June 14, 2018By Lance Baily

INACSL 2018 Continues with Adam Cheng Plenary on Debriefing

INACSL President Kristina Thomas Dreifuerst once again took the stage to open the first full day of the 2018 International Nursing Association for Clinical Simulation and Learning conference. She reminded the audience about the INACSL Standards of Best Practice, which now includes an Operations Specialist Standard developed in support with SimGHOSTS, and are also being translated into multiple languages thanks to support from Laerdal. Read the updates from yesterday’s INACSL 2018 Grand Opening and Keynote Address here.

Next Adam Cheng, MD, FRCPC, Director of Research at KidSIM Simulation Program, Associate Professor at the University of Calgary at Alberta Children’s Hospital, and Co-Founder of Debrief2Learn.org, took to the stage to provide the Day 2 Plenary Session entitled “Debriefing Expertise: A Journey of Discovery, Growth and Maturity”. Adam started by asking the audience “What is it that makes someone an expert in debriefing?” and then began to share a new theory on modeling debriefers expertise.

Cheng reminded us that simulation educators regularly conduct debriefings but struggle to gain debriefing expertise despite best intentions, suggesting that in many instances they are not fully aware of the knowledge and skills necessary to build expertise that will positively impact and optimize learning outcomes. Adam discussed a structured framework for developing debriefing expertise that incorporates evidence and best practice to inform faculty development efforts for simulation educators.

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He shared 3 conceptual phases simplified from the literature on modeling experise for our purposes:

  1. Discovery Phase (Novices) – Adapting debriefing method to need/context.
    1. Major Points: Understand Evidence, Learn Methods, Adapt Method to Context, Apply Tools to Support Growth
    2. What evidence that supports debriefing? Tannennaum (2013) states that “Organizations can improve individual and team performance by 20-20% by using properly conducted debriefs”. Structured debriefing improves clinician knowledge, skill, acquisition and implementation.
    3. Do you have the tools necessary to debrief learners in a multitude of their learning performances? There are many methods, but how do you know which to use at the right time?
      1. Focused Facilitation
      2. Learner Self-Assessment
      3. Feedback and Teaching
    4. Consider:
      1. Time, Domain, Rationale, Experience
      2. Use continual analysis to determine which method will work best for specific situations and “Blend”.
  2. Growth Phase (Routine Experts) – Valuing and integrating contributions from learners and co-facilitators.
    1. Appreciation of the Debriefing and the “many layers of the onion”.
    2. Balance Learner & Instructor Contributions
      1. Reactions: Identify the learner agenda
      2. Analysis: Prioritize content for discussion, promote learner-assessment, and manage transitions to close performance gaps.
      3. Summary: Identifying key take home messages (This can be very surprising to see what learners are taking away!)
      4. As learners move from novice to expert, the more learner centered the debriefing can be vs. instructor-centered.
    3. Manage Emotion
      1. Disinterested, sad or angry learners won’t be engaging effectively.
        1. Name the dynamic
        2. Validate it, and/or paraphrase it
        3. Normalize it (& give personal example)
        4. Give silence or generalize
        5. Preview the future
    4. Engage Co-Facilitator
      1. Proactive and Reactive strategies depending on phase
      2. Engage and debrief the debriefing
  3. Maturity Phase (Adaptive Experts) – Soliciting feedback to improve and transfer skills to the clinical environment to enhance patient outcomes. Expertise exceeds confidence.
    1. Adaptive Expertise
      1. Expecting the unexpected and comfortable with that is called “Adaptive Expertise”, can’t be trained but must be cultivated.
    2. Coach Peers
      1. Review before the event, promote shared growth, and plan for a debriefing debrief
      2. Plan for peer coaching plan throughout the entire simulation program, from internal and external sources.
    3. Clinical Debriefing
      1. Don’t miss the opportunity to learn from clinical events because “Debriefing Saves Lives” (Wolfe, 2014).
      2. Build a culture, identify a champion, pick the right learning opportunities, and collect and analyze data.

Learn more about these wonderful debriefing strategies from
Adam and his colleagues at the free to use Debrief2learn.org!

Following this Teresa Gore, Past-President of INACSL, handed out awards to recognize key individuals within the INACSL community.

Stay up to date with all the latest updates with the #INACSL18 hashtag on Twitter

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