Presentation on theme: "Debriefing in Simulation"— Presentation transcript:
1 Debriefing in Simulation Garth Meckler, MD, MSHSMary Anna Gordon, DNP, RN
2 Overview Is Debriefing Important? History Theory Goals and Objectives ConsiderationsElementsApproaches & StylesMethods & StrategiesTips / Tricks / AdjunctsPracticeTheory: Kolb Learning Cycle, Circumplex Model of Emotion, AndrogogyApproaches: Judgmental, Non-judgmental, Good judgmentMethods: Reactions, Plus/Delta, Advocacy/Inquiry, Team approachTips: The difficult debriefingPractice: Monster’s Inc. and Communication Simulation
3 Is Debriefing Important? Feedback is the most important feature of simulation-based medical educationIssenberg et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic reviewPerceived skill of the debriefer has the highest independent correlation to perceived overal quality of the simulationWilhelm J. Survey of simulation participants. 1991
4 History Military Aviation Psychology After-action review Response to accidents in 1970sPre-flight briefings / Post-flight debriefingsPsychologyExperiments using deceptionStaff processing
5 Theory Andragogy Kolb Learning Cycle Adult learning Malcolm Knowles ExperienceSimulationAdragogy:Independent/self-directingExperiencedValue learning that is relevant to their livesInterested in immediate, problem centered vs. subject-centered approachesInternally rather than externally motivatedImplications: involve learners in defining needs/goals/curriculum, support learners in carrying out their own learning plans, identifying resources, and critical self-evaluationKolb Learning Cycle: Experience (act of simulation), Reflect / Conceptualize (act of debriefing), Experiment (incorporate learning into real life)ExperimentReflectTranslationDebriefingConceptualizeReflection
6 Theory Circumplex Model of Emotion Russel and Feldman-Barrett ActivationTenseAlertNervousExcitedStressedElatedUpsetHappyUnpleasantPleasantSadContentDepressedSereneBoredRelaxedFatiguedCalmDeactivation
7 Goals Facilitate learning through insight, understanding, and meaning SafetyRespectCuriosityTied to educational goals of the experience
8 Objectives All Debriefer Participants Provide a safe, activating environment for learningDebrieferElucidate the thoughts and actions of the participantsImpart critical knowledge, skills, and attitudesEvaluate the educational experience and strategyParticipantsImprove insight, knowledge, skills, and attitudesImprove performance performance in similar situations
9 Considerations Educational goals and objectives Learners Teachers Time TimingSettingDebriefing should focus on meeting the educational goals and objectivesConsideration of the number of learners, learner background (multi-disciplinary groups) and individual learning stylesConsideration of the number and experience of teachers; who will debrief? Self-debriefing? Peer debriefing?Time protected for debriefing (depends on the educational goals / objectives – less time for technical skills, more time for team skills / communication)Timing: Immediate, delayed, longitudinal (blog, journal, reflection)Setting: In situ, removed, remote. Physical arrangement – where to place the facilitators?
10 Elements (Pre-briefing) Emotions / Reactions (Impact) Events (Process) Explanation / analysis (Reflection)Information (Didactic)Applicability (Relevance)EvaluationPre-briefing: safety contract, orientation, goals / objectives, expectations, emotional valence, trust, suspension of disbeliefAnticipates / guides the debriefingCan eliminate distractions, help focus learnersProvides insight into individual learning styles, group dynamicsEvaluation: Of learners and of educational experience, strategy
11 Approaches Three Levels of Debriefing (Dismukes, Aviation Model) High: participants debrief themselves with minimal guidanceIntermediate: increased instructor involvement in analysisLow: Intensive instructor involvementHigh – Carl Rogers, teacher as catalyst, facilitatorIntermediate: Re-phrasing of learner’s observations/statements. Asking questions in multiple ways. Asking questions of multiple participantsLow: Directed discussion, specific questions and answers, recapping, agreeing, reinforcing, encouraging.
12 Styles Judgmental Non-judgmental Goal: Make you to do the right thing Assumption: I know what went wrongApproach: blaming, shame, statement of “truth”Non-judgmentalGoal: Avoid shameAssumption: as aboveApproach: kind, gentle, lead learner to my answerCarl Rogers: facilitator as catalyst with congruence, acceptance, empathy
14 Good Judgment CMS “Good Judgment” Goal: mutual learning without shame Assumptions: learner is smart and wants to do the right thingMistakes are puzzles, not crimesApproach: mutual respect, curiosityAdvocacy: first person observationInquiry: uncover learner’s frame
15 CMS Debriefing Process Reactions PhaseProcess emotionsPlus/DeltaUnderstanding PhaseExplore “Frames” using advocacy/inquiryTeach through modeling and didacticsSummary PhaseWhat went well and didn’tTake home learning pointsReal-world application
18 Understanding Phase Learner Frames: The “minds’-eye” of the learner Assumptions, feelings, knowledge, awareness, context, goals of the learnerFrameResultActionUncoveredObserved
19 Advocacy-Inquiry Advocacy: Inquiry: First person observation of an action or resultConcern 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?”
20 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?
21 Tips and Tricks for the Difficult Debriefing PreventionPre-briefPrepare debriefing guidesWork in TeamsCo-facilitatorBody LanguageValidate EmotionsReflective listeningNormalizeElaborateDeflectSafety contract, orientation, fiction contractCo-facilitator: follow-up questions, re-directing, de-escalatingReflect: So what I hear you saying is…Is that right?Normalize: Almost everyone performs differently in these simulations than they do in real life….Video: anectode about CPR and OBGYN ChairElaborate: I understand that you were feeling rushed. How come?Deflect: ask a second participant to comment from their perspective. Change to a less charged topic. Share your own experiences