Accessing the living laboratory: trigger films as an aid to developing, enabling, and assessing anesthesia clinical instructors.

Problems arise when clinical instructors are placed in situations for which they are ill prepared. Teaching occurs in settings where patient safety and quality must be ensured. Trigger films are 2- to 4-minute vignettes simulating real-life situations that finish abruptly, stimulating participants to analyze situations in a safe environment. This study's purpose was to develop and assess the validity of high fidelity trigger films in facilitating nurse anesthesia clinical instructor development. Trigger films were produced in our simulation laboratory involving: (1) the overly confident student, (2) the self-defeating student, and (3) teaching stressed by production pressure. Trigger films consisted of Part A, the introduction of a complex teaching situation, and Part B, offering 1 possible resolution. Trigger films attained validity using a national panel of experts (kappa > 0.88, all indices). Seventy-four clinical instructors viewed trigger films, completing an extensive evaluation. Scenario themes were consistently described; the depicted, desirable clinical instructor attributes were routinely identified by the participants. This study initiated the process of demonstrating validity and reliability of trigger films in this setting. Trigger films may offer a systematic approach to facilitating clinical instructor development by safely engaging clinical instructors in a range of complex scenarios in the "living laboratory." They may have application in other healthcare domains as well.