debriefing in simulation garth meckler, md, mshs mary anna gordon, dnp, rn
TRANSCRIPT
Debriefing in Simulation
Garth Meckler, MD, MSHS
Mary Anna Gordon, DNP, RN
Overview
• Is Debriefing Important?• History• Theory• Goals and Objectives• Considerations
• Elements• Approaches & Styles• Methods & Strategies• Tips / Tricks / Adjuncts• Practice
Is Debriefing Important?
• Feedback is the most important feature of simulation-based medical education– Issenberg et al. Features
and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. 2005.
• Perceived skill of the debriefer has the highest independent correlation to perceived overal quality of the simulation– Wilhelm J. Survey of
simulation participants. 1991
History
• Military– After-action review
• Aviation– Response to accidents in 1970s– Pre-flight briefings / Post-flight debriefings
• Psychology– Experiments using deception– Staff processing
Theory
• Andragogy – Adult learning– Malcolm Knowles
• Kolb Learning Cycle
Experience
Conceptualize
ReflectExperiment
Simulation
Reflection
DebriefingTranslation
Theory
• Circumplex Model of Emotion– Russel and Feldman-Barrett
Activation
Deactivation
PleasantUnpleasant
Alert
Excited
Elated
Happy
Calm
Relaxed
Serene
Content
Fatigued
Bored
Depressed
Sad
Upset
Stressed
Nervous
Tense
Goals
• Facilitate learning through insight, understanding, and meaning– Safety – Respect– Curiosity
• Tied to educational goals of the experience
Objectives
• All– Provide a safe, activating environment for learning
• Debriefer– Elucidate the thoughts and actions of the participants– Impart critical knowledge, skills, and attitudes– Evaluate the educational experience and strategy
• Participants– Improve insight, knowledge, skills, and attitudes– Improve performance performance in similar
situations
Considerations
• Educational goals and objectives
• Learners
• Teachers
• Time
• Timing
• Setting
Elements
• (Pre-briefing)
• Emotions / Reactions (Impact)
• Events (Process)
• Explanation / analysis (Reflection)
• Information (Didactic)
• Applicability (Relevance)
• Evaluation
Approaches
• Three Levels of Debriefing (Dismukes, Aviation Model)– High: participants debrief themselves with
minimal guidance– Intermediate: increased instructor involvement
in analysis– Low: Intensive instructor involvement
Styles
• Judgmental– Goal: Make you to do
the right thing– Assumption: I know
what went wrong– Approach: blaming,
shame, statement of “truth”
• Non-judgmental– Goal: Avoid shame– Assumption: as above– Approach: kind,
gentle, lead learner to my answer
– Carl Rogers: facilitator as catalyst with congruence, acceptance, empathy
Example
Good Judgment
• CMS “Good Judgment”– Goal: mutual learning without shame– Assumptions: learner is smart and wants to
do the right thing• Mistakes are puzzles, not crimes
– Approach: mutual respect, curiosity• Advocacy: first person observation• Inquiry: uncover learner’s frame
CMS Debriefing Process
• Reactions Phase– Process emotions– Plus/Delta
• Understanding Phase– Explore “Frames”
using advocacy/inquiry– Teach through
modeling and didactics
• Summary Phase– What went well and
didn’t– Take home learning
points– Real-world application
ExampleEmotions & Plus / Delta
ExampleSummary
Understanding Phase
• Learner Frames:– The “minds’-eye” of the learner
• Assumptions, feelings, knowledge, awareness, context, goals of the learner
ActionResultFrame
ObservedUncovered
Advocacy-Inquiry
• Advocacy:– First person observation of an action or result– Concern or judgment about observation
• “I noticed that you left the door to the child’s room open. I am concerned that this might allow humans into our world which could be very dangerous.”
• Inquiry:– Question designed to explore learner’s frame– “Clean Question”
• “What was on your mind when you walked through that door?”
Practicing Advocacy-Inquiry
• Why didn’t you call for help?
• You forgot to wear gloves and a face shield, are you trying to get Hepatitis?
• I noticed you seemed to get very busy as the code progressed, and I thought you could have used some additional help. I’m wondering where you were on that?
• I didn’t see you put on gloves or a face shield. That’s the most common mistake I see in codes like this. I wonder why that happens?
Tips and Tricks for the Difficult Debriefing
• Prevention– Pre-brief– Prepare debriefing
guides
• Work in Teams– Co-facilitator
• Body Language
• Validate Emotions– Reflective listening– Normalize– Elaborate– Deflect
Additional Strategies / Methods
Strategies
• Self debriefing• Peer debriefing
Methods
• Collaboration Script• Written debriefing• Video debriefing
Practice….
Practice…..