Debriefing ACLS and PALS with the AHA Structured and Support Debriefing Model David L. Rodgers, EdD, EMT-P, NRP, FAHA Manager Clinical Simulation Center Tammi Bortner, BSN, RN Program Manager Resuscitation Sciences Training Center

Disclosures Dr. Rodgers is one of the lead authors of the American Heart Association Structured and Supported Debriefing model. He received no compensation from this project. Dr. Rodgers’ spouse is employed by the AHA. Ms. Bortner has no relevant COI. Background is N05A/B/C/D

Debriefing – What is it? Debriefing is facilitator-led participant discussion of events, reflection, and assimilation of activities into the participants’ cognition to produce long-lasting learning. Fanning,, R. & Gaba, D. (2007). The Role of Debriefing in Simulation-Based Learning. Simulation in Healthcare, Vol. 2, No. 2,

ECC Instructor Debriefing requires a new skill set in which many instructors have little experience A different way of teaching – Learner self-discovery

Debriefing Is not technology dependent Asmund Laerdal and Bjorn Lind demonstrate CPR on the original Resusci Anne

Reflection To be complete, a simulation needs to be more than just the experience. Debriefing following a simulation experience provides the opportunity for reflection on actions. This is where the real learning occurs Schon, D. A. (1983). The Reflective Practitioner: How Professionals Think in Action. Basic Books, NY.

Debriefing Debriefing vs. Feedback What’s the difference?

Structured and Supported Debriefing Model O’Donnell, J.M., Rodgers, D.L., Lee, W,, Edelson, D. P., Haag, J., Hamilton, M. F., Hoadley, T., McCullough, A., Meeks, R., (2009), Structured and Supported Debriefing [Computer Software]. American Heart Association, Dallas, TX.

Important Up-Front Considerations Structured and Supported Debriefing Model Important Up-Front Considerations Simple in structure and easy to learn Validated by practice – Extensive testing in the University of Pittsburgh School of Nursing and the WISER simulation center Rapidly acquire basic skills in the organization of a debriefing Other skills in interviewing are going to take longer Scalable: Designed for ACLS and PALS Flexible - Can expand for longer events (CRM) or contracted for shorter events (task training)

Definition of ‘Structured and Supported’ Structured and Supported Debriefing Model Definition of ‘Structured and Supported’ Structured elements include three specific debriefing phases with related goals, actions, and time estimates. Supported elements include both interpersonal support as well as use of protocols, algorithms, and best evidence to inform debriefing statements/questions

Objective Data

Debriefing Structure – GAS Organizing the debriefing – 3 Steps Gather Participants provide their perspective Team leader perspective Team member perspective Facilitator asks questions Analyze Facilitate student reflection/analysis Ask probing questions Review log/debriefing viewer Report observations (good and bad) Summarize Lessons learned What will learners do differently

Structured and Supported Debriefing Model Phase Goal Actions Sample Questions Time Gather Listen to participants to understand what they think & how they feel about session Request narrative from team leader Request clarifying or supplemental information from team All: How do you feel? Team Leader: Can you tell us what happened? Team members: Can you add to the account? X min Analyze Facilitate participants reflection on & analysis of their actions Review of accurate record of events Report observations (correct & incorrect steps) Ask a series of question to reveal participants’ thinking processes Assist participants to reflect on their performance Direct/redirect participants to assure continuous focus on session objectives I noticed… Tell me more about… How did you feel about… What were you thinking when… I understand, however, tell me about “X” aspect of the scenario… Conflict resolution: Let’s refocus- “what’s important is not who is right but what is right for the patient…” Summarize Facilitate identification & review of lessons learned Participants identify positive aspects of team or individual behaviors & behaviors that require change Summary of comments or statements List two actions or events that you felt were effective or well done Describe two areas that you think you/team need to work on…

Impossible to debrief everything at once Structured and Supported Debriefing Model Impossible to debrief everything at once Debriefing should be learner-centric and conducted within a safe environment Participants need and value feedback An accurate log should be created and used Video, Simulator log, checklist Debriefing points are derived through session/course objectives

Debriefing Zone Russell, J. A. & Feldman Barrett, L. (1999). Core affect, prototypical emotional episodes, and other things called emotion : Dissecting the elephant. Journal of Personality and Social Psychology, 76, 805- 819. Russell, J.A. (1980). A circumplex model of affect. Journal of Personality and Social Psychology: 39, 1161–1178

Instructor or Facilitator? The facilitator generates critical thinking and learner self-discovery Learners analyze their performance Facilitator acts as a catalyst - leads, guides, and directs through questioning in order to achieve objectives Learners draw their own conclusions and generate a prescription for change

VIDEO example of ACLS session Practice VIDEO example of ACLS session OnlineAHA.org Don’t … Lecture and have the debriefing become an instructor-centered session Give your own analysis and evaluation before the learner has completed their analysis Give the perception that only your perceptions are important Interrupt learner discussion Interrogate – be positive when discussing problems Have a rigid agenda

Debriefing Do… Set the expectation for learner participation Guide the session to the extent necessary to achieve the debriefing objectives Adjust facilitation to the level needed to engage the learner to the maximum extent possible Draw out quiet learners Ensure that all critical points are covered McDonnell, L.K., Jobe, K.K., & Dismukes, R.K. Facilitating LOS Debriefings: A Training Manual in NASA Technical Memorandum 112192 (Ames Research Center: North American Space Administration, 1997).

Debriefing Do… Integrate instructional points as needed into the learners’ discussion Reinforce positive aspects of the learners’ behavior Not everything is important – know what is and what is not Ask probing questions Refer to an objective log of the simulation event Clarify questions Refer to the Guidelines, textbooks, and handbooks Link learning activities to real world application McDonnell, L.K., Jobe, K.K., & Dismukes, R.K. Facilitating LOS Debriefings: A Training Manual in NASA Technical Memorandum 112192 (Ames Research Center: North American Space Administration, 1997).

Debriefing Don’t … Lecture and have the debriefing become an instructor-centered session Give your own analysis and evaluation before the learner has completed their analysis Give the perception that only your perceptions are important Interrupt learner discussion Interrogate – be positive when discussing problems Have a rigid agenda Don’t … Lecture and have the debriefing become an instructor-centered session Give your own analysis and evaluation before the learner has completed their analysis Give the perception that only your perceptions are important Interrupt learner discussion Interrogate – be positive when discussing problems Have a rigid agenda McDonnell, L.K., Jobe, K.K., & Dismukes, R.K. Facilitating LOS Debriefings: A Training Manual in NASA Technical Memorandum 112192 (Ames Research Center: North American Space Administration, 1997).

And now for something completely different.

Action-linked Phrases: A novel approach to life support training David L. Rodgers, EdD, EMT-P, NRP, FAHA Manager Clinical Simulation Center Tammi Bortner, BSN, RN Program Manager Resuscitation Sciences Training Center

The Problem Delays in chest compressions and defibrillation were observed in simulated cardiac arrest events and real events even when the responders knew the patient was pulseless or was in ventricular fibrillation.

The Problem

Action-linked Phrases The Solution Once you make an observation or discovery, the next words you state need to be related addressing that specific issue. Action-linked Phrases

The Results

Observation Action “No response, get the code cart” “There’s no pulse, start compressions” “Shock delivered,

Observation Action “No response, get the code cart” “There’s no pulse, start compressions” “Shock delivered, “That’s V-fib, prepare to shock” “The patient is in PEA, “The patient has a pulse, check BP and get a 12-lead”

The Results BLS ACLS

Observation Action “No response, get the code cart” “There’s no pulse, start compressions” “That’s V-fib, prepare to shock” “Shock delivered, “The patient is in PEA, “The patient has a pulse, check BP and get a 12-lead”

Questions David L. Rodgers, EdD, EMT-P, NRP, FAHA Manager Clinical Simulation Center & Resuscitation Sciences Training Center Penn State Hershey Medical Center drodgers1@hmc.psu.edu Tammi Bortner, BSN, RN Program Manager tbortner@hmc.psu.edu