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Pre‐Conference: De‐Briefing with Good Judgement

Integrating Simulation Into Regional Core Training (RCT)

West Coast Child Welfare Trainers Conference

Morning Session 

July 31, 2018

Why Debrief at all?

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Deliberate Practice

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The Feedback Traps

Debriefing as Feedback

• Debriefing #1

• Debriefing #2

A Better Way?

Debriefing with Good Judgement

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Debriefing with Good Judgment (DGJ) is

A structured facilitated model of debriefing conducted in a conversational style

• designed to provide psychological safety for the learner, and

• elicit underlying frames and mental models that influence behavior(actions)

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Kolb’s Experiential Learning Cycle

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“It is not enough just to do, and neither is it enough just to think.  

Nor is it enough simply to do and think.  

Learning from experience must involve links between the doing and the thinking” 

(Gibbs, 1988, p. 14)

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CORE COMPONENTS OF DEBRIEFING WITH GOOD JUDGEMENT (DGJ)

• Centrality of Psychological Safety for Learning• Importance of Frames as Drivers of Action• Reflection as Critical to Changing Frames• Use of Advocacy Inquiry to Support Reflection• Debriefer and Participant Both Contribute to

Understanding what Happened

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We believe that everyone participating in the

simulation is intelligent, capable, cares about doing

their best, and wants toimprove.

Team Psychological

Safetyand

the Basic Assumption

Our Adaptation to DGJ Model: Mindfulness

• Rationale

• Evidence

• Our Experience

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Before We Begin . ..

• Choose an opponent for thumb wrestling

• The goal is for you to win this competition.

• To win, you will need to pin your opponent’s thumb more times than they pin yours during 45 seconds

Adapted from Sweeney & Meadows The Systems Thinking Playbook, 2001.

What Happened?

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• How many points did you get?

• What were the assumptions you brought into this game?

• How did your assumptions affect your behavior?

Mental Models (Frames)

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• The images, assumptions, and stories we carry in our minds of ourselves, other people, institutions, and every aspect of the world

• They determine what we see, and most importantly, how we act

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Reflective Practice A Conceptual Model where participants’ “frames”—comprised of such things as knowledge, assumptions, and feelings—drive their actions. Their actions, in turn, produce practice results.

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Closing the Performance Gap

• Debriefing is time to identify performancegaps and close them through discussionand reflection

• Debriefing gives learner the tools tochange and improve their performance

• Learner may demonstrate exceptionalframes – this too should be noted in debrief

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Skills for Working with FramesReflection – understanding your own mental models and the implications

Inquiry – learning the questions you can ask to help you test others’ mental model

Advocacy – making your thinking and reasoning more visible to others

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Take action based on belief

Adopt beliefs

Make assumptions

Select piece of information

All observable data and experience

(Argyris & Schön, 1978)

Ladder of Inference- Tool for Examining Frames

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SIMULATION PHASES

Pre-Briefing

Simulated Scenario

Phases of Debriefing

• Reaction & Facts (3-5minutes)

• Analysis – (25 minutes)

Preview, Advocacy, Advocacy, Inquiry,

Listen (PAAIL)

• Summary(5-8 minutes)

Following Debriefing- Evaluation

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The Heart of Debriefing: Reflection ….

allows learners to uncover the thoughts, feelings and behaviors that drive behavior

Enables us to:

• Learn

• Be conscious of our potential for bias

• Use reflection as tool for lifelong learning

• Maximize own learning opportunities

• Can observe gap between desired and actual actions

• Acknowledges and empowers learners

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Questioning Tool: Advocacy-Inquiry• I Saw: Your concrete observations

Specific facts, ‘bottom rung of ladder’, objective• — “I saw…” or “I heard…” or “I noticed….”• I Think: Your perspective and why it matters

Your point of view in the context of effect on caregiver— “I think…” or “I wonder …” or “I am pleased…”

• I Wonder: Open-ended inquiry into learner perspective

Short, open-ended questions/statements about learner thoughts• — “How do you see it…? or “What were you

thinking….?”

Advocacy

Inquiry

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States conclusionsImposes solutionsGives no examplesDoes not explain thinking

Explains thinkingGives examplesSeeks other’s viewsProbes thinkingEncourages challenge

ObservesWithdrawsAsks general questions

Seeks confirming viewsAsks leading questionsDiscourages challenge

INQUIRY

asking questions

Low

Low High

High

ADVOCACY

making statements

The Learning Grid: Assessing the Quality of Conversations

Debriefing with Good Judgement

An Example

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References• Andersen, J. P. and H. Gustafsberg (2016). "A Training Method to Improve Police Use

of Force Decision Making." SAGE Open 6(2)

• Argyris, Chris (1990). Overcoming organizational defenses: Facilitating organizational learning. Needham Heights, MA: Allyn and Bacon

• Christopher, M. S., et al. (2016). "A Pilot Study Evaluating the Effectiveness of a Mindfulness-Based Intervention on Cortisol Awakening Response and Health Outcomes among Law Enforcement Officers." Journal of Police and Criminal Psychology 31(1): 15-28.

• Edmondson, A. (1999). "Psychological Safety and Learning Behavior in Work Teams." Administrative Science Quarterly 44(2): 350-383.

• Fanning, R. M. and D. M. Gaba (2007). "The role of debriefing in simulation-based learning." Simulation in Healthcare Journal 2.

• Gaba D. (2004). The future of simulation in health care. Quality and Safety in Health Care, 13:2–10.

• Hyland et. al., Mindfulness at Work: A New Approach to Improving Individual and Organizational Performance. Industrial and Organizational Psychology / October 2015, pp 1 – 27.

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References• Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and

development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.

• Kruzich, J..M., Mienko, J. & Courtney, M.. (2014). Individual and Work Group Influences on Turnover Intention Among Public Child Welfare Workers:The Effects of Work Group Psychological Safety. Children and Youth Services Review.

• Rudolph, J. W., et al. (2008). Debriefing as formative assessment: closing performance gaps in medical education. Academic Emergency Medicine 15.

• Rudolph, J. W., et al. (2016). "A DASH to the Top: Educator Debriefing Standards as a Path to Practice Readiness for Nursing Students." Clinical Simulation in Nursing12(9): 412-417.

• Rudolph J.W., Raemer, D.B, & Simon R.(2014) Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simulation in Healthcare Dec;9(6):339-49.

• Rudolph J.W.,et. al.(2013). Helping without harming: the instructor's feedback dilemma in debriefing--a case study. Simulation in Healthcare. Oct;8(5):304-16

Before We Try It Out

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Time to Try it Out!

Simulation: Learning Objectives

Explain your role to Mrs. Jimenez.

Build rapport with Mrs. Jimenez.

CPSGather information about the allegation

Review the Protective Action Plan

CFWSExplore her understanding of the concerns and the requirements, and clearly articulate yours.

Initiate a discussion about concurrent planning.

Simulation: Layout and Logistics

Each group will have a coach assigned

Coach will take you to one of 3 “stations” to interview Mrs. Jimenez

Interviews will be done round robin style• Your group will decide what order you’ll interview in, 

and how you’ll sit in the room

When your interview time is almost over, the coach will tell you (“last question” or “30 seconds”)

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Simulation: Layout and Logistics

Before we enter we’ll review our learning objectives

Half the group will do the interview and the other will observe and take notes (depending on group size)

After the interview, the Coach will facilitate a debrief within that room

We’ll take a break between interviews, and switch stations for the next interview

Simulation: Our Basic Assumption

We believe that you are intelligent, capable, care about doing your best and want to improve.

Simulation: Your Role

• Act as if this was a real parent • Use the structure and approaches we reviewed, as well as your other skills

• Apply the basic assumption to yourself, your peers, and your coach

• Be willing to reflect on what happened within the interview

• Keep confidentiality

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Simulation: Our Role

Apply the basic assumption to each of you and ourselvesProvide hints or nudges when needed within the simulationPause the simulation if a re‐do is neededKeep the group on timeUse the debrief to identify the moments that are richest for learningand to reflect together on how those moments went

Calming the Body and Mind