May 17, 2021By Lance Baily

Mixed Debriefing Study Shows Benefits Over Group Debriefing for Clinical Simulation

In their recent LEARN platform webinar entitled “Exploring Self Debriefing and Group Debriefing in Clinical Simulation” by Merveille Ndondo, BScN, RN, MN and Raquel Lashley-Trambulo, BScN, RN of Ryerson University, the team shared about their team’s powerful research which showed that a self-debriefing event just after the Simulation-based Training (SBT) but just prior to a group debriefing leads to “some benefits” to learners. Here we look closer at the lessons they shared about the study and the powerful results of mixed debriefing modalities, as well as highlights from their studies published in INACSL’s Clinical Simulation in Nursing journal.

Recorded Webinar: Exploring Self Debriefing and Group Debriefing in Clinical Simulation
(1 Contact Hour of RN CE Credit from the CA-BRN Lic#17566)

There are many standardized debriefing methods in healthcare simulation. In an academic setting, simulation in nursing is usually run for novice learners. They come with little to no experience in their field of study and participate in simulation with knowledge gained from lectures and practice labs. Adding a self-debrief to a facilitated group-debrief was found to enhance students’ simulation experience. A mixed-method study was done on fourth-year baccalaureate nursing students and results will be shared in this presentation. Four themes were discussed in the webinar: psychological safety, learning, methodology, and reflection.

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Learning Objectives:

    1. Analyze how self-debriefing enhances self-awareness and reflection.
    2. Examine how psychological safety can be enhanced with self-debriefing prior to group-debriefing.
    3. Discuss how the use of combining debriefing formats can optimize learning after simulation.

During the webinar, Merveille and Raquel shared with the global clinical simulation audience that the self-debrief needs to be followed by a group debrief to be most effective, that 20 minutes was too much time allotted for the self-debriefing process (which was handed out to students at the end of the simulation scenario, and that literature supports using an educational tool to aid during the reflection. The recorded webinar pulled from their work with their fellow researchers on two key studies:

Exploring Self-Debriefing Plus Group-Debriefing: A Focus Group Study (Verkuyl et al.)

Best practice guidelines for debriefing in-person simulation recommend a facilitated, group-debrief. This study explored students’ experiences of self-debrief followed by a facilitated group-debrief after an in-person simulation. This study offers insight into students’ perceptions of completing a self-debrief before a facilitated group-debrief. Psychological safety and self-awareness of personal beliefs and values can be enhanced by offering self-debriefing before group-debriefing.

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A distinctive feature of self-debriefing is the potential for increased self- awareness of personal thoughts, feelings, attitudes, and knowledge. Another important characteristic is the opportunity to work through reflections on the simulation experience individually, at one’s own pace. Fey, Scrandis, Daniels, and Haut (2014) suggest that the primary goal of debriefing is self-reflection where personal mental models are examined resulting in increased under- standing of perceptions and interpretations of the simula- tion experience. In facilitated group-debrief, this is achieved by creating a psychologically safe environment for students to explore their emotions, identify meaning from the experience, and link the solidified or new learning to future practice. The group-debrief is facilitated by a trained, competent debriefer who promotes an atmosphere of confidentiality, trust, and open communication so that learning can occur (INACSL Standards Committee, 2016).

We do know, however, that not all students feel psy- chologically safe during a debriefing session which may negatively affect learning (Turner & Harder, 2018). Tosterud, Hall-Lord, Petz€all, and Hedelin (2014) found in small and large group-debriefs that some students have to overcome a fear of disgrace or failure to actively partici- pate. Kang and Min’s (2019) focus group study found that some nursing students did not share their viewpoint in the debrief; they were anxious that educators and peers had observed their errors during the simulation and being videotaped and watching the video as a group was intimi- dating. These factors make it challenging for facilitators who are striving to create a psychologically safe debriefing environment for all participants.

Debriefing guidelines and recommendations for in-person simulation experiences are continuing to evolve based on research evidence. Our study provides support for an imme- diate self-debrief plus a facilitated group-debrief after an in-person simulation to optimize reflection, increase the authenticity of learners’ self-reflection, and heighten the group discussion. Further research will help to determine the impact of self-debriefing on students’ comfort in the group-debrief.

Adding Self-Debrief to an In-Person Simulation: A Mixed-Methods Study (Verkuyl et al.)

Current literature suggests a knowledge gap exists about the self-debriefing process and the impact of self-debriefing after a simulation. The self-debrief may provide some benefits to students’ personal analysis of the simulation and help them to collect their thoughts before engaging in a group debrief. More research is needed to explore students’ experiences in engaging in a self-debrief plus group debrief.

Although the benefits of facilitated group debriefing are well-documented, some simulation participants find the process intimidating; they worry about how the facilitator and their peers will view or judge their observations and decisions (Fanning & Gaba, 2007). Turner and Harder (2018) raise questions related to debriefing and psychologically safe learning spaces. In our study, we question whether self-debriefing might have a role in helping students prepare for a group debrief, thereby enhancing learning during the simulation experience. Self-debriefing is defined by Lapum et al. (2018) as ‘‘an individual, written activity in which a series of questions (based on a theoretical debriefing framework) facilitate learners’ reflections on a simulation’’ (p.1). Self-debriefing is designed to provide the learner with a systematic reflection process that is achieved through checklists or open-ended questions (Boet et al., 2011; Lapum et al., 2018).

Currently, there appears to be a knowledge gap between the actual self- debriefing process and a lack of understanding of the impact of the self-debrief. Best practice guidelines at this time do not mention self-debriefing; they only recommend a facilitated group debrief immediately after the in-person simulation (International Nursing Association for Clinical Simulation and Learning [INACSL] Standards Committee, 2016). That said, studies with graduate-level students found self-debriefing led to similar educational outcomes when compared with a facilitator-led group debrief (Boet et al., 2011; Oikawa et al., 2016); however, self-debriefing alone may not suffice as the sole learning structure for baccalaureate nursing students.

Findings from our study reveal either self-debrief plus group debrief or group debrief only produce similar quantitative outcomes. Therefore, until we conduct more research, educators can feel confident using either approach. Another finding is that students strongly sup- ported a self-debrief followed by a self-debrief. We can therefore conclude that it can be valuable to add a self- debrief component to the group debrief with self-debriefing providing a tool to enhance students self-analysis and reflection. Future research is needed to increase our understanding of the self-debrief process within the context of the overall simulation experience.

Watch the CE Webinar Covering the Benefits of Mixed Debriefing Now!

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