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Debriefing in Simulation Garth Meckler, MD, MSHS Mary Anna Gordon, DNP, RN.

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Presentation on theme: "Debriefing in Simulation Garth Meckler, MD, MSHS Mary Anna Gordon, DNP, RN."— Presentation transcript:

1 Debriefing in Simulation Garth Meckler, MD, MSHS Mary Anna Gordon, DNP, RN

2 Overview Is Debriefing Important? History Theory Goals and Objectives Considerations Elements Approaches & Styles Methods & Strategies Tips / Tricks / Adjuncts Practice

3 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 Perceived skill of the debriefer has the highest independent correlation to perceived overal quality of the simulation –Wilhelm J. Survey of simulation participants. 1991

4 History Military –After-action review Aviation –Response to accidents in 1970s –Pre-flight briefings / Post-flight debriefings Psychology –Experiments using deception –Staff processing

5 Theory Andragogy –Adult learning –Malcolm Knowles Kolb Learning Cycle Experience Conceptualize ReflectExperiment Simulation Reflection DebriefingTranslation

6 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

7 Goals Facilitate learning through insight, understanding, and meaning –Safety –Respect –Curiosity Tied to educational goals of the experience

8 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

9 Considerations Educational goals and objectives Learners Teachers Time Timing Setting

10 Elements (Pre-briefing) Emotions / Reactions (Impact) Events (Process) Explanation / analysis (Reflection) Information (Didactic) Applicability (Relevance) Evaluation

11 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

12 Styles Judgmental –Goal: Make you to do the right thing –Assumption: I know what went wrong –Approach: blaming, shame, statement oftruth 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

13 Example

14 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 learners frame

15 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 didnt –Take home learning points –Real-world application

16 Example Emotions & Plus / Delta

17 Example Summary

18 Understanding Phase Learner Frames: –The minds-eye of the learner Assumptions, feelings, knowledge, awareness, context, goals of the learner ActionResultFrame ObservedUncovered

19 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 childs room open. I am concerned that this might allow humans into our world which could be very dangerous. Inquiry: –Question designed to explore learners frame –Clean Question What was on your mind when you walked through that door?

20 Practicing Advocacy-Inquiry Why didnt 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. Im wondering where you were on that? I didnt see you put on gloves or a face shield. Thats the most common mistake I see in codes like this. I wonder why that happens?

21 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

22 Additional Strategies / Methods Strategies Self debriefing Peer debriefing Methods Collaboration Script Written debriefing Video debriefing

23 Practice….

24 Practice…..

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