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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 .
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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… • 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 • 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 • 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!) • 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 take-home 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
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 • 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