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Peer Coaching to Improve Debriefing Skills
for Simulation-based Education
Adam Cheng1, Vincent Grant1, Helen Catena1, Amy ...
Disclosure
• Cheng
– Royal College of Physicians and Surgeons of Canada
– Drexel University College of Medicine
• Szyld
– ...
Adam Cheng @docchenger
Walter Eppich @learnthrutalk
Demian Szyld @demianszyld
Debrief2Learn @debrief2learn
M. Meguerdichia...
Objectives
After this session:
• Describe elements of debriefing
performance that can be explored
when providing feedback
...
Workshop Outline
Do you debrief the debrief?
Are your methods meeting your
needs?
Why is this important?
• We are in the feedback business
• Opportunities to refine debriefing skills
are not accessible to...
Defining Peer Coaching
• “A form of work-based learning
… involving observation of
teaching and feedback …
where two facul...
Why Peer Coaching?
• Both the coach and educator learn – “peer learning
partnership”
• Encourages and promotes respectful
...
Who Can be a Peer Coach?
• Purest form = equal levels of training
• Power differentials threaten psychological safety
• Se...
When does Peer Coaching Occur?
Scenario Debriefing Scenario Debriefing Scenario Debriefing
Targeted Peer Coaching
• Short,...
What are You Looking For?
Debriefing Assessment Tool - OSAD
Arora et al, 2012
Debriefing Assessment Tool - DASH
Debriefing Assessment for Simulation in Healthcare (DASH) Student Version©
Directions: P...
Debriefing Assessment Tool - DASH
www.harvardmedsim.org
Element 3
I structured the debriefing in an organized way
Rating E...
Peer Coaching Feedback Form
Cheng et al, 2017 (in press)
Debriefing
Element
Item N/A
Psychological Safety  Was a psycholo...
Rudolph et al, 2014
Eppich, Cheng 2015
Cheng et al, 2016
Kolbe et al, 2013
Cheng et al, 2016
Cheng et al, 2015
Sawyer et al, 2016
Peer Coaching Feedback Form
Cheng et al, 2017 (in press)
Debriefing
Element
Item N/A
Psychological Safety  Was a psycholo...
Eppich et al, 2016
How do we Peer Coach?
How do we Peer Coach?
Eppich et al, 2016
Targeted Peer Coaching
• Brief focused facilitation
and/or self-assessment
• Dire...
Exercise
• Watch a video of a debriefing
• Use group + / Δ to help identify performance
gaps in preparation for the feedba...
Case
• Teenager with exercise-induced asthma exacerbation
• Learning Objectives
– Demonstrate effective management of asth...
+ (What went well) Δ (What would you like to see done
differently?)
Peer Coaching Feedback FormPeer Coaching : Debriefing Feedback Form
Debriefing
Element
Item Not
applicable
Psychological
S...
Play Time
Case
• 8 year old with anaphylaxis to peanuts
• Learning Objectives
– Demonstrate effective management of anaphylaxis
– De...
Implementing a Peer Coaching Program
Communicate
Need,
Benefits and
Program
Goals /
Expectations
Select
Debriefing
Assessm...
www.debrief2learn.org
@debrief2learn
Summary
• Various elements of debriefing
performance can be explored – the
Peer Coaching Feedback Form can
help!
• Impleme...
Questions
Adam Cheng @docchenger
Walter Eppich @learnthrutalk
Demian Szyld @demianszyld
Debrief2Learn @debrief2learn
M. Meguerdichia...
Peer coaching to improve debriefing skills for simulation-based education
Peer coaching to improve debriefing skills for simulation-based education
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Peer coaching to improve debriefing skills for simulation-based education

This workshop presentation aims to:
1. Describe the elements of debriefing performance which can be explored when providing feedback on the quality of debriefing sessions.
2. Apply a faculty development tool designed to help with peer coaching and feedback.
3. Describe and implement a strategy for effective faculty development in a simulation program

Peer coaching to improve debriefing skills for simulation-based education

  1. 1. Peer Coaching to Improve Debriefing Skills for Simulation-based Education Adam Cheng1, Vincent Grant1, Helen Catena1, Amy Cripps1, Gavin Burgess1, Traci Robinson1, Stuart Rose1, Demian Szyld2, Michaela Kolbe3, Bastian Grande3, Michael Meguerdichian4, Walter Eppich5 1KidSim Simulation Program, University of Calgary; 2Center for Medical Simulation; 3University of Zurich; 4NYC Health + Hospitals, 5Ann & Robert Lurie Children’s Hospital, Northwestern University
  2. 2. Disclosure • Cheng – Royal College of Physicians and Surgeons of Canada – Drexel University College of Medicine • Szyld – Center for Medical Simulation • Eppich – Center for Medical Simulation – New York City Health + Hospitals – PedSim
  3. 3. Adam Cheng @docchenger Walter Eppich @learnthrutalk Demian Szyld @demianszyld Debrief2Learn @debrief2learn M. Meguerdichian @mmegue01 #peercoaching #IMSH2017 #debriefing
  4. 4. Objectives After this session: • Describe elements of debriefing performance that can be explored when providing feedback • Apply a tool designed to help with peer coaching for debriefing • Identify strategies for implementing a peer coaching program
  5. 5. Workshop Outline
  6. 6. Do you debrief the debrief? Are your methods meeting your needs?
  7. 7. Why is this important? • We are in the feedback business • Opportunities to refine debriefing skills are not accessible to all • Quality assurance – ‘creep’ of old / bad habits – want facilitators to reflect on teaching performance continually – encourage self-improvement – culture of feedback
  8. 8. Defining Peer Coaching • “A form of work-based learning … involving observation of teaching and feedback … where two faculty members voluntarily work together to improve approaches to education” • Peer Coach: may have similar, more, or less experience Boillat et al, 2014 Huston et al, 2008
  9. 9. Why Peer Coaching? • Both the coach and educator learn – “peer learning partnership” • Encourages and promotes respectful communication • Builds a culture of professionalism • Creates a sense of accountability between colleagues Eisen, 2000 Bonder et al, 2010
  10. 10. Who Can be a Peer Coach? • Purest form = equal levels of training • Power differentials threaten psychological safety • Setting the Stage: – Clarify expectations – Review personal goals – Location, duration and timing – Establish ground rules Cheng et al, 2017 (in press)
  11. 11. When does Peer Coaching Occur? Scenario Debriefing Scenario Debriefing Scenario Debriefing Targeted Peer Coaching • Short, between simulation sessions • Focus on specific skills Debriefing the Debriefer • Long, at end of day • Focus on framework, skills, complex concepts Cheng et al, 2017 (in press) Setting the Stage Targeted Peer Coaching Targeted Peer Coaching Debriefing the Debriefer
  12. 12. What are You Looking For?
  13. 13. Debriefing Assessment Tool - OSAD Arora et al, 2012
  14. 14. Debriefing Assessment Tool - DASH Debriefing Assessment for Simulation in Healthcare (DASH) Student Version© Directions: Please summarize your impression of the introduction and debriefing in this simulation- based exercise. Use the following scale to rate the “Behaviors” and the six “Elements.” If a listed behavior is impossible to assess (e.g., how the instructor handled upset people if no one got upset), leave it blank and don’t let that influence your evaluation. The instructor may do some things well and some things not so well within each Element. Do your best to rate the overall effectiveness for the whole Element guided by your observation of the Behaviors that define it. The overall Element rating is not an average of the Behavior Scores; it’s your overall impression of how well the Element was executed by the instructor. Rating Scale Rating! 1! 2! 3! 4! 5! 6! 7! Descriptor! Extremely Ineffective / Detrimental! Consistently Ineffective / Very Poor! Mostly Ineffective / Poor ! Somewhat Effective / Average! Mostly Effective / Good! Consistently Effective / Very Good! Extremely Effective / Outstanding! Element!1!assesses!the!introduction!at!the!beginning!of!a!simulation5based!exercise.!! Skip%this%element%if%you%did%not%participate%in%the%introduction.%% If%there%was%no%introduction%and%you%felt%one%was%needed%to%orient%you,%your%rating%should%reflect%this.% Element 1 The instructor set the stage for an engaging learning experience. Rating Element 1 _________ Behavior Behavior Score A. The instructor introduced him/herself, described the simulation environment, what would be expected during the activity, and introduced the learning objectives. B. The instructor explained the strengths and weaknesses of the simulation and what I could do to get the most out of simulated clinical experiences. C. The instructor attended to logistical details as necessary such as toilet location, food availability, and schedule. D. The instructor made me feel stimulated to share my thoughts and questions about the upcoming simulation and debriefing and reassured me that I wouldn’t be shamed or humiliated in the process.. Elements!2!through!6!assess!a!debriefing.!! Element 2 The instructor maintained an engaging context for learning. Rating Element 2 _________ Behavior Behavior Score A. The instructor clarified the purpose of the debriefing, what was expected of me, and the instructor’s role in the debriefing. B. The instructor acknowledged concerns about realism and helped me learn even though the case(s) were simulated. C. I felt that the instructor respected participants. D. The focus was on learning and not on making people feel bad about making mistakes. E. Participants could share thoughts and emotions without fear of being shamed or humiliated. www.harvardmedsim.org
  15. 15. Debriefing Assessment Tool - DASH www.harvardmedsim.org Element 3 I structured the debriefing in an organized way Rating Element 3 _________ Example Behaviors · I guided the conversation such that it progressed logically rather than jumping around from point to point · Near the beginning of the debriefing, I encouraged participants to share their genuine reactions to the case(s) and I took their remarks seriously · In the middle, I helped the participants analyze actions and thought processes as we reviewed the case(s) · At the end of the debriefing, there was a summary phase where I helped tie observations together and relate the case(s) to ways the participants could improve their future clinical practice Element 4 I provoked in-depth discussions that led them to reflect on their performance Rating Element 4 _________ Example Behaviors · I used concrete examples—not just abstract or generalized comments—to get participants to think about their performance · My point of view was clear; I didn’t force participants to guess what I was thinking · I listened and made people feel heard by trying to include everyone, paraphrasing, and using non- verbal actions like eye contact and nodding etc · I used video or recorded data to support analysis and learning · If someone got upset during the debriefing, I was respectful and constructive in trying to help them deal with it Element 5 I identified what they did well or poorly – and why Rating Element 5 _________ Example Behaviors · I provided concrete feedback to participants on their performance or that of the team based on accurate statement of fact and my honest point of view · I helped explore what participants were thinking or trying to accomplish at key moments Element 6 I helped them see how to improve or how to sustain good performance Rating Element 6 _________ Example Behaviors · I helped participants learn how to improve weak areas or how to repeat good performance · I was knowledgeable and used that knowledge to help participants see how to perform well in the future · I made sure we covered the most important topics Copyright, Center for Medical Simulation, www.harvardmedsim.org, 2011!
  16. 16. Peer Coaching Feedback Form Cheng et al, 2017 (in press) Debriefing Element Item N/A Psychological Safety  Was a psychologically safe environment for debriefing created? Framework  Was the desired debriefing framework applied effectively? Method / Strategy  Was the appropriate debriefing strategy used (for specific situations)?  Did specific (or series of) questions achieve the desired outcome? Content  Were the pre-defined learning objectives addressed?  Were the learning objectives appropriately prioritized?  Were patient safety issues fully addressed?  Were performance gaps appropriately closed? Learner- Centeredness  Was the learner agenda identified and addressed?  Were performance gaps closed in a learner-centered fashion? Co-facilitation  Were rules of engagement established ahead of time?  Was the co-debriefing approach effective?  Were transitions and interruptions handled effectively? Difficult Situations  Were difficult situations managed appropriately? Debriefing Adjuncts  Was video used effectively to facilitate learning?  Was a debriefing script / tool used effectively to facilitate learning? Individual Style  Was body language and eye contact used effectively and appropriately?  Was tone of voice and silence used to effectively promote learning?
  17. 17. Rudolph et al, 2014
  18. 18. Eppich, Cheng 2015
  19. 19. Cheng et al, 2016
  20. 20. Kolbe et al, 2013
  21. 21. Cheng et al, 2016
  22. 22. Cheng et al, 2015
  23. 23. Sawyer et al, 2016
  24. 24. Peer Coaching Feedback Form Cheng et al, 2017 (in press) Debriefing Element Item N/A Psychological Safety  Was a psychologically safe environment for debriefing created? Framework  Was the desired debriefing framework applied effectively? Method / Strategy  Was the appropriate debriefing strategy used (for specific situations)?  Did specific (or series of) questions achieve the desired outcome? Content  Were the pre-defined learning objectives addressed?  Were the learning objectives appropriately prioritized?  Were patient safety issues fully addressed?  Were performance gaps appropriately closed? Learner- Centeredness  Was the learner agenda identified and addressed?  Were performance gaps closed in a learner-centered fashion? Co-facilitation  Were rules of engagement established ahead of time?  Was the co-debriefing approach effective?  Were transitions and interruptions handled effectively? Difficult Situations  Were difficult situations managed appropriately? Debriefing Adjuncts  Was video used effectively to facilitate learning?  Was a debriefing script / tool used effectively to facilitate learning? Individual Style  Was body language and eye contact used effectively and appropriately?  Was tone of voice and silence used to effectively promote learning?
  25. 25. Eppich et al, 2016 How do we Peer Coach?
  26. 26. How do we Peer Coach? Eppich et al, 2016 Targeted Peer Coaching • Brief focused facilitation and/or self-assessment • Directive feedback • One or few targeted aspects of performance • Immediate improvement Preview Statement
  27. 27. Exercise • Watch a video of a debriefing • Use group + / Δ to help identify performance gaps in preparation for the feedback session • Practice peer coaching – role play as debriefer in the video
  28. 28. Case • Teenager with exercise-induced asthma exacerbation • Learning Objectives – Demonstrate effective management of asthma exacerbation – Demonstrate effective team dynamics Debriefing • 1 facilitator (male) • 1 nurse, 1 resp therpist, 1 resident doctor
  29. 29. + (What went well) Δ (What would you like to see done differently?)
  30. 30. Peer Coaching Feedback FormPeer Coaching : Debriefing Feedback Form Debriefing Element Item Not applicable Psychological Safety ¨ Was a psychologically safe environment for debriefing created? If so, how? ¨ Framework ¨ Was the desired debriefing framework applied effectively? (ie. were there distinct phases?) ¨ Method / Strategy ¨ Was the appropriate debriefing method / strategy used (for specific situations)? ¨ Did specific questions (or series of questions) achieve the desired or anticipated outcome? ¨ Content ¨ Were the pre-defined learning objectives addressed? ¨ Were learning objectives appropriately prioritized? ¨ Were patient safety issues fully addressed? ¨ Were important performance gaps appropriately closed? ¨ Learner- Centeredness ¨ Was the learner agenda identified and addressed? ¨ Were performance gaps closed in a learner-centered fashion? ¨ Co- Facilitation ¨ Was a co-debriefing approach established ahead of time? ¨ Were rules of engagement established ahead of time? ¨ Was the co-debriefing approach effective? ¨ Were transitions handled effectively? ¨ Were there interruptions? How were they handled? ¨ Difficult Situations ¨ Were difficult situations managed appropriately? ¨ Debriefing Adjuncts ¨ Was video used effectively to facilitate learning? ¨ Was a debriefing script / tool used effectively to facilitate learning? ¨ Individual Style ¨ Was body language used effectively and appropriately? ¨ Was eye contact used effectively and appropriately? ¨ Was tone of voice used to promote learning? ¨ Was silence used to effectively promote discussion? ¨ Adapted from Cheng et al, Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs. Simulation in Healthcare, 2017. In Press. Cheng et al, 2017 (in press)
  31. 31. Play Time
  32. 32. Case • 8 year old with anaphylaxis to peanuts • Learning Objectives – Demonstrate effective management of anaphylaxis – Demonstrate effective team dynamics Debriefing • 1 facilitator (male) • 2 nurses, 1 resp therpist, 1 resident doctor
  33. 33. Implementing a Peer Coaching Program Communicate Need, Benefits and Program Goals / Expectations Select Debriefing Assessment Tool or Feedback Form Provide Coach Training Implement Program Evaluate Program Review and Revise Program Cheng et al, 2017 (in press)
  34. 34. www.debrief2learn.org @debrief2learn
  35. 35. Summary • Various elements of debriefing performance can be explored – the Peer Coaching Feedback Form can help! • Implementing a peer coaching program to improve debriefing should involve multiple carefully planned steps
  36. 36. Questions
  37. 37. Adam Cheng @docchenger Walter Eppich @learnthrutalk Demian Szyld @demianszyld Debrief2Learn @debrief2learn M. Meguerdichian @mmegue01 #peercoaching #IMSH2017 #debriefing

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This workshop presentation aims to: 1. Describe the elements of debriefing performance which can be explored when providing feedback on the quality of debriefing sessions. 2. Apply a faculty development tool designed to help with peer coaching and feedback. 3. Describe and implement a strategy for effective faculty development in a simulation program

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