Healthcare simulation debriefing has common pitfalls and traits that can emerge in the process for a novice debriefer to acquire experience in this skillset. Awareness of these common clinical simulation debriefing pitfalls and traits can assist debriefers as they gain experience or reflect on how their healthcare simulation debriefs can be improved. This article by Erin Carn-Bennett, RN, MSN will discuss these common pitfalls, why they matter and how to combat each despite what debriefing methodology or framework is in use. These pitfalls will relate to the debriefing of team based clinical simulation scenarios, not individual clinical skills training with a side by side facilitator.
The Debrief Fixer Tells More Than Listens
A common pitfall for many healthcare simulation debriefers at all levels, particularly the novice debriefer, is the want to fix challenges for their clinical simulation participants. Often this trait may stem from the healthcare simulation debriefers discomfort with uncomfortable emotions. This is a very common trait, particularly for novice clinical simulation debriefers. For a fixer debriefer, the thought to make the experience as comfortable as possible for their clinical simulation participants means they often feel that this will encourage participants to feel that the clinical simulation based education experience was a positive one.
Psychological safety is often at the forefront of many clinical simulation debriefers’ minds and the want to keep clinical simulation participants safe in their clinical simulation experience. However, psychological safety and discomfort are two different elements of healthcare simulation experiences. Discomfort is very common in clinical simulation for participants and is often where the greatest depth of learning experiences can occur. Healthcare simulation debriefers should pause and practice to sit in the discomfort that is felt by their participants.
Other common traits of a fixer debriefer can include to overshare personal experiences or provision of answers to clinical simulation participants prematurely without the allowance for the adult learner to have experiential learning experience to figure this out on their own or with assistance from other clinical simulation participants. As a debriefer these traits are usually founded in a discomfort with silence. The first step is an awareness of this tendency, then to practice a pause in the moment to allow silence and discomfort. With time, experience and practice this tendency to want to fix can be overcome in the debrief circle.
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The Awkward or Anxious Debriefer
Debriefing can bring up a lot of feelings of awkwardness or anxiety for a novice healthcare simulation debriefer. Debriefing is a skillset that requires a lot of practice and experience to bring about mastery and comfort within the role of a healthcare simulation debriefer. For any debriefer there are days where debriefs don’t always go to plan. To debrief a clinical simulation scenario can at times create intimidation, especially when there are very senior staff involved or complex team dynamics. Participant behaviours in clinical simulation scenarios and debrief can at times be amplified as well due to participant anxiety at their clinical performance being observed.
Awkward or anxiety based debriefers can present as struggle with words, physical sensations of stress (increased heart, diaphoresis etc.) or an over reliance on debrief framework prompts or scripts, rather than a more natural guided conversation. All novice debriefers have at times had to combat these challenges in their journey to acquire experience in the debrief circle. Tools such as box breathing to calm nervousness and practice to not be so fixed on prompts are skills that can be acquired with time and experience. Reflection after debriefs alongside another senior debriefer can be useful to consider how to improve debriefing for the next clinical simulation experience.
The Debriefer that Goes Off Script
Sometimes either intentionally or unintentionally a debriefer may go off the script or debrief methodology. This can work out really well and is a balance to meet learning objectives and foster deep learning but also not derail the clinical simulation debrief. This can particularly be an issue when co-debriefing alongside someone where there has been a pre-selected debrief modality, yet the other debriefer goes off script.
There is a lot of normalcy that as experience is acquired, debriefers will want to try our new ways to debrief. If a co-debriefer goes off script, do not panic and trust the process. Assumptions can not be made as to why a debriefer has chosen to freestyle and go off script from the chosen debrief modality. Minor to moderate deviations are fairly normal. However, if a large deviation has occurred and as a co-debriefer there is uncertainty as to why this can be a great learning opportunity.
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After the debrief enquire with genuine curiosity and ask as to why the co-debriefer has debriefed in a certain manner. The debriefer may have observed an action or inaction which the co-debriefer did not or there may be other rationale. When debriefing with others, assume the best intentions of colleagues and trust in the power of reflection after the debrief. Individuals are generally incredibly hard on themselves, so if an error has been made they are more than likely already in consideration of their actions on their own.
Balance Between Silence, Listening and Guidance
No debrief of a healthcare simulation experience is ever perfect and this is an unachievable goal, particularly for the novice debriefer. A debriefer should aim to listen deeply and steer conversations in the best possible direction in a foundation of psychological safety. To obtain skills such as these to a high degree can take years of experience and also reflection on experiences. Seasoned debriefers, no matter what debrief modality utilized can give great advice that can be useful to refine these skills.
This article has discussed common healthcare simulation debriefing pitfalls and traits, particularly from the viewpoint of a novice debriefer. Discussion has been centered around causes of these pitfalls and what to do in order to combat them. As with most elements of clinical simulation, practice, experience and reflection are some ways in which to take healthcare simulation debriefing skills to the next level.
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