Debriefing sessions are, arguably, the most important step in a successful medical simulation. They allow for effective reflective learning through discussion guided by an expert facilitator and are key to developing the practice of doctors and nurses all over the world.
In this article, we’d like to take a look at what is involved in a debriefing and talk about what makes a successful, worthwhile session.
Debriefing is a term which is taken from the military where these types of meetings were used as a means of dissecting a mission, allowing both soldiers and officers the opportunity to process what happened and discuss how the strategy for the mission could be improved on the next time.
Obviously, a hospital is not a war-zone but the purpose of debriefings is the same.
Initially developed as a learning tool for medical simulation, debriefings have gained traction outside the realms of student doctors and nurses and are now regularly used to breakdown responses to emergency situations, allowing all medical staff to benefit from full and frank discussions and, ultimately, improving the response to similar future scenarios.
For the purpose of this article, however, we are going to focus on student learning and look at how debriefing sessions can be used specifically as a learning and self-reflection tool...one that is essential to the learning process.
So, what exactly is a debriefing?
Basically, it’s a meeting which, under normal circumstances, is held directly after a medical simulation. It allows the student to reflect on what happened during the event and consider whether they could have played their roles better.
The session will usually be conducted by the facilitator of the scenario and any observers that were present during the simulation. In addition, debriefing sessions will be conducted with the full team of participants present rather than with individual students. Individual meetings are usually used for giving specific feedback.
Although guided by the facilitator, every student will be given the opportunity to speak and share their thoughts on the scenario that has been simulated.
In essence, debriefing is a teaching strategy which can have enormous influence on a student’s learning experience and, if done well, can prepare them adequately for life in real-life clinical situations.
So, how are simulation debriefings conducted and what is the best practice for facilitators?
What follows are six tips for leading great debriefing sessions…
A successful debriefing session starts with good planning. There is no point entering into a simulation situation if there are no specific learning objectives set.
In addition, the student should be made aware of what these goals are and what they are going to be observed doing. Essentially, what this means is that before the debriefing, before the simulation session even begins, there must be a briefing in which the learner is made aware of their role within the scenario.
This may seem obvious, but an unplanned scenario is likely to be chaos, effectively rendering the debriefing pointless.
Simulation sessions are usually filmed in order to provide video evidence which can be useful for the learning and debriefing process (more on this later).
Medical simulations can be extremely stressful for all involved and a student’s post-event recall may be unreliable at best. For that reason, they need to be presented with evidence of their actions which is 100% objective and there’s no better way to collect evidence than with video.
At this point, we’d like to mention that Codimg Video Analysis Software is perfect for collecting this type of evidence.
We won’t go into great detail about how the software works but, as a quick overview, using the goals and evaluation criteria that have been set in section one above, the observer creates a template of clickable buttons that correspond to each behaviour they want to pay attention to in the briefing.
When they see one of these behaviours during the simulation, they click or press the relevant button on a laptop or iPad. This behaviour is then “tagged” in the video and a short video clip is added to a database video clips for the whole session.
Using the Codimg data matrix, these video clips can be accessed very easily during the debriefing session and shown to the student, saving an extraordinary amount of time for the simulation facilitator.
Creating a database of clips is just one of the tools in Codimg’s video analysis suite. We won’t go into the others in this article but please feel free to browse our website, the other articles in our blog and our YouTube channel to get a full idea of the power of Codimg.
Let’s move on...
It is essential that debriefings are structured well. This is important as it establishes rules and ensures that everyone understands their role within the session.
Generally speaking, there are three core phases which are included in every debriefing session. These are:
In this phase, the facilitator gives their impressions of what happened during the simulation and each student has the chance to give their thoughts and feelings about the event.
This is the reflection stage and where the majority of learning will occur. The group analyses their individual and collective performances and tries to establish what they did well and what can be improved.
Although led by the facilitator, this phase should involve a large degree of self-analysis and critical thinking on the part of the student in order for them to get the most out of the session.
A good summary is essential to the learning process and should give students sufficient food for thought on how to improve their performance in future simulation sessions.
We’ll talk more about the importance of the summary later in this article.
Incidentally, these three phases are practically identical to the video analysis process with Codimg which are collecting data, analysing data and presenting conclusions.
There is no universal structure for conducting medical debriefing and each hospital or learning centre is free to create their own. However, there are a few common frameworks which are worth considering when conducting your own debriefing. As a brief overview here are three of the most common:
Standing for Promoting Excellence and Reflective Learning in Simulation, PEARLS is a resource for conducting guided debriefs and is used widely around the world.
Developed by the Imperial College London, SHARP is another widely used debriefing tool. SHARP is an acronym which stands for:
• Set learning objectives
• How did it go
• Address concerns
• Review learning points
• Plan ahead
SHARP is a comprehensive tool which covers all the main debriefing bases.
With an easy to remember acronym, D.E.B.R.I.E.F, again, covers all the bases of medical simulation debriefings and stands for:
• Define roles
• Explain learning objectives
• Benchmarks for performance
• Review what should have happened
• Identify what happened
• Examine why
As you can see, most of these frameworks use the same structures with slight differences. Many hospitals and learning centres prefer to work with bespoke structures. As long as the three core phases of data collection, analysis and summary are respected, the debriefing is sound.
Moving on to the actual content of the debriefing, one of the biggest mistakes made by facilitators of medical debriefings is to turn the session into a lecture. It’s much better to allow the student to explore their own performance and be self-critical. This approach will allow them to learn and grow much more effectively than any half hour lecture.
To do this, the facilitator should ask open ended, guided questions about what happened in the simulated situation. Instead of “Do you think you did well?” ask “What do you think you did well?”. This encourages the student to review their own performance and think a bit more deeply.
It’s also important that every member of the group is included in the debriefing. Peer review is one of the most powerful tools at a facilitator’s disposal. Students can learn from each other and improve critical team working and leadership skills at the same time.
A useful tactic here is to utilise some of the clips collected previously with Codimg. Show a selection of clips and ask the students to work together to identify what they did well and what could be improved. This is a completely objective method of feedback which encourages critical thinking.
Again, this may seem like an obvious point, but this is a phase that many facilitators either forget or don’t do well.
At the end of a debriefing session, students must be aware of the salient points of the session. They need to be clear on what they are doing well and the areas that need improvement as this will help them create an actionable plan for future simulations and real-world environments.
The debriefing itself must contain a comprehensive summary of the main talking points and some typed up notes sent out to students at a later time are also essential.
Another advantage of using Codimg is that the facilitator can collect all the video clips and quickly create video presentations for dissemination to students through online platforms such as Sharimg. Text notes, drawings and audio notes can easily be added to these presentations to make them even more effective.
It’s not only students that can learn from reviewing their own performance. It’s also a good idea for a simulation facilitator to look at their own performance in debriefing sessions to see in what areas they can improve.
Not involving every student? Lecturing too much? Not encouraging critical learning? Failing to adequately cover certain phases of the debrief process? Identify and change your practice to maximise your own performance and student learning.
Again, Codimg can help with this. Set up a camera before the session (remember to inform the student that you are doing this and assure them it’s for your own performance and not theirs), film yourself, analyse your performance using Codimg’s intuitive button templates, dashboards and extensive suite of analytical tools and use this data to improve your own performance.
Create a database of video clips and information that can be used to monitor yourself over a longer period of time and see the difference for yourself.
Codimg is already used in hospitals around the world, so why not add video analysis to your own arsenal of tools.
We offer a free 30-day trial of our software and can give you advice on how to get set up in the world of video analysis. Contact us today for a no obligation chat about your needs and to get set up with your free trial.
Remember, the analysis of simulation and debriefings is not just for students. You can benefit too!
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