1. 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

2. 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.

3. 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, Debriefing – What is it?

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

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

6. 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. Reflection

7. Debriefing vs. Feedback What’s the difference? Debriefing

8. 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. Structured and Supported Debriefing Model

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

10. 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 Structured and Supported Debriefing Model

11. Objective Data

12. Organizing the debriefing – 3 Steps GatherParticipants provide their perspective Team leader perspective Team member perspective Facilitator asks questions AnalyzeFacilitate student reflection/analysis Ask probing questions Review log/debriefing viewer Report observations (good and bad) SummarizeLessons learned What will learners do differently Debriefing Structure – GAS

13. PhaseGoalActionsSample QuestionsTime G 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 A 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…” X min S 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… X min Structured and Supported Debriefing Model

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

15. 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

16. 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 Instructor or Facilitator?

17. Practice VIDEO example of ACLS session OnlineAHA.org

18. Debriefing 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). Do… l Set the expectation for learner participation l Guide the session to the extent necessary to achieve the debriefing objectives l Adjust facilitation to the level needed to engage the learner to the maximum extent possible l Draw out quiet learners l Ensure that all critical points are covered

19. Do… l Integrate instructional points as needed into the learners’ discussion l Reinforce positive aspects of the learners’ behavior l Not everything is important – know what is and what is not l Ask probing questions l Refer to an objective log of the simulation event l Clarify questions l Refer to the Guidelines, textbooks, and handbooks l Link learning activities to real world application Debriefing 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).

20. 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 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).

21. And now for something completely different.

22. David L. Rodgers, EdD, EMT-P, NRP, FAHA Manager Clinical Simulation Center Tammi Bortner, BSN, RN Program Manager Resuscitation Sciences Training Center

23. The Problem l 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.

24. The Problem

25. The Solution l Once you make an observation or discovery, the next words you state need to be related addressing that specific issue.

26. The Results

27. ObservationAction “No response, get the code cart” “There’s no pulse, start compressions” “Shock delivered, start compressions”

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

29. The Results l BLS  ACLS

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

31. 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 Resuscitation Sciences Training Center Penn State Hershey Medical Center tbortner@hmc.psu.edu