The initial reactions or feelings phase of a healthcare simulation debrief, no matter the debrief modality utilized, is an incredibly critical part of any clinical simulation debrief. For many debriefing strategies in clinical simulation, the reactions phase is generally the first phase after the debrief outline is described. The reactions phase is a space for participants to share how the clinical simulation felt personally for them and gives debriefers a valuable analysis of where to focus the debrief. With proper attention and respect paid to the reaction phase element of a healthcare simulation debrief, critical information can be included, the debrief may fall flat, and participants may leave unsatisfied. This article by Erin Carn-Bennett, MSN, RN, will explore the reactions phase of a clinical simulation debrief and how to make the most of this phase of debrief.
The Importance of the Debrief in Clinical Simulation
Different clinical simulation debrief philosophies and frameworks are tools with different components to guide clinical simulation participants through a guided conversation. The purpose of a debrief is to move clinical simulation participants to a place of guided reflection on individual and team performance in the clinical simulation scenario. For many clinical simulation debrief styles, the initial phase of a debrief is the reactions or feelings phase.
The creation of a psychologically safe debrief space is essential to success not only in the reactions phase of a clinical simulation debrief but also in the overall debrief experience for participants. According to the Healthcare Simulation Dictionary, psychological safety is defined as a feeling (explicit or implicit) within a simulation-based activity in which participants are comfortable participating, speaking up, sharing thoughts, and asking for help as needed without concern for retribution or embarrassment. There is also a perception of team members that the team is safe for risk-taking, and mistakes will be considered learning opportunities rather than embarrassment or punitive consequences. A psychologically safe debriefing environment can be curated through a well-designed prebrief before the clinical simulation scenario starts. This sets the scene for psychological safety from the start of the clinical simulation, which can then be extended into the clinical simulation debrief.
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Reactions Phase Creates Space for Rich Reflection
The reactions phase of a clinical simulation debrief is arguably the most important phase. After a road map explanation to clinical simulation participants, which lays the foundation of the debrief plan, for most debrief methodologies, the next phase is the reactions phase. The purpose of the reactions phase is to allow participants to offload and unpack how the scenario felt to be a part of the clinical simulation in the debrief environment. As a clinical simulation faculty member in the debrief position, the reactions phase of the debrief is an incredibly rich place of information.
The reactions phase is important to ‘mine for the gold’ in the debrief to determine what the clinical simulation participants want to discuss during the debrief session. As a debriefer, there is great importance to park what the faculty member wants to talk about and guide the conversation around what the clinical simulation participants want to discuss. The primary way to achieve this with the participants’ best interests at heart is to maximize what can be gathered in the reactions phase.
Maximize the Debrief by Relearning How to Ask Questions
There are many tips and tricks that can assist to make the most out of the clinical simulation reactions phase of the debrief. As a debriefer, consider “how to” ask and encourage the flow of reactions by participants in the debriefing. Participants will commonly try to start the reactions phase before the start of debriefing. This can be stopped by asking participants to save their reactions for debrief and not begin to debrief themselves early. Then, the debriefer can launch into the road map of debriefing quickly and enter into the reactions phase.
Start the reactions phase off strongly with a statement such as “How did the clinical simulation scenario feel to be a participant today?”. Commonly, clinical simulation participants will give one-word answers in response to this statement. As a clinical simulation debriefer, this is a great time to interject with statements such as “Tell me a little bit more about that.” Encouragement should be given to participants who provide one-word answers to extend their response and give more explanation if they feel comfortable. As a debriefer, one-word answers only give limited information, miss an opportunity for rich information to be provided, and extend learning opportunities for all participants and the debriefers!
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Common Errors in the Reactions Phase of Debriefing
Particularly as a new debriefer, the reactions phase may be glossed over and not given the time and patience to set up a successful debrief. Without any realization, great opportunity can be missed by a reactions phase that is shortened or not extended beyond one-word answers. This potentially means that clinical simulation participants may leave the clinical simulation scenario with a feeling of unresolved actions within the scenario. Do everything possible as a debriefer to extend the reactions phase. Use prolonged silence and body language as necessary to encourage participation alongside other tools offered by the debrief modality.
As a debriefer who has observed a clinical simulation, there can be a temptation to enter into a debrief with a list of items to check off and notify the team about. However, these items may differ significantly from what has been said in the reactions phase. The items on the debriefers list may differ greatly from what is most important and unresolved for the clinical simulation participants. Trust that the clinical simulation scenario participants are adult learners and will do their own reflections. There may be other items of more priority to the participants, so trust the process.
Park Assumptions and Agendas During the Debrief
The debriefer should park any personal assumptions and agendas about what they think the participants should learn and listen to what is stated in the reactions phase. The reactions phase gives debriefers valuable information about what the clinical simulation participants want to discuss further and unpack in other areas of the debrief. One of the biggest errors that can be made as a debriefer is allowing adequate time and space for reflections from participants in the reactions phase.
As a clinical simulation debriefer, there can be much temptation to control the conversation and not give adequate time and dedication to the reactions phase of the debrief. There are many small but impactful ways to make the most of the reactions phase of the clinical simulation debrief. This article has explored common errors and easy tweaks that can be made as a clinical simulation educator to maximize this incredibly valuable section of the debrief. Do not underestimate the value of allowing clinical simulation participants the space and time to reflect on their reactions and the positive effect this can have on the other debriefing sections.
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