MITE Monthly Tip
August 2023
Brittany Lachance, DO
A Review of Debriefing after Simulation
Debriefing is an intentional process of reflecting on a simulation exercise to consolidate, analyze, and improve upon future performance. This process occurs between facilitator and student, and studies have consistently demonstrated the critical importance of debriefing in the effectiveness of simulation education. Thus, training facilitators in effective debriefing methodology is essential to optimizing simulation-based education. While no gold-standard in debriefing methodology has been identified, models tend to share in some fundamental characteristics:
- Establishing psychosocial safety for the learner
- Creating a “basic assumption” that all participating in the simulation are engaged, capable, and willing to do their best.
- Setting debriefing rules such as confidentiality and active participation
- Establish a shared mental model by walking through the simulation details
- Address key learning objectives
- Use open-ended questions
- Use silence
Many debriefing models can be broken down into three main phases:
- Reaction/description
a. Time for learners to decompress
b. Use of open-ended questions about how learners feel the experience went
c. Review facts of the simulation event - Understanding/analysis
a. Preview learning objectives
b. Explore, discuss: What happened and why? - Application/summary
a. Take-home messages
b. Apply learning to a future encounter
c. Allow for questions
Several debriefing techniques have been published, and Cheng et al demonstrated that nearly all of these are effective if used properly. Thus, how the debriefing is done is not nearly as important as the act of debriefing itself. Below are some common debriefing models described in the literature:
- Plus-delta: straight-forward, good for novices
a. Good behaviors and actions are added to the + column, while behaviors that participants would change are applied to the delta column - Three-phase debriefing (RAS): also described as “debriefing with good judgement”
a. Reaction: “How did that feel?”
b. Analysis: What, why, and how actions evolved during the simulation exercise; Note gaps during the scenario, discuss the rationale; Reflective discussion
c. Summary: Lessons learned, “take home” - PEARL: Promoting Excellence and Reflective Learning in Simulation: Four-phase framework
a. Involves the three phases of RAS and adds an additional descriptive phase to summarize key events
b. Involves explicit steps with proposed language/scripting making it easy to use
The linked paper at the bottom of this tip includes several other models and frameworks, as well as additional details and links to the models above. In addition to the use of a clear framework for debriefing, several adjuncts have been proposed:
- Co-debriefing
a. More than one facilitator involved
b. Benefits: larger pool of expertise, complementing styles
c. Challenges: may have different agendas, one may dominate discussion - Debriefing script
a. The use of a clear script for the debriefing session
b. Benefits: standardizes the debriefing experience for all involved, may improve the ability to lead the debrief in an organized manner
c. Challenges: may limit the conversation rather than allowing it to flow naturally based on the events of that specific simulation event - Video review
a. Watching video of the simulation event to enhance the debriefing session
b. Benefits: helps to ground the discussion with video as evidence of events, highlights both areas of excellent and poor performance
c. Challenges: may negatively impact the “safe space” by reinforcing areas of poor performance
Overall, literature has clearly demonstrated that simulation events themselves are not as impactful as simulation-based education with incorporated debriefing. Simulation participants have consistently reported increased positive outcomes and improved impact on future performance when effective debriefing was incorporated into their simulation experience, reinforcing the need for simulation facilitators to be aware of debriefing methods and frameworks and to routinely incorporate these into their simulation events.
https://www.ncbi.nlm.nih.gov/books/NBK546660/
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