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Debriefing in Simulation

Debriefing in Simulation . Garth Meckler, MD, MSHS Mary Anna Gordon, DNP, RN. Overview. Elements Approaches & Styles Methods & Strategies Tips / Tricks / Adjuncts Practice. Is Debriefing Important? History Theory Goals and Objectives Considerations. Is Debriefing Important?.

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Debriefing in Simulation

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  1. Debriefing in Simulation Garth Meckler, MD, MSHS Mary Anna Gordon, DNP, RN

  2. Overview Elements Approaches & Styles Methods & Strategies Tips / Tricks / Adjuncts Practice • Is Debriefing Important? • History • Theory • Goals and Objectives • Considerations

  3. Is Debriefing Important? Perceived skill of the debriefer has the highest independent correlation to perceived overal quality of the simulation Wilhelm J. Survey of simulation participants. 1991 • Feedback is the most important feature of simulation-based medical education • Issenberg et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. 2005.

  4. History • Military • After-action review • Aviation • Response to accidents in 1970s • Pre-flight briefings / Post-flight debriefings • Psychology • Experiments using deception • Staff processing

  5. Theory • Andragogy • Adult learning • Malcolm Knowles • Kolb Learning Cycle Experience Simulation Experiment Reflect Translation Debriefing Conceptualize Reflection

  6. Theory • Circumplex Model of Emotion • Russel and Feldman-Barrett Activation Tense Alert Nervous Excited Stressed Elated Upset Happy Unpleasant Pleasant Sad Content Depressed Serene Bored Relaxed Fatigued Calm Deactivation

  7. Goals • Facilitate learning through insight, understanding, and meaning • Safety • Respect • Curiosity • Tied to educational goals of the experience

  8. Objectives • All • Provide a safe, activating environment for learning • Debriefer • Elucidate the thoughts and actions of the participants • Impart critical knowledge, skills, and attitudes • Evaluate the educational experience and strategy • Participants • Improve insight, knowledge, skills, and attitudes • Improve performance performance in similar situations

  9. Considerations • Educational goals and objectives • Learners • Teachers • Time • Timing • Setting

  10. Elements • (Pre-briefing) • Emotions / Reactions (Impact) • Events (Process) • Explanation / analysis (Reflection) • Information (Didactic) • Applicability (Relevance) • Evaluation

  11. Approaches • Three Levels of Debriefing (Dismukes, Aviation Model) • High: participants debrief themselves with minimal guidance • Intermediate: increased instructor involvement in analysis • Low: Intensive instructor involvement

  12. Styles • Judgmental • Goal: Make you to do the right thing • Assumption: I know what went wrong • Approach: blaming, shame, statement of “truth” • Non-judgmental • Goal: Avoid shame • Assumption: as above • Approach: kind, gentle, lead learner to my answer • Carl Rogers: facilitator as catalyst with congruence, acceptance, empathy

  13. Example

  14. Good Judgment • CMS “Good Judgment” • Goal: mutual learning without shame • Assumptions: learner is smart and wants to do the right thing • Mistakes are puzzles, not crimes • Approach: mutual respect, curiosity • Advocacy: first person observation • Inquiry: uncover learner’s frame

  15. CMS Debriefing Process • Reactions Phase • Process emotions • Plus/Delta • Understanding Phase • Explore “Frames” using advocacy/inquiry • Teach through modeling and didactics • Summary Phase • What went well and didn’t • Take home learning points • Real-world application

  16. ExampleEmotions & Plus / Delta

  17. ExampleSummary

  18. Understanding Phase • Learner Frames: • The “minds’-eye” of the learner • Assumptions, feelings, knowledge, awareness, context, goals of the learner Frame Result Action Uncovered Observed

  19. Advocacy-Inquiry • Advocacy: • First person observation of an action or result • Concern or judgment about observation • “I noticed that you left the door to the child’s room open. I am concerned that this might allow humans into our world which could be very dangerous.” • Inquiry: • Question designed to explore learner’s frame • “Clean Question” • “What was on your mind when you walked through that door?”

  20. Practicing Advocacy-Inquiry • Why didn’t you call for help? • You forgot to wear gloves and a face shield, are you trying to get Hepatitis? • I noticed you seemed to get very busy as the code progressed, and I thought you could have used some additional help. I’m wondering where you were on that? • I didn’t see you put on gloves or a face shield. That’s the most common mistake I see in codes like this. I wonder why that happens?

  21. Tips and Tricks for the Difficult Debriefing • Prevention • Pre-brief • Prepare debriefing guides • Work in Teams • Co-facilitator • Body Language • Validate Emotions • Reflective listening • Normalize • Elaborate • Deflect

  22. Additional Strategies / Methods Strategies Methods Collaboration Script Written debriefing Video debriefing • Self debriefing • Peer debriefing

  23. Practice….

  24. Practice…..

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