Presentation on theme: "The Art and Science of Debriefing"— Presentation transcript:
1The Art and Science of Debriefing Debriefing, 听取汇报, comentários, maoni,フィードバック, terugkoppeling, ردود الفعل, প্রতিক্রিয়া, Rückkopplung, thông tin phản hồi, обратная связь, Debriefing, 听取汇报, comentários, maoni,フィードバック, terugkoppeling, ردود عل, প্রতিক্রিয়া, Rückkopplung, thông tin phản hồi, обратная связь, Debriefing, 听取汇报, comentários, maoni,フィードバック, terugkoppeling, ردود الفعل, প্রতিক্রিয়া, Rückkopplung, thông tin phản hồi, обратная связь, Debriefing, 听取汇报, comentários, maoni,フィードバック, terugkoppeling, ردود الفعل, প্রতিক্রিয়া, Rückkopplung, thông tin phản hồi, обратная связь, Debriefing, 听取汇报, comentários, maoni,フィードバック, terugkoppeling, ردود الفعل, প্রতিক্রিয়া, Rückkopplung, thông tin phản hồi, обратная связь, Debriefing, 听取汇报, comentários, maoni,フィードバック, terugkoppeling, ردوعل, প্রতিক্রিয়া, Rückkopplung, thông tin phản hồi, обратная связь, Debriefing, 听取汇报, comentários, maoni,The Art and Science ofDebriefingGeoffrey T. MillerAssistant Professor, School of Health SciencesDirector Simulation, Technology and ResearchSentara Center for Simulation and Immersive LearningEastern Virginia Medical School
2Bottom line, up front…Debriefing is an art form… One which is honed through repeated practice, and experience… There are many approaches and techniques… And very few absolute rules
3Sessions aims Identify the goals of debriefing. Discuss the elements of debriefing that improve outcomes.Identify various approaches to debriefing.Discuss the process of debriefing.
4Human processing in action… ARE YOUHAPPY?DO YOU WANT TO BE HAPPY?NOCHANGE SOMETHINGYESKEEP DOING WHATEVER YOU’RE DOINGYESNO
5Human processing Natural order of human processing Reflect on it Experience an eventDiscuss it with othersLearn & modify behaviors based on the experience
6Why feedback/debriefing matters… A = EducationB = Things youknowABC = Things youknow youdon’t knowACD = Things youdon’t know,you don’tknowAD
7Feedback… Debriefing… isn’t it all just the same thing?
8FeedbackFeedback comprises a wide array of informational inputs, which may occur prior to, during, and after an experienceFeedback is the most important feature of simulation-based learningKnowledge of performance results - key to learningAppears to slow the decay of acquired skillsAllows for self-assessmentIssenberg SB,McGaghie WC, Petrusa ER, Gordon D, Scalese RJ (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher 27(1): 10–28.
9Feedback sourcesPre-briefings, instructions, in-case sources, debriefings, peers(team members), log files [manikin, computer, etc], standardized checklists, rating forms, evaluators (faculty, peer, patient), recordings (video)…The KEY is to use multiple sources of feedback… share them with the learnerDevelop a plan for feedback that supports the individual and/or team learning goals
10DebriefingA deliberative, learner-centric process designed to standardize the instructor/student post-event interaction to assist learners in thinking about:What they did,When they did it,How they did it,Why they did it andHow they can improve.
11Factors influencing debriefing Objective of the experiential exerciseComplexity of the scenarioExperience level of participantsExperience level of participants with simulation environmentTime available for the sessionThe role of the simulation in the overall curriculumIndividual personalities and relationships, if any, between the participants
13Debriefing myths…“There is a highly defined process or method for conducting learner debriefing”
14Realities…“there are surprisingly few papers in the peer-reviewed literature to illustrate how to debrief, how to teach or learn to debrief, what methods of debriefing exist and how effective they are at achieving learning objectives and goals”Fanning, RM, Gaba, DM. The Role of Debriefing in Simulation-Based Learning. Simulation in Healthcare. Vol. 2, No. 1, Spring 2007.
15Debriefing myths…“The most effective facilitation is achieved when the learners or participants do all of the talking… not the instructor”
16Realities…Some learners or learner groups may lack an adequate understanding of the event and it’s elements, or posses enough prior learning and experience to effectively reflect and learn.
17Debriefing myths…“Debriefings should always be conducted in a separate space or environment”
18“Debriefings should always be held after the simulation ” Debriefing myths…“Debriefings should always be held after the simulation ”
19Realities…“in certain circumstances (teaching a technical skill, fatal errors, or seriously flawed behaviors), debriefing may need to occur during the simulation (AKA: in- scenario debriefing)”
21The ultimate failure of debriefing “Learners are left with the mistaken impression that they are doing just fine”“Ignorance more frequently begets confidence than does knowledge”Charles Darwin – The Descent of Man (1871)
24Coaching, prompting & cueing Directing, instructing and training a person or group of people, with the aim to achieve some goal or develop specific skillsPromptingTo move to actionCueingGiving verbal or non-verbal triggers/clues for an action to be carried out at a specific timeInstructionFacilitation
25Debriefing Amount/Time Debriefing ‘Dose’“Debriefing Amount / Time will decrease with higher learner expertise, It will not reach zero”Debriefing Amount/TimeLearner ExpertiseNoviceExpert
26Lots of debriefing modes Private bedside debrief by facilitator immediately post scenarioPrivate ‘debriefing room’ debrief by facilitator immediately post-scenarioDebrief by peers outside of simulation suiteSelf-guided reflection of video performance26
27Feedback, debriefing & deliberate practice PrepDebriefSimChangeEricsson’s Model of Deliberate Practice:“Practice does not make perfect…practice makes permanent”Ericsson, KA. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Med. 79(10 Supplement):S70-81.
28Important debriefing points/skills Be genuine and student centricAsk open not closed ended questions:DON’T- Did you have a good experience?DO- Tell me about your experience.Use pauses and silences to elicit feedbackUse probing inquiry to gain deeper understanding
29Perspective on use of video Use if necessary; typically to observe specific events or processesHave participants compare their memory with the recording- “Tell me what happened”Peer input can be inappropriate- facilitator needs to guide the discussion into positive channel4141
31Structured & supported debriefing (SSD) Developed in collaboration with American Heart AssociationDefinition of ‘structured and supported’Structured elements include three specific debriefing phases with related goals, actions, and time estimates.Supported elements include both interpersonal support as well as use of protocols, algorithms, and best evidence to inform debriefing statements/questionsOther considerationsSimple, can be learned rapidly, scalable, validated by practiceAdapted from: O’Donnell, J.M., Rodgers, D.L., Lee, W, W., Edelson, D. P., Haag, J., Hamilton, M. F., Hoadley, T., McCullough, A., Meeks, R., (2009), Structured and Supported Debriefing [Computer Software]. American Heart Association, Dallas, TX.
32G GAS Model GATHER 25% Goal: Actions: Sample Questions: Listen to participants to understand what they think & how they feelActions:Request narrative from team leaderRequest clarifying or supplemental information from teamSample Questions:All: “How do you feel?”Team Leader: “Can you tell us what happened?”Team members: “Can you add to the account?”GGATHER25%
33A GAS Model ANALYZE 50% Goal: Actions: Sample Questions: Facilitate reflection on & analysis of actionsActions:Review accurate record of eventsReport observations (correct & incorrect steps)Reveal participants’ thinking processesReflect on performanceAssure continuous focus on session objectivesSample Questions:“Tell me more about…”“What were you thinking when…”“I understand, however, tell me about “X” aspect of the scenario…”“Let’s refocus… what’s important is not who is right but what is right for the patient…”AANALYZE50%
34S GAS Model SUMMARIZE 25% Goal: Actions: Sample Questions: Facilitate identification & review of lessons learnedActions:Participants identify positive aspects of team or individual behaviors & behaviors that require changeSummary of comments or statementsSample Questions:“List two actions or events that you felt were effective or well done”“Describe two areas that you think you/team need to work on…”SSUMMARIZE25%
35Plus- DeltaA student-centric approach simulation debriefing using a 2 X 2 matrix. Designed to rapidly gain participant feedback on both instructor and participant performance
36Debriefing With ‘Good Judgment’ Trainee ‘Frames’ ApproachFrames to Actions to ResultsA frame is the internal trainee environmentPerceptions, knowledge, assumptions, feelings, training etc….Instructor role- ‘cognitive detective’Tries to figure out frames through using a ‘stance of curiosity’Genuinely curious inquiryAdvocacy and Inquiry modelRudolph, J.W. et al., Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin 25 (2), (2007).
39New role for debriefing? To learn the skills to recognize ones own “limitations” (also described by some as incompetence) “To have such knowledge would already be to remedy a good portion of the offense” (Miller, WI. 1993)
40A possible future…Debriefing and feedback become normative processes encompassing all levels, domains and professional identities of the healthcare system
41A final note…Any simulation activity is a “snapshot-in-time”, It is reflective of the performance and behaviors which occurred during that specific time interval, It is not a positive or negative predictor of future performance
42SummarySimulation-based learning activities are supported by instruction (coaching) and facilitation (prompting and cueing)Consider the types of feedback available, and employ those best suited to achieve the desired outcomesFormulate a plan to provide structured debriefing following simulation activitiesDebriefing should be learner-centric and conducted within a safe environmentParticipants need and value the feedbackDebriefing points are derived through setting appropriate session/ course objectives
44For additional information… Geoffrey T. MillerAssistant Professor, School of Health SciencesDirector Simulation, Technology and ResearchSentara Center for Simulation and Immersive LearningEastern Virginia Medical School