Transcript Debriefing | Sandi Feaster, CISL

Debriefing
Sandra J. Feaster, RN, MS,MBA
Program Director
Center for Immersive and Simulationbased 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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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
 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, semistructured 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”
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
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 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 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
 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
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
 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 state can affect retention and
activation
 How has the learner “framed” the
experience
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
Debriefing leads to new frames
FRAME
ACTIONS
RESULTS
Debriefing
changes later
actions
Rudolph, Simon, Dufresne & Raemer
Factors to consider in debriefing
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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
 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
 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
 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 - 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
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
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
 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 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 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 QUESTIONS
 Questions regarding task overload
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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 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 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
 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
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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
 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
Thank You!
[email protected]
http://cisl.stanford.edu