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Shimaoka debriefing

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    Shimaoka debriefing Shimaoka debriefing Presentation Transcript

    • Debriefing When  Learning  Occurs
    • Debriefing ふりかえり あいかわらず  依然として  得体の知れないもの  
    • Review ArticlesThe Role of Debriefing in Simulation-Based Learning Ruth M. Fanning, Mb, MRCPI, FFARCSI; and David M. Gaba, MDT he aim of this paper is to critically review what is felt to beimportant about the role of debriefing in the field of simula- when they can immediately apply what they have learned.3 Their attitudes towards any specific learning opportunity willtion-based learning, how it has come about and developed vary and depend on factors such as their motivation for at-over time, and the different styles or approaches that are used tending training, on whether it is voluntary or mandatory,and how effective the process is. A recent systematic review of and whether participation is linked directly to recertificationhigh fidelity simulation literature identified feedback (in- or job retention. Traditional teaching methods based on lin-cluding debriefing) as the most important feature of simula- ear communication models (ie, a teacher imparts facts to thetion-based medical education.1 Despite this, there are sur- student in a unidirectional manner) are not particularly ef-prisingly few papers in the peer-reviewed literature to fective in adult learning, and may be even less so in team-illustrate how to debrief, how to teach or learn to debrief, oriented training exercises. The estimated half-life of profes-what methods of debriefing exist and how effective they are at sional knowledge gained through such formal education mayachieving learning objectives and goals. be as little as 2 to 2.5 years.4 In the case of activities requiring This review is by no means a systematic review of all the both formal knowledge and a core set of skills, such as Ad-literature available on debriefing, and contains information vanced Cardiac Life Support, retention can be as little as 6 tofrom both peer and nonpeer reviewed sources such as meet- 12 months.5,6ing abstracts and presentations from within the medical field Much of the research in teaching adults indicates thatand other disciplines versed in the practice of debriefing such active “participation” is an important factor in increasing theas military, psychology, and business. It also contains many effectiveness of learning in this population.7 In fact, in anyexamples of what expert facilitators have learned over years of given curriculum, learning occurs not only by the formalpractice in the area. We feel this would be of interest to nov- curriculum per se but informally through personalizedices in the field as an introduction to debriefing, and to ex- teaching methods (informal curricula), and even more soperts to illustrate the gaps that currently exist, which might be through embedded cultures and structures within the orga-addressed in further research within the medical simulation nization (hidden curricula).8community and in collaborative ventures between other dis- Adults learn best when they are actively engaged in theciplines experienced in the art of debriefing. process, participate, play a role, and experience not only con- crete events in a cognitive fashion, but also transactionalTHE BACKGROUND OF SIMULATION-BASED events in an emotional fashion. The learner must make sense of the events experienced in terms of their own world. TheLEARNING combination of actively experiencing something, particularly Generally, in simulation-based learning, we are dealing if it is accompanied by intense emotions, may result in long-with educating the adult professional. Adult learning pro- lasting learning. This type of learning is best described asvides many challenges not seen in the typical student popu- experiential learning: learning by doing, thinking about, andlation. Adults arrive complete with a set of previous life ex-periences and frames (“knowledge assumptions, feelings”),ingrained personality traits, and relationship patterns, which assimilation of lessons learned into everyday behaviors. Kolb describes the experiential learning cycle as containing four Debriefingに関する総説 related parts: concrete experience, reflective observation, ab-drive their actions.2 Adult learners become more self-di- stract conceptualization, and active experimentation.9 Gibbsrected as they mature. They like their learning to be problem also describes four phases: planning for action, carrying outcentered and meaningful to their life situation, and learn best action, reflection on action, and relating what happens backFrom the Department of Anesthesia, Stanford University, Stanford, CA. to theory.10 Grant and Marsden similarly describe the expe- riential learning process as having an experience, thinking Society  for  Simula9on  in  Healthcare                                                                                                                2007   The authors have indicated they have no conflict of interest to disclose. about the experience, identifying learning needs that wouldReprints: Ruth M. Fanning, Department of Anesthesia, Stanford improve future practice in the area, planning what learning toUniversity Medical School, 300 Pasteur Drive, Stanford, CA 90314 (e-mail:ruthfanning@ireland.com). undertake, and applying the new learning in practice.11Copyright © 2007 Society for Simulation in Healthcare Simulation training sessions, which are structured withDOI: 10.1097/SIH.0b013e3180315539 specific learning objectives in mind, offer the opportunity toVol. 2, No. 2, Summer 2007 115
    • 私たちの学びにおいて  もっとも大きな要素はなにか
    • 経験学習 学習とは経験の変換によって   知識が形成される過程である Kolb  
    • Simulation 安全な状況下で Experience を提供する
    • 体験することが目的ではない 体験して学び取ることが目的
    • 経験学習 学習とは経験の変換によって   知識が形成される過程である Kolb  
    • Not  everyone  is  naturally  capable  of  analyzing,  making  sense,  and  assimila9ng  learning  experience  on  their  own,  par9cularly  those  included  in    Highly  dynamic  team  based  ac9vi9es.   すべての人が自らの学習経験を  分析したり意味付けしたりすることが  できるわけではない
    • そこでデブリーフィングが登場する…. Debriefing  represents     facilitated  or  guided  reflec9on     in  the  cycle  of  experien9al  learning デブリーフィングとは経験学習サイクルの中で ファシリテーション、もしくはガイドつきで   行われる「振り返り」である         
    • THE  DEBRIEFING  PROCESS Models  of  Debriefing The  natural  order  of  human  processing  (普通のプロセスとして)        1)  to  experience  an  event(ある出来事を経験する)      2)  to  reflect  on  it(それを振り返る(内省する))      3)  to  discuss  it  with  others(他者と話し合う)      4)  learn  and  modify  behaviors  based  on  the  experience         (学習し、その経験に基づき行動変容をする。) Reflec9on  aYer  learning  experience  might  occur  naturally,                  but  it  is  likely  to  be  unsystema9c. 普通にしていれば学習経験のあとの振り返りは自然と生じるはずだが   でも、それはあまりシステマチックにはならないんですね、、、 システマチックに行える方法として、、、デブリーフィングが必要
    • Debriefing Process    Ini9al  phase  :    The  recollec9on  of  what    happened  and                                                          discrip9on  of    what  par9cipant  did  in  their  own  words                (自分の言葉で何がおこったのか、何をしたのか説明)    Second    Phase  :  Described  as  iden9fying  the  ways  in  which  emo9on              was  involved either  individually  or  for  the  group         (どのように思ってどのように感じてそのようにしたかを説明)    Third  Phase  :  iden9fying  the  different  views  formed  by  each            par9cipant  and how  they  correlate  with  the  picture  as          a  whole;  generaliza9on  and  applica9on  of  the            experience,  during  which  par9cipants                                                      a^empt  to  make  comparisons  with  real  life  events                (客観的に参加者それぞれの視点から考える。               実際の出来事と比較してみて一般化していく。)  
    • 「ふりかえりの 3ステップ」    何を(what?)、  だから何/なぜ(so  what?)、  ゆえに何/どうする(now  what?)      という構造化を用いる
    • THE  DEBRIEFING  PROCESS To  Debrief  or  Not?(デブリーフィングをするのかしないのか) Typically  topics  that  at  benefit  from  debriefing(デブリーフィングが効果的なのは?)                          1)  Team  training(チームワークトレーニング)                        2)  Crew  resource  management(CRMスキルトレーニング)                        3)  Mul9disciplinary  training(多職種トレーニング) Teaching  technical  skills,such  as  intunba9on,  does  not  require     In-­‐depth  debriefing  or  reflec9ons   テクニカルスキルにおいてはあまり深いデブリーフィングは要求されない Learning    objec9ves,  Target  popula9on,  and  modali9es  of  simula9on  will  drive                whether  a  debriefing  is  useful  or  not   学習目標、どのようなグループに行うか、シミュレーションの種類などによって   デブリーフィングが有効かそうでないかが分かれる
    • もしできなかったら 失敗したらどうしよう
    • THE  DEBRIEFING  PROCESS Approach  to  Debriefing(デブリーフィングに際し考慮すべきこと)   Approximately  half  of  the  par9cipants  found  It   a  stressful  and  in9mida9ng  environment   fear  of  the  educator  and  their  peer’s  judgement 参加者の約半数が     教える側の人間や一緒に受講する人による        「自分に対する評価」をストレスに感じている
    • THE  DEBRIEFING  PROCESS Approach  to  Debriefing(デブリーフィングに際し考慮すべきこと)   Facilitator  must  provide  a  ‘suppor9ve  climate’   where  students  feel  valued,  respected,   And  free  to  learn  in  a  dignified  environment. ファシリテーターは受講者が尊重され、   自由に学べるような   「支持的環境(SUPPORTIVE  CLIMATE)」を   作らなくてはならない  
    • THE  DEBRIEFING  PROCESS Approach  to  Debriefing(デブリーフィングに際し考慮すべきこと)   Par9cipants  need  to  be  able  to  ‘share  their  experiences    in  a  frank,  open,  and  honest  manner’ 受講者側もフランクに、オープンに、   正直に経験を共有することができるように
    • THE  DEBRIEFING  PROCESS Role  of  the  Facilitator  in  the  Debriefing  Process the  skill  of  facilitators  as  being     an  important  factor  in  the  learning  process     and  the  CREDIBILITY  OF  THE  COURSE  ファシリテーターのスキル     →学習のプロセスにおいての重要な要素       コースの信頼度にも関わってくる  
    • THE  DEBRIEFING  PROCESS Role  of  the  Facilitator  in  the  Debriefing  Process UNLIKE  THE  TRADITIONAL  CLASSROOM  TEACHER,     facilitators  tend  to  posi9on  themselves     not  as  authori9es  or  Experts,   but  rather  as  COLEARNERS 伝統的な教師と異なり、  ファシリテーターは「ともに学ぶ人」という立場    
    • THE  LEVEL  OF  FACILITATION  and  THE  INVOLVEMENT  IN  THE  DEBRIEFING  PROCESS   DEPEND  ON  A  VARIETY  OF  GENERIC  FACTORS            (いろいろな要素でファシリテーションの度合いはかわるのです)      1  The  objec9ve  of  the  experien9al  exercise(目的)    2  the  complexity  of  the  scenarios(シナリオの複雑さ)    3   the  experience  level  of  the  par9cipants  as  individuals  or  team(経験の差)    4  The  familiality  of  the  par9cipants  with  the  simula9on  environment(慣れ)    5   9me  available  for  session(時間)    6   The  role  of  simula9on  in  the  overroll  curriculum(シミュレーションの役割)    7   Indivisual  personali9es  and  rela9onships,  if  any,  between  par9cipants(個人の関係性)  
    • Three  Levels  of  facilita9on  in  Debriefing  Process High Par9cipants  largely  debrief  themselves          (自分でdebriefingできるチームの場合)  Facilitators  gently  guide  the  discussion  only  when  necessary          (必要なときだけ介入)  High  level  faci.  Is  a  low  level  of  involvement          (ファシリテーション高い、介入度低い)  Fasilitator  as  catalyst          (ファシリテーターは触媒)  The  use  of  pauses  to  allow  thoughmul  responses  and  comment                                                (ちょいと待つ)  Open-­‐ended  ques9on,  and  phrases  rather  than  statements  of  fact                                              (決めつけるよりはオープンクエスチョン)  The  armul  use  of  silence  is  the  technic  to  draw  further  discussion  from  the  group                                              (沈黙をより深いディスカッションのために使用する)  
    • Three  Levels  of  facilita9on  in  Debriefing  Process intermediate Increased  level  of  instructor  involvement                (より介入の度合いがあがる)  Individuals  and  teams  requires  help  to  analyze  in  deep  levels                     but  are  capable  of  much  independent  discussion              (助けはいるがちょいと助けると勝手に進んで行く)  Rewording  and  Rephrasing  rather  than  giving  an  answers                (答えを与えるより言い方を変えて話してみる)
    • Three  Levels  of  facilita9on  in  Debriefing  Process Low An  intensive  level  of  instructor  involvement.(かなり集中的にインストが介入)  Teams  show  li^le  ini9a9ve  or  respond  only  superficially(表面的な反応でしかない)  Asking  many  Ques9ons  /  strongly  directs  the  nature  of  discussion(たくさん質問する)  Faciitators  needs  to  be  direc9ve  to  operate  a  stepwise  or  pa^ern  of  analysis                              (かなり指導的に細かく分析が必要)  Ex)  answering  for  par9cipants(答える)  /  confirming  statements(確認する)      agreeing(承認する)  /reinforcing  thoughts  and  ideas(考えを強化する)      ac9ve  listening(能動的にきく)  /       nonverbal  encouragement  such  as  nodding,    leaning  forward,                            and  focused  eye  contact(非言語的な承認勇気づけ)
    • THE  DEBRIEFING  PROCESS The  Debriefing  Seong Debriefing  oYen  take  place  in  a  room  separate  from  the  ac9ve  por9on  of  the    Simula9on  to  allow  diffusion  of  ten9on  and  to  provide  a  seong  conduc9ve  to    Reflec9on  (場所を変える テンションの開放など) The  debriefing  room  should  be  comfortable  private,  and  a  rela9vely  in9mate    emvironment(ex  a  large  auditorium  would  typically  not  to  be  appropriate)              (居心地のよい場所 あまり広すぎない場所)  
    • THE  DEBRIEFING  PROCESS The  Debriefing  Seong The  sea9ng  arrangement  may  vary  with  the  style  of  debriefing                                   and  the  degree  of  facilita9on  intended                                                    Tradi9onal  teaching  aproach  :  the  facilitator  may  posi9on  himself    at  the  head  of  the  table                  (伝統的な教え方ではテーブルのトップに偉い人が座る)    Per9cipant-­‐directed  debrief  :  the  facilitator  may  posi9on  himself    among  the  par9cipants                                                                                                                    away  from  the  table  /  out  of  the  sight  /    outside  of  the  room                   (部屋から出て行っていい!!)  
    • THE  DEBRIEFING  PROCESS The  Debriefing  Seong Not  all  debriefings  are  held  aYer  the  sims  :      teaching  technical  skils                team  behaviors  are  seriously  flawed                     ‘  in  scenario  debriefing  ’ (デブリーフィングは必ずしもシナリオの終わりにやらなくてもよい)
    • THE  DEBRIEFING  PROCESS The  Effec9veness  of  Debriefing  Sessions Elements  of  a  good  debrief    Elements  of  a  poor  debrief       The  use  of  open-­‐ended  ques9on   The  use  of  closed  ques9ons         (オープンクエスチョン)         (クローズドクエスチョン)   Posi9ve  reinforcement   Cri9cism(批判的)         (前向きな強化)   Ridicule(侮辱的)   The  use  of  cogni9ve  aids   Concentra9ng  on  errors(エラーにだけ)         (認知的補助)   Concentra9ng  too  much  on  technical  points   The  good  use  of  audiovisual         (テクニカルなことにだけ)                    capabili9es   Not  enough  on  CRM  skills         (視聴覚機材の使用)     (CRMスキルについて十分出ない)  Crea9ng  a  non-­‐threatnening atmosphere Performed  poorly  could  harm  the  trainee
    • 最近思うこと
    • よりリアルに近づき過ぎて シナリオに失敗したときに  受講生の心が深く傷ついてしまう可能性がある。  
    • メンタリング
    • Shimaoka    Debriefing  Method 開発中 Vent   What  happened?   Analyze(What  you  have  done  well?)   Analyze(What  you  have  done  Wrong?)   What  is  the  problem?  And  Solu9ons?   Summarize   Encouragement