1. The Art and Science of Debriefing: a Simulation Experience
Mary Cantrell, MA
PULSE Center – Director
Arkansas Children’s Hospital

2. Debriefing
The most important aspect of running any simulation - Debriefing
“Simulation is just a good excuse to do debriefing”
Dan Ramer

3. Learning Model Unconsciously – Incompetent Consciously - Incompetent
Consciously – Competent
Unconsciously - Competent

4. Your Best Teacher was…
Smart
Wise
Caring
Concerned
Unspoken expert

5. How people practice Internal Frames EXAMPLES:
Thanksgiving is a day I eat all my favorite food.
Dancing makes me look goofy
If I don’t leave work by 4:45 I will be stuck in traffic.

6. Learners Frames Feelings Assumptions Knowledge Stuff I know is true
Stuff I learned in school

7. Frames shape actions
Thanksgiving is a day I eat all my favorite food. – Eat all day – I can diet tomorrow.
Dancing makes me look goofy – Don’t go near the party with a dance floor.
If I don’t leave work by 4:45 I will be stuck in traffic. - Hurry all day to get it done because I don’t want to get home at 6pm.

8. Medical Frames & Actions
Residents don’t have any power… and I can’t tell my attending what to do. When you do airway, you have to use an AMBO bag. I can’t find one and I think this patient is not going to make it. I just got out of school and everyone thinks I know what I am doing.

9. How do you define errors?
Intentionally rational action
Seemed like a good idea at the time, given the circumstances.
Lack of knowledge

10. Our Basic Assumption
Everyone participating in activities in the PULSE Center is intelligent, well trained, cares about doing their best and they want to improve.

11. Debriefers Job
Help learner to surface their frames and analyze the impact on their actions.
Be the UNSPOKEN EXPERT
Facilitate open/safe discussion

12. Debriefing leads to new frames
Debriefing changes later actions
Frames
Actions
Results

13. Judgmental Statements & Questions
Can anyone tell us where John made his big mistake?
Does someone have a clue as to what went wrong with this patient?
Setting them straight
I’m right – You are wrong
I know --- you don’t (essential failure in thinking)
Truth------error (next time do it my way)
I know the answer- can you guess what I am thinking?
“pimping”

14. Non-Judgmental (???)
I’m right – your wrong – but I don’t want to upset you.
“Feedback Sandwich”
Something soft (complement)
Something meaty (criticism)
Creates confusion
Has hidden truths
Consequences unclear

15. Debriefing with Good Judgment
How did the learner make meaning of what happened
Instructor “From what I know this happened in the simulation and this is where I saw the problems”
Learner is also smart and well trained trying to do the best so… why did the learner take these actions? (they must have a good reason)

16. Errors are discussable
Mistakes are made and recognized and then changes happen
Source of learning happens when you know what happened and how it can be different
Make mistakes discussable
Enhance patient safety
Let learners identify their own mistakes

17. Debriefing with Good Judgment
Learner makes a mistakes
Debriefer is genuinely curious
Discuss what that looked like
Learners feel worthwhile and intelligent
Respectfully insert your expertise
Frame changes can happen!

18. Debriefing is Discussion (not lecture!)
The Debriefer should talk less
Try only asking questions
Get the learners to talk to each other
Make it SAFE to discuss
Be a facilitator; not a lecturer
Closed ended questions – as appropriate
Open ended questions

19. Three Elements of Debriefing
Reactions
Feelings
Facts
Understanding
Explore deeper meaning
Summary
The take home message

20. Advocacy-Inquiry Advocacy – observation, statement, fact - neutral
Inquiry – question or curiosity*
*GENUINE Curiosity (you want to understand)

21. Successful Debriefing
Genuinely interested – You see yourself as the good teacher not the good healthcare worker
Pre-scenario briefing of expectations
Reinforcing good practice
Correct a limited number of errors
Avoid excessive correction (people only remember 1 or 2 things - what is the take-home message?)

22. Successful, Con’t Stress key educational points
Use playback so the learners can see themselves
Talk less, facilitate more
Be respectful of any learner criticism
Use Advocacy – Inquiry
Plus /Delta

23. Plus/Delta

24. Encounter Detractors Lack of purpose, objectives
Excessive criticism, negative feedback
Humiliating a team member
Fixating on medical procedure

25. Encounter Detractors Underestimating the learner’s emotions/feelings
Lecturing
Hypercriticizing learner’s performance
Allowing discussion to focus on limitations of simulation

26. Debrief Roadblocks This would never happen
If this was a real case, I would have done things differently
No matter what you say, I don’t agree with you

27. Good Debriefing Questions
How do you think that went?
What did you do well?
How would you do this differently next time?
How do you rate your communication between team members?

28. Good Debriefing Questions
What was not done?
How did you feel?
What do you think happened?
Has this ever happened to you in the past, how did you react?

29. Good Debriefing Questions
What did you see happening?
Would you have done the same thing as _____?
What information was being used?
Did you need anything that was not there?

30. Thank you! Mary Cantrell, MA
University of Arkansas for Medical Sciences
PULSE Center – ACH