Kevin Floyd, RN, MS, CCRN Jennifer Mattice, RN,MS Debriefing Kevin Floyd, RN, MS, CCRN Jennifer Mattice, RN,MS

Debriefing Debriefing is the “heart and soul” of the simulated experience… Rall, Manser, & Howard, 2000 Knowing how to debrief is as important as knowing how to create and initiate a simulated experience. Jeffries, 2005 A process in which after an experience the learner is lead through a purposeful discussion related to the experience Fanning & Gaba, 2007 1. Rall, M., Manser, T., & Howard, S. K. (2000). Key elements of debriefing for simulator training. European Journal of Anaesthesiology, 17(8), 516-517. doi: 10.1046/j.1365-2346.2000.00724-1.x 2. Jeffries, P. R. (2005). A frame work for designing,implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103. doi: 10.1043/1536-5026(2005)026<0096:AFWFDI>2.0.CO;2 3. Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115-125. doi: 10.1097/SIH.0b013e3180315539

Defining Debriefing Merriam-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> "Debrief." Merriam-Webster.com. Merriam-Webster, n.d. Web. 20 Aug. 2014. <http://www.merriam-webster.com/dictionary/debrief>.

Debriefing Debriefing is the most valuable aspect of simulation experience Equal or more time then the actually scenario It provides immediate feedback to the participants Self refection to assist with self identification of strengths and areas for improvement The participants develop an emotional connection to the learning Focus on information sharing/learning

Goal of Debriefing Allows for the recognition and release emotions Reinforces the objectives of the simulation Provides time immediately for clarification of information Fosters critical thinking and problem solving Encourages reflective learning Proves a opportunity to link the simulation to the “Real World”

Gibbs Reflective Cycle(1988) Gibbs G (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford. http://www.brookes.ac.uk/services/upgrade/study-skills/reflective-gibbs.html

Driscoll Cycle http://www.supervisionandcoaching.com/pdf/reflectivelearning.pdf

Goals of debriefing Offer a safe, educational atmosphere Offer constructive feedback Encourage self learning and self assessment Promote communication and debriefing among team members Foster culture that will improve attitudes towards “errors” Constructively correct behavior, attitudes, and actions that hamper individual and team performance

Debriefing Format Video Review Positive: Challenges: Group Review Self Identify issues more readily Details on performance clear Challenges: Intimidating Cost of AV equipment Need review room Group Review Positive: Immediate Less time Not need for additional room Challenges Difficult to break role Harder to see behavior Interactions

Factors that could distract Lack of defined purpose and objective Excessive instruction Close ended questions Too many teaching points Allowing discussions on the limitation of simulation Not acknowledging or underestimating the emotions

Factors to Consider for Debriefing Plan Objective of the exercise Complexity of the scenario Experience level of the learners Familiarity of learners Time available for the session Role of simulation Individual personalities

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-judgmental 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

Facilitation Facilitated self reflection of the participants aids in the development of critical thinking and problem solving skills Active participation in self reflection process produces deeper analysis which may lead to longer retention and better retrieval Participant learn and retain more when they take an active role in the self reflection and perform their own analyses

Process of Debriefing Introduction Personal Reactions Discussion of Events Summary

Introduction Prepare student to active analyze and evaluate Communicate the expectations of the participants Safe environment Review the objective of the simulation

Personal reactions Allow the students to explore and deal with their feeling that have arose during the simulation Ensure that each participants have the opportunity to respond Begin with open questions How did the scenario go? How are you feeling? How did that go for you and the team?

Debriefing Focus Information sharing/learning Plus (+) Delta Seek information Tell me your perception of the experience What did you do well? What would you do differently to improve outcome? Plus (+) Delta

Discussion of events For each participant to share and discuss positive aspects of experience. At least one positive of self and others. *What went well? What were you thinking at that moment? For each participant to share and discuss less desirable aspects of experience. At least one of the less desirable aspects of self and others. What could have been done better? Are there any other opportunities for improvement?

Discussion of Events For each participant to share and discuss what they learned and how they will use that new knowledge in their own practice. Their own personal action plan. How will what you learned today change your current practice? Do you have an example of something you will do differently from now on?

Debriefing Non-threatening discussion Capture and fostering “ah-ha” moments Seek similar real-world experiences Help apply the experience to real-world practice Information sharing/learning

Summary Active listening Participant self refection Save environment What happen is Vegas stays in Vegas Open ended Questions Keep the debriefing moving Keep an open mind Learn, Learn, Learn

Questions