The Art and Science of
Debriefing: a Simulation
Experience
Mary Cantrell, MA
PULSE Center – Director
Arkansas Children’s Hospital
Debriefing
The most important aspect of
running any simulation Debriefing
“Simulation is just a good
excuse to do debriefing”
Dan Ramer
Learning Model
Unconsciously – Incompetent
Consciously - Incompetent
Consciously – Competent
Unconsciously - Competent
Your Best Teacher was…
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Smart
Wise
Caring
Concerned
Unspoken expert
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.
Learners Frames
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Feelings
Assumptions
Knowledge
Stuff I know is true
Stuff I learned in school
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.
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.
How do you define errors?
• Intentionally rational action
• Seemed like a good idea at the
time, given the circumstances.
• Lack of knowledge
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.
Debriefers Job
• Help learner to surface their frames
and analyze the impact on their
actions.
• Be the UNSPOKEN EXPERT
• Facilitate open/safe discussion
Debriefing leads to
new frames
Debriefing
changes later
actions
Frames
Actions
Results
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”
Non-Judgmental (???)
• I’m right – your wrong – but I don’t want
to upset you.
• “Feedback Sandwich”
– Something soft (complement)
– Something meaty (criticism)
– Something soft (complement)
Creates confusion
Has hidden truths
Consequences unclear
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)
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
Debriefing with Good
Judgment
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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!
Debriefing is Discussion
(not lecture!)
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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
Three Elements of Debriefing
Reactions
– Feelings
– Facts
Understanding
– Explore deeper meaning
Summary
– The take home message
Advocacy-Inquiry
• Advocacy – observation, statement,
fact - neutral
• Inquiry – question or curiosity*
*GENUINE Curiosity (you want to understand)
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 takehome message?)
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
Plus/Delta
Encounter Detractors
• Lack of purpose, objectives
• Excessive criticism, negative
feedback
• Humiliating a team member
• Fixating on medical procedure
Encounter Detractors
• Underestimating the learner’s
emotions/feelings
• Lecturing
• Hypercriticizing learner’s
performance
• Allowing discussion to focus on
limitations of simulation
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
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?
Good Debriefing Questions
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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?
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?
Thank you!
Mary Cantrell, MA
University of Arkansas for Medical
Sciences
cantrellmaryj@uams.edu
PULSE Center – ACH
cantrellmj@archildrens.org