Sim Ed - “The Beginning” – A debrief blog.
Over the past two years or so, Simulation Based Education (SBE) has become a passion in my life. One component of SBE which I especially find both exciting and rewarding is debriefing.
Guiding and watching the learners reflect upon their actions within the scenario and explore the knowledge and thought processes which led to the actions is gratifying. So much deep learning can occur during such a short period of time if the debrief facilitator’s questions asked are well thought out, the responses of the learners considered, and time is allowed for reflection, discussion and metacognition.
This blog will be the first in a series of three where I will share my experiences with the SBE debrief. “The beginning”, “the middle” and “the end” are my creative titles, with “the beginning” covering planning for debriefs and opening questions, “the middle” covering narrative sense making and tips for handling difficult debriefs, and “the end” discussing take home messages, faculty debrief and the importance of honest evaluation of the debrief .
So, let’s start at the most logical place, the beginning.
I was initially presented with a framework for SBE debrief through an article which was presented in the NHET-Sim program. Arora et al.,(2012) identified eight components of an effective debrief, “approach, learning environment, learner engagement, reaction, reflection, analysis, diagnosis and application” (p. 984)., and I have used these features as a guide to my own practice.
This framework complemented the informal experiential learning I had acquired through years of daily debriefs with undergraduate nursing students. I cannot stress enough how much the facilitator’s approach to learning and the provision of a safe learning environment is essential to a successful debrief. If the goal of the debrief is deep, reflective learning then the absence of an informed, constructive, non-threatening and supportive debrief facilitator is nothing short of sabotage.
Another component I have identified which is not discussed in the above article is planning. Although this may seem obvious, planning for the debrief is often overlooked. I consider careful planning for the debrief just as important as any other aspect in SBE eg. learning outcome or scenario development. As I prepare for the SBE, I think about the characteristics of the learner group (age, level of education, discipline etc.) as knowledge of the individual learners or how the group works together can assist with the planning of strategies for possible challenges eg. how will I encourage the quiet learner to contribute or how will I deal with the verbose learner?
A great idea is to meet with simulation faculty prior to the simulation to discuss the learner characteristics and possible strategies which may be employed within the debrief to facilitate learning eg. ground rules, debriefing outline, possible questions and how to and who will deal with the not uncommon learner reactions such as crying and defensiveness.
I also reflect upon past debriefs, especially similar delivered scenarios, evaluating what worked well, what didn’t and why. I also try to prepare a list of questions which relate to the learning objectives. These questions are very handy to start up discussion amongst the learners and are also a great tool to get the debrief back on track if it becomes side-tracked.
I usually ask the list to be reviewed by the content experts who are participating in the SBE to ensure the questions align with best practice guidelines / intended learning outcomes and I keep a hard copy of the questions beside me – excellent for when I have the occasional mental blank, don’t judge :-).
My opening line
I will get back to my opening question in a tick but prior to that I will share with you my opening line in the debrief.
The first and the last thing I say in the debrief is “thank you”. I thank the participants for “putting themselves out there so that not only can they develop their own skills and knowledge but through their participation they are enabling learning for their colleagues who are observing the scenario and participating in the debrief”.
Participating in a scenario is stressful and for some participants, being placed in such a transparent situation, nothing short of excruciating. Saying thank you and acknowledging the stressful environment they have participated in is important for developing a respectful and safe learning environment. A little bit of gratitude is also just good manners and the majority of people appreciate a simple, genuine gesture of thanks. Quite often this introduction gives the participants a chance to gather their thoughts and emotions.
I give a short outline of how the debrief will proceed and timeframe during the prebrief but a reminder of this as well as any ground rules which you want to present can also occur at the beginning of the debrief.
My first question always feels a little awkward (probably due to my own anxiety). I ask “how do you feel?” which in my experience is often ignored by the learners as they are keen to state what they believe “they did wrong”. I gently seek out any emotions and then pursue the reason behind the emotion.
Inquiring as to their emotional state gives an opportunity to the learners to “vent” so that they can then move forward in the debrief rather than being caught up in an unresolved emotional state. The debrief facilitator is given an opportunity to validate the participants present feelings which quite often revolve around the fear and stress participation in the scenario evokes. Once acknowledged, I have often seen the fear and stress miraculously disappear. Reflection upon the actions and thought processes of the participants can then be explored.
So this is the beginning of the SBE debrief I facilitate. I hope you gained some learning from this blog and look forward to any feedback you have to offer. Please be kind, as this is my first ever blog. #anolddogcanlearnnewtricks.
Arora, S., Ahmed, M., Paige, J., Nestel, D., Runnacles, J., Hall, L., Darzi, A., Sevdalis, N. (2012). Objective Structured Assessment of Debriefing. Annals of Surgery, 256 (6), 982 – 988. Retrieved from http://www.annalsofsurgery.com