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Co-debriefing workshop
- 1. Co-Debriefing for Simulation-based Education: Strategies for Success Adam Cheng1,2, Traci Robinson1, Helen Catena1, Wendy Bissett1, James Huffman1, Jon Duff3, Walter Eppich4, Jenny Rudolph5, Janice Palaganas5, Kate Morse6, Jose Maestre Alonso7 1KidSim Simulation Program, University of Calgary Alberta Children’s Hospital 2The Royal College of Physicians and Surgeons of Canada 3Stollery Children’s Hospital 4Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago 5Center for Medical Simulation, Harvard University 6Drexel University 7Hospital Virtual Valdecilla
- 2. Objectives • Describe common challenges associated with co-debriefing • Identify, practice and apply proactive and reactive strategies for effective co- debriefing
- 3. Workshop Outline x2 5 min 5 min 40 min 40 min
- 4. Debriefing • Feedback and debriefing an essential component of simulation-based education1,2 • What about co-debriefing? – No studies3 – No described methodology 1Issenberg et al. 2005 2McGaghie et al. 2010 3Cheng et al. 2014
- 5. What does Co-Debriefing mean to you?
- 6. Co-Debriefing • Defined as a debriefing that is co-facilitated by 2 or more educators • Educators: may be from the same or different profession / discipline Goal: Educators work together to manage the flow and content of discussion in an integrated and fluid fashion to promote effective learning
- 7. Benefits of Co-facilitation • Larger pool of expertise • Diverse viewpoints • Cross monitoring • Complementary styles • Mutual support for challenging situations • Faculty development • Model effective teamwork Cheng A, Palaganas J, Rudolph J, Eppich W, Robinson T, Grant V. Co-debriefing for Simulation- based Education – A Primer for Facilitators. Simulation in Healthcare, In Press
- 8. Case • Septic Shock : 5 year old with fever • Learning Objectives – Demonstrate effective management of septic shock – Demonstrate effective team dynamics Debriefing • 2 nurses, respiratory therapist, attending ER physician, resident doctor • 1 MD facilitator, 1 nurse facilitator
- 9. Challenges?
- 10. Common Challenges • Lack of knowledge of learning objectives (and how they relate to various professions) • Facilitators have different personal agendas • Facilitator expertise is not optimally used • Interruptions / hijacking train of thought • One facilitator dominates discussion • One facilitator speaks directly/only to learners from one profession • Open disagreement between facilitators Cheng et al, Simul Healthc In Press
- 11. Failure to recognize and address challenges discordance, power struggle
- 13. Apply Structure
- 14. How do new approaches to co-debriefing fit within PEARLS? Eppich et al, Simul Healthc In Press REACTIONS DESCRIPTION SUMMARY Provide Information (Directive Feedback and Teaching) Discussion and Teaching May shorten if learners appear to have a shared understanding of case Reactions Phase Eppich & Cheng Were All Learning Objectives Covered? YES Application / Summary Educator GuidedLearner Guided NO L ANALYSIS 1. How much time do you have? ASK: 2. Is the rationale evident? 3. What is the content area? Shorter Time + Rationale Content: Technical/ Cognitive Select Learning Objective Less Time; Poor Learner Insight Educator Guided: Teaching More Time; Good Learner Insight Learner Guided: Discussion RevisitLearningObjectives Description Phase Select Strategy Learner Self-Assessment Focused Facilitation (e.g. Advocacy-Inquiry, Guided Team Self-Correction) Learner Generates Objectives (+/D) Analyze Performance related to Objective Less Time +/- Rationale Content: Undefined More Time - Rationale Content: Cognitive/ Behavioral Learners may reveal key areas that are important to them
- 15. Facilitator A Facilitator A Follow the Leader Facilitator A or B REACTIONS DESCRIPTION SUMMARY Provide Information (Directive Feedback and Teaching) Discussion and Teaching May shorten if learners appear to have a shared understanding of case Reactions Phase Eppich & Cheng Were All Learning Objectives Covered? YES Application / Summary Educator GuidedLearner Guided NO L ANALYSIS 1. How much time do you have? ASK: 2. Is the rationale evident? 3. What is the content area? Shorter Time + Rationale Content: Technical/ Cognitive Select Learning Objective Less Time; Poor Learner Insight Educator Guided: Teaching More Time; Good Learner Insight Learner Guided: Discussion RevisitLearningObjectives Description Phase Select Strategy Learner Self-Assessment Focused Facilitation (e.g. Advocacy-Inquiry, Guided Team Self-Correction) Learner Generates Objectives (+/D) Analyze Performance related to Objective Less Time +/- Rationale Content: Undefined More Time - Rationale Content: Cognitive/ Behavioral Learners may reveal key areas that are important to them Divide and Conquer Ping Pong
- 16. Questions?
- 18. Pre- Debriefing Debriefing Post- Debriefing • Post-Debriefing Huddle • Facilitator pre- briefin g • Se ng the stage for the learners • Post-simula on touch-point • Non-verbal communica on • Listen, observe, reflect • Open nego a on • Previewing • Open nego a on • Pulse check • Post-Debriefing Huddle Proac ve Strategies Reac ve Strategies Cheng et al, Simul Healthc In Press
- 19. Proactive Strategies Permissible Interruptions • Verbally request or provide permission to speak Deliberate Transitions • Use preview statement to signal change in topic
- 20. Proactive Strategies Facilitator Prebrief • Clarifying roles • Ground rules • Clinical / educational expertise • Learning objectives • Personal agendas • Debriefing roles and methodology • Codebriefing approach
- 21. Proactive Strategies Post-Sim Touchpoint • Run scenario in “steady state” for last 1-2 minutes • Discuss observations Setting the Stage for Learners • Role of multiple facilitators, background, expertise
- 22. Pre- Debriefing Debriefing Post- Debriefing • Post-Debriefing Huddle • Facilitator pre- briefin g • Se ng the stage for the learners • Post-simula on touch-point • Non-verbal communica on • Listen, observe, reflect • Open nego a on • Previewing • Open nego a on • Pulse check • Post-Debriefing Huddle Proac ve Strategies Reac ve Strategies
- 23. Proactive Strategies Non-verbal communication • Position yourself • Make frequent eye contact Previewing • Verbalize intent to transition to next topic, solicit input
- 24. Proactive Strategies Listen, Observe, Reflect • Listen to discussion, observe body language, reflect on optimal time to engage • Ask: – “Will I be interrupting a line of questioning if I speak now?” – “Has the current topic of discussion been brought to a close? – “Will my contribution help to address the issue at hand?”
- 25. Proactive Strategies Open Negotiation • Promotes transparent communication between facilitators • A. Share train of thought • B. Share reasoning • C. Inquire about alternate course of action
- 26. Case • Infant with increased intracranial pressure • Requiring intubation and management of ICP Exercise • Conduct a facilitator pre-briefing • Select a co-debriefing approach • Conduct a debriefing with your co-facilitator and utilize proactive strategies Applying Proactive Strategies Small Group Exercise – 15 minutes
- 27. Discussion
- 28. Reactive Strategies Open Negotiation • A. Name they dynamic • B. Normalize • C. Generalize • D. Engage learners to identify solution
- 29. Reactive Strategies Pulse Check • Clarify understanding with “neglected” learner group – “I am wondering if I can take a moment to clarify….” • Check in with learners when one facilitator is dominating – “I wondering if we can press the pause button for a moment to see how this is resonating with the learners…”
- 30. Case • Adult with cardiac arrest • Learners fail to detect pulselessness Debriefing • 2 facilitators: lead facilitator (ER doctor), associate facilitator (ICU doctor) • Learners: pediatric resident, inpatient nurse Applying Reactive Strategies
- 31. • You will play the role of the associate / co-facilitator (ICU doctor) • Apply open negotiation and/or pulse check to manage conflict with your co-facilitator Exercise Small Group Exercise – 15 minutes
- 32. Pre- Debriefing Debriefing Post- Debriefing • Post-Debriefing Huddle • Facilitator pre- briefin g • Se ng the stage for the learners • Post-simula on touch-point • Non-verbal communica on • Listen, observe, reflect • Open nego a on • Previewing • Open nego a on • Pulse check • Post-Debriefing Huddle Proac ve Strategies Reac ve Strategies
- 33. Post-Debriefing Huddle Facilitator Huddle • Any issues? (discuss examples) • Simulation scenario • Co-debriefing approach • Rules of engagement
- 35. Take Home Messages • Codebriefing is often accompanied by challenges • Proactive and reactive strategies can help facilitators overcome these common challenges
- 36. Acknowledgements • Vincent Grant, James Huffman, Jon Duff, Wendy Bissett, Helen Catena, Traci Robinson, Ping Chen, James Leung, Jennifer Davidson, Kevin Murray (KidSim Team) • Elaine Sigalet (Sidra) on
Editor's Notes
- Types of interruptions Interrupt during reactions phase While exploring/identifying frames Interrupt to close performance gaps (after the first debriefer has identified frames) Closing the gap twice (being repetitive) Sidebar discussions When one debriefer is being really mean – what does the other one do?
- Done in front of the whole group 2 learners do a debriefing We debrief them
- Done in front of the whole group
- Done in front of the whole group