Simulation allows making experience without risking safety for our “real” patients. But how do we make sure that our learners in the sim center really “learn” in the end? We all know that debriefing is important, but what are the basic ideas behind doing debriefings?

What we know

The Debriefing …

  • … is the key element in simulation-based education and the key element responsible for the learning outcome of our participants.
  • … allows to learn from the just experienced points from the scenario (good points as well as weaknesses).
  • … is ideally a structured talk or discussion after the simulated scenario.

Since we are dealing mostly with adults and we are assisting them in learning, the adult learning principles are to be considered.

Authors like Kolb (with the idea of “learning from experience”), the National Training Laboratories Institute (with their “learning pyramid”) or Chris Argyris (with his research on “double loop learning”) are some of the principles that are always referred to. Please see former safety articles or other research to refresh your memories if needed.

Reflection of an activity and a well-done analysis after a sceneario are the cornerstones of the experiential learning experience. Grant and Marsden describe this process as having an experience (in simulation this would be a scenario f.e.), thinking about it, identifying learning needs that would improve future practice (first parts of debriefing), planning what to undertake (these are f.e. the take home messages of the latter part of the debriefings), and applying the new learning in practice (could be next scenarios f.e.).

We also know that adults like learning when it is problem based and relevant to their jobs and daily doings.

In adult learning active participation of our learners is crucial. We learn more as adults, when there are interactive discussions. A linear and unidirectional learning is less effective and may limit learning outcomes, especially when it comes to more complex team scenarios.

To allow open discussions and admitting weaknesses/mistakes establishing an environment with psychological safety, setting a safe and confidential situation with a lot of trust is key.

It’s not that we just learn from mistakes, a lot of learnings can come from enhancement of the things that went well.

What this means for us as teachers

For us as debriefers or facilitators – as we tend to call the debriefers (since we are trying to facilitate the learning process) – this means

  • The debriefing should be tailored to the learning objectives
  • Unlike the traditional classroom “teacher,” facilitators tend to position themselves not as authorities or experts, but rather as co-learners. This more fraternal approach may be most productive where the learning objective is behavioral change.
  • We are trying to promote, facilitate and moderate discussions and making our participants reflect and think of what just happened in the scenario.
  • We ask (open) questions to make our participants think and reflect on possible reasons and solutions.
  • If we (or also our learners) see deficits or risks for patients (we treated in our scenarios f.e.) we must address them. Addressing “negative points” is hard to do and needs to be trained. That’s why it is so important that professionals are facilitating debriefings
  • We are aiming to guide and direct our learners rather than to lecture.
  • Debriefing takes time when done as described above. It may take twice or triple as long as the scenario.
  • Video-analysis can be used in the debriefing process

This review is NOT a systematic review of all the literature available on debriefing. It contains info from many peer and nonpeer reviewed sources.

Written by Lukas Drabauer from Alpha Medical Concepts (AMC)




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