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Debriefing. Sandra J. Feaster, RN, MS,MBA Program Director Center for Immersive and Simulation-based Learning ( CISL ) Stanford University, CA http://cisl.stanford.edu. DEBRIEFING IS THE “HEART AND SOUL” OF THE SIMULATED EXPERIENCE - RALL, MANSER, & HOWARD, 2000. Objectives.

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Debriefing

Debriefing

Sandra J. Feaster, RN, MS,MBA

Program Director

Center for Immersive and Simulation-based Learning (CISL)

Stanford University, CA

http://cisl.stanford.edu


Debriefing is the heart and soul of the simulated experience rall manser howard 2000
DEBRIEFING IS THE “HEART AND SOUL” OF THE SIMULATED EXPERIENCE- RALL, MANSER, & HOWARD, 2000


Objectives
Objectives

  • Identify the goals of debriefing

  • Discuss the elements of debriefing

  • Identify various approaches to debriefing

  • Discuss the process of debriefing

  • Formulate questions that assist students in self-reflection


Defining debriefing
Defining Debriefing

  • Merrian-Webster (1945)

    • 1 : to interrogate (as a pilot) usually upon return (as from a mission) in order to obtain useful information

    • 2 : to carefully review upon completion <debrief the flight>

  • Wikipedia, the free encyclopedia

    • A debriefing or psychological debriefing is a one-time, semi-structured conversation with an individual who has just experienced a stressful or traumatic event. In most cases, the purpose of debriefing is to reduce any possibility of psychological harm by informing people about their experience or allowing them to talk about it.


Debriefing starts with the prebriefing
Debriefing starts with the “Prebriefing”

Prebriefing

The instructor should be prepared

To understand that learners will come with their own experiences and frames

  • Describe the purpose of the simulation

  • The learning objectives

  • How the process of debriefing will occur

  • The learner will in turn:

    • Know the expectations of the simulation

    • Know the ground rules for their experience


The origins of debriefing
The Origins of Debriefing

  • Military -

    • the account individuals gave on returning from a mission

    • Information analyzed and used to strategize for future missions/exercises (educational & operational)

    • An aided process to reduce the psychological damage of a traumatic event


The origins of debriefing1
The Origins of Debriefing

  • Critical Incident Debriefing

    • Used to mitigate stress among emergency first responder

    • CISD (Critical Incident Stress Debriefing)*

    • Psychological debriefing (modified CISD)**

      • Facilitator-led approach to enable participants to review the facts, thoughts, impressions and reactions after a critical incident

      • Aim - reduce stress and accelerate recovery after a traumatic event

      • Issue - concern that a single session approach may be inadequate is certain situations or with certain people

        * Mitchell, JT, Everly GS: Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster workers (1993)

        **Dyregrov A : Caring afor heapers in diseaster situations: Psychological debriefing: Disaster Manage 1989


The origins of debriefing2
The Origins of Debriefing

  • Experimental Psychology

    • Participants who have been deceived as a part of a psychology study are informed of the true nature of the experiment

    • Purpose is to allow dehoaxing to occur and reverse the negative effects of the experience


Educating adult learners via simulation
Educating Adult Learners via Simulation

  • Much of learning from simulation is dependent on the impact of the experience.

    • The event/experience needs to be relevant to make an impact.

    • The learner must be moved by the event/experience to make an impact.

    • EXAMPLE: Simulation with airway obstruction


Learning and debriefing in simulation
Learning and Debriefing in Simulation

I hear and I forget

I see and I remember

I do and I understand

  • Confucius

  • I trust and discuss

    • Fanning, Gaba*

      * Fanning, RM, Gaba, DM, The Role of Debriefing in Situation-based Learning, Simulation in Healthcare, 2007


  • Debriefing principles
    Debriefing Principles

    • Foster Discussion in a non-threatening fashion

    • Capture and leverage “golden or ah-ha” moments

    • Seek similar real-world experiences

    • Help apply the experience to real-world practice


    Emotional learning
    Emotional Learning

    • Emotional state can affect retention and activation

    • How has the learner “framed” the experience


    Reflective practice
    Reflective Practice

    • Method used to scrutinize one’s own taken-for granted assumptions and professional work practices.

    • The theory of reflective practice draws on cognitive science, social psychology, and anthropology.

    • People make sense of external stimuli through internal cognitive “frames” (or frame of reference, mental models, etc), internal images or external reality.

      Rudolph, JW, Simon, R, Dufresne, RL, Raemer, DB. There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. Simulation in Healthcare, 2006


    Frames are invisible to the instructor
    Frames are invisible to the instructor

    Debriefing leads to new frames

    FRAME

    ACTIONS

    RESULTS

    Debriefing changes later actions

    Rudolph, Simon, Dufresne & Raemer


    Factors to consider in debriefing
    Factors to consider in debriefing

    • Objective of the exercise

    • Complexity of the scenario

    • Experience level of the learners

    • Familiarity of learners with the environment

    • Time available for the session

    • Role of simulation in curriculum

    • Individual personalities and relationships


    Factors to consider from the facilitators point of view
    Factors to consider from the facilitators point of view

    • How many facilitators

      • Has a plan been worked out in advance for how you will facilitate

      • What are the personalities of the faciltators?

        • Talkative, condescending, passive

    • Where should the facilitator(s) sit?


    Practical aspects of debriefing
    Practical Aspects of Debriefing

    • Setting - Physical

      • Comfortable and private

      • Think about seating style

      • In-situ simulations

    • Setting – Emotional

      • Prebrief – set the expectations

        • Confidentiality, role of the facilitator, role of the participant


    Practical aspects tips
    Practical Aspects - Tips

    • Questioning

      • Open ended, non-judgemental

      • Begin questions with what, how, or why to encourage deeper discussion

    • Follow-up on participant comments

      • Make the participant feel their contribution is important

    • Consider the emotional impact of the exercise


    Practical aspects tips1
    Practical Aspects - Tips

    • Include ALL participants

      • Bring the quiet, withdrawn participant into the discussion (they have thoughts about what is happening, but may have trouble sharing)

    • Reflect questions back to the participants

    • Use silence appropriately (10 seconds is NOT too long)

    • Be observant to the body language of the group or individual

    • Understand group dynamics


    Debriefing
    Tips

    • Pros – Cons – Alternatives

    • Plus (+) Delta


    Things to avoid
    Things to Avoid

    • Too much instructor talking

      • Trap of “telling” to teach

      • Avoid “personal” evaluation before the discussion ends

    • Too much medical/technical

    • Too judgementa/condescending

      • Avoid interruptions

      • Avoid “guess what I am thinking”

    • Have an agenda, use cognitive aids……. be flexible


    Helpful questions
    HELPFUL QUESTIONS

    • Generic

      • Repeating what the participant said to help reiterate a point, or open a discussion

      • Relate the event to real life

      • If participants are apathetic, address questions to them by name or go around the room in sequence

      • Consider starting the debriefing by calling on someone other than the primary participant


    Helpful questions1
    HELPFUL QUESTIONS

    • Generic statements

      • What were the pros, cons, or alternatives to an action

      • If this were to happen in real life, what might you do in the future

      • Did you find the scenario challenging


    Helpful questions2
    HELPFUL QUESTIONS

    • Opening lines

      • How do you feel that went

      • What were your first impressions when you arrived on scene

      • Did you get an adequate handover

      • Who/what where are other sources of information about the patient/scenario

      • Who was the leader

      • Did you ask for help


    Helpful questions3
    HELPFUL QUESTIONS

    • Questions regarding task overload

      • Were you and others in control of the situation

      • What needed to be done

      • How many people would this have required

      • Ask the other participants how they felt – was the person or scenario overloaded


    Helpful questions4
    HELPFUL QUESTIONS

    • Fixation Errors

      • What did you think was happening

      • Has anything like this happened in real life

      • What made it difficult to think of other options or possibilities at the time


    Helpful questions5
    HELPFUL QUESTIONS

    • Wrap up

      • How did you hand over the scenario

      • What were the take home messages of the scenario (+ delta or pro, cons, alternatives can help here)

      • Review the aim of the simulation and how this can help in real life practice

      • Give the participants the opportunity to discuss/recontact you if there are further questions


    In summary elements of a good debriefing
    In Summary: Elements of a Good Debriefing

    • Opened ended questions

    • Positive reinforcement (but not false positive)

    • Use of cognitive aids

    • Good use of AV capabiity


    In summary elements of a poor debriefing
    In Summary: Elements of a Poor Debriefing

    • Closed questions

    • Criticism

    • Focus on errors

    • Focus on technical points

    • Ignoring team work and communication

    • Focusing too much on the AV or AV problems


    Closing thoughts
    Closing Thoughts

    • Many of our peers feel that debriefing is the most important part of simulation training

    • Many also feel that poor debriefing can harm the trainee

    • Most feel a thorough prebriefing is essential

    • Confidentiality and a non-threatening atmosphere is important


    Debriefing

    Thank You!

    sfeaster@stanford.edu

    http://cisl.stanford.edu