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.
Background is N05A/B/C/D

3. 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,

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

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

6. 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.

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

8. 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.

9. 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)

10. 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

11. Objective Data

12. 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

13. 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…

14. 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

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,
Russell, J.A. (1980). A circumplex model of affect. Journal of Personality and Social Psychology: 39, 1161–1178

16. 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

17. 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

18. 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 (Ames Research Center: North American Space Administration, 1997).

19. 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 (Ames Research Center: North American Space Administration, 1997).

20. 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 (Ames Research Center: North American Space Administration, 1997).

21. And now for something completely different.

22. 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

23. 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.

24. The Problem

25. 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

26. The Results

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

28. 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”

29. The Results
BLS
ACLS

30. 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”

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