10 Commandments for the Medical Simulation Novice Debriefer

Debriefing in medical simulation has been a hot topic of discussion for years. There has been literature published to help relay to simulationists that a huge portion of the healthcare simulation learning experience is derived from debriefing. However, not all novice simulationists understand how to begin this process. This HealthySimulation.com article shares 10 basic guidelines to help learners on their journeys to becoming the debriefer that their simulation center and learners need.

Medical simulation is an increasingly popular tool used in healthcare education to improve patient safety and enhance clinical skills. One critical aspect of medical simulation is the debriefing process, which provides an opportunity for participants to reflect on their experiences, identify areas for improvement, and develop strategies to enhance their performance.

Effective debriefing can significantly impact the success of a clinical simulation program, but it requires skill and experience. For novice debriefers, navigating the debriefing process can be challenging. Yet, “ten commandments” exist that can help novice debriefers to develop their skills and build their confidence in the debriefing process. These commandments serve as guidelines to ensure that the debriefing process is productive, educational and engaging for all participants.

1. Find a framework that works.
   1. Learners may have heard of some of the various frameworks for debriefing in medical simulation (PEARLS, DASH, OSAD, Plus/Delta, etc) and they all have their strengths and weaknesses when used appropriately. But this can be very tricky when starting out to know what works best for healthcare simulation educator and their learners (or perhaps a mix of various frameworks).
   2. Finding one that is preferred and sticking to this is best. By doing that, educators remove other variables and can get into a more consistent rhythm which will naturally allow them to focus on the other aspects of the debrief. As they get more experienced they can venture out into other frameworks and begin to experiment. I would personally recommend the Plus/Delta model for most new debriefers, but they are all effective.
2. Don’t feel the need to be the expert on all content.
   1. The role of a debriefer is to guide the conversation in a fruitful way that increases the learning value of the medical simulation they just experienced. To do this successfully doesn’t require educators to “know” every answer. For particularly advanced scenarios having a content expert as a participant in the debrief who can be called upon when the group has a question that needs a specific technical answer is helpful.
3. Strive to create a safe environment for the participants.
   1. Medical Simulation can be a highly stressful experience for learners, and recognizing any difficulty is important. Reminding them that the debrief is a place for learning, where the team is working from the basic assumption that they are all working together to improve the care of future patients, is essential. An environment where the learner feels safe is the only environment where they will actually learn.
4. Get away from the manikin.
   1. Educators can often think that the best place to debrief is in the clinical simulation room right after the scenario has ended. Some sim centers may require this as they lack dedicated debriefing space, but healthcare simulation educators should always strive to get the learners away from the simulator and into a new environment. This allows the experience to feel separated from what they just went through and view the events in a more objective view.
5. Silence can work to educators’ advantage.
   1. New debriefers can be so quick to fill silence because educators equate silence with a failure on their part. Sometimes the learners are just thinking. Clinical simulation educators should challenges themselves to sit in that silence just a little longer than they think. They shouldn’t be surprised when a participant speaks up.
6. Don’t seek to fill a time quota.
   1. Simulation educators may have heard that debriefing should be as long as the healthcare simulation itself and ideally twice as long. This can be tough, especially when starting out. If the conversation has been fruitful and the clinical simulation educator feels as though the objectives were met don’t be afraid to wrap up the session. As they and the learner become more familiar with the process of debriefing, the sessions will gradually grow longer as they are able to better read their audience and the participants better understand the value of debriefing.
7. Encourage everyone to speak up.
   1. During a scenario 1-2 of the participants often make up an outsized percentage of the case while others naturally fade to the background. The debrief is where medical simulation educators can reach out to those that may have participated less and get them more involved. This can be done either through direct questioning, which can be tricky if the educator hasn’t done the work to create a safe environment or by asking each participant to go around and share something they might take away from the experience.
8. Begin with a summary of the case.
   1. To have a successful debrief session all the participants need to have a shared mental model of what just occurred in the scenario. Scenarios are often multi-faceted, and learners can miss important parts of the case by being preoccupied with another aspect. Try to begin debriefs by asking if anyone would like to summarize the scenario.
   2. After that summary, politely ask if anyone else has anything they would like to add. Educators will often find that fully painting a picture of what happened may take several attempts. Once that summary is agreed upon by the group they can begin the rest of the debriefing and know with confidence that they have a solid foundation to move forward.
9. Use video sparingly.
   1. The ability to record healthcare simulations is an undeniably fascinating and powerful tool but if used incorrectly can really hurt the flow of the debrief. When educators are considering bringing in the video recording, they should ask themselves if there is any other way to discuss this topic without video first. Finding the exact right sequence in the video can take time, and some learners get awkward viewing themselves on the recording.
10. Address performance gaps.
    1. The point of the debrief is to maximize the learning of the individuals participating in the exercise. While the scenario is going try to write down some of the things that educators will know they want to hit on later in the debrief. This could be a specific learning topic that they want to make sure they take away, something that happened in the scenario that was unsafe and they need to address or something a learner did that they are curious to learn more about.
    2. Having that list with them when they go into the debrief will allow them to ensure that the debrief flows nicely. This is the case after they have checked all of their observations off so that they can be sure that the learners got what they intended for them to get.
11. Bonus: Educators Must Debrief
    1. No single exercise will improve a healthcare simulation educator’s abilities as a debriefer like allowing someone else who has witnessed the debriefs to critique. Medical simulation educators must emphasize the importance of constant improvement. They should strive to always improve to showcase that they do practice what they preach.

Just as healthcare simulation educators understand that healthcare simulation is an essential tool for medical professionals and learners to enhance their skills and improve patient care, effective debriefing is also critical for the success of the simulation experience. These 10 commandments for novice debriefers will provide a framework for debriefing that can help to ensure that healthcare simulation educators’ sessions are effective and meaningful.

By following these guidelines, novice debriefers can gain confidence and experience, and contribute to the success of their clinical simulation programs. With continued practice and education, debriefers can help to further promote a culture of continuous learning and improvement within the medical community.

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