October 20, 2023By Teresa Gore

Clinical Simulation Research Focus: Debriefing Methodology 2023 Part II

Debriefing in healthcare simulation is considered essential for all simulation experiences to assist the learners to translate knowledge gained in the simulation into clinical practice. The Healthcare Simulation Dictionary defines debriefing as “an activity that follows a simulation experience and led by a facilitator to encourage participants’ reflective thinking and provide feedback about their performance, while various aspects of the completed simulation are discussed.” As a verb, debriefing is to “conduct a session after a simulation event shere educators/instructors/facilitators and learners re-examine the simulation experience for the purpose of moving towards assimilation and accommodation of learning to future situations.” This HealthySimulation.com series by Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN will explore the published research in simulation literature in 2023 on debriefing methodologies. Read the first part of this article on Debriefing Methodology Research from October 2023.

Oliver et al. (2023). The Scottish centre debrief model. International Journal of Healthcare Simulation, (null), 1-1: The importance of using a structured debriefing model in simulation is well established and forms a pivotal phase in experiential learning [1–4]. There are several notable structured debriefing models designed to promote individual and team reflection [2,5,6]. In 1998, the Scottish centre debriefing model (SCDM) was developed by the Scottish Centre for Simulation and Clinical Human Factors (SCSCHF). It is a learner-centred, multi-phased, facilitated reflection tool, widely used across Scotland. This Key Concept article explains the SCDM structure: reactions, agenda, analysis, and take-home messages.

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O’Regan et al. (2023). Debriefers are observers too: leveraging learning objectives to focus debriefer observations and frame the debriefing conversation. International Journal of Healthcare Simulation, (null), 1-5 : Debriefing is challenging and daunting for the novice debriefer. Debriefing literature is focused on the debrief conversation and the process of debriefing, with little guidance provided on how to observe the scenario and prepare for the debrief. Research in the simulation learner observer role reveals that engagement with the scenario through directed observation primes the learner to notice actions and events which may have been otherwise overlooked.

Similarly, using the scenario learning objectives to prime and focus their attention, novice debriefers can develop their own observation tool to support data gathering during the scenario. By engaging with the learning objectives to clarify what they may expect to see or hear if the learning objectives are achieved, debriefers are better positioned to notice and collect relevant observational data and frame a debriefing conversation anchored to the scenario objectives.

Penalo (2023). Virtual Simulation Prebriefing-Debriefing Educational Strategy on Nursing Students’ Self-Efficacy and Performance Concerning the Care of Patients Experiencing a Myocardial Infarction: A Quasi-Experimental Study. Clinical Simulation in Nursing, 82, 101431: Through the use of virtual simulations nursing students are exposed to a variety of clinical scenarios that may potentially improve their learning of competencies, increase their self-efficacy (confidence), and enhance their future clinical performance. Guided by the National League for Nursing Jeffries Simulation Theory, Bandura’s self-efficacy theory, and the Healthcare Simulation Standards of Best PracticeTM, this quasi-experimental, two-group, pretest/post-test educational intervention study examined the effects of the synchronous Virtual Simulation Prebriefing-Debriefing strategy on Associate Degree Nursing students’ self-efficacy perceptions and virtual simulation performance scores in the care of patients experiencing a myocardial infarction.

Study results revealed statistically significant findings concerning the effectiveness of the Virtual Simulation Prebriefing / Debriefing strategy on students’ self-efficacy perceptions (in the cognitive, psychomotor, and affective domains) and virtual simulation performance scores. Results also support that there is a small positive correlation between students’ self-efficacy perceptions and virtual simulation performance scores. This study also provided evidence that the study’s educational strategy caused positive changes in students’ self-efficacy perceptions and virtual simulation performance scores regardless of students’ age, previous experience with video or computer gaming, or previous healthcare work experience.

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Findings suggest that a high-quality virtual simulation experience that integrates the Healthcare Simulation Standards of Best PracticeTM, including structured prebriefing and debriefing strategies, can positively influence students’ self-efficacy perceptions and virtual simulation performance scores.

Persico & McDermott (2023). Comparison of two debriefing methods for nurse orientation. Teaching and Learning in Nursing: Hospital-based nurse educators are charged with providing an efficient orientation process, frequently with simulation, to expedite onboarding of nurses for patient care settings. The purpose of this study was to compare two different debriefing methods (DEBRIEF and 3D-DDD) in an orientation program to determine their effects on nurses’ perception of psychological safety, satisfaction with development of clinical reasoning skills, and satisfaction with learning. This quasi-experimental study used a post-test-only design to compare groups debriefed using the two different methods. Although results were not significant in the difference of the two methods, overall indicators reinforced findings from previous studies and the HSSOBP™ Debriefing about the importance of debriefing on the psychological safety of learners. More research is critical to assist hospital-based educators in finding efficient and timely methods for onboarding nurses.

Rajendran et al. (2023). The ABCDE (Avoid Shaming/Personal Opinions, Build a Rapport, Choose a Communication Approach, Develop a Debriefing Content, Ensure the Ergonomics of Debriefing) Approach: A Simplified Model for Debriefing During Simulation in Emergency Medicine. Cureus, 15(2): Several debriefing models have been described in the literature. However, all these debriefing models are designed in the general medical education format. Hence, for people involved in patient care and clinical teaching, sometimes it may become tedious and difficult to incorporate these models. In the following article, we describe a simplified model for debriefing using the well-known mnemonic ABCDE.

The ABCDE approach is expanded as follows: A – Avoid Shaming/Personal Opinions, B – Build a Rapport, C – Choose a Communication Approach, D – Develop a Debriefing Content, and E – Ensure the Ergonomics of Debriefing. The unique thing about this model is that it provides a debriefing approach as a whole rather than only the delivery. It deals with human factors, educational factors, and ergonomics of debriefing, unlike other debriefing models. This approach can be used for debriefing by simulation educators in the field of emergency medicine and also by educators in other specialties.

Rosvig et al. (2023). Healthcare providers’ perceptions and expectations of video-assisted debriefing of real-life obstetrical emergencies: a qualitative study from Denmark. BMJ open, 13(3), e062950: Video-assisted debriefing (VAD) of real-life obstetrical emergencies provides an opportunity to improve quality of care, but is rarely used in clinical practice. A barrier for implementation is the expected mental reservations among healthcare providers. The aim of this study was to explore healthcare providers’ perceptions and expectations of VAD of real-life events. Participants were recruited from two Labour and Delivery Units in Denmark. In both units, VAD of real-life obstetrical emergencies had never been conducted. Twenty-two healthcare providers (10 physicians, 9 midwives and 3 nursing assistants). During the study period (August–October 2021), semi-structured, individual interviews were conducted. Interviews were analysed using thematic analysis. A qualitative description of healthcare providers’ perceptions and expectations of VAD of real-life events.

Three major themes were identified: (1) Video-assisted debriefing (VAD) as an opportunity for learning: All participants expected VAD to provide an opportunity for learning and improving patient care. All participants expected the video to provide a ‘bigger picture’, by showing ‘what was actually done’ instead of ‘what we believed was done’. (2) Video-assisted debriefing (VAD) as a cause for concern: The primary concern for all participants was the risk of being exposed as less competent. Participants were concerned that being confronted with every minor detail of their clinical practice would enhance their self-criticalness. (3) Preconditions for video-assisted debriefing (VAD): Participants emphasised the importance of organisational support from management. In addition, creating a safe environment for VAD, for example, by using only expert debriefers was considered an essential precondition for successful implementation. The risk of being exposed as less competent was a barrier towards VAD of real-life events. However, the majority found the educational benefits to outweigh the risk of being exposed.

Sá-Couto et al. (2023). Debriefing or feedback: exploring the impact of two post-scenario discussion methods in the acquisition and retention of non-technical skills. Acta Médica Portuguesa, 36(1), 34-41: There is a paucity of quantitative studies objectively comparing debriefing and feedback as methods for post-scenario discussion and its impact on healthcare teams’ acquisition and retention of non-technical skills. The main purpose of this study is to provide some insight on this research question, using a sample of medical students. A secondary objective explores students’ opinion and preference on the post-scenario discussion. Forty-five medical students were distributed among 15 teams, and randomly allocated to two groups. Each team participated in three different simulated scenarios, with similar levels of difficulty and opportunities to apply specific non-technical skills: leadership, communication, and task management.

To assess the acquisition and retention of skills, scenarios occurred on days one (baseline), two (acquisition) and 20 (retention). Team performance was objectively evaluated by an observer, using scenario recordings. Students individually assessed different aspects of debriefing and feedback. Both debriefing and feedback groups showed similar overall increase in objective scores, with significant increase between days one and two (acquisition), and a smaller increase between days two and 20 (retention). Students indicated debriefing as the preferred discussion method. Debriefing and feedback are effective post-scenario discussion methods, promoting acquisition and retention of non-technical skills, by undergraduate students. Allying debriefing reflexive practice with feedback directive style, and shifting appropriately between facilitation and instruction, can be a good compromise to achieve a timely and educationally meaningful discussion.

To remain current in best healthcare simulation practices, simulationists must read and evaluate the literature and research published. This clinical simulation review on debriefing methodology research is part of a series to focus on published research in healthcare simulation for 2023.

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