Debriefing | Sandi Feaster, CISL
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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
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
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
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
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