PEARLS Debriefing Tool (Journal Club)

Journal Club Article: Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefingSimulation in Healthcare10(2), 106-115.

About PEARLS

Promoting Excellence And Reflective Learning in Simulation [PEARLS] is an integrated conceptual framework for a blended approach to debriefing.

The PEARLS framework integrates:

  1. Learner self-assessment,
  2. Facilitating focused discussion, and
  3. Providing information in the form of directive feedback and/or teaching.

The aim of PEARLS debriefing tool is “the use of scripted language to guide the debriefing process in simulation-based education.

“PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration.”

A Rationale for Scripted Debriefing: A cognitive aid to support the debriefing process in clinical contexts and simulation based education.

A Rationale for a Blended Approach to Debriefing: “3 broad categories of learner self-assessment, focused facilitation to promote critical reflection and deeper understanding of events and providing information through directive performance feedback and/or focused teaching.

In merging these 3 broad educational strategies into a blended debriefing framework, we have kept key learning principles in mind, namely, that learning should be active, collaborative, and self-directed and learner-centered” (pg. 2).

PEARLS Debriefing Framework

“Debriefing script supports simulation educators in 3 main areas as follows:

  • Setting the stage for the debriefing;
  • Organizing the debriefing to include initial participant reactions followed by a description of relevant case elements, an analysis of positive and suboptimal areas of performance using the PEARLS framework to select a debriefing approach, and finally a summary of lessons learned; and
  • Formulating questions that empower educators to share clearly their honest point of view about events.”

PEARLS outlines 4 distinct phases of the debriefing process:

  • Reactions phase
  • Description phase
  • Analysis
  • Summary: Learner or Educator guided

Resources

Debrief 2 Learn

Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with good judgment: combining rigorous feedback with genuine inquiryAnesthesiology Clinics25(2), 361-376.

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learningSimulation in healthcare2(2), 115-125.

The Role of Debriefing in Simulation-Based Learning. 

Journal Club Article: Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115-125.

Purpose

Determining what is important in the aspects of debriefing within simulation based learning.

Background

The importance of remembering the adult learner, and all the experience they bring through knowledge, assumptions and feelings. Active participation and leveling (#Heutagogy) of the traditional hierachies between teacher and learner are part of the adult learning philosophy. The adult learner is seen as self-directed, motivated and learns from meaningful and work related education that can applied in workplace.

“Adults learn best when they are actively engaged in the process, participate, play a role, and experience not only concrete events in a cognitive fashion, but also transactional events in a emotional fashion. The learner must make sense of the events experienced in terms of their own world” (pg. 115).

“The concept of reflection on an event or activity and subsequent analysis is the cornerstone of the experiential learning experience.” (pg. 116).

Origins of debriefing in simulation were from critical stress incident debriefing and to do this in a timely manner post incident, with the aim to stimulate group cohesion and empathy.

The Debriefing Process

  • Supportive climate; open, sharing, honest, free to learn.
  • Environment of trust; the pre-brief to explain the purpose of the simulation and what is to be expected.
  • The roles of debriefer and those to be debriefed.

Models of Debriefing

The aim of the debrief is to make sense of the event. The structure of the simulation may be:

  1. Experience the event,
  2. Reflect on the event,
  3. Discuss the event with other participants,
  4. Learn and modify behaviour learnt from the experience.

Objectives

As ever match learning such as the debriefing to the learning objectives. Allow emergent and evolving learning that occurs throughout the simulation process. “Two main questions:

  1. Which pieces of knowledge, skills, or knowledge are to be learned?
  2. What specifically should be learned about each of them?”

Role of The Facilitator

The facilitator will be a Co-learner in the simulation with the aim to guide and direct, rather than a traditional lecture based authoritarian approach. Debriefing is a skill and requires training and development. Resources such as the support from experts to guide and develop are important in developing simulation skills.

Debriefing 

Dismukes & Smith (2017) describe three levels of facilitation:

  1. High: High level facilitation actually requires low level of involvement from the facilitator. “Participants largely debrief themselves with the facilitator outlining the debriefing process and assisting by gently guiding the discussion only when necessary, and acting as a resource to ensure objectives are met” (pg 119).
  2. Intermediate: “An increased level of instructor involvement may be useful when the individual or team requires help to analyze the experience at a deep level, but are capable of much independent discussion” (pg 119).
  3. Low: “An intensive level of instructor involvement may be necessary where teams show little initiative or respond only superficially” (pg 120).

Summary 

The debrief is described as ” the heart and soul of the simulation”.

Resources

Dismukes, R. K., & Smith, G. M. (2017). Facilitation and debriefing in aviation training and operations. Routledge.

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115-125.

Lederman, L. C. (1991, July). Differences that make a difference: Intercultural communication, simulation, and the debriefing process in diverse interaction. In Annual Conference of the International Simulation and Gaming Association, Kyoto, Japan (pp. 15-19).

Petranek, C. (1994). A maturation in experiential learning: Principles of simulation and gaming. Simulation & Gaming25(4), 513-523.

Thatcher, D. C., & Robinson, M. J. (1985). An introduction to games and simulations in education. Hants: Solent Simulations.