Debriefing is an incredibly powerful tool in healthcare simulation, but the methodology comes with a lot of challenges. Commonly, there is a statement that states clinical simulation is done so that debriefing can occur. Debriefing is defined in the Healthcare Simulation Dictionary as a formal, collaborative, reflective process within the clinical simulation learning activity. This article written by Erin Carn-Bennett will explore common ways that clinical simulation debriefing can be derailed in all debriefing styles and solutions for debriefers to utilize to improve their craft in the art of debrief.
What is Debriefing in Healthcare Simulation?
Debriefing allows participants that have been placed on the edge of their learning curve in a clinical simulation to work through emotions and problem-solving in a safe environment. The lessons learned during debriefing can translate into improved patient outcomes clinically if done effectively. Debriefers of healthcare simulation are in a powerful role to influence change in healthcare or potentially cause harm to their participants.
There are many different modalities that can be used to debrief a clinical simulation or real-life scenario for healthcare. This article will be generalized in the nature of debriefing, the aspects and concepts are applicable to all debriefing structures.
In general, most debriefing modalities used in clinical simulation will consist of three phases: feelings, exploratory, and solutions. Another concept to help establish a positive, safe environment is to establish a safe learning environment that promotes exploration and expansion of knowledge and application of knowledge.
Rudolf et al (2006) describes clinical simulation instructors that disclose judgment skillfully are debriefers with good judgment. Clinical simulation instructors do not intend to do harm to their participants. Sense-making in clinical simulation debriefing is a reflective practice comprised of three parts 1) frames, 2) genuine curiosity, & 3) advocacy inquiry. Critical judgment in a clinical simulation debriefing used in a safe manner is essential to the participants ability to learn.
However, harm can occur through unconscious actions of clinical simulation instructors, if the participants’ perspective is not considered and delivered in a safe and effective approach. The next section will explore potentially unconscious actions that can derail debriefs unintentionally and how to solve these issues.
Cutting the Feelings Phase Short
The feelings phase of a clinical simulation debriefing is such a rich source of information for many reasons. The feelings phase allows participants to express how they felt in the clinical simulation scenario. For some learners they will be vocal and offload a lot of information. For other participants it may take some time for them to share their feelings or they may choose not to at all.
When the feelings phase is cut short this may rob participants the opportunity to offload how the clinical simulation felt for them and also limit the information shared to the debriefer. Sometimes the debriefer must allow for a prolonged pause; around twenty seconds to have some participants talk. Participants often cannot help but share a lot of the time with the discomfort of a long pause.
Do not underpredict the power of the feelings phase. The information shared is not just for the debriefer, but also for participants to understand how the clinical simulation felt for their peers. The feelings phase can assist to allow participants to understand assumptions and judgments that they may have made of their peers. To understand others perspectives if shared in the feelings phase is an incredibly powerful element of healthcare simulation.
On reflection at times if the feelings phase has been cut short, the rest of the debriefing can at times be derailed. This may occur because participants did not get to voice how they felt and may continue to focus introspectively on this throughout the rest of the debriefing instead of involvement in other ways and progress in the sense making process of debrief.
There is a simple solution to the feelings phase. The debriefer must schedule time and make sure the feelings phase is conducted.
Polling the Room for Feelings
Some debriefing modalities poll participants for how they felt in the feelings phase of debrief. This can be effective for a lot of participants. However, not for all. Not all participants will feel comfortable to share their feelings for a variety of reasons. An introverted personality or a participant that is still attempting to make sense in their head about the simulation may choose not to contribute in debrief.
Based on what debriefing modality used, the polling consideration should be applied when in the clinical simulation instructor role. As with most elements of clinical simulation, the choice to remain non-judgmental of the adult learner and to trust their learning process if they choose not to participate is a must. As clinical simulation instructors and debriefers assumptions should not be made of individuals if they choose to not put forward their feelings or voice into the debriefing circle.
A learner may not be ready to learn for a variety of reasons as an adult learner of which assumptions are not helpful. Trust participants and choose not to judge them in a negative manner. A potential solution for the debriefer to address non-participation in the debriefing session is to ask each participant to share one aspect of success during the simulation scenario. Many times the participants only focus on errors or what could have been done differently. So, asking each participant for one positive can help address their mindset and promote a positive atmosphere.
Instructor or Debriefer Talking Too Much
As clinical simulation instructors, a common action can be to talk too much in the debrief. As a debriefer in clinical simulation, many emotional intelligence and communication skills are utilized to move participants through emotions and create space for deep reflection. Remember as a clinical simulation instructor the main purpose is to remain curious and guide the conversation not be the main voice. Debriefing is not additional lecture time. The Healthcare SImulation Standards of Best Practice should be reviewed for debriefing, facilitation, and simulation design.
The Frame
When in an advocacy inquiry debriefing modality (or with use of a why question of an action in clinical simulation), not checking in with the participant about their frame expressed can reduce trust between participant and instructor. Ensure that the participant gives the all clear that the instructor has heard the frame expressed correctly prior to movement into the solutions phase. As a novice debriefer it can be essential to receive feedback from more experienced debriefers until one can hone their debriefing skills.
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The Distressed Participant
Despite our best efforts as healthcare simulation instructors and debriefers, debriefing does not occur the way it is planned. Debriefers are human and not perfect. As a healthcare simulation instructor consider what process and follow-up process (formal or informal) there is for management of any distressed participants post debrief. A simple check in the next day by a member of faculty is often enough to ensure that any participants of clinical simulation that appeared distressed are alright. The key aspect for debriefing is to have an established plan that can consist of a policy, procedures, or protocols for a student that becomes distressed or triggered during a clinical simulation scenario. The simulation instructor and debriefer should be knowledgeable of the plan and how to implement the plan to assist the participant in distress.
In this article common ways that clinical simulation debriefs derail have been discussed. There have been simple considerations and actions for clinical simulation instructors and debriefers to consider while in the debriefing circle to increase participant psychological safety.
