Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry

Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118-2526, USA.
Anesthesiology Clinics 07/2007; 25(2):361-76. DOI: 10.1016/j.anclin.2007.03.007
Source: PubMed

ABSTRACT Drawing on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through reflective practice, we develop a model of "debriefing with good judgment." The model specifies a rigorous reflection process that helps trainees surface and resolve pressing clinical and behavioral dilemmas raised by the simulation. Based on the authors' own experience using this approach in approximately 2000 debriefings, it was found that the "debriefing with good judgment" approach often sparks self-reflection and behavior change in trainees.

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    • "And development of such a capacity requires that individuals and teams take (and are given) time to analyze their own activity (Falzon and Sauvagnac, 2001). This requires specific training sessions during which ergonomists and psychologists assist activity analysis for reflective practice (Rudolph et al., 2007). A way to achieve this can be, in our example, to conduct training based on real cases of " calls for help " , provided that these training sessions are conducive to reflective practice (Mollo and Falzon, 2004; Sch€ on, 1983). "
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    ABSTRACT: This exploratory research aims to understand how teams organize themselves and collectively manage risky dynamic situations. The objective is to assess the plausibility of a model of a collective trade-off between “understanding” and “doing”. The empirical study, conducted in the pediatric anesthesia service of a French university hospital, was supported by a “high fidelity” simulation with six teams. Data on the teams' behavior and on the verbal communications were collected through video recordings. The results highlight three modes for management of dynamic situations (determined management, cautious management, and overwhelmed management). These modes are related to the way in which teams manage their cognitive resources. More precisely, they are related to the teams' ability to collectively elaborate a trade-off between “understanding” and “doing”. These results question existing perspectives on safety and suggest improvements in the design of crisis management training (concerning for example the recommendation of “calling for help”).
    Applied Ergonomics 03/2015; 47:117–126. DOI:10.1016/j.apergo.2014.09.004 · 2.02 Impact Factor
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    • "An important stage after the oral presentations are delivered is debriefing. Debriefing has been successfully used as a learning strategy in a variety of settings (Rudolph et al,2007). In our experiment, debriefing provided an opportunity for the students to interact with the board of instructors. "
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    ABSTRACT: The need to develop oral presentation skills with reference to students’ specialized professional contexts has been well-recognised (Haber and Lingard, 2004). Attempts have also been made to develop collaboration between engineering faculty and language teaching professionals (Quinn,1993). In this paper, we describe an experiment where students were given an opportunity to demonstrate their technical know-ho and integrate it with oral presentation skills. The paper discusses specifics of collaboration between the engineering faculty and the language teachers. Specifications for development of a transparent assessment framework have also been elaborated. It is concluded that such design-based approach is more likely to develop skills required of students to perform in competitive communicative environments.
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    • "B-line (Washington, DC) video technology was used to synchronize the patient's vital signs with the videotape for debriefing and research purposes. At the conclusion of the scenario, participants were debriefed using an objectives-oriented advocacy-inquiry approach [13]. The debrief process ensured that all the participants were able to discuss the crisis resource management training goals. "
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    ABSTRACT: Background High-quality teamwork among operating room (OR) professionals is a key to efficient and safe practice. Quantification of teamwork facilitates feedback, assessment, and improvement. Several valid and reliable instruments are available for assessing separate OR disciplines and teams. We sought to determine the most feasible approach for routine documentation of teamwork in in-situ OR simulations. We compared rater agreement, hypothetical training costs, and feasibility ratings from five clinicians and two nonclinicians with instruments for assessment of separate OR groups and teams. Materials and methods Five teams of anesthesia or surgery residents and OR nurses (RN) or surgical technicians were videotaped in simulations of an epigastric hernia repair where the patient develops malignant hyperthermia. Two anesthesiologists, one OR clinical RN specialist, one educational psychologist, one simulation specialist, and one general surgeon discussed and then independently completed Anesthesiologists' Non-Technical Skills, Non-Technical Skills for Surgeons, Scrub Practitioners' List of Intraoperative Non-Technical Skills, and Observational Teamwork Assessment for Surgery forms to rate nontechnical performance of anesthesiologists, surgeons, nurses, technicians, and the whole team. Results Intraclass correlations of agreement ranged from 0.17–0.85. Clinicians' agreements were not different from nonclinicians'. Published rater training was 4 h for Anesthesiologists' Non-Technical Skills and Scrub Practitioners' List of Intraoperative Non-Technical Skills, 2.5 h for Non-Technical Skills for Surgeons, and 15.5 h for Observational Teamwork Assessment for Surgery. Estimated costs to train one rater to use all instruments ranged from $442 for a simulation specialist to $6006 for a general surgeon. Conclusions Additional training is needed to achieve higher levels of agreement; however, costs may be prohibitive. The most cost-effective model for real-time OR teamwork assessment may be to use a simulation technician combined with one clinical rater to allow complete documentation of all participants.
    Journal of Surgical Research 02/2014; DOI:10.1016/j.jss.2013.11.861 · 2.12 Impact Factor
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Questions & Answers about this publication

  • Jennifer Obbard added an answer in Nursing:
    What is the best methodology for debriefing in clinical simulations?

    What is the best methodology for debriefing in clinical simulations?
    Use some background?

    Jennifer Obbard · Birmingham City University

    I haven't read through the other responses just due to my own time constraints.  I have found that having a structure helps and there are many examples of this.  However, I find what is most important in effective debriefing is the approach that the Harvard Center for Medical Simulation takes of Debriefing with Good Judgment via an Advocacy & Inquiry approach, as well as, holding a basic assumption of good will (learners are intelligent, want to learning and do their best).  It has a lot to do with the self-awareness and transparency of the facilitator.  I also find that creating a 'learning conversation' is also key and includes the need to consider 'what comes up for the facilitator as well as the students in terms of identity, feelings and what happened.  See Stone, D., Patton, B. & Heen, S. (2000). Difficult Conversations:  How to talk about what matters most. London:  Penguin Books Ltd.  These are great places to start.  There are other methodological considerations that I haven't included here.  All the best, Jennifer