Simulation in healthcare is a vital part of the educational approach to learning. For the adult learner this provides problem-centred, relevant and hands-on training (active participation) where past experiences are valued. Simulation training is part of an experiential learning educational approach (Rudolph et al, 2007; Fanning & Gaba, 2007).
So you have your training planned, with level of fidelity, equipment, instructor/s, learning objectives all organised? The next part is to review the breakdown of the session and ask yourself, ‘have I left enough time for the debrief at the end? Instead of leaving a hurried 10 mins at the end of the session, the structure should be more a 50:50 simulation to debrief time frame. The debrief is just as, maybe actually more important for learning and development to take place. Evidence for simulation skill training states that the learning effect maybe lasts 6-12 months (possibly even only 3 months) and should then be repeated, which does question the value of yearly competency training.
The human factors aspect of simulation training provide the task training but the debrief then allows meaning and sense from the training itself, with the adult learner moving towards the key learning objectives and adjusts their performance and actions (Rudolph et al, 2007). Across healthcare and emergency services (including armed forces) the use of critical incident stress debriefing has been formulated to provide a review of facts and perceptions to allow recovery from stress after a traumatic event. In essence the debrief is the reflective practice, and where the learning and development actually occurs.
Debriefing with Good Judgement by Rudolph et al (2007)
- Theory of using reflective practice for self-scrutiny.
- Create a safe, yet challenging environment.
- The sweet point on the stress curve to challenge the participant but not to breaking point.
- Environment of trust.
- Safe environment to make mistakes- this is where the educator can really try to understand the ‘framing’ of the situation from the learners perspective and then provide clarifying education to then eradicate the previous error. Its not a shame and blame situation.
- Allow the difficult discussions to be discussed, critical judgements are valued as long as the discussion is respectful (advocacy and inquiry approach). This is important in healthcare training to be direct about critical errors observed to then eradicate.
- Both instructors and participants views are valued in the discussion phases.
Rudolph et al (2007) describe the debrief as the ‘heart and soul’ of the simulation experience, so we really need to ensure we follow the debrief with good judgement principles.
Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiology Clinics, 25(2), 361-376.
Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in healthcare, 2(2), 115-125.
Thanks to Chris ‘LITFL‘ Nickson for guiding to these simulation resources.