September 14, 2023By Erin Carn Bennett

Are Difficult Conversation Skills Transferable to Clinical Simulation Debriefing?

Healthcare simulation is a perfect environment to train healthcare professionals in practical medical and communication skills. One communication skill is difficult conversation. Difficult conversations are inevitable in life and workplaces. There are a number of learned communication skills that relate to difficult conversations that can be transferred into all elements of healthcare simulation, particularly in the debrief. This article by Erin Carn-Bennett, MSN, RN, will explore transferable skills from the management of difficult conversations that can be used in the clinical healthcare environment.

Healthcare simulation is a proven effective experiential learning modality for healthcare workers. In all parts of clinical simulation, having skills to manage all kinds of conversations in an emotionally intelligent manner is very important. Participants in clinical simulation education may have stressors from outside the workplace that are brought into the clinical simulation. Behaviors may also arise within the clinical simulation that are worth exploring in the debrief rather than the allowance of assumptions to take hold either by faculty or participants.

To find the right words in the moment as a conversation becomes more difficult is a skill that is worthwhile to put some effort into mastery of. Difficult conversations, particularly in the workplace, are often avoided. As healthcare simulation is often an experiential place to learn and be psychologically safe for many provides an idealistic environment to practice and hone these skills for the healthcare workforce.

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Clinical simulation participants and faculty members can utilize difficult conversation skills. Participants of clinical simulation scenarios can practice the skill to navigate difficult conversations as opportunities arise in the clinical simulation scenario. Clinical simulation faculty members will employ these skills within the debrief and potentially in the pre-brief and clinical simulation scenario.

The use of difficult conversation skills may allow for the space to challenge more complex and difficult subjects in debriefs and within the clinical simulation. These subjects include hierarchy, leadership, suboptimal communication, and teamwork difficulties. With practice, skills can be learnt so that these conversations can be executed with less awkwardness for both the person who delivers and receives the conversation.

The end goal of these conversations should always be for relationships to remain intact, introspection and reflection to occur, as well as learning. With this in mind, skills from difficult conversations dovetail well when transferred into the healthcare simulation environment. Psychological safety and personal and team growth are at the forefront of clinical simulation programs learning objectives.

Difficult Conversation Skills for Faculty and Participants

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Be genuinely curious as a clinical simulation debriefer. This can be aided by the application of communication skills and alteration of mindset prior to the difficult conversation or debrief. Instead of framing the conversation as difficult or in a negative context, try to go into the conversation more positively. For example, think of the conversation as constructive when asking a potentially difficult question in the debrief. The debriefer should focus on not placing assumptions into the conversation, just genuine curiosity and the desire to understand.

As a faculty member and clinical simulation participant, think of the constructive elements of conversations as normal. To be flexible and fluid in responses when asking and receiving questions in the debriefing environment will be helpful. Ensure psychological safety in the pre-brief is explicitly stated and that everyone is clear on the vision of the debrief to improve teamwork, communication, and patient care in a non-judgmental and exploratory environment.

As a faculty member in healthcare simulation, a difficult conversation can be anticipated and prepared for with a repertoire of possible responses for debriefing that are simple, clear, direct, and neutral in tone and content. Acknowledge all perspectives that are shared and show interest in all perspectives shared. Be compassionate, courageous, honest, and fair. Slow the pace of the debrief to allow introspection and reflection for all members to listen, especially the debriefer.

As a participant in the clinical simulation, if the above strategies are employed in a debrief, the environment will likely feel higher psychological safety. Higher psychological safety in a debrief will allow participants to be more vulnerable and feel safer in that position to do so. As a participant, try not to feel like a victim when questioned about actions in a clinical simulation scenario. Remember the pre-brief statements to ensure psychological safety about the shared vision of to improve and grow in a non-judgemental environment.

Space and time in the debrief are incredibly important, like a difficult conversation environment. The ability to slow conversations down to enable reflections and learning is a vital skill for faculty to listen with accuracy and to allow participants to process time. Process time and trust in learners learning in their time links to adult learning theory which is the basis for most fundamentals of conversation skills and clinical simulation debrief core values.

In the process time, there is an allowance for participants to consider what they would do differently next time and share if they are comfortable within the solutions phase of debrief. The allowance for silence and process time can assist in reconnecting the team if there have been challenges in the clinical simulation scenario. Space, silence, and process time enable the team to reach a new depth of knowledge.

View the LEARN CE/CME Platform Webinar Creating a Psychologically Safe Space in Clinical Simulation to learn more!

As with a difficult conversation, the debriefing tone and body language play a key part in psychological safety and the assessment of outcomes. As a faculty member, mindset and body language are essential for psychological safety. The ability to observe these traits in participants will give valuable information as to the current headspace of participants. For example, a participant with crossed arms looking at their shoes and a more harsh tone is potentially deep in thought and does not feel great. However, another with more open body language and a softer tone potentially feels more at ease and psychologically safe to share and move through emotions and experiences in debrief.

This article has discovered similarities in difficult conversation communication skills to those that are or can be utilized in clinical simulation debriefs. These soft skills of clinical simulation are essential to learn as a faculty member within the debrief circle. However, as a participant in clinical simulation, they are equally important to learn and translate into improved patient care at the bedside post-clinical simulation. Emotional intelligence, communication skills, and psychological safety are important skills to master to succeed as a healthcare worker and assist in the maintenance of personal wellness and those of patients care for.

Learn How to Infuse Emotional Intelligence Into Clinical Simulation!

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