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Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting

https://doi.org/10.1016/j.bpa.2015.01.002Get rights and content

In this article, we review the debriefing literature and point to the dilemma that although debriefings especially intend to enhance team (rather than individual) learning, it is particularly this team setting that poses risks for debriefing effectiveness (e.g., preference-consistent information sharing, lack of psychological safety inhibiting structured information sharing, ineffective debriefing models). These risks can be managed with a mindful approach with respect to content (e.g., specific learning objectives), structure (e.g., reactions phase, analysis phase, summary phase), attitude (e.g., honesty, curiosity, holding the trainee in positive regard) and setting (e.g., briefings to provide orientation and establish psychological safety). We point to the potential of integrating systemic methods such as circular questions into debriefings, discuss the empirical evidence for debriefing effectiveness and highlight the importance of faculty development.

Section snippets

Why teams need to reflect on teamwork

The empirical evidence demonstrating that poor teamwork represents one of the major factors contributing to medical error and can result in the loss of life has been growing [17], [18]. Still, medical and nursing schools do not yet sufficiently teach teamwork skills, resulting in clinicians' underestimation of the contribution of teamwork to high-quality patient care [17]. The importance of good teamwork and the unawareness of this importance are all the more reason to help health care teams

Ingredients for debriefing success

To overcome the barriers for debriefing effectiveness, instructors can use a mindful interplay of content, structure, attitude and setting factors.

The content of the debriefing is to a large extent predefined by the learning objectives of the simulated case or the clinical encounter ∗[43], [44]. They provide the basis for defining the desired behaviour. After having observed a gap between (or match of) desired and actual performance, the instructor provides feedback on this gap (or match) and,

Does it matter? Evidence for debriefing effectiveness

Research on debriefings is growing. A recent meta-analysis found that debriefings improved performance by 20–25% on average [76]. In surgery, for example, regular, role-based and guided debriefings were found to be associated with higher team performance [14]. However, empirical research investigating how differences in instructor communication are related to differences in debriefing outcome is just beginning to emerge. Although there is evidence demonstrating that facilitated debriefings are

Conclusion

As conducting debriefings is a challenging task – especially in light of the instructor's feedback dilemma of offering honest feedback without damaging the relationship with the trainees [25] – instructors benefit from deliberate practice as well as from training helping them to reflect on their debriefing practice [6]. Faculty development programmes can help instructors on basic, intermediate and advanced level to develop and enhance their debriefing competence. Especially for instructors on

Conflicts of interest statement

MK and BG received a grant from the Swiss National Science Foundation for the project ‘Debriefings as Enabler for Learning in Ad-hoc Action Teams in Healthcare’. MK and BG received their simulation instructor training from the Institute of Medical Simulation at the Center for Medical Simulation in Boston, MA.

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