What comes to mind when you hear/read the term “debriefing”?  Some may conjure images of an intense interrogation, often accompanied by statements such as “so, what went wrong?” or some other variant.  However, the intended outcome of the debriefing process is to provide a non-threatening, non-judgmental forum through which the participants can gain a better understanding of the actions and events that occurred during the simulated healthcare scenario. 

Harvard University’s Center for Medical Simulation identifies debriefing as a: “…conversation among two or more people to review a simulated event or activity in which participants explore, analyze and synthesize their actions and thought processes, emotional states and other information to improve performance in real situations.”

     Why conduct debriefing? 

Within the healthcare industry, simulation learning experiences are conducted so that the participants can enhance and ultimately improve their future performance when delivering quality healthcare in various clinical situations. 

The purpose of debriefing is to deconstruct and reconstruct the actions and thought processes that occurred during the simulation so that the participants will be able to reflect upon and address any issues or processes encountered during the exercise.  Constructive feedback regarding the simulation event, coupled with the participant’s reflective thinking, work in tandem to deepen the meaning of the learning. 

Through the debriefing process, the learner’s critical thinking skills are engaged and thereby enhancing their clinical knowledge.  It is the cornerstone of experiential learning, as a definitive connection between thinking and doing is made, integrating the participant’s current knowledge with the experience of the simulation event.

     Who debriefs? 

The ability to facilitate a debriefing is just as important as the ability to conduct a simulation scenario or operate a manikin.  These facilitators should be trained in a theory-based debriefing method, along with a competency assessment of their own debriefing skills, to ensure consistency and continuity of the learning outcomes. 

There are several established methods of debriefing that include, but are not limited to:  Debriefing for Meaningful Learning (DML), Debriefing Assessment for Simulation in Healthcare (DASH), Debriefing with Good Judgement, Promoting Excellence And Reflective Learning in Simulation (PEARLS), Gather, Analyze, Summarize (GAS), and Plus Delta, to name a few. 

An effective simulation program will have simulationist(s) trained in at least one theory-based debriefing method.  When considering which debriefing method to utilize, it is best to select the method that most meets the needs of the learner, as well as to meet the scenario learning outcome(s). 

In the interest of fairness and impartiality, we at Gaumard Scientific do not endorse any one specific debriefing model, except that our fellow simulationists should employ at least one theory-based model in their simulation program.  Fortunately, there are training opportunities available to the simulation community at-large via simulation workshops, conferences, simulation organizations, as well as various academic offerings.

     When and Where to Debrief 

Since the debriefing process relies on learner self-reflection, most times (but not all), it is conducted post-event, which is at the conclusion of the simulation scenario.  However, in some instances, it may be beneficial for the debriefer to utilize microdebriefing (reflection-on-action occurring within the event or at pauses in the action) to provide immediate feedback for re-direction. 

In the context of a post-scenario debriefing, it may be best to consider to host the debriefing as soon as practical (optimally within 45 minutes of the event), to avoid recollection atrophy.  Even in cases where microdebriefing is employed, learners can also benefit from a full debrief after the learning event to better capture the reflective process. 

The amount of time allocated for debriefing does have conflicting opinions with some suggesting the debriefing to be two-to- three-times the actual scenario (e.g., for a 15-minute scenario, up to 45 minutes for debriefing), although the time-frame can be subjective (even if it is 1:1). 

Again, the intent of the debriefing process is to foster reflection and learning, not peer derision.  When building a healthcare simulation scenario, it is prudent and encouraged to factor in time for debriefing. 

The location wherein the debriefing takes place may be limited to the resources available to the simulationist.  Some may be fortunate to have a dedicated space to conduct the debriefing in, away from the simulation scenario; however, this may not be an option for others. 

A benefit of having a separate space for debriefing is that distractions to the process can be minimized or even eliminated. The lack of a dedicated debriefing space should not deter any simulationist from conducting a debriefing since it can easily be conducted in almost any setting.  The key is to minimize distractions so that the learner is present and engaged. 

     Conclusion 

Over this brief blog, we’ve addressed the What, Why, Who, When, and Where aspects of debriefing within the context of healthcare simulation. We have only begun to scratch the surface of this exciting and dynamic topic. 

Debriefing has been recognized as a collaborative discussion between a debriefer and the participant conducted in a safe, non-judgmental (non-derisive) environment that promotes reflection to deepen learning. 

The goal of healthcare simulation is not limited to just task performance, but rather to engage and foster critical thinking and teamwork to better integrate current knowledge with the relevant simulated learning experience.

To learn more about debriefing, read our WHITE PAPER HERE.

To learn more about tools that facilitate debriefing, click on the CARE IN MOTION link.