Debriefing with DEOR
- Thoughtful discussion after the simulation is necessary so the learner can sort out and interpret what happened and why.
- How much participants learn and take back to their practice relies on the effectiveness of the debriefing. (1)
Debriefing practices vary. Elements of debriefing may include:
- Participant self-discovery
- Guided Reflection
- Evaluation (summative or formative)
Do's and Don'ts of Debriefing
- Set the expectation for the participant
- Guide the session to the extent necessary to achieve the debriefing objectives
- Adjust facilitation to the level needed to engage the learner to the maximum extent possible
- Draw out quiet learners
- Ensure that critical points are covered
- Integrate instructional points as neededReinforce positive aspects of the learners' behavior
- Lecture. Stay learner-centered rather than instructor-centered
- Give your own analysis and evaluation before the learner has completed his/her analysis
- Interrupt the learner discussion (unnecessarily)
- Interrogate - be positive in discussing problems
- Have an overly rigid agenda
- Shortchange high-performance learners by cutting sessions short (2)
Diagnostic Educational Objective-based Reflection (DEOR)
Barriers to Quality Debriefing
- Lack of Standardization across facilitators.
- Lack of Training in debriefing best practices.
- Current courses on debriefing may be vague, expensive, and take 2-3 days to complete.
Debriefing is a critical component of the simulation experience. The progression of learning for a simulation experience generally consists of the following steps.
- Goals and objectives define what the student is to learn.
- Self-study materials start the learning.
- Lectures and other didactic experiences enhance the learning.
- Simulation focuses the learning.
- Scenario "Checklists" expose what has and has not been learned.
- Feedback reinforces what has been correctly learned and identifies and extinguishes what has not.
Using the Laerdal Debriefing Tool to Simplify and Standardize Debriefing
How does the Laerdal Debriefing tool aid this process? The following is an annotated screen shot of the Laerdal SimMan® debriefing log. The scenario was programmed to show grading in the form of a green check mark (correct) or red "x" (incorrect). Other information concerning the scenario was also programmed to appear with the debriefing log.
The debrief log provides a "semi-automated", standardized guide for providing student feedback during debriefing.
Using a Checklist to Standardize Debriefing
In situations where the Laerdal Debrief log is not available a paper or computerized checklist should be used to identify what the student did correctly and what the student did not do correctly. It is very important that each scenario have specific goals and objectives and that the checklist address these.
Focus the Debriefing to Areas Needing Improvement
The programmed scenario debrief log or the objective-based checklist enables the facilitator to focus the debriefing to those areas needing improvement. The next step is for the facilitator to probe for causes of errors. Generally the error will be one of lack of knowledge, limited or lack of skill, or erroneous judgment.
Consider the Incorrect notation from the Laerdal example above: "Did NOT assess Pain within first 5 minutes..."
Facilitator probes might include:
- Knowledge Probes:
- Do you know that it is important/required to assess pain in the post-op patient?
- What are the steps in assessing pain?
- Skill Probes:
- Do you know how to actually asses pain?
- Show me how you would do this
- Facilitator Judgment Probes:
- Why is it important to assess pain?
- When should pain be assessed?
Student responses might include:
- Response to the Knowledge Probes:
- I think I know how to assess pain.
- These are the specific steps...
- Response to the Skill Probes:
- I know what to do but I'm not sure how to actually do it.
- Response to the Facilitator Judgment Probes:
- I did not realize how important it was from the patient's perspective to do this quickly.
With a specific educational diagnosis identified, the facilitator guides the trainee to fill the knowledge/skill/judgment gap through deliberate practice.
- In the debriefing area cue up the debriefing log and video for that session.
- Check the mood & decompress/support/re-direct as needed:
- Ask an open ended question to assess the mood of the participant(s): "How do you feel it went?"
- Decompress/support/re-direct egos as necessary
- Review the overview of the case (located at the top of the debrief log when using Laerdal) to re-orient the participant(s) to the goals of the scenario.
- Review the log or the checklist with the student; reinforce things they did correctly.
- Read the general statements associated with incorrect actions. This provides the preliminary "educational diagnosis." If you or the participant(s) do not remember what happened at this point in the session, review the video together as needed.
- Use the preliminary educational diagnosis to specifically identify "Why" (Probe: Knowledge/Skill/Judgment). Probe from superficial to deep in each learning domain.
- With a specific educational diagnosis identified, guide the trainee to fill the knowledge/skill/judgment gap through:
- providing knowledge
- providing deliberate practice of a skill
- reviewing how the clinical decision process could have alternately be handled
- it may be valuable to let them re-try this applying what they learned through simulation
- If more than one participant is involved in the exercise, direct questions alternately to different trainees
- This methodology is not meant to be used for formal "Team Training" (other tools are used).
- Lori K. McDonald, Kimberly K. Jobe, R. Key Dismukes. "Facilitating LOS Debriefing: A Training Manual." NASA Technical Memorandum 112192 DOT/FAA/AR-97/6 March 1997.
- Adapted from McDonald, Jobe, & Dismukes 1997.