debriefing sandra j. feaster, rn, ms,mba program director center for immersive and simulation- based...
TRANSCRIPT
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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
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DEBRIEFING IS THE “HEART AND SOUL” OF THE SIMULATED EXPERIENCE
- RALL, MANSER, & HOWARD, 2000
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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
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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.
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Debriefing starts with the “Prebriefing”
Prebriefing 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 instructor should be prepared
To understand that learners will come with their own experiences and frames
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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
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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
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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
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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
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Learning and Debriefing in Simulation
I hear and I forgetI see and I rememberI 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
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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
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Emotional Learning
Emotional state can affect retention and activation
How has the learner “framed” the experience
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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
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Frames are invisible to the instructor
FRAME ACTIONS RESULTS
Debriefing leads to new frames
Debriefing changes later actions
Rudolph, Simon, Dufresne & Raemer
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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
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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?
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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
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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
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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
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Tips
Pros – Cons – Alternatives Plus (+) Delta
+ Delta
Example of good behaviors/actions
Behaviors/actions that would change or improve in the future
Easier Task or behaviors Behaviors or actions that were difficult
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Thank You! [email protected]://cisl.stanford.edu