April 9, 2024By Erin Carn Bennett

How to Overcome Unexpected Learner Behavior in Healthcare Simulation Debriefs

The healthcare simulation debrief, if performed to a high standard, can often be an incredibly vulnerable space for both healthcare simulation participants, and as well, faculty debriefers. Sometimes an unexpected element for faculty in clinical simulation debrief is the management and direction required for any unexpected events that can occur in a debrief space. As healthcare workers there is a responsibility to make appropriate and safe clinical shared decisions. Once in the position of clinical simulation faculty debriefer there is an increase in pressure to provide a transformative educational experience in healthcare simulation. The pressure to get the clinical simulation experience and debrief to a high and safe standard can feel like a lot. This article by Erin Carn-Bennett, MSN, RN, will unpack the concept of how to manage unexpected events that may occur in healthcare simulation scenarios and debrief. Take home tips and reassurance will be provided for those in the healthcare simulation debriefer role.

Psychological Safety Should Never be Underestimated

Psychological safety should underpin all healthcare simulation experiences for both clinical simulation participants and also clinical simulation faculty. Psychological safety is not a final destination which is achieved, stated to be present and then closed off. Psychological safety in healthcare simulation should not only be woven into all parts of a healthcare simulation program, but be in constant revision and reassessment for all involved. Psychological safety levels will rise and fall and require continuous improvements and attention.

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The need for psychological safety is particularly apparent with unexpected events within the healthcare simulation debrief environment. Unexpected events should be expected in the healthcare simulation debrief environment due to the very nature of the human experience and also clinical simulation. After an unexpected event occurs in a clinical simulation debrief, this is a perfect opportunity to review psychological safety of the course, participants and faculty and the impact which this had on the unexpected event in the healthcare simulation debrief.

Assumptions and Judgment Damage Debrief Significantly

As healthcare simulation debriefers, a core belief should be to remove any assumptions of why individuals have performed or not performed tasks. As a clinical simulation participant in debrief, psychological safety will deplete when a clinical simulation faculty member assumes why a task has been or not been completed. Unless able to put aside personal assumptions as a debriefer and inquire in a psychologically safe manner, this may contribute to unexpected events within a clinical simulation debrief.

Judgment of clinical simulation participants actions or inaction can also derail psychological safety of clinical simulation participants in debrief. This in turn can also contribute to unexpected events in a healthcare simulation debrief. Judgment can be obvious by clinical simulation faculty in the way in which a debrief question is asked or a debrief is managed.

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Judgment can also be less obvious and subtle through unconscious mechanisms of body language. As humans communicate through body language eighty percent of the time in an unconscious manner, there is no way to fake non judgment. Immersing into complete non judgment and non assumption in debrief is a conscious choice. This will usually raise psychological safety and work to decrease the chance of unexpected events in healthcare simulation debrief.

A possible unexpected event in a healthcare simulation debrief is the management of an emotional clinical simulation participant. This unexpected event in debrief may mean a number of things. Examples may include a clinical simulation participant who becomes overcome with emotion or cries. If working in healthcare simulation for long enough a clinical simulation participant overcome with emotion will absolutely occur.

Healthcare Simulation Debrief can be Emotional

As humans, all people bring baggage to healthcare simulation based education. Some days, if given the option to not participate, many would take this option. However as healthcare workers even after bereavements of pets or patients, in the throes of burnout or other events of personal turmoil there is the need to show up. Many health professionals do not have the option but to turn up to work and to also partake in education in order to advance oneself.

Due to these humanistic factors there is a tendency in a vulnerable space such as healthcare simulation debrief to unexpectedly unravel emotionally when carrying baggage already even prior to the clinical simulation scenario. As clinical simulation faculty we are in a position of power to not only allow this to occur, but also to give space for individuals and teams to experience this. There is often not a tickbox advice sheet of how best to manage such a situation.

However, as healthcare simulation debriefers awareness of emotional intelligence and humanistic behaviors in these moments can assist to know how best to proceed in the moment. If a participant leaves the room due to emotional overwhelm, a faculty member to follow is best to check in as able. A follow up check the day after can also be a simple but impactful action as well. As faculty there is merit to consider the part played in this moment in the debrief by faculty. However, mostly faculty should trust the adult learner and that the learner will take from the experience what there is ability to.

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

Anger and Disengagement Can Occur in Debrief of Clinical Simulation

Occasionally other unexpected clinical simulation debrief experiences can also include the angry clinical simulation participant. Anger is a surface emotion and can often carry other emotions underneath. Some examples of emotions that can lie underneath anger include: sadness, overwhelm, insecurity, guilt, jealousy and hurt. Often the allowance of the emotions to just be in the clinical simulation debrief space and trusting that emotions will be worked through with the debrief process can be the most helpful course of action.

A disengaged participant may be angry or potentially even burnt out and at the point of apathy. The disengaged clinical simulation participant may also have low levels of psychological safety and be threatened that the clinical simulation scenario may paint their clinical practice in a negative light. Consideration should be given as to why a clinical simulation participant is disengaged or even in attempts to derail the clinical simulation scenario. Often the answers can lie in the level of psychological safety within the team or between the team and the clinical simulation faculty members.

First Healthcare Simulation Experiences are Carried for a Long Time

Previously harmed clinical simulation participants can also potentially contribute to unexpected events in clinical simulation debrief. A lot of clinical simulation participants have been exposed to psychologically unsafe healthcare simulation practices and carry these experiences (and sometimes trauma) into current clinical simulation scenarios. Generally if asked people will share about their previous unsafe experiences. Normalization and also sharing that these experiences were psychologically unsafe and will not be the same as the clinical simulation today and why can help.

Clinical simulation faculty are in powerful positions to ensure that first clinical simulation scenarios and debriefs are psychologically safe. Healthcare simulation faculty should not underestimate the transformative power to allow safe spaces for reflective practices in debrief. At times these experiences may not be pretty. However, a steady and calm presence that allows and trusts in all participants’ experiences and the debrief process can be truly transformative. Participants do not want to be fixed or fussed over. An allowance for whatever is brought forward alongside validation and understanding can be more than enough for most.

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