Traci Robinson

Faculty development for simulation programs: Five issues for the future of debriefing training

STATEMENT Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing be used to improve debriefing quality within programs? (5) How can we individualize debriefing training opportunities to the learning needs of our educators?

Helping without harming: the instructor's feedback dilemma in debriefing--a case study.

Introduction Simulation instructors often feel caught in a task-versus-relationship dilemma. They must offer clear feedback on learners’ task performance without damaging their relationship with those learners, especially in formative simulation settings. Mastering the skills to resolve this dilemma is crucial for simulation faculty development. Methods We conducted a case study of a debriefer stuck in this task-versus-relationship dilemma. Data: The “2-column case” captures debriefing dialogue and instructor’s thoughts and feelings or the “subjective experience.” Analysis: The “learning pathways grid” guides a peer group of faculty in a step-by-step, retrospective analysis of the debriefing. The method uses vivid language to highlight the debriefer’s dilemmas and how to surmount them. Results The instructor’s initial approach to managing the task-versus-relationship dilemma included (1) assuming that honest critiques will damage learners, (2) using vague descriptions of learner actions paired with guess-what-I-am-thinking questions, and (3) creating a context she worried would leave learners feeling neither safe nor clear how they could improve. This case study analysis identified things the instructor could do to be more effective including (1) making generous inferences about the learners’ qualities, (2) normalizing the challenges posed by the simulation, (3) assuming there are different understandings of what it means to be a team. Conclusions There are key assumptions and ways of interacting that help instructors resolve the task-versus-relationship dilemma. The instructor can then provide honest feedback in a rigorous yet empathic way to help sustain good or improve suboptimal performance in the future.

Co-debriefing for simulation-based education: A primer for facilitators

STATEMENT As part of simulation-based education, postevent debriefing provides an opportunity for learners to critically reflect on the simulated experience, with the goal of identifying areas in need of reinforcement and correcting areas in need of improvement. The art of debriefing is made more challenging when 2 or more educators must facilitate a debriefing together (ie, co-debriefing) in an organized and coordinated fashion that ultimately enhances learning. As the momentum for incorporating simulation-based health care education continues to grow, the need for faculty development in the area of co-debriefing has become essential. In this article, we provide a practical toolbox for co-facilitators by discussing the advantages of co-debriefing, describing some of the challenges associated with co-debriefing, and offering practical approaches and strategies to overcome the most common challenges associated with co-debriefing in the context of simulation-based health care education.

Postresuscitation debriefing in the pediatric emergency department: a national needs assessment.

OBJECTIVES The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. METHODS A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported. RESULTS Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. CONCLUSION PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.

Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs

Summary Statement Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educators debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.

Simulation for Patient- and Family-Centered Care

Simulation for patient- and family-centered care recognizes that the patient and family are integral members of the healthcare team and should be encouraged to participate in their healthcare plan. This collaboration enhances respect, dignity, information sharing, and participation among all members of the team (i.e., healthcare providers and home caregivers) who are involved in the simulation. Instructor- and learner-centered objectives shape the scenarios and take into account the learners’ anxiety level and emotional state. Technical, cognitive, and behavioral skills may be taught through realistic scenarios that maintain the fidelity of the home caregiver’s environmental surroundings. The timing, frequency, and duration of the simulation may be influenced by the severity of the illness, urgency of the condition, complexity of the skills being taught, and the participants’ readiness to learn. Expectations of the simulation should be set for the learners during a pre-brief. This will give them an opportunity to better understand the active participation needed as they take part in this safe educational forum where they are encouraged to ask questions during repetitive practice. Debriefing simulation for patient- and family-centered care may include corrective feedback as well as time for reflection and discussion. Co-debriefing with non-healthcare providers with experience in patient- and family-centered care may also be beneficial.