For medical training to be effective, it must contend with learners’ demographics1. Healthcare workers, with rare exceptions, are adults. Adult learners learn and retain information better from experiences and reflection than from classical didactic educational methods. This experiential learning process is characterized by four key components: experience, reflection, conceptualization, and experimentation2.
As a prominent form of experiential learning, medical simulation training has been incorporated in most medical educational programs1. Simulation training allows learners to get hands-on experience without risking harm to human patients. Research shows that this kind of training helps learners improve their skills and patient care3. An essential piece of medical simulation training is post-session debriefing1.
Debriefing is a review process that helps participants identify critical insights and solidify them to make the lessons learned during training stick. This article will break down the process of medical debriefing, its role in medical education, the different forms it takes, and how VR can augment debriefing to maximize its benefits for learners and their patients.
In medical simulation training, debriefing is an application of experiential learning wherein facilitators lead participants through a semi-structured conversation after a training session1. The facilitator asks learners a series of targeted questions, often leaving a brief period of silence in between participants’ answers and the following question to give learners time to absorb and reflect. Participants and facilitators cooperatively identify key learning points, missteps, and concepts through this process.
History of Debriefing
Debriefing as a concept has been through many iterations but originally began within the military1,4. There, it serves the purpose of relaying information and reducing the acute stress and long-term impact of experiencing traumatic events that occur during military engagement5. A key goal is to help prevent the occurrence of post-traumatic stress disorder (PTSD).
The first application of debriefing in medicine was in emergency medicine1. First responders and healthcare workers in emergency medicine are exposed to traumatic scenes on a regular basis. To help mitigate the effects of this trauma, the field adapted military debriefing into the process of psychological debriefing6,7. Much like military debriefing, the key point is to help process traumatic events to reduce the incidence of PTSD. However, research has shown that psychological debriefing does not offer appreciable benefits and may be harmful to participants6,7.
Eventually, medical educators adapted the concept of debriefing into an experiential learning tool. One study showed that debriefing in nursing simulations is associated with greater skill competence and self-confidence than those undergoing programs without debriefing8. This process is a critically important source of feedback in medical education. In addition, it is invaluable for developing the skills and analytical prowess of healthcare workers. As a result, debriefing is a component in the majority of medical simulations.
According to the medical simulation expert Linda Lederman, there are seven critical uniting structural components to debriefing9,10. She considered the debriefer and the learner the first two components, without which debriefing is impossible. The experience, she posited, is the third piece of a debriefing.
The fourth component is the impact that the experience, the simulation, had on participants. She placed emphasis on this because impact is critical for adult learning. Recollection and reporting are the fifth and sixth components of the process, which are necessary to consolidate and contextualize the information learned from the simulation.
Finally, she puts forward that time is the seventh and final element to debriefing. By this, she refers to the duration of time between the experience and the debriefing. This time window is often exceedingly brief, but in some cases, this could be extended depending on the context of the simulation.
Another way to conceptualize the process is by examining several vital principles underlying an effectively structured debriefing process9. First and foremost is establishing a non-judgemental atmosphere. This is necessary for learners to feel comfortable and open to sharing their thoughts and experiences without fear of emotional or social reprisal9. If learners feel like their questions or interpretations could lead to mockery or dismissal, they will be less engaged in the process. The facilitator must establish their debriefing stance directly and indirectly that all participants are intelligent and act in good faith.
Creating an encouraging attitude during debriefing actually starts before the simulation in the pre-brief1. The pre-brief is a short session that takes place just before the simulation. During a pre-brief, the facilitator explains to learners the goals of the simulation, what the learning objectives are, and the process of the simulation and debriefing. The facilitator also uses this time to get a gauge on the individual learning styles of the participants to better tailor their approach during the simulation and debrief.
After establishing a welcoming environment, the facilitator needs to lay out the ground rules for the debrief session9. Otherwise, some participants may either be shut out of discussion or withdraw. Moreover, establishing rules helps prevent the debriefing from getting derailed.
Once learners have begun discussing the simulation details through guided debriefing questions, the facilitator must frame the insights gained with clearly established learning objectives9. This also keeps the session on track, but, more importantly, it helps ensure dialog helps advance the overall purpose of the training simulation. This is aided by a focus on open-ended questions that spur conversation. Finally, periods of silence are essential so that learners can think over and consolidate the information they just learned.
There are also different levels of facilitation, as detailed by aviation instructors Dismukes and Smith11. They define these levels by involvement but in an inverse manner. High-level facilitation is characterized by a largely hands-off approach and works best with actively engaged learners. The facilitator sparks conversation and lets participants guide the conversation naturally. Intermediate-level facilitation is valuable when participants are participating in independent conversation but need occasional guidance. Finally, low-level facilitation involves continuous active engagement on the part of the facilitator, which is needed when learners only participate at a superficial level.
Although many different models exist, debriefings often follow a three-stage pattern1,12. The first stage is the reaction. In this stage, participants and the facilitator(s) discuss the clinical simulation’s factual events and emotional impact. During the second stage, the analysis phase, learners and educators break down what the events of the simulation mean in relation to the simulation. Finally, the third main stage is summary, where participants and facilitators work together to discern the key lessons and insights they gleaned through the analysis section. Learners also put their heads together to consider how to apply the lessons they’ve identified to future real-world scenarios9.
Each particular debriefing model for simulation has its own specific order of events that may eschew this general three-step flow. However, these different types of debriefing all contain elements of the aforementioned key principles. A few examples of varying debriefing strategies are described below.
The PEARLS method, short for Promoting Excellence and Reflective Learning in Simulation, adds another step to the 3-step method12. A description phase is added before the analysis phase to focus on summarizing key events before breaking them down. This orients learners and facilitators towards a shared mental model of the experience to make analysis more intuitive.
The SHARP method developed at the Imperial College of London has five main components that each serve as questions13. They are as follows.
S – Set Learning Objectives.
H – How did it go?
A – Address concerns.
R – Review learning points.
P – Plan ahead.
A key benefit of the SHARP method is that it can be implemented in situations when time is limited and a full debrief is unfeasible.
The Bubble Briefs method is built around eight cards with topics related to human factors involved in the simulation experience13. These cards are presented during the pre-brief to prime learners for the details and lessons to look out for during the experience that can help make the debrief more valuable for all parties.
The GAS method was developed to be easy to learn and apply12. As the name implies, the first component is to gather information by listening to learners as they discuss their perspective of the experience. The second component is analysis, wherein the facilitator helps learners identify points of improvement and areas where they deserve praise.
Virtual reality (VR) medical simulations offer several benefits over traditional clinical simulations, and these benefits extend to debriefing. The SimX VR platform is the most advanced VR medical training system available. On top of its industry-leading customization options and expansive list of scenarios, SimX offers unique debriefing opportunities that aren’t possible in traditional clinical simulations. For example, critical actions can be scored automatically within the SimX framework, letting instructors pay more attention to the case as a whole. Additionally, the entire case is recorded for future playback and analysis.
While traditional simulations can also be recorded, a SimX allows learners and facilitators to step back into the scenario in 3 dimensions and display metrics that would otherwise be unavailable. Finally, SimX training is cloud-based and enables learners and instructors to work together despite being in different locations.
Visit us by clicking here to see our different pricing options and download a free trial to see how SimX can set your medical simulation debriefing sessions up for success.
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