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


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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Available from: Peter Rivard, Oct 13, 2015
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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
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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.
    • "The first author (M.F.) facilitated all simulations and debriefings using the Debriefing with Good Judgment model (Rudolph et al., 2006, 2007). The first author completed the 5-day instructor training and the graduate course at the Center for Medical Simulation (Cambridge, MA). "
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    ABSTRACT: Background Debriefing is critical to learning in simulation-based education. The body of research related to debriefing is growing. However, few empirical studies exist that define specific techniques that facilitate learning during debriefing. Methods This phenomenological study investigated baccalaureate nursing students' perceptions about the characteristics of debriefing that contributed to their ability to learn. Twenty-eight students participated in focus groups after simulation experiences. Results Five themes emerged as supporting the students' abilities to learn during debriefing in simulation-based education. The themes were: Safe Environment, Debriefing to Explore Thoughts, Feedback from Multiple Perspectives, All in This Together, and Group Facilitation. Conclusions This study provides guidance to debriefing facilitators regarding specific actions that can be taken to facilitate learning during debriefing discussions. Establishing an environment of psychological safety, drawing on multiple perspectives, conducting debriefing as a reflective conversation, and use of specific facilitation techniques were identified as being critical to learning during debriefing.
    Clinical Simulation in Nursing 05/2014; 10(5):e249–e256. DOI:10.1016/j.ecns.2013.12.009
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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

    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