sometimes even serves as a pretext for debriefing. Most often, debriefing takes place easily, producing a qualitative feedback and an optimal learning transfer. But sometimes, the facilitator faces difficulties. An unproductive debriefing can be described as follows: the debriefing of a clinical simulation session is unproductive when facilitators or learners perceive the occurrence of an obstacle that has hindered the learning process. Objectives & method. Considering the difficulties encountered in this type of debriefing, we believe it is necessary to investigate the topic in depth in order to bring out some theoretical principles. Based on a Nominal Group Technique involving the authors of this article, this project aimed at drawing up and proposing informed recommendations for ensuring productive debriefing in simulation-based education in healthcare. Results. The authors make the following recommendations: Reflect on your own performances as an instructor (asking for feedback from the learners and peers, and being appropriately trained as an instructor who can facilitate learning) Establish simulation ground rules (preparing and briefing the learners before the simulation experience, controlling the timing of the simulation session and the quality of the scenarios) Manage unexpected events and intended learning objectives by using a confederate during scenarios. Respect the steps of the debriefing process and good practice recommendations regarding learning psychology. Maintain the balance between emotion and teaching by decontextualizing the experience from the participants during the debriefing. Manage the input from the peers during the debriefing so they do not antagonise the learning process. Reflect on your own performances as an instructor (asking for feedback from the learners and peers, and being appropriately trained as an instructor who can facilitate learning) Establish simulation ground rules (preparing and briefing the learners before the simulation experience, controlling the timing of the simulation session and the quality of the scenarios) Manage unexpected events and intended learning objectives by using a confederate during scenarios. Respect the steps of the debriefing process and good practice recommendations regarding learning psychology. Maintain the balance between emotion and teaching by decontextualizing the experience from the participants during the debriefing. Manage the input from the peers during the debriefing so they do not antagonise the learning process. Conclusion. Six key recommendations are proposed. They have been deemed as core skills required of every simulation facilitator to prepare for productive debriefing and so the set learning objectives of a simulation session can be achieved successfully

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These articles were published by mistake in the May 2016 issue of BJA due to an administrative error. They were supposed to go into this special issue on Airway Management. The articles can be accessed free of charge at the following link

Airway management is a core competency for many different medical specialties. Despite continuous improvements in equipment, clinical understanding, education and training, airway management complications remain a significant cause of morbidity and mortality worldwide. Several international airway management guidelines already exist, but there has never been a national consensus document for Switzerland. The Fondation Latine des Voies Aériennes (FLAVA) has developed a new set of airway management guidelines based on the latest scientific evidence and the authors’ extensive clinical experience. These recommendations are intended to guide and assist clinicians in managing a wide array of airway situations. They are applicable to the daily routine management of anticipated and unanticipated airway difficulties. The new 2022 FLAVA Airway Guidelines (FLAGs) combine cognitive aids for using the latest technical skills and non-technical skills. Specially-designed key mnemonics and ergonomic tools complement these guidelines, including a colour-coded airway cart.

Prehospital endotracheal intubation (ETI) can be challenging, and the risk of complications is higher than in the operating room. The goal of this study was to compare prehospital ETI rates between anaesthesiologists and non-anaesthesiologists. This retrospective cohort study compared prehospital interventions performed by either physicians from the anaesthesiology department (ADP) or physicians from another department (NADP, for non-anaesthesiology department physicians). The primary outcome was the prehospital ETI rate. Overall, 42,190 interventions were included in the analysis, of whom 68.5% were performed by NADP. Intubation was attempted on 2797 (6.6%) patients, without any difference between NADPs and ADPs (6.5 versus 6.7%, p = 0.555). However, ADPs were more likely to proceed to an intubation when patients were not in cardiac arrest (3.4 versus 3.0%, p = 0.026), whereas no difference was found regarding cardiac arrest patients (65.2 versus 67.7%, p = 0.243) (p for homogeneity = 0.005). In a prehospital physician-staffed emergency medical service, overall ETI rates did not depend on the frontline operator’s medical specialty background. ADPs were, however, more likely to proceed with ETI than NADPs when patients were not in cardiac arrest. Further studies should help to understand the reasons for this difference.