4 Your Best Teacher was…SmartWiseCaringConcernedUnspoken expert
5 How people practice Internal Frames EXAMPLES: Thanksgiving is a day I eat all my favorite food.Dancing makes me look goofyIf I don’t leave work by 4:45 I will be stuck in traffic.
6 Learners Frames Feelings Assumptions Knowledge Stuff I know is true Stuff I learned in school
7 Frames shape actionsThanksgiving is a day I eat all my favorite food. – Eat all day – I can diet tomorrow.Dancing makes me look goofy – Don’t go near the party with a dance floor.If I don’t leave work by 4:45 I will be stuck in traffic. - Hurry all day to get it done because I don’t want to get home at 6pm.
8 Medical Frames & Actions Residents don’t have any power… and I can’t tell my attending what to do. When you do airway, you have to use an AMBO bag. I can’t find one and I think this patient is not going to make it. I just got out of school and everyone thinks I know what I am doing.
9 How do you define errors? Intentionally rational actionSeemed like a good idea at the time, given the circumstances.Lack of knowledge
10 Our Basic AssumptionEveryone participating in activities in the PULSE Center is intelligent, well trained, cares about doing their best and they want to improve.
11 Debriefers JobHelp learner to surface their frames and analyze the impact on their actions.Be the UNSPOKEN EXPERTFacilitate open/safe discussion
12 Debriefing leads to new frames Debriefing changes later actionsFramesActionsResults
13 Judgmental Statements & Questions Can anyone tell us where John made his big mistake?Does someone have a clue as to what went wrong with this patient?Setting them straightI’m right – You are wrongI know --- you don’t (essential failure in thinking)Truth------error (next time do it my way)I know the answer- can you guess what I am thinking?“pimping”
14 Non-Judgmental (???)I’m right – your wrong – but I don’t want to upset you.“Feedback Sandwich”Something soft (complement)Something meaty (criticism)Creates confusionHas hidden truthsConsequences unclear
15 Debriefing with Good Judgment How did the learner make meaning of what happenedInstructor “From what I know this happened in the simulation and this is where I saw the problems”Learner is also smart and well trained trying to do the best so… why did the learner take these actions? (they must have a good reason)
16 Errors are discussable Mistakes are made and recognized and then changes happenSource of learning happens when you know what happened and how it can be differentMake mistakes discussableEnhance patient safetyLet learners identify their own mistakes
17 Debriefing with Good Judgment Learner makes a mistakesDebriefer is genuinely curiousDiscuss what that looked likeLearners feel worthwhile and intelligentRespectfully insert your expertiseFrame changes can happen!
18 Debriefing is Discussion (not lecture!) The Debriefer should talk lessTry only asking questionsGet the learners to talk to each otherMake it SAFE to discussBe a facilitator; not a lecturerClosed ended questions – as appropriateOpen ended questions
19 Three Elements of Debriefing ReactionsFeelingsFactsUnderstandingExplore deeper meaningSummaryThe take home message
20 Advocacy-Inquiry Advocacy – observation, statement, fact - neutral Inquiry – question or curiosity**GENUINE Curiosity (you want to understand)
21 Successful Debriefing Genuinely interested – You see yourself as the good teacher not the good healthcare workerPre-scenario briefing of expectationsReinforcing good practiceCorrect a limited number of errorsAvoid excessive correction (people only remember 1 or 2 things - what is the take-home message?)
22 Successful, Con’t Stress key educational points Use playback so the learners can see themselvesTalk less, facilitate moreBe respectful of any learner criticismUse Advocacy – InquiryPlus /Delta