Debriefing in Medical Simulation
Manu Madhok, MD, MPH
Emergency Department
Children’s Hospital and Clinics of
Minnesota
Disclosures
• I have no financial disclosures or conflict of
interest
Objectives
• Review Simulation and Debriefing background
• Describe debriefing for various goals
• Present debriefing components
• Introduce a medical debriefing tool
• Review a simulation session
• Practice debriefing using scripted debriefing tool
• Translate to clinical settings
Why Simulation
• To transmit knowledge, impart skills, and
inculcate the values of medicine that will
improve health outcomes
Cooke, Irby, O’Brien. Carnegie Foundation
Report: Educating Physicians: A call for reform of medical school and
residency. 2010
Simulation
• Virtual realism
• Technique and not technology
• Goal is the transfer of skills
Aviation industry
Simulation Based Learning
• Educating adult professionals
• Active participation increases learning effectiveness*
• SBL offers opportunities for structured experiential
learning (includes practice and also thinking about it)
• Reflection on these learning events is part of experiential
learning which is facilitated by Debriefing
*Seaman, et al. Effective Strategies for Teaching Adults. Merrill, 1989.
Simulation: Bench/Book to Bedside
?? See one, Do one, Teach one??
Debriefing
• Facilitated or guided reflection in the cycle of
experiential learning
Why Debriefing
• Learner reactions
• Modification of attitudes
• Acquire knowledge and skills
• Change in behavior
• Practice change
• Patient outcome
Goal Specific
Scenarios built around sentinel events to
improve outcomes
• In-situ multi-disciplinary team
• Team work and communication skills
• Identify and address knowledge gaps
How do you make all of this
happen?
Teamwork divides the task and multiplies the success
TEAM
Airway
Monitor/Defib
Compressor
Recorder
IV/IO/meds
TEAM LEADER
Closed Loop Communication
Team Leader:
1.Give request
2.Listen for verbal confirmation that request was
heard
3.Awaits confirmation that task is completed
4.Confirms receipt of a completed assignment
Team Member:
1. Confirms that request is heard
2. Inform team leader when task
begins/ends
3. Verifies orders for drugs/treatments
before given
Learner Oriented
• Procedural competence
• Utilizing multimedia tools like video
• Competence tool
POISE network
Credentialing
• Scenarios of procedural sedation
• Hybrid of hi-fidelity manikin and scripted actor
What is the evidence about debriefing?
“Allows trainees to explain, analyze, and synthesize
information and emotional states to improve
performance in similar situations in the future”
“Sharing critical judgments is an essential part of
learning in simulation and debriefing”
Rudolph (2007), Debriefing with Good Judgment, Anesthesiology Clin 25: 36176.
Components of Simulation- Debriefing
• Facilitator
• Participant
• Simulated Scenario
Debriefing
• Recollection-Review
• Reflection with structure
• Renewed knowledge, skills and application
Role of Facilitator/Debriefer
• Sets the tone of the
environment
• Sets
•
expectations/objectiv •
es
• Determines if
•
objectives were met
• Fosters dialogue
Encourages reflection
Recognizes gaps in
learning
Provides clear
feedback and shares
teaching points
Debriefing Session
•
•
•
•
•
•
•
•
Set time and state your role as facilitator
Brief introductions
Review Objectives
Share expectation of active evaluation of self and
team performance
Answer learner questions, Reflections
Analysis: review decision-action-results
Teaching points, examples and applications
Conclusion with take home points and feedback
from learners
Reflection/Self-Appraisal
• Asks open-ended questions in a tone of
curious inquiry
• Uses non-directed phrases- I saw, I heard..
• Promotes advocacy for engaging the learner
• Encourages the learner to provide his frame of
reference
WHAT WENT WELL
provide answer format
• How do you think the scenario went?
….I saw, I observed…
• How successful were you as a team?
….I noticed, I felt…
• Were directions clear?
….I heard…
HOW DID THE TEAM FUNCTION
• What was your role?
• Would you have performed better in a
different role?
• What happened to the team during the
simulation?
• Did team members act professionally?
• Did a leader emerge? Why/ why not?
• Was important information shared clearly?
WHAT ELSE HAPPENED
Share domains
• What were some of your challenges?
Communication- ? closed loop
Shared Mental Model- ? situational awareness
Resource Management- ?roles/expertise utilization
• How could you have been more effective?
• What were favorite/ least favorite aspects?
• What emotions did this experience trigger?
Process analysis
• Review decisions- actions-results
• Provide examples of positive interactions/
outcomes
• Link scenario to real life
• Review the teaching point/objective
How would this improve patient care
•
•
•
•
What new knowledge did you gain?
Are you comfortable with your skill level?
How would this help you in practice?
How will you apply this to the clinical setting?
Summarize
• These are the things you identified as going
well…
• These are the things you identified as needing
to work on…
• I saw improvements in the areas of….
• Review take home points
• Thanks
Translation to Clinical Setting
• Learners who are debriefed in the clinical
setting feel more supported by faculty, display
improved knowledge and skill retention
• Best time is to do after a difficult interaction,
code blue, procedure documentation.. as
quality of feedback decays with time