1. Understanding the Debrief Process
Professor Robert P. O’Brien
Clinical Education Fellow
Department of Medical Education
School of Medicine
Faculty of Medicine, Dentistry and Health Sciences

2. Adjunct Faculty – CAE Healthcare University Appointments
Disclosures
Adjunct Faculty – CAE Healthcare
University Appointments
University of Melbourne
University of Western Australia
Consultant – Belridge Park
Editorial Board – BMJ STELI
Immediate Past Chair – Australian Society for Simulation in Healthcare (ASSH)
Education Committee - Society for Simulation in Healthcare (SSH)
Advisory Boards – Simulation Centres Internationally

3. WHAT IS DEBRIEFING
A conversation between two or more people to review a real or simulated event in which participants analyse their actions and reflect on the role of thought processes, psychomotor skills, and emotional states to improve or sustain performance in the future.
Centre for Medical Simulation (Harvard)

4. Facilitated reflection in experiential learning1
Involves “the active participation of learners, guided by a facilitator or instructor whose primary goal is to identify and close gaps in knowledge and skills.”2
1Fanning and Gaba 2007
2Raemer et al. 2011

5. What educators are doing?
Applying phases1
Provide directive feedback and teaching2
Ask learners to self-assess3
e.g. Plus-Delta (+/Δ); Pros-Cons-Alternatives
Provide focused facilitation
e.g. Advocacy-Inquiry4,5,6
1Steinwachs 1992
2Archer 2010
3 Fanning & Gaba 2007
4,5,6Rudolph et al. 2006, 2007, 2008

6. Comparative studies: Video vs no video Expert modeling
Debriefing Research
Comparative studies:
Video vs no video
Expert modeling
Terminal vs concurrent
Oral vs multimedia
Self vs instructor-led
In-person vs. web-based
Limited vs extensive
Technical vs cognitive
Cheng et al. 2014

7. Effective debriefings
Safe learning environment
Honest but non-threatening approach
Organized
Dialogue (usually)
Reflection and analysis of performance gaps
Trainees shares his/her perspective
Focus on improvement or sustaining excellence
Simon et al. 2010
Ahmed et al. 2012
Arora et al 2012

8. Dieckmann’s model of the simulation setting
Simulation Phases
Setting Introduction
Simulator Briefing
Theory Inputs
Scenario Briefing
Simulation Scenario
Debriefing
Course Ending
Dieckmann’s model of the simulation setting
Dieckmann et, al. 2012

9. Should it be a cycle? Setting Introduction Simulator Briefing
Theory Inputs
Scenario Briefing
Simulation Scenario
Debriefing
Course Ending

10. Kolb

12. Behaviorist Learning Theory Reflective Learning Theory
Educational Theories
Behaviorist Learning Theory
Knowledge acquisition and Automated response (Content , knowledge)
Reflective Learning Theory
Internal Examination
Constructivist Learning Theory
Transference to new real situations
Cognitive Learning Theory
Restructuring understanding through repetition, reinforcement and feedback

13. Adult Learning Principles
Have prior learning and experience
Are self directed learners
Learn most effectively when they perceive a need for learning
Prefer problem-centred approaches
Self Evaluation
Require Feedback
Value experiential learning opportunities

14. LEARNING SYSTEM FEEDBACK LOOP
Objectives
Course Material
Simulation
Debrief
LEARNING SYSTEM FEEDBACK LOOP

15. WHAT IS THE PURPOSE OF THE DEBRIEF
Formative Feedback
Reflective learning
Part of a process of Experiential learning
Develop metacognition

16. Actions Reactions WHERE DO WE AIM TO GO?
Rudolph,J. Simons,R. Dufresne,R. Raemer,D Theres no such thing as “nonjudgmental”debriefing: a theory and method for debriefing with good judgement. Simulation in Healthcare Vol.1 No.1, Spring 2006
Actions
Reactions

17. Aviation based debriefing After action Review
PLUS (+) / DELTA (Δ)
Aviation based debriefing
After action Review
Student centric approach
Plus focuses on things that went well
Delta focuses on things that need to change and how to change them
All participants are expected to speak
Simulation

18. PLUS (+)
DELTA (Δ)

19. WISER GAS MODEL

20. Reactions Phase – Clear the air and set the stage for discussion
HARVARD MODEL
Three Phase model
Phase 1
Reactions Phase – Clear the air and set the stage for discussion
Feelings
Facts

21. Understanding Phase – Analyse and Apply
HARVARD MODEL
Three Phase model
Phase 2
Understanding Phase – Analyse and Apply
Exploring – explore trainee’s perspective on scenario events
Discussion and teaching – help move trainees to new perspectives, understanding and skills
Generalise and apply- lessons learned to real setting

22. Summary – distill lessons learned for future use
The Harvard Model
Three Phase model
Phase 3
Summary – distill lessons learned for future use
What worked well
What should be changed nest time
Major ‘take-away’ take home message

23. PEARLS
Combination of methods depending on the time available, experience, content of the session.

24. Where does the debrief aim to go?
Rudolph,J. Simons,R. Dufresne,R. Raemer,D Theres no such thing as “nonjudgmental”debriefing: a theory and method for debriefing with good judgement. Simulation in Healthcare Vol.1 No.1, Spring 2006
Frames
Actions
Reactions

25. Assumptions Feelings Goals Rules Knowledge Base Situation Awareness
Frames
Assumptions
Feelings
Goals
Rules
Knowledge Base
Situation Awareness
Influence of context
Frames

26. RUDOLPH – GOOD JUDEGEMENT TECHNIQUE
Sharing critical judgements is an essential part of learning in simulation & debriefing
There is no such thing as “non judgemental debriefing” - aim for “good judgement”
“rigorous reflection” - bring to the surface both the clinical/ behavioural issues brought up by the simulation and the judgement of the instructor

27. Observation + Inquiry Curiosity
ADVOCACY INQUIRY
Observation + Inquiry
What did I see and my point of view about it
Curiosity
Ask an open ended question about how the participant saw the issues
Rudolph,J. Simons,R. Dufresne,R. Raemer,D Theres no such thing as “nonjudgmental”debriefing: a theory and method for debriefing with good judgement. Simulation in Healthcare Vol.1 No.1, Spring 2006

28. HARVARD MODEL Three Phase model Phase 1
Reactions Phase – Clear the air and set the stage for discussion
Feelings
Facts
Phase 2
Understanding Phase – Analyse and Apply
Exploring – explore trainee’s perspective on scenario events
Discussion and teaching – help move trainees to new perspectives, understanding and skills
Generalise and apply- lessons learned to real setting
Phase 3
Summary – distill lessons learned for future use
What worked well
What should be changed nest time
Major ‘take-away’ take home message

29. Resources

30. Professor Robert P. O’Brien
Clinical Education Fellow
Department of Medical Education
School of Medicine
Faculty of Medicine, Dentistry and Health Sciences