2. Objectives
Define debriefing
Goals of debriefing
Process of debriefing
Phases of debriefing
Various approaches to debriefing
Role of Facilitator
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3. What is Debriefing
Debriefings in healthcare are defined as an after-event discussion
regarding performance and thought processes of the team during
the scenario to promote reflective learning and improve clinical
performance.
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4. Types of Debriefing
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Co-facilitated debriefing
(> 1 facilitator)
Video assisted
debriefing
Facilitator only
debriefing
Facilitator only debriefing is as effective as facilitator and
video assisted debriefing in achieving learning outcomes
5. Debrief’s Function
Discussion of set learning objectives
Encourage reflective practice
―Learning from good practices
―Learning from mistakes
Establish safe learning environment
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7. 7
Who must conduct the debriefing
Facilitator must have the following requirements:
Proficient in debriefing
Knowledge of subject area
Observe complete simulation
Ability to adjust the level of facilitation
9. How to Prepare?
Create a plan
―Observed behavior
―Observed clinical practice
―Focus on learning objectives
Obtain feedback from
―co-faculty “in” the simulation
―observer
―operator
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10. How to start?
Establish a safe environment
Explain the purpose of debrief
Set yourself a time limit
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12. Reaction Phase
A chance for the participant:
―To express feelings/thoughts
―To describe sequence of the scenario
A chance for everyone:
―To get a common understanding of what happened
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Reaction
13. Analysis Phase
In depth analysis of key elements in the scenario
Encourage participants to reflect on their performance
Ask open ended questions
―What helped to perform well?
― What hindered optimal performance?
Analysis
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Analysis
15. Know the Frame of Reference
Action Result
Frames
Debriefing
leads to new
frames
Debriefing
changes later
actions
After: Jenny W. Rudolph, Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry
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16. Summary Phase
Requires effective analysis in the previous phase
Take home messages from the scenario and debriefing
How to do it?
―Ask participants to summaries what just happened
―Involve all participants starting with those in the hot seat.
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Summary
17. Role of facilitator in debrief
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Clear the air and
guide the initial
discussion
Questions like “So
how did you feel
this case went”
This is the bulk of the debrief.
Spending time to understand
“what happened and why it
happened”
Try to understand the frame of
mind of participants, their
mental models
Review what happened, what
was discussed and try to apply
it to the context
You could say something like
‘let us identify some take
home points from this case
for future practices”
Reaction Analysis Summary
18. Role of facilitator in debrief
Allow enough time
Ask the right questions –based on what you observed
Listen carefully to the participants
Involve all participants
Encourage participants to address performance gap with action plans
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19. Approaches to Debriefing
Time-in/Time-out
Structured and Supported Debriefing
Debriefing with Good Judgment
Plus/Delta (+/Δ)
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Debriefing is the heart and soul of simulation based training
It is a facilitated or a guided reflection in the cycle of experiential learning.
These are the following objectives of this session.
We will now look at not just the “how” of debriefing but also the who, what, when and where of debriefing.
This facilitation method assists learners in identifying gaps either in knowledge, application, or performance. Based on identified gaps, learners are then facilitated in addressing them for future application of optimal performance
Video assisted debrief: the facilitator conduct the discussion with the help of recorded video of scenario.
Facilitator only debrief: single facilitator conduct debrief.
Co-facilitated debrief: more than one facilitator conduct debrief.
Reflection on the simulation experience should focus on the objectives identified as essential during the simulation planning stages
Therefore, the debriefing centers on how participants met or did not meet objectives and facilitates bridging those gaps in performance, or reinforcing those positive learned behaviors or thinking
2. Establishing a psychologically safe learning environment (Decker et al., 2013) through transparency of both participant and facilitator expectations. Amy Edmonson, (1999) Psychologist defines psychological safety as an environment in which individuals feel comfortable in participating in actions that may incorporate interpersonal risk taking. This concept was extended into healthcare education using simulation and described as the safe container (Rudolph et al., 2014). Setting this environment for the learners requires an explicit discussion encouraging open and honest communication of mistakes as the platform for learning, not actions for which to be ashamed.
Debriefing are kept within the group and not discussed among other facilitators, faculty, or participants.
At times, Consider using a confidentiality agreement signed by all participants (Hravnak, Tuite, & Baldisseri, 2005)
In post-simulation debriefing, the participants are allowed to actually experience the consequences of their mistakes, without interrupting during simulation. In contrast, when debriefing is given throughout a simulation, the simulation is suspended at the time of error, and the participants are told what the consequences of the error would have been.
Overall post simulation debriefing was more effective than the debriefing that occurred during simulation.
Experiencing the consequences of their actions can have a greater impact and leave a greater imprint on the participants than simply being told what the results would have been.
Hot vs Cold
on constructive feedback during skills training or in-scenario – it is shorter and possibly intermittent debriefing discussions
Simulations more complex in their objectives or emotional engagement -longer periods
Debriefing can be lead by the person who is formally trained in debriefing (Safe learning environment & focused discussion is ensured for learning) and expert in content area (Knowledge is necessary for leading discussion) . If facilitator is not expert in content area, then content expert should be there with facilitator.
The facilitator who has observed pre-briefing and scenario can only make comment on the students’ performance and lead the discussion.
Facilitation should be adjusted as per the level of students.
Participants
When determining the appropriate number of participants for the simulation, identify how best to ensure a safe learning environment for the number of individuals involved.
Facilitator(s)
1.An important element in establishing and maintaining the safe learning environment is keeping the facilitator consistent from pre-brief, to simulation, to debrief.
Observer(s)
Debriefing is not solely for the active participants of the simulation experience; active observers may provide an alternative perspective from their outside view of the simulation encounter (Peters & Vissers, 2004). For example, observers may see participant strengths that participants do not see themselves.
Standardized Participants
When considering incorporation of SPs into simulation scenarios, be mindful of the intended role of the SP during the feedback or debriefing process as well
To conduct debriefing the facilitator should keenly observe the scenario and make a note of students’ behavior.
It is necessary to note clinical performance of students.
The analysis is done based on the learning objectives only.
The co-Faculty, Observer, operator may have some important feedback to share.
Establish a good/safe environment
Remember I ‘m Ok, you are OK
Seating arrangement
Explain the purpose of debrief
Mistakes/errors are allowed
Learning experience
Reinforce that discussion to centre around what happened
Set yourself a time limit (Students should know how much time they are going to spend in debriefing).
Debriefing is most effective when structured and facilitated.
It is the analysis phase that takes maximum time.
In reaction phase, participants are asked about their overall emotions, they undergo during scenario. It avoids the clouding of thinking process in subsequent phases of debriefing.
The participants are also asked to share sequence of event. It is necessary for everyone to have common understanding and establishment of a shared mental model of what happened during the scenario.
The analysis part include discussion over good performance as well as low performance.
Reflection of events is done to know their frame of reference.
Each of the team member should be involved in discussion, as each one of them possess unique perspective and each perspective is important to understand individual and team strengths and weaknesses.
By asking open ended question and practicing self re-straining while answering the questions, facilitator guides but avoids dominating the discussion and gives room for more discussion.
Corridor of expected performance is the learning objectives of the scenario. Few performances may be really well, that is above the expectations and few may be the low performances that is below the expected performance.
Focus on deep analysis of good performance and how to reproduce and reapply it. Also discuss about low performances to understand their frame of reference that will improve their clinical performance.
More focus should be given on performance within the corridor of normal performance.
The observed outcome is the result of action and observed action is result of frame of reference acquired by a person. It is the responsibility of facilitator to bring out that frame in discussion.
A good debrief can change the frame of reference that will leads good outcome.
(Talk about the above example)
The debriefing ends with a summarization of what will be done differently in future and identification of issues that require further follow up. A detailed and focused discussion in analysis, helps the students to come up with take home message
It is the learning, they will implement in the clinical practice.
The debriefing ends with a summarization.
It is the learning, they will implement in the clinical practice.
A detailed and focused discussion and identification of issues done in analysis helps the students to come up with take home messages.
It is self explanatory.
To encourage the involvement, participants should be allowed to speak.
A direct question should be asked in non-judgemental way.
Active listening encourages participants for continued participation.
Participants should come up with the solution of the performance gap.
Time-in/Time-out
For example, if a participant or participants get stuck in a simulation with a patient in respiratory distress, the facilitator may pause the simulation in order to cue the participant/s to reflect while in action. The facilitator may say something like, “What is your top nursing priority for this patient?” or “What is your top nursing intervention here?”
Structured and Supported Debriefing
ask questions such as: “Give me specific examples of where not knowing this information might have hindered optimal performance,” “What might you have done differently?,” and “How might you improve this next time?”
Advocacy enquiry
“Sara, I noticed it took you five minutes to place a nasal cannula on the patient after his pulse-ox dropped to 89% and he began complaining of shortness of breath (observation). I was concerned that a five-minute delay in providing supplemental oxygen to a patient who has signs and symptoms of respiratory distress could cause his condition to deteriorate faster (point of view). I’m curious about what you were considering at the time (inquiry).”
Plus delta
Works well when there is limited time or when novice facilitators are debriefing
Discuss about what went well (the plus) ,
what behaviors/actions (could include inactions) they would want to change if they were in the situation again (the delta) and
How could they bring the change (the plus)
