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The Relationship Between Facilitators' Questions and the Level of Reflection in Postsimulation Debriefing

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Abstract

Introduction: Simulation-based education is a learner-active method that may enhance teamwork skills such as leadership and communication. The importance of postsimulation debriefing to promote reflection is well accepted, but many questions concerning whether and how faculty promote reflection remain largely unanswered in the research literature. The aim of this study was therefore to explore the depth of reflection expressed in questions by facilitators and responses from nursing students during postsimulation debriefings. Methods: Eighty-one nursing students and 4 facilitators participated. The data were collected in February and March 2008, the analysis being conducted on 24 video-recorded debriefings from simulated resuscitation teamwork involving nursing students only. Using Gibbs' reflective cycle, we graded the facilitators' questions and nursing students' responses into stages of reflection and then correlated these. Results: Facilitators asked most evaluative and fewest emotional questions, whereas nursing students answered most evaluative and analytic responses and fewest emotional responses. The greatest difference between facilitators and nursing students was in the analytic stage. Only 23 (20%) of 117 questions asked by the facilitators were analytic, whereas 45 (35%) of 130 students' responses were rated as analytic. Nevertheless, the facilitators' descriptive questions also elicited student responses in other stages such as evaluative and analytic responses. Conclusion: We found that postsimulation debriefings provide students with the opportunity to reflect on their simulation experience. Still, if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. Furthermore, it is important that facilitators consider what kind of questions they ask to promote reflection. We think future research on debriefing should focus on developing an analytical framework for grading reflective questions. Such research will inform and support facilitators in devising strategies for the promotion of learning through reflection in postsimulation debriefings.

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... Although these fundamentals might work in theory, studies that examine the practical accomplishment of debriefing show discrepancies between guidelines provided in the pedagogical literature and empirical practice (Husebø et al. 2013;Johansson et al. 2017;Nordenström 2019;Sellberg 2018;Skovholt et al. 2019). These studies investigate, in interactional detail, how facilitators work to guide students in reflecting, evaluating and commenting on performance in relation to professional standards (Johansson et al. 2017;Sellberg 2018), and how students give formative assessments of their own or each other's work or performance during debriefings (Nordenström 2019;Skovholt et al. 2019). ...
... In particular, the sequential positioning and design of questions asked by facilitators, as well as follow-up questions, are important for focusing students' reflections on clinical practice and professional standards (Johansson et al. 2017). The importance of question design is seen also in Husebø et al. (2013). Using Gibbs' reflective cycle (Fig. 1) for analyzing the relation between facilitators' questions and students' responses, Husebø et al. (2013) found that few of the facilitators' questions seen in debriefing were formulated as analytic questions. ...
... The importance of question design is seen also in Husebø et al. (2013). Using Gibbs' reflective cycle (Fig. 1) for analyzing the relation between facilitators' questions and students' responses, Husebø et al. (2013) found that few of the facilitators' questions seen in debriefing were formulated as analytic questions. An analytical question would elicit "deep reflection" and metacognitive processes. ...
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This study examines storytelling episodes in 13 video-recorded and fully transcribed post-simulation debriefings from a maritime navigation course. The aim is to scrutinize the facilitators' practice of telling stories from the sea during debriefings, to explore the organization and inner function of storytelling in debriefing. A combination of dialogical-performative analysis and a structural narrative model was conducted to analyze and contextualize stories from working at sea in the debriefing practice. The analysis shows how storytelling in debriefing frequently occurred, and was mainly occasioned by critical discussions about students' mistakes during the simulated scenario. In such a critical debriefing practice, the results show how telling stories about lived experiences of professional dilemmas and mistakes serves multiple functions. In line with research results from previous studies on storytelling in higher education, this study demonstrates how storytelling connects the simulated event to the professional responsibilities on board seagoing ships. In addition, storytelling might also serve face-saving purposes in this critical debriefing practice, which raises important questions regarding psychological safety and the debriefing climate.
... Reflection is not an unknown phenomenon in practical skill learning in nursing education (Ewertsson et al. 2015;Havnes, Christiansen, Bjørk, & Hessevaagbakke, 2016;Husebø et al., 2013;Reierson, Haukedal, Hedeman, & Bjørk, 2017), and is often defined in the nursing literature as critical thinking (Sullivan, 2012). In many nursing educational institutions, both in academic and clinical settings, reflection takes place both before and after an action, so-called briefing and debriefing. ...
... In many nursing educational institutions, both in academic and clinical settings, reflection takes place both before and after an action, so-called briefing and debriefing. Nurse teachers/nurses and students are thus able to reflect together on different elements of the practical skill performance (Edwards, 2017;Husebø et al., 2013;Jarnulf et al., 2019;Phillips, Duke, & Weerasuriya, 2017;Reierson et al., 2017). Ryle (1949), however, argued that reflection before or after an action was an inadequate way to think about learning, and was not defined as "intelligent practice". ...
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Background Peripheral vein cannulation is one of the most common invasive practical nursing skills performed by registered nurses. However, many registered nurses lack competence in this practical skill. Learning peripheral vein cannulation associated with successful placement and maintenance is not well understood. Framework Ryle’s ways of knowing, “knowing that” and “knowing how”, can be used during peripheral vein cannulation learning to guide development and competence in this practical skill. Aim The aim of the article was to provide an overview of Ryle’s ways of knowing and to make recommendations for best practices for nurse teachers and nurses teaching students peripheral vein cannulation. Conclusion Ryle’s ways of knowing can assist nursing students in their learning and development of peripheral vein cannulation.
... The briefing phase involves assistance, orientation or introduction of learners to outlining scenario objectives and providing them with information about the environment where the scenario takes place [20,21]. Briefing helps the participants understand the rationale for care, encourages them to widen their understanding of the upcoming situation and gives information about the content of the simulated scenario [22]. Moreover, briefing involves familiarization with technology, equipment and the opportunities and limitations of the scenario [23]. ...
... A structured debriefing promotes reflection by learning to self-correct and assimilate new and previous experiences in improving professional competence [16,17,29]. The steps included in the debriefing usually include description, analysis and application phases (Figure 1), which involve discussing feelings and reactions related to the scenario, positive behavior detected during the simulation as well as activities that need to be developed, and a summary of how the gained knowledge is transferred into clinical practice [22,30]. ...
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Aim: The purpose of this study was to describe the experiences of learning interprofessional collaboration among students and professionals who participated in a social and health care large-group simulation organized online. Background: Gathering interprofessional (IP) experiences is already important during education, because joint education increases IP understanding and clarifies the responsibilities of different professionals. This study illustrates that the use of a large-group simulation, even online, can increase students' and professionals understanding of IP collaboration. The large-group simulation concerned encountering a client who was a victim of domestic violence and had substance abuse problems.
... 22 One study showed that facilitators mostly asked questions on lower (descriptive and evaluative) levels even though these were able to also promote reflection on a higher level. 23 Another study which investigated novice doctors' reflection during debriefings concluded that the relatively inexperienced participants only reached lower levels of reflection. 24 They could however not note any differences in the instructor interventions across different levels of participant reflection. ...
... A primary goal of a facilitator is to help learners identify and close gaps in knowledge and skills 22 and previous research on the relationship between facilitators' questions and the level of reflection in postsimulation debriefing has indicated the need for understanding which facilitator questions promote reflection. 23 The Interaction Analysis in this study has enabled identifying and characterising a number of recurring types of facilitator behaviours, which successfully contributed to advancing the participants' analyses. ...
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Introduction Analyses of simulation performance taking place during postsimulation debriefings have been described as iterating through phases of unawareness of problems, identifying problems, explaining the problems and suggesting alternative strategies or solutions to manage the problems. However, little is known about the mechanisms that contribute to shifting from one such phase to the subsequent one. The aim was to study which kinds of facilitator interactions contribute to advancing the participants’ analyses during video-assisted postsimulation debriefing. Methods Successful facilitator behaviours were analysed by performing an Interaction-Analytic case study, a method for video analysis with roots in ethnography. Video data were collected from simulation courses involving medical and midwifery students facilitated by highly experienced facilitators (6–18 years, two paediatricians and one midwife) and analysed using the Transana software. A total of 110 successful facilitator interventions were observed in four video-assisted debriefings and 94 of these were included in the analysis. As a starting point, the participants’ discussions were first analysed using the phases of a previously described framework, uPEA (unawareness (u), problem identification (P), explanation (E) and alternative strategies/solutions (A)). Facilitator interventions immediately preceding each shift from one phase to the next were thereafter scrutinised in detail. Results Fifteen recurring facilitator behaviours preceding successful shifts to higher uPEA levels were identified. While there was some overlap, most of the identified facilitator interventions were observed during specific phases of the debriefings. The most salient facilitator interventions preceding shifts to subsequent uPEA levels were respectively: use of video recordings to draw attention to problems (P), questions about opinions and rationales to encourage explanations (E) and dramatising hypothetical scenarios to encourage alternative strategies (A). Conclusions This study contributes to the understanding of how certain facilitator behaviours can contribute to the participants’ analyses of simulation performance during specific phases of video-assisted debriefing.
... Expertise of the debriefer is critical in ensuring learners achieve the best possible learning outcomes. (Husebø et al., 2013;The INACSL Standards Committee, 2016). Debriefers need a specific skill set in order to balance several priorities, including: covering all learning objectives, facilitating reflection, incorporating teaching and feedback, managing student questions, maintaining psychological safety, and at the same time, allowing conversation to flow (The INACSL Standards Committee, 2016). ...
... Our findings support previous research which showed a large percentage of debriefers did not receive training, and did not use structured approaches in debriefing (Fey & Jenkins, 2015;Waznonis, 2015). Additionally, our findings demonstrated that without training and mentorship, novice debriefers are likely not able to conduct debriefings in accordance with the recommended best practices of using a structured approach, maintaining psychological safety, and promoting reflection (Husebø et al., 2013;Kolbe et al., 2015;Tannenbaum & Cerasoli, 2013;The INACSL Standards Committee, 2016). Our novice debriefers resorted to using "winging it" as the main debriefing approach. ...
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Introduction Effective debriefing of simulation-based experiences is critical for learning. Approximately 33% of health professions instructors are debriefing novices. However, specific faculty development needs of novice debriefers has not been studied. This study examines how health professions instructors approach debriefing when they are new to debriefing simulation-based experiences. Methods This pilot qualitative study used a thematic analysis approach to explore novice debriefers’ experiences in conducting post-simulation debriefings. Eligible participants engaged in one-hour semi-structured interviews. Recruitment continued until data saturation was reached. We reviewed verbatim interview transcripts, hand-coded the data, and formed codes into themes. Results Nine novice debriefers participated. The overarching theme “I’m on my own…and they’re on their own,” reflects debriefers’ view that they are on their own, without resources. Debriefers also believe learners should identifying their own errors. Three main themes emerged: “Deep divide between me and the learners” portrays a separation between debriefers and learners in terms of expectations, roles, and responsibilities. “Winging it” depicts debriefers’ making-up their own debriefing approaches. “Debriefing quality: missing pieces of the puzzle” portrays novice debriefers unaware of criteria for effective debriefing. Conclusions Novice debriefers in this study perceived that they were on their own, having little to no debriefing training and mentorship. Study participants expressed debriefing struggles in several areas including discussing errors, facilitating learner participation, and assessing debriefing quality. Our findings shed light on simulation as a growing specialty by health profession educators and it is critical that resources are devoted to faculty development for debriefing skill acquisition. These findings can serve as a basis for future studies on debriefer skill acquisition.
... While the number of debriefing approaches is growing (Eppich, Mullan, Brett-Fleegler, & Cheng, 2016;Kessler, Cheng, & Mullan, 2015;Kolbe, Marty, Seelandt, & Grande, 2016;Mullan, Kessler, & Cheng, 2014;Weiss, Kolbe, Grote, Spahn, & Grande, 2016), empirical insights into debriefing interaction patterns are scarce . Few studies have examined actual debriefing conversations and how differences in debriefers' communication influence learners' outcomes (Husebø, Dieckmann, Rystedt, Søreide, & Friberg, 2013). More knowledge on debriefing interactions is important for obtaining insights into associations between debriefing, reflection, and learning, for comparing different debriefing approaches, and for gaining knowledge on what modern forms of teams should do to learn. ...
... Thus, measuring group debriefing quality seems challenging and the characteristics of behavioral marker systems (Table 4.1) may limit their potential for uncovering debriefing characteristics. Instead, coding the group's communication process during debriefings has the potential of revealing insights into debriefings' ideal macrostructure (e.g., reaction Using scores for pre-post comparisons Frequency analysis (Weiss et al., 2014), Density analysis (Manser, Dieckmann, Wehner, & Rall, 2007), Lag sequential analysis (Kolbe et al., 2012), Pattern analysis (Su et al., 2017), Comparison of different task phases Kolbe et al., 2010;Tschan et al., 2015;Tschan et al., 2006) phase, analysis phase, summary phases, Rudolph et al., 2007) and microstructure (e.g., what kind of facilitator's communication behaviours trigger group members' reflection statements, Husebø et al., 2013;Seelandt, Kolbe, Heckel, & Grande, 2016). Thus, using a research procedure similar to the team meeting research described abovecontinuous event-or time-based behavior codingmay help understand how groups can reflect and even discuss "undiscussable" topics (Kolbe, Grande, & Spahn, 2015). ...
... Studies emphasise the teachers' role in planning and organising reflection, since it will influence the learning process and outcome (Dieckmann et al., 2009;Jossberger et al., 2015;Nyström et al., 2016a). However, various studies also show that teachers do not include reflection as a self-evident part of the training (Husebø, Dieckmann, Rystedt & Friberg, 2013;Jossberger et al., 2015). Therefore, it is necessary to develop an analytical framework for probing questions in order to facilitate deeper reflection on learning (Husebø et al., 2013). ...
... However, various studies also show that teachers do not include reflection as a self-evident part of the training (Husebø, Dieckmann, Rystedt & Friberg, 2013;Jossberger et al., 2015). Therefore, it is necessary to develop an analytical framework for probing questions in order to facilitate deeper reflection on learning (Husebø et al., 2013). ...
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This article aims to review the pedagogical research on simulation training in voca-tional education and training (VET) and to discuss the emerging teaching practice from a socio-material perspective on learning and practice. Literature reviews on research into simulation training with pedagogical interests show that there are three main themes: 1) the effect of technology-enhanced simulation training, 2) the fidelity and authenticity of simulation and learning, and 3) pedagogical consideration and under-pinnings. The article draws on a sociomaterial perspective on learning and practice to problematise and discuss the findings of previous research. This theoretical perspec-tive makes it possible to discuss how technology, educational practice and social rela-tions are intertwined and precondition each other.Through the lens of sociomaterial theory, the article discusses how the introduction of the new technologies brings about changes and expectations of what can be learned, how the teaching practices are enacted and how this affects the relationship between teachers and students.
... The facilitator tends to be in the prominent role quite similarly to teaching in general (Zulkosky, 2012), which is not in accordance with recommendations for stimulating students as self-regulated learners (Lefroy et al., 2015;Nicol & Macfarlane-Dick, 2006). The facilitator's feedback style and abilities in facilitating are crucial and have a great impact on the learning environment (Cantrell, 2008;Davis-Berman & Berman, 2002;Husebø et al., 2013;Keitel et al., 2011). It is recommended that the facilitators would benefit from practicing techniques for stimulating involvement and reflective practice in the participants (Husebø et al., 2013;Spanager et al., 2015). ...
... The facilitator's feedback style and abilities in facilitating are crucial and have a great impact on the learning environment (Cantrell, 2008;Davis-Berman & Berman, 2002;Husebø et al., 2013;Keitel et al., 2011). It is recommended that the facilitators would benefit from practicing techniques for stimulating involvement and reflective practice in the participants (Husebø et al., 2013;Spanager et al., 2015). ...
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Background. In the use of simulation as a learning approach, a structured debriefing is important for students to achieve learning. The facilitator’s feedback style and abilities in facilitating are crucial, and have a great impact on the learning environment. The facilitators should facilitate for student active learning, and provide helpful feedback to empower students as self-regulated learners. The aim of the study was to explore the Steinwachs structure and the Critical Response Process structure when used in debriefing in medical simulation, and how each of them affected the facilitator’s role. Method. A multi-method, comparative quasi-experimental design was used. Results. Structuring debriefing in accordance with the Critical Response Process facilitated a facilitator role that coincided with factors highlighted in theory on how to facilitate student active learning and the development self-regulating learners. Structuring debriefing in accordance with the Steinwachs structure revealed that debriefing seemed to be based more on the facilitator’s frames and dominance than the students’ frames and involvement. Conclusion. The results of this study showed that Critical Response Process (CRP) can be an appropriate structure to use in debriefing in medical simulation. It reduced the facilitator’s dominance and frames, coincident with what is empathized in collaborative, active and learner-centered learning.
... The conceptual work has focused on how to conduct debriefings (Rudolph et al., 2007(Rudolph et al., , 2008(Rudolph et al., , 2013(Rudolph et al., , 2014Cheng et al., 2014;Eppich et al., 2015Eppich et al., , 2016Kessler et al., 2015;Sawyer et al., 2016a;Cheng et al., 2017;Kolbe and Rudolph, 2018;Endacott et al., 2019). The empirical work has focused on communication in debriefings, albeit rather unsystematically and rarely applying rigorous team science methodology (e.g., Husebø et al., 2013;Kihlgren et al., 2015). Consequences of previous research on teamwork in debriefings include valuable knowledge on debriefing effectiveness and on macro-level debriefing process on the one hand and very limited actionable knowledge on optimal debriefing interaction processes and facilitation for high quality reflection on the other hand. ...
... To complement existing research on team debriefing processes and effectiveness we recommend to collect data by means of event-based or time-based sampling of interaction behavior and to analyze data by applying coding systems which have been designed to help uncovering conversational team learning processes (Table 3). For example, using DECODEthe coding scheme for assessing debriefers' and learners' communication in debriefings (Seelandt et al., 2018) or the act4teams Coding Scheme (Kauffeld et al., 2018) for analyzing debriefing communication behavior could provide useful insights into the debriefings' ideal macro (e.g., reaction phase, analysis phase, summary phases, Rudolph et al., 2007) as well as micro structure (e.g., what kind of facilitator's communication behaviors trigger group members' reflection statements, Husebø et al., 2013), in particular with respect to feedback and inquiry (Rudolph et al., 2007;Hughes et al., 2016;Kolbe et al., 2016). It could inform the potential association of team members' status, professional discipline, actual profession, and their contributions to the debriefing discussion , the emergence and impact of counterproductive debriefing behaviors such as arriving late, complaining, lecturing, and engaging in irrelevant discussions (Allen et al., 2015(Allen et al., , 2018Kolbe et al., 2015), the optimal balance of understanding and exploring vs. engaging in finding solutions (Kolbe et al., 2015), characteristic modes of argumentation in debriefings depending on status, context, authority gradient, and potential turning points and use of structural instabilities in communication, and the role of leadership in debriefing discussions (Koeslag-Kreunen et al., 2018). ...
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In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
... Simulations are central to training in safety-critical domains such as healthcare, aviation, and the military (Aebersold, 2016). In the literature on simulation-based training, the importance of post-simulation debriefing for student learning and reflection is emphasized (Husebø et al., 2013;Kolb, 2014). To support this aim, some researchers suggest the use of structured debriefing models that outline specific phases of the debriefing activities, such as 'description', 'analysis', and 'application' (e.g. ...
... Kihlgren et al., 2015). By coding different stages of reflection in a video-recorded debriefing session, for instance, Husebø et al. (2013) conclude that these activities 'provide students with the opportunity to reflect on their simulation experience ' (p. 140). ...
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The literature on simulation-based training highlights the importance of post-simulation debriefings as occasions for student self-reflection. Another central feature of these debriefings, which has not gained the same interest, is how debriefings are used by instructors to demonstrate professional modes of reflection-inaction: how they are used to show the deeply reasoned and skilled practices that characterize professional conduct. Based on video recordings of debriefing sessions in a navigation course for master mariners, this study discusses a case where an instructor demonstrates how navigational rules should be applied in line with good seamanship. With a starting point in the visual representation of the scenario, and by re-enacting the students' performance, the instructor formulates the problem that the students confronted in the scenario as well as potential solutions. In this way, the students' attempts to solve the task are explicated in terms of the more general lessons that the scenario was designed to teach. The study concludes by a) discussing the empirical case in relation to Schön's 'Educating the Reflective Practitioner' and b) outlining some implications for educational practice.
... This investment culminates in a vast volume of research that evaluates, prescribes, and develops models of simulation pedagogy (Dieckmann & Ringsted, 2013). The literature speaks to all phases of the simulation cycle, although research that focuses on the simulation itself (Berragen, 2014: Fritz, Gray, & Flanagan, 2008 and debriefing (Husebø, Dieckmann, Rystedt, & Friberg, 2013;Levett-Jones & Lapkin, 2014) is more extensive. There is also a significant number of articles that evaluate aspects of simulation and learning (Cook et al., 2011;Palaganas, Epps, & Reamer, 2014). ...
Article
Simulation is a pedagogy that has been widely used in a number of educational settings (e.g., aviation, transport, social work, nursing education). While it can take numerous forms, it often involves an assortment of high-tech equipment (e.g., flight simulators, manikins) that seek to replicate real settings. Specifically, this paper provides an empirically driven exploration of how simulation laboratories, used in the professional education of nurses, and medical and other health professionals in higher education settings, are practised. Informed by sociomaterial understandings, the paper problematises and disrupts homogeneous understandings of the simulation space as found in much of the health sciences literature. This is done by providing a number of layers ranging from accounts of simulation in literature and empirically driven accounts of simulation in action through to more abstract discussion. The paper is attentive to both the distinct materiality of the spaces involved and the human activities the spaces engender. This dual focus enables the consideration of spatial injustices as well as new directions for the development of simulation pedagogies.
... The assimilation of the experience allowed by role-playing occurs during the debriefing, which offers to students the opportunity to reflect on the experience. The facilitator should structure the technique through questions (open questions) that optimize the development and promote the reflection of the students (23) . The debriefing with an appropriate judgment is based on open sharing of personal opinion and point of view. ...
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Objective: Describe the reflections of nursing students on nursing care through the use of role-playing. Method: Qualitative research with descriptive-exploratory approach and documentary base. The data were collected from portfolios of 32 students from an undergraduate course in the Southern Brazil. The analysis of the data followed the steps of sorting, classification in structures of relevance, synthesis and interpretation. Results: Two empirical categories were obtained: (1) Feelings in the act of taking care and receiving care and (2) Reversing roles: benefits to the nurse in the act of caring. Final considerations: The use of role-playing as a strategy for teaching the theme of care to undergraduate students encouraged reflections about the skills and abilities necessary for the act of taking care and favored the students' self-perception as nurses, appropriating the essence of their future profession: care.
... Debriefing practices within these phases vary considerably, and they might have different names in the different phases: the facilitator might tell the participants what they did well or not so well or he/she might ask them to describe their own view around these issues; the leader during the simulation scenario might be in the center of the discussion or he/she might choose to listen to what the team members have to say; the content focus might shift throughout, giving more weight to certain discussions over others; the team might seek consensus around certain aspects or nurture diversity of views. Several papers try to describe debriefing practice in more detail, for example, who speaks with whom about what in a debriefing ), how debriefing interactions unfold in different cultures (Ulmer et al. 2018), how people interact in debriefings with each other and with the material they have available (Nystrom et al. 2016), how facilitators' questions are related to the discussions and reflections during debriefings (Kihlgren et al. 2015;Husebo et al. 2013), if and how video is used during debriefings (Johansson et al. 2017), and what kind of thought and emotions facilitators might experience during debriefing (Rudolph et al. 2013). ...
... The simulation-based training included a subsequent standardized 1-on-1 debriefing session led by an experienced educator (former therapist/dosimetrist, member of the research team, and trained by a simulation-based expert; also, member of our research team; Table 2 shows the broad safety concepts included in our debriefing sessions as proposed by Mazur et al 20,21 ) on how to conduct these debriefing sessions. [21][22][23][24][25][26][27] Specifically, based on the recommendations by Mazur et al, 21 each debriefing session started with a review of the importance of comprehensive timeout concepts and elements, the need for communication and resolution of any errors before treatment, and proper documentation of decision and actions on any encountered errors, followed by the actual review and discussion of participants' mental workload, situation awareness, and performance. The overarching goal of the debriefing session was to help participants better appreciate how safety mindfulness 21 during timeout and treatment procedures can enhance patient safety and protect them from unintended human errors resulting from suboptimal mental workload (eg, rushing, distractions) and reduced situation awareness (eg, complex information, vague communication, documentation, and patient movement). ...
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Purpose This study aimed to assess the impact of simulation-based training intervention on radiation therapy therapist (RTT) mental workload, situation awareness, and performance during routine quality assurance (QA) and treatment delivery tasks. Methods and Materials As part of a prospective institutional review board–approved study, 32 RTTs completed routine QA and treatment delivery tasks on clinical scenarios in a simulation laboratory. Participants, randomized to receive (n = 16) versus not receive (n = 16) simulation-based training had pre- and postintervention assessments of mental workload, situation awareness, and performance. We used linear regression models to compare the postassessment scores between the study groups while controlling for baseline scores. Mental workload was quantified subjectively using the NASA Task Load Index. Situation awareness was quantified subjectively using the situation awareness rating technique and objectively using the situation awareness global assessment technique. Performance was quantified based on procedural compliance (adherence to preset/standard QA timeout tasks) and error detection (detection and correction of embedded treatment planning errors). Results Simulation-based training intervention was associated with significant improvements in overall performance (P < .01), but had no significant impact on mental workload or subjective/objective quantifications of situation awareness. Conclusions Simulation-based training might be an effective tool to improve RTT performance of QA-related tasks.
... Facilitation of debriefings is viewed as a difficult skill to master. Effective debriefers are often seen to encourage reflection, uncover performance gaps and promote a discussion of how to improve management of future scenarios [3,4]. ...
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Background Various rating tools aim to assess simulation debriefing quality, but their use may be limited by complexity and subjectivity. The Debriefing Assessment in Real Time (DART) tool represents an alternative debriefing aid that uses quantitative measures to estimate quality and requires minimal training to use. The DART is uses a cumulative tally of instructor questions (IQ), instructor statements (IS) and trainee responses (TR). Ratios for IQ:IS and TR:[IQ + IS] may estimate the level of debriefer inclusivity and participant engagement. Methods Experienced faculty from four geographically disparate university-affiliated simulation centers rated video-based debriefings and a transcript using the DART. The primary endpoint was an assessment of the estimated reliability of the tool. The small sample size confined analysis to descriptive statistics and coefficient of variations (CV%) as an estimate of reliability. Results Ratings for Video A ( n = 7), Video B ( n = 6), and Transcript A ( n = 6) demonstrated mean CV% for IQ (27.8%), IS (39.5%), TR (34.8%), IQ:IS (40.8%), and TR:[IQ + IS] (28.0%). Higher CV% observed in IS and TR may be attributable to rater characterizations of longer contributions as either lumped or split. Lower variances in IQ and TR:[IQ + IS] suggest overall consistency regardless of scores being lumped or split. Conclusion The DART tool appears to be reliable for the recording of data which may be useful for informing feedback to debriefers. Future studies should assess reliability in a wider pool of debriefings and examine potential uses in faculty development.
... As learning also occurs through observing the actions of others, this should be accounted for when developing methods for applying simulation pedagogy in large groups. Nevertheless, more research is still needed on how the students observing a simulation participate in the simulation practice and subsequent learning discussion (Husebø, Dieckmann, Rystedt, Soreide, & Friberg, 2013). As all the participants of the present study participated in the simulation as observers, this study provides new insight into learning and teaching in a simulation. ...
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Abstract Aim: This study aimed to describe the learning experiences of social and healthcare students and professionals of an interprofessional large-group simulation. A simulation on sudden infant death syndrome (SIDS) was organized in collaboration between a Finnish university, university hospital and university of applied sciences. Design: A case study. Methods: The research data were collected at the large-group simulation with a questionnaire containing variables on a five-point Likert scale and open questions. The questionnaire was filled out by 350 students and professionals participating in the simulation. The quantitative data were analysed using descriptive statistical methods and the open-ended questions by inductive content analysis. Results: The large-group simulation proved to be a valid teaching and learning method for collaborating with other professionals and interacting with clients and the method can be considered as cost-effective compared with small-group simulations. The produced knowledge can be used in planning simulations in basic and in-service training. K E Y W O R D S interprofessional collaboration, learning, nurses, nursing simulation, teaching
... Im Zuge der Kompetenzorientierung in der Bildungsforschung, der Pädagogik und der beruflichen Bildung seit den 1990er Jahren haben handlungs-und erfahrungsorientierte Konzepte vermehrt Eingang in die Methodik und Didaktik anderer Lehr-, Entwicklungs-und Therapieansätze gefunden. Exemplarisch dafür können im Feld der beruflichen Aus-und Weiterbildung die Anwendung von Simulationstrainings in klinischen Berufen (Garden et al. 2015;Husebø et al. 2013;Maestre & Rudolph 2015;Sawyer et al. 2016), dem Militär und der Luftfahrt sowie weiteren Formen des Lernens am Arbeitsplatz (Workplace Learning) (Lundgren et al. 2017) genannt werden. Im Feld der Hochschuldidaktik stellt Service Learning ein zentrales und viel beforschtes Anwendungsfeld für erfahrungsorientiertes Lernen dar, das ausgehend vom angloamerikanischen Raum zunehmend in Europa Verbreitung findet (Furco & Norvell 2019;Harvey, Coulson & McMaugh 2016). ...
Thesis
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Outdoor activities in the field of pedagogy, counselling and (psycho)therapy are mainly based on experiential and action-oriented learning concepts. In the process of learning and development of individuals, teams and groups, reflection is crucial. Hardly any empirical studies provide evidence how the setting of the reflection impacts the process and the outcomes. The research questions are: (1) Of what relevance is the process of reflection in current experiential and action-oriented theoretical concepts and models? (2) How does the setting of the reflection impact the process and outcomes of the reflection? A comprehensive state of the art literature review makes evident, that reflection in experiential outdoor activities is meanwhile taken for granted within the theoretical models and concepts. The present quasi-experimental study (n=75) is testing for 30 hypotheses on how the setting (reflection in pairs versus alone) impacts the reflection process and its outcomes. Bi- and multivariate findings point out, that the setting mainly impacts the process rather than the outcomes. Reflection questions are of greater importance in single settings than in settings of pairs. In contrast, reflecting in pairs broadens the addressed content and increases the level of emotional activation. Gender and health status are the main predictors of the outcome. Findings testing for the moderator effect of self-reflection and insights lead to the following conclusion: Individuals scoring higher on the insight subscale (SRIS-IN) gain less new insights through the reflection in pairs. Therefore, trainers should try to gather the participants’ ability to self-reflect and their prior experience, to better adapt, design and facilitate the process of learning and reflection. The question, whether health status impacts the learning outcome in experiential outdoor settings more than in solely cognitive indoor settings, should be investigated in future studies.
... Thus, a strength of using simulation debriefs may also include providing a tool for assessing needs across individual, team and system levels. Furthermore, this finding highlights the importance of working to structure the debriefs to promote deeper reflection, 36 hence potentially surfacing unknown unknowns that combined with the quantitative data (normative needs) from the simulation offers more depth than eliciting only felt needs (known unknowns). ...
Article
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Objective To better understand the potential of a needs assessment approach using qualitative data from manikin-based and virtual patient simulation debriefing sessions compared with traditional data collection methods (ie, focus groups and interviews). Design Original data from simulation debrief sessions was compared and contrasted with data from an earlier assessment of critical care needs in a community setting (using focus groups and interviews), thus undertaking secondary analysis of data. Time and cost data were also examined. Debrief sessions were coded using deductive and inductive techniques. Matrices were used to explore the commonalities, differences and emergent findings across the methods. Setting Critical care unit in a community hospital setting. Results Interviews and focus groups yielded 684 and 647 min of audio-recordings, respectively. The manikin-based debrief recordings averaged 22 min (total=130 min) and virtual patient debrief recordings averaged 31 min (total=186 min). The approximate cost for the interviews and focus groups was $13 560, for manikin-based simulation debriefs was $4030 and for the virtual patient debriefs was $3475. Fifteen of 20 total themes were common across the simulation debriefs and interview/focus group data. Simulation-specific themes were identified, including fidelity (environment, equipment and psychological) and the multiple roles of the simulation instructor (educative, promoting reflection and assessing needs). Conclusions Given current fiscal realities, the dual benefit of being educative and identifying needs is appealing. While simulation is an innovative method to conduct needs assessments, it is important to recognise that there are trade-offs with the selection of methods.
... 8 In an analysis of 24 videoed debrief sessions from resuscitation simulations with nurses, researchers found students did not progress in their critical thinking to the final stage of reflection, that is, 'What will I do differently next time?' without the right questions from educators. 2 The authors recommended that simulation educators would benefit from training in reflection in order to support students to achieve a complete learning experience. With this in mind, data in the current study suggest that both within simulation reflectionfor-action and postsimulation reflection-for-learning is needed to maximise student learning. ...
Article
Background Simulated learning environments are increasingly common in interprofessional education (IPE). While reflection is key to simulated learning, little is known about the nature of these conversations during simulation. The aim of this exploratory paper was to quantify communicative features of conversations during interprofessional simulation scenarios between dietetics students, speech-language therapy students and their educators. Methods Conversations between students and educators during the pauses between simulated scenario phases were recorded and transcribed. Student and educator utterances were quantitatively analysed for speech acts, question types and elements of IPE (clinical reasoning, roles and responsibilities, client and family centred care, interprofessional collaboration, clinical procedural tasks). Results Across 1340 utterances from six scenarios, analyses of conversational speech acts and question types highlighted similar patterns of usage between two educators despite different clinical scenarios and professional backgrounds. Educators used a minimally higher proportion of open compared with closed questions, and higher-level problem-solving questions predominated in comparison to simple factual questioning. Educators used more requests for action and attention and students displayed more performative and responsive acts (p<0.05). Students were exposed to all elements of IPE through conversations in all scenarios. Conclusions Conversations during pauses in immersive simulated scenarios between educators and students enable rich IPE opportunities and higher-level problem-solving. Educators encouraged students to problem solve within and across disciplines with open questions. Educators provided few factual responses to questions themselves rather diverting questions back to the students. This approach to the analysis of conversation can support educators to evaluate their own communication during interprofessional simulations.
... As learning also occurs through observing the actions of others, this should be accounted for when developing methods for applying simulation pedagogy in large groups. Nevertheless, more research is still needed on how the students observing a simulation participate in the simulation practice and subsequent learning discussion (Husebø, Dieckmann, Rystedt, Soreide, & Friberg, 2013). As all the participants of the present study participated in the simulation as observers, this study provides new insight into learning and teaching in a simulation. ...
Article
Full-text available
Aim This study aimed to describe the learning experiences of social and healthcare students and professionals of an interprofessional large‐group simulation. A simulation on sudden infant death syndrome (SIDS) was organized in collaboration between a Finnish university, university hospital and university of applied sciences. Design A case study. Methods The research data were collected at the large‐group simulation with a questionnaire containing variables on a five‐point Likert scale and open questions. The questionnaire was filled out by 350 students and professionals participating in the simulation. The quantitative data were analysed using descriptive statistical methods and the open‐ended questions by inductive content analysis. Results The large‐group simulation proved to be a valid teaching and learning method for collaborating with other professionals and interacting with clients and the method can be considered as cost‐effective compared with small‐group simulations. The produced knowledge can be used in planning simulations in basic and in‐service training.
... From a learning perspective, debriefing sessions are considered central for the participants' learning and provide the learner with the opportunity to reflect their understanding of the course of the scenario and their actions and interactions in the team [16]. However, the achieved level of reflection is interconnected with the questions posed by the facilitator and it is a challenging task for the instructor to facilitate reflection at a deep level in the participants [17]. It is reasonable to assume that different approaches to pedagogy in simulation also might influence clinical outcomes differently. ...
Article
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Background: To assess the impact of 10 years of simulation-based shoulder dystocia training on clinical outcomes, staff confidence, management, and to scrutinize the characteristics of the pedagogical practice of the simulation training. Methods: In 2008, a simulation-based team-training program (PROBE) was introduced at a medium sized delivery unit in Linköping, Sweden. Data concerning maternal characteristics, management, and obstetric outcomes was compared between three groups; prePROBE (before PROBE was introduced, 2004-2007), early postPROBE (2008-2011) and late postPROBE (2012-2015). Staff responded to an electronic questionnaire, which included questions about self-confidence and perceived sense of security in acute obstetrical situations. Empirical data from the pedagogical practice was gathered through observational field notes of video-recordings of maternity care teams participating in simulation exercises and was further analyzed using collaborative video analysis. Results: The number of diagnosed shoulder dystocia increased from 0.9/1000 prePROBE to 1.8 and 2.5/1000 postPROBE. There were no differences in maternal characteristics between the groups. The rate of brachial plexus injuries in deliveries complicated with shoulder dystocia was 73% prePROBE compared to 17% in the late postPROBE group (p > 0.05). The dominant maneuver to solve the shoulder dystocia changed from posterior arm extraction to internal rotation of the anterior shoulder between the pre and postPROBE groups. The staff questionnaire showed how the majority of the staff (48-62%) felt more confident when handling a shoulder dystocia after PROBE training. A model of facilitating relational reflection adopted seems to provide ways of keeping the collaboration and learning in the interprofessional team clearly focused. Conclusions: To introduce and sustain a shoulder dystocia training program for delivery staff improved clinical outcome. The impaired management and outcome of this rare, emergent and unexpectedly event might be explained by the learning effect in the debriefing model, clearly focused on the team and related to daily clinical practice.
... Whether during clinical placement or simulation-based learning, reflection and reflective learning in health professional education might be facilitated by clinical supervisors or educators. However, in some cases, these individuals might not be experienced at stimulating higher-order reflective thinking with effective questioning (Husebø, Dieckmann, Rystedt, Søreide, & Friberg, 2013;Philips & Duke, 2001;Philips, Duke, & Weerasuriya, 2017). Furthermore, considering when, where, and how debriefing is to occur during an extended period, as is the case for an SCP experience, requires consideration of models, timing, and spaces for debriefing to occur during an SCP that reflect the realities of an authentic clinical placement (Eraut, 2007;Herrington & Oliver, 2000). ...
... The learning process in simulation is different to learning in most real clinical placement experiences as it incorporates three definite phases; pre-brief, simulation activity, and debrief (Kelly et al., 2016;Ker & Bradley, 2014;Page-Cutrara & Turk, 2017). The debrief phase, that is the time immediately following the learning experience in simulation, is used to promote reflection (Husebo et al., 2015), with the value and depth of reflection being dependent upon the questions that are asked of the learners during this phase (Husebo et al., 2013). ...
... "Despite their central importance in simulation-based education, only a few studies have examined the content of debriefing conversations (Husebo et al. 2013;Kihlgren et al. 2015;Kolbe et al. 2015; Seelandt et al. 2018) and how these influence learner reflections [defined as: "those intellectual and affective activities in which individuals engage to explore their experience in order to lead to new understanding and appreciations" (Boud et al. 1996)]. ...
Article
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Background: Debriefing is an indispensable component of simulation-based medical education, and it has great potential for contributions to reflective learning. Little is known about the relevance of communication during debriefings. We developed a category framework to assess the communication content of debriefings, which we used to analyze possible relationships to participant learning outcomes. Method: We deductively and inductively developed a category framework for qualitative content analysis of debriefings. We coded 20 debriefings using this framework, and correlated debriefing frequency with learning outcomes (i.e. engagement, satisfaction, individual and team learning success). Results: The category framework comprised 9 main and 81 subcategories (48 debriefers, 27 participants, 6 simulated patients), which yielded good intercoder agreement. Debriefers and participants communicated equally using mostly advocacy, inquiry, illustration, and confirmation. Debriefer questions and participant inputs were positively related to learning outcomes. In contrast, guess-what-I-am-thinking, apologies, observations, use of materials, participant descriptions, simple repetition of statements, and evaluation by other participants were not positively associated with learning outcomes. Conclusion: This study provides important new information about communication content during debriefings. The association between communication content and learning outcomes appears particularly relevant to further enhance efficacy of debriefings and simulation-based medical education.
... Historically, research on cognition and emotions has been conducted separately, although there has been a shift towards a more integrative approach to provide a holistic understanding of students' learning processes. Studies have focused on student learning and reflection during simulation (Cant & Cooper, 2010, 2017Hegland et al., 2017;Husebo et al., 2013). Student learning outcomes include acquisition of patient care skills and clinical competency in addition to improved knowledge, consider alternative solutions to a clinical problem and critical thinking abilities. ...
Article
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Aim: Simulation-based education establishes a specific learning environment capable of activating emotions before, during and after the task. Research has identified stress and anxiety related to simulation. However, the role of various emotional experiences in a simulation that favour learning is still unclear. This review describes, interprets and synthesizes the current research findings on health professional students' experience of emotions and the effects on student learning in simulations. Design: This study design was guided by integrative review method. Methods: Databases were systematically searched for articles. 9,323 records were screened and 16 studies met the inclusion criteria. The study protocol was reported in Prospero. Results: Three themes emerged from the analysis: (a) simulation as a fearful and stressful situation, (b) variability in emotions experienced during simulation as a rollercoaster of emotions and (c) emotions wide-ranging effects on students' learning in the simulation.
... The authors observed that students' emotions, such as anger, frustration and anxiety, are often missed or ignored during the debriefing phase [41]. Husebø et al. [42] found that mostly evaluative questions and a few emotional questions are asked in the debriefing phase. Gibbs's reflective cycle [43] is another theoretical framework for guiding the debriefing phase that includes the emotional dimension. ...
Article
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Background Simulation exercises are increasingly being used as a teaching method in the field of undergraduate nursing education. Thus, the present study sought to identify, describe and discuss enablers of the successful implementation of simulation exercises in undergraduate nursing education. Methods This study had a qualitative descriptive design and involved individual interviews conducted between November and December 2018 with six nurse teachers from three different university campuses in Norway. The transcribed interviews were analysed by means of a qualitative thematic analysis. Results The majority of the interviewees wanted to offer more simulation exercises as part of their respective undergraduate nursing education programmes. Moreover, creating a safe environment, facilitating student-centred learning and promoting reflection were all identified by the interviewees as enablers of the successful implementation of simulation exercises. Conclusions The findings of this study indicate that nurse teachers consider simulation to be a valuable teaching method for improving students’ learning outcomes. In addition, the findings could guide the future implementation of simulation exercises in undergraduate nursing education. Trial registration ClinicalTrials.gov ID: NCT 04063319 . Protocol ID: 52110 Nursing Students’ Recognition of and Response to Deteriorating Patients.
... Los estudios mostraron que, de hecho, los niveles de reflexión en los debriefings no son muy profundos en los escenarios, al menos para los participantes menos experimentados, y que la mayoría de las interacciones son relatos de lo que sucedió en el escenario con algunas descripciones de por qué este fue el caso. (Kihlgren, 2015) (Husebo, 2013). Las conexiones adicionales entre la situación y las acciones de los involucrados se discuten mucho menos. ...
Chapter
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El capítulo describe algunas estrategias para promover la reflexión en simulación y plantea algunas estrategias de diseño de escenarios y otras de debriefing para lograr este propósito.
... The immersive, guided experience of SBL is enhanced by real-time debriefing with social work students, instructors, and actors. Prior research with nursing students suggests that postsimulation debriefing is an important facilitator of deep reflection (Husebø et al., 2013). During these segments of class, students who were fresh off simulation reflected on their performances, their successes and their struggles, and they received feedback from instructors, fellow MSW peers, and actors. ...
... Regardless, it is our view that the use of any tool as a single approach to faculty development is limited. Locally, we are now using the tools listed above with the data-driven approach assessed in the study [35]. We use either video conferencing or a real-time approach depending on the current local policy on social distancing and remote learning [36]. ...
Article
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Background Debriefing is an essential skill for simulation educators and feedback for debriefers is recognised as important in progression to mastery. Existing assessment tools, such as the Debriefing Assessment for Simulation in Healthcare (DASH), may assist in rating performance but their utility is limited by subjectivity and complexity. Use of quantitative data measurements for feedback has been shown to improve performance of clinicians but has not been studied as a focus for debriefer feedback. Methods A multi-centre sample of interdisciplinary debriefings was observed. Total debriefing time, length of individual contributions and demographics were recorded. DASH scores from simulation participants, debriefers and supervising faculty were collected after each event. Conversational diagrams were drawn in real-time by supervising faculty using an approach described by Dieckmann. For each debriefing, the data points listed above were compiled on a single page and then used as a focus for feedback to the debriefer. Results Twelve debriefings were included (µ = 6.5 simulation participants per event). Debriefers receiving feedback from supervising faculty were physicians or nurses with a range of experience ( n = 7). In 9/12 cases the ratio of debriefer to simulation participant contribution length was ≧ 1:1. The diagrams for these debriefings typically resembled a fan-shape. Debriefings ( n = 3) with a ratio < 1:1 received higher DASH ratings compared with the ≧ 1:1 group ( p = 0.038). These debriefings generated star-shaped diagrams. Debriefer self-rated DASH scores (µ = 5.08/7.0) were lower than simulation participant scores (µ = 6.50/7.0). The differences reached statistical significance for all 6 DASH elements. Debriefers evaluated the ‘usefulness’ of feedback and rated it ‘highly’ (µ= 4.6/5). Conclusion Basic quantitative data measures collected during debriefings may represent a useful focus for immediate debriefer feedback in a healthcare simulation setting.
... But during debriefing, the learner-based discussion can go into areas like burns management and medicolegal issues related to burns. A study performed by Husebø et al. 2 found out that the quality of facilitators' questions promotes appropriate reflection. They also concluded that if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. ...
Article
Objectives: Clear and specific content for debriefing promotes learning and reflection for the learner. Currently, there is no universal tool for developing the content for debriefing. Methods: We developed a tool for debriefing that can be applied for developing content for debriefing, which can be used for instructor-led and within-team debriefing. These tools include two sets of eight questions, namely, the how and the what questions. Results: We used these tools in our monthly simulation activities and got a favorable response from the residents who used them. Conclusions: The how question deals with human factors, and the what questions deal with educational factors.
... However, the effectiveness of simulation is strongly dependent on the debriefing session, since learning actually occurs when it is based on proper feedback aimed at stimulating reflection about individual and team dynamics. The ability to analyze each other's performance retrospectively is crucial when it is focused not only in talking about what went well and what did not, but also on why it went well and why something else did not [28,29]. ...
Article
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Background: Simulation is a useful method to improve learning and increase the safety of work operations, both for technical and non-technical skills. However, the observation, assessment, and feedback about these skills is particularly complex, because the process needs expert observers, and the feedback could be judgmental and ineffective. Therefore, a structured process to develop effective simulation scenarios and tools for the observation and feedback about performance is crucial. To this aim, in the present research, we developed a training model for electricity distribution workers, based on high fidelity simulation. Methods: We designed simulation scenarios based on real cases, developed, and tested a set of observation and rating forms for the non-technical skills behavioral markers, and we tracked behaviors based on non-verbal cues (physiological and head orientation parameters). Results: The training methodology proved to be highly appreciated by the participants and effective in fostering reflexivity. An in-depth analysis of physiological indexes and behaviors compliant to safety procedures revealed that breath rate and heart rate patterns commonly related with mindful and relaxed states were correlated with compliant behaviors, and patterns typical of stress and anxiety were correlated with non-compliant behaviors. Conclusions: a new training method based on high fidelity simulation, addressing both technical and non-technical skills is now available for fostering self-reflection and safety for electricity distribution workers. Future research should assess the long-term effectiveness of high-fidelity simulation for electricity workers, and should investigate non-invasive and real-time methods for tracking physiological parameters.
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Introduction: Rapid Cycle Deliberate Practice (RCDP) is a team-based simulation method, emphasizing repetitive practice over reflective debriefing, with progressively more challenging rounds, frequent starts and stops, and direct coaching. Although some studies have shown improved performance, no study has evaluated learners' perceptions. We aimed to explore learners' experiences during RCDP. Methods: This was a qualitative study of participants' perceptions regarding RCDP during their pediatric emergency medicine rotation. Participants completed surveys about RCDP learning. A purposive sample of residents and nurses were interviewed. Two coders analyzed all interview transcripts to identify emerging themes. Constant comparison analysis was performed until thematic saturation was achieved. Results: Forty-four participants completed surveys. Participants found RCDP interruptions beneficial and felt that they learned most during interruptions. Participants who were able to compare traditional and RCDP simulations felt that RCDP allowed more focused correction of mistakes, acquisition of new skills, and timely practice of team behaviors. Fourteen participants were interviewed. Three themes emerged. (1) The real-time corrections during RCDP allowed for learning and creation of new skills through repetition and practice. (2) The RCDP allowed learners to gain confidence, decrease anxiety, and learn in a safe environment. (3) By introducing new information in smaller chunks, participants maximized learning without cognitive overload. Conclusions: Rapid Cycle Deliberate Practice is well received by learners. Because of frequent interruptions, learners noted early error correction, a safe learning environment, and skill improvement during RCDP. Learners recognized that the progressive advancement of RCDP helped prevent cognitive overload. Future studies should measure cognitive load and skills retention.
Book
Cambridge Core - Communications - The Cambridge Handbook of Group Interaction Analysis - edited by Elisabeth Brauner
Chapter
Simulation ist ein rasch wachsendes Forschungsfeld und beinhaltet 2 Schwerpunkte: Simulation als Trainingsmethode und Simulation als Untersuchungsmethode. Die Forschung zur Simulation als Trainingsmethode ist v. a. anwendungsorientiert mit dem Ziel, Informationen darüber zu erlangen, wie Simulationstrainings gestaltet werden können, damit die Teilnehmenden möglichst viel und nachhaltig lernen. Die Forschung mit Simulation als Untersuchungsmethode beinhaltet v. a. Grundlagenforschung mit dem Ziel, via Simulation Prozesse und Zusammenhänge zu untersuchen, die sonst nicht oder weniger gut zu untersuchen wären. In diesem Kapitel geben wir einen kurzen Überblick über beide Forschungsgebiete, weisen auf interdisziplinäre Herausforderungen und aktuelle Forschungslücken hin und bieten dazu Handlungsempfehlungen an.
Article
Objective To determine whether a dynamical analysis of neural and communication data streams provide fine-grained insights into healthcare team debriefings. Background Debriefing plays a key role in experiential learning activities such as healthcare simulation because it bolsters the transfer of experience into learning through a process of reflection. There have been few studies examining the neural and communication dynamics of teams as team members are supported by trained facilitators in making better sense of their performance. Method Electroencephalographic (EEG)–derived brain waves and speech were recorded from experienced and medical student healthcare teams during post-simulation debriefings. Quantitative estimates of the neurodynamic organizations of individual team members and the team were modeled from the EEG data streams at different scalp locations and at frequencies from 1-40 Hz. In parallel the dynamics of speech turn taking were quantified by recurrence frequency analysis. Results Neurodynamic organizations were preferentially detected from sensors over the parietal lobes with activities present in the alpha, beta and gamma frequency bands. Rhythmic structures emerged as correlations between speech, discussion blocks and team & team member neurodynamic organizations. Conclusion Organizational representations help reveal the neurodynamic, communication, and cognitive structures of debriefing. Application The quantitative neurodynamic and communication measures will allow direct comparisons of debriefing structures across teams and debriefing protocols.
Chapter
This chapter has a particular focus on the observers’ role in simulation-based learning activities. Simulation-based learning is often organised so that participants rotates between active participation in the scenario and participation as observers. The research examples provided show that the conditions for learning are related to the locations where and the ways the observers are situated, and to how the instructions to the observers are formulated. Arguments are put forward that the observers’ role in simulation has unexploited potential for developing skills of noticing.
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Several recent literature reviews have been published with the aim to determine how to optimise a debriefing. A main element found in these reviews was the importance of structuring the debriefing. Within the steps usually outlined in the debriefing, the description phase allows participants to describe their recollections and establish a shared mental model of what happened during the simulation. The description phase is used in many debriefing models but how to realise this description remains unclear. We provide an original tool to ensure a highly structured description phase: the “Timeline Debriefing Tool”. The Timeline Debriefing Tool, or TDT, is constructed on visual support such as a whiteboard or a flipchart. It allows for a clear description phase, makes the process more dynamic, promotes exchanges between participants and establishes a clear and shared vision of the simulation in visual support which can be used by the instructor in the analysis phase. Moreover, the timeline allows participants to discover their performance gaps by themselves, thus beginning deeper cognitive processing in the participants’ mind and promoting reflection in the analysis phase.
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There are many barriers and logistical burdens for implementing off-site simulation programs (i.e., in a simulation center) for healthcare teams in practice, including team availability, travel time to and from locations, and limited realism. In situ simulation, which utilizes a functional clinical environment with real staff, equipment, and systems to provide rehearsal and training for clinical teams, has been touted as one possible solution to ensure that healthcare providers can train together on simulated patients to develop and examine core team competencies.
Article
Background: Simulated learning activities are on the rise worldwide. Debriefing is viewed as a central element in simulated learning to enhance learning. Still, the question of how students learn in debriefing is underexplored. Aim, design and method: The paper offers a contribution to the academy to better understand debriefing by presenting an in-depth, qualitative analysis of the practice of debriefing, carried out with 40 first-year nursing students (n = 40) in relation to roleplay simulation, training in clinical decision-making and patient involvement. The simulation sessions were carried out at a university hospital in Copenhagen, Denmark during clinical practice periods. Findings: Using theoretical conceptualizations from learning theorist Knud Illeris as sensitizing concepts, the paper points to the emergence of intended as well as unintended learning processes. In addition, it highlights the importance of focusing on facilitators' empowering as well as disempowering impact on students' motivation to engage in debriefing learning processes. An important finding is that the curricular overload leads to a prioritization of learning outcome related to natural science at the expense of "softer" competencies, e.g. patient involvement. The analysis also finds that students' motivation to process their real-life clinical experiences tends to be neglected. The conclusion thus points to a profound dilemma, unidentified in the literature, of learning ambitions in debriefing: the tension between attaining the formal learning objective and thus facilitating a tightly structured and focused debriefing on the one side, and the wish to develop critical and independent thinking on the other.
Chapter
Team neurodynamics is the study of the changing rhythms and organizations of teams from the perspective of neurophysiology. As a discipline, team neurodynamics is located at the intersection of collaborative learning, psychometrics, complexity theory, and neurobiology with the resulting principles and applications both drawing from and contributing to these specialties. This article describes the tools for studying team neurodynamics and illustrates the potential and the challenges these methods and models have for better understanding healthcare team training and performance. The fundamental metric is neurodynamic organization, which is the tendency of teams and its members to enter into prolonged metastable relationships when they experience and resolve uncertainty. The patterns of these relationships are resolved by symbolic modeling of electroencephalographic (EEG) power levels of the team members, and the information in these patterns are calculated using information theory tools. The topics discussed in this chapter anticipate the time when dynamic biometric data can contribute to our understanding of how to rapidly determine a team’s functional status, and how to use this information to optimize outcomes and training. The rapid, dynamic, and task neutral measures make the lessons learned in healthcare applicable to other complex group and team environments, and provide a foundation for incorporating these models into machines to support the training and performance of teams.
Article
Introduction Debriefing is a core element in simulation-based education but successful debriefing modalities remain unspecified. In educational sciences, teaching approaches that are structured, explicit and instructor directed have been shown to be systematically more effective than implicit, reflective approaches with minimal guidance, particularly for novice or intermediate learners. The aim of this study is to compare explicit, highly guided debriefing with implicit and low-guided debriefing in nurse education. Method This study is a single-centre randomised prospective study comparing the efficacy of explicit, implicit or mixed debriefing procedures. The experimental modalities focused on the description and the analysis phase of the debriefing. The primary outcome was knowledge. The secondary outcomes were self-efficacy and self-confidence. Results 136 nursing students participated during 46 simulation sessions. Knowledge, self-efficacy and self-confidence increased in all conditions. Linear regression analysis showed that knowledge learning was higher in the debriefing conditions in which the analysis was carried out in an explicit manner. There was no debriefing type effect on self-efficacy and self-confidence increase. Conclusion For nursing students, using explicit, highly guided debriefing with direct teaching of content was shown to be more effective on learning than implicit, reflective debriefing with little guidance.
Chapter
Debriefing framework and approach inform a number of factors, including participant group and learning needs, type of predetermined learning objectives, and those debriefing points that emerge from the discussion. Although general principles for healthcare debriefing exist, special considerations apply for emergency care settings. In emergency medicine, debriefings should highlight the unique logistic and cognitive demands on individuals as well as interprofessional, multi-disciplinary teams. One size does not fit all, and debriefing approach for various components of any one simulation scenario are not mutually exclusive. For emergency settings, aspects about individual thought processes, teamwork, and systems issues may be relevant for a single debriefing session. Debriefing is an essential element of healthcare simulation and the information summarized here helps educators develop and implement an informed strategy.
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Health- and social care large group simulation – experiences in learning interprofessional cooperationMarja Silén-Lipponen, PhD, Mira Korvenoja, MNSc, Tarja Välimäki, PhD, Suvi Aura, PhD, Kaarina Mönkkönen, PhD, Terhi Saaranen, PhD Aim: To describe the social and health care professionals’ and students’ experiences of learning interprofessional collaboration in a large group simulation. In the large group simulation, professional actors were in the roles of the clients and professionals in the roles of the employees. All the learners were observers. Data and methods: The data were collected with five group interviews (n=23) and analyzed by thematic content analysis. Results: The realism of the simulation and the use of digital applications promoted learning. The browser-based participation system allowed joint discussion and sharing experiences with a large number of participants. It was suggested that the simulations should be guided according to the learning objectives. In addition, for some learners in different professions and study fields, the objectives of the simulation were unclear. Conclusions: The development of large group simulation requires the development of both pedagogical designing and debriefing facilitation, that the objectives of the simulation would be presented more clearly. Additionally, the debriefing should be equal from the perspectives of different professional groups. The results of the study can be utilized in designing future interprofessional large group simulation teaching. Keywords: interprofessional learning, interprofessional collaboration, teaching method large group simulatio
Article
Background Significant learning occurs during debriefing, yet specific debriefing descriptors that improve learners’ thinking are lacking. The Debriefing for Meaningful Learning (DML) Evaluation Scale was developed and tested to assess DML behaviors, yet a more precise measure resulted in psychometric testing of a new iteration. Methods The revised DML Evaluation Scale was tested with 19 educators at five nursing programs, who facilitated debriefing with nursing students. Debriefings were recorded, viewed and scored by a six member research team. Results The Debriefing for Meaningful Learning Evaluation Scale (DMLES) data demonstrated internal consistency, interrater reliability, content, construct, and criterion-related validity. Conclusions This study's findings demonstrate ongoing evidence of validity and reliability for the scale as a measure of competence and formative assessment.
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Developed by the leading experts in neonatal simulation, this innovative new resource delivers neonatology health care providers and educators essential guidance on designing, developing, and implementing simulation-based neonatal education programs. Available for purchase at https://shop.aap.org/neonatal-simulation-a-practical-guide-paperback/ (NOTE: This book features a full text reading experience. Click a chapter title to access content.)
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Contexte : Le débriefing dans le secteur de la santé est souvent considéré comme un processus de réflexion centré sur l’apprenant nécessaire pour la construction des connaissances, où le formateur joue un rôle de facilitateur. Cependant, diverses études soulignent l’importance que le débriefing soit explicite pour les apprenants novices. Cet article examine l’efficacité de différents types de débriefing, simulation, pour des apprenants expérimentés qui travaillent dans des équipes d’urgence. Objectif : Cette étude vise à vérifier si le débriefing explicite est aussi efficace pour les professionnels expérimentés qu’il l’a été pour les apprenants novices. Méthodes : Cette étude prospective randomisée monocentrique a été réalisée dans le cadre d’un programme de simulation basé sur des interventions d’urgence lors d’un arrêt cardiaque. Les connaissances déclarées de chaque participant, leur auto-efficacité et l’efficacité de l’équipe ont été mesurées avant et après la formation par simulation. Résultats : Les résultats montrent un effet bénéfique sur les connaissances et l’auto-efficacité pour les deux types de débriefing. Les soins apportés aux patients ont aussi été optimisés pour les deux types de débriefing. Conclusion : Les deux types de débriefing post-simulation sont efficaces pour les équipes d’urgence expérimentées.
Article
Background Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants’ reflection in debriefings. Methods In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants’ verbalisation of a mental model as a particular form of reflection. Results The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers’ observation to debriefers’ opinion (z=9.85, p<0.001), from opinion to debriefers’ open-ended question (z=9.52, p<0.001) and from open-ended question to participants’ mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. Conclusion When debriefers pair their observations and opinions with open-ended questions, paraphrase participants’ statements and ask specific questions, they help participants reflect during debriefings.
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This paper examines how reflective learning can be promoted and developed explicitly within the disciplines of geography, earth and environmental sciences. A review of various theoretical perspectives on reflection is provided, as well as a brief summary of the ways of incorporating reflection in the curriculum. The substantive part of this paper is based on a UK Learning and Teaching Support Network (LTSN) Subject Centre for Geography, Earth and Environmental Science (GEES) funded research project on reflective learning which was completed in 2001. A questionnaire survey was sent to GEES departments/schools to obtain information about the incorporation of reflective learning in the curriculum. From the analysis of the questionnaire returns, the project team identified four themes regarding the relevance of reflective learning to GEES disciplines. Project findings demonstrate how the inclusion of reflective learning exercises and activities is at an embryonic stage in many UK GEES departments/schools. The paper concludes by highlighting certain challenges that geographers, earth and environmental scientists could address if they wish to seek to develop reflective learning and enhance the student learning experience.
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There is a critical need for faculty, a shortage of clinical sites, and an emphasis on quality and safety initiatives that drive increasing use of simulation in nursing education. Debriefing is an essential component of simulation, yet faculty are not consistently prepared to facilitate it such that meaningful learning, demonstrated through clinical reasoning, occurs from the experience. The purpose of this exploratory, quasi-experimental, pre-test-post-test study was to discover the effect of the use of a simulation teaching strategy, Debriefing for Meaningful Learning (DML), on the development of clinical reasoning in nursing students. Clinical reasoning was measured in 238 participant students from a Midwestern university school of nursing taking an adult health course that uses simulation. Participants were assigned to either the experimental or control group where the DML was compared to customary debriefing using the Health Sciences Reasoning Test (HSRT) before and after the debriefing experience, and the Debriefing Assessment for Simulation in Healthcare©–Student Version (DASH©–SV) with four supplemental questions about the DML (DMLSQ) process, during the post-debriefing assessment. This research sought to understand if the DML debriefing strategy positively influenced the development of clinical reasoning skills in undergraduate nursing students, as compared to usual and customary debriefing. The data revealed that there was a statistical difference between total mean test scores measured by the HSRT. There was, additionally, statistical significance in the change in scores between pre-test and post-test for those who used the DML as compared to the control. There was also a difference in the student’s perception of the quality of the debriefing measured by the DASH©–SV with the DML rated statistically higher than usual debriefing. Finally, there was a significant correlation, demonstrated through regression analysis, between the change in HSRT scores and students’ perception of quality debriefing and the use of the DML. This study contributes to the growing body of knowledge about simulation pedagogy, provides tools for use in debriefing, and informs faculty on best practices in debriefing. Indiana University-Purdue University Indianapolis (IUPUI)
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Describing what simulation centre leaders see as the ideal debriefing for different simulator courses (medical vs. crisis resource management (CRM)-oriented). Describing the practice of debriefing based on interactions between instructors and training participants. Study 1 - Electronic questionnaire on the relevance of different roles of the medical teacher for debriefing (facilitator, role model, information provider, assessor, planner, resource developer) sent to simulation centre leaders. Study 2 - Observation study using a paper-and-pencil tool to code interactions during debriefings in simulation courses for CRM for content (medical vs. CRM-oriented) and type (question vs. utterance). Study 1 - The different roles were seen as equally important for both course types with the exception of 'information provider' which was seen as more relevant for medical courses. Study 2 - There were different interaction patterns during debriefings: line - involving mostly the instructor and one course participant, triangle - instructor and two participants, fan - instructor and all participants in a dyadic form and net - all participants and the instructor with cross references. What simulation centre heads think is important for the role mix of simulation instructors is (at least partly) not reflected in debriefing practice.
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A case study involving a planned home birth in an unusual location is examined using Gibbs reflective cycle to highlight the issues for supervisors of midwives. A number of points are raised that relate to the supervisor's role, such as support, advocacy and risk management.
Article
High-fidelity simulation, in which students engage in clinical scenarios replicating actual clinical situations, is now well integrated into nursing education. Experiential learning philosophy underlies simulation education, in which students are able to develop and refine knowledge. Simulation debriefing guides students through a reflection on what occurred during a simulation scenario, with the goal of developing the knowledge, skills, and rationales underpinning clinical practice. Debriefing is central to the actual simulation event and equally beneficial, if not more so. The paucity of nursing research on evidence-based strategies for efficacious debriefing frameworks is cause for concern, considering the importance of simulation debriefing. The aim of this review is to analyze the literature on the use of simulation debriefing in nursing education and to recommend avenues of further study. As simulation education is rapidly expanding, nursing education needs to gain a deeper understanding of debriefing in order to develop evidence-based practice frameworks.
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The theme of teacher as reflective prac titioner has become an important rally ing point in current efforts to reform teaching. Wildman and Niles discuss the rhetoric of reform and balance it against the realities of promoting teacher reflec tion. The authors caution that reform ef forts will fail if crucial conditions for reflection are disregarded.
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Reflective learning is the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in a changed conceptual perspective. We suggest that this process is central to understanding the experiential learning process. In this article, we describe the process of reflective learning as identified through analysis of three distinct sets of data, including sequential interviews, single interviews, and written questionnaires, using three separate samples. The sequential interviews revealed a pattern of becoming aware of one's own reflective learning patterns and deciding to use them consciously. Then, the six stages in the reflective learning process are abstracted and described. Implications of the process for personal change and growth, for facilitating learning from experience and changing perspectives, and for further research are also discussed.
Article
Background: This education-focused research project evaluated the benefit of a structured debriefing session on students' learning after the students completed three pediatric-based clinical simulations. Method: Eleven students participated in this study, in which their performance was videotaped during each simulation. They received a verbal debriefing at the conclusion of each clinical simulation and then received a structured debriefing session involving a review of the videotape during a qualitative focus group interview. Results and Conclusions: Descriptive findings from the discussion of the debriefing session suggest that students have a strong need for debriefing immediately following the conclusion of each simulation to help them decompress and integrate the experience into their knowledge base. © 2008 International Nursing Association for Clinical Simulation and Learning.
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Reflection, reflective learning, reflective writing and reflective practice are used increasingly in higher education and professional development–but we do not work to one definition and there are considerable differences in the views of educationists on issues of definition. Such discrepancies can exist between the staff working with the same student group. The situation can lead to difficulties in indicating to students how to reflect, and what reflective writing ‘should look like’. Once students do manage to represent their reflection broadly in the required manner (usually writing), there is frequently observed to be a further problem because their reflection is superficial and descriptive. A consequence is that their learning from the reflective process is restricted. This paper addresses the issue of definition of reflection initially through clarifying the different words used around the notion of reflection (e.g., reflection, reflective learning, reflective writing) and providing some suggested definitions. It then addresses the matters both of how we should help students to start with reflection, and with the problem of the superficiality of much of their work. The ‘depth’ of reflection is a concept that has not been much discussed in the literature of reflection and yet it seems to be closely related to the quality of reflective work. The paper discusses the concept of depth and then introduces a style of exercise in which a scenario is reproduced at progressively deeper levels of reflection. The exercise is related to a generic framework for reflective writing. The rationale and justification for the exercise and the framework are discussed and suggestions are made for its manner of use. The exercise and the generic framework for reflective writing are in Appendices 1 and 2. The use of reflection to enhance formal learning has become increasingly common in the past 7 years. From the principle beginnings of its use in the professional development of nurses and teachers, its use has spread through other professions. Now, in the form of personal development planning (PDP), there is an expectation that all students in higher education will be deliberately engaging in reflection in the next 2 years. ¹ In addition, there are examples of the use of reflective learning journals and other reflective techniques in most, if not all, disciplines. ² Reflection is not, however, a clearly defined and enacted concept. People hold different views of its nature, which only become revealed at stages such as assessment. For example, what is it that differentiates reflective writing from simple description? There are difficulties not only with the definition itself but also in conveying to learners what it is that we require them to do in reflection and in encouraging reflection that is deeper than description. In this paper, we consider some issues of definition and then focus on the means of encouraging learners to produce a reflective output of good-enough quality for the task at hand. The latter is presented as an exercise for staff and learners (Appendix 1) with a framework that underpins it (Appendix 2).
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In this chapter we consider the measurement of interrater agreement when the ratings are on categorical scales. First, we discuss the case of the same two raters per subject. Next, we consider weighted kappa to incorporate a notion of distance between rating categories, followed by the case of multiple ratings per subject with different sets of raters. We discuss applications to other problems and then relate the results of the preceding sections to the theory presented in an earlier chapter on correlated binary variables. A problem solving section appears at the end of the chapter.
Critical and autonomous thinking must take precedence over the uncritical assimilation of knowledge. Transformative learning is a route to the development of critical thinking.
Article
Despite the widespread adoption of reflective practices across many fields of study, a critical analysis of the concept of reflection and its application within higher education has been lacking. This article provides an examination of several major theoretical approaches to reflection including those of Dewey; Loughran; Mezirow; Seibert and Daudelin; Langer; Boud, Keogh and Walker; and Schn. Commonalties in terminology, definitions, antecedents, context, process, outcomes, and techniques to foster reflection are addressed. The implications of the findings for higher education are explained.
Article
Problem-based learning (PBL) is a constructivist approach to learning which is believed to promote reflective thinking in students. This study investigated how students in one particular institution developed in their reflective thinking habits—Habitual Action, Understanding, Reflection, and Critical Reflection—as they went through the daily practice of PBL. A 16-item questionnaire measuring the four levels of reflective thinking habits was administered to four cohorts of students: an incoming cohort, first-years, second-years, and third-years. First-year students rated themselves higher on Reflection and Critical Reflection, while third-years reported the highest levels of Habitual Action. Discriminatory and scatterplot analysis on the third year cohort revealed that while a proportion of students (47%) reported higher levels of Habitual Action with lower levels of Reflection, there was a small subgroup who also reported higher levels of both Habitual Action and Reflection. Overall, the results showed that PBL does promote the development of reflective thinking, particularly for first-year students, but that this development is not sustained consistently after that. This pointed to other possible factors that could hinder students’ development of reflective thinking in PBL. KeywordsReflection–Critical reflection–Transformative learning–Problem-based learning–Higher education–Reflection questionnaire
Article
Debriefing is a process involving the active participation of learners, guided by a facilitator or instructor whose primary goal is to identify and close gaps in knowledge and skills. A review of existing research and a process for identifying future opportunities was undertaken. A selective critical review of the literature on debriefing in simulation-based education was done. An iterative process of analysis, gathering input from audience participants, and consensus-based synthesis was conducted. Research is sparse and limited in presentation for all important topic areas where debriefing is a primary variable. The importance of a format for reporting data on debriefing in a research context was realized and a "who, when, where, what, why" approach was proposed. Also, a graphical representation of the characteristics of debriefing studies was developed (Sim-PICO) to help guide simulation researchers in appropriate experimental design and reporting. A few areas of debriefing practice where obvious gaps that deserve study were identified, such as comparing debriefing techniques, comparing trained versus untrained debriefers, and comparing the effect of different debriefing venues and times. A model for publication of research data was developed and presented which should help researchers clarify methodology in future work.
Article
This paper describes the development, implementation and evaluation of a clinical skills course for pharmacist independent and supplementary prescribers. The aim of the course was to develop the clinical and procedural skills of pharmacists to enable safe practice at an advanced level, in conjunction with their prescribing role. The development of the programme used qualitative data from interviews with practising pharmacists, senior pharmacists and clinical skills teachers to identify the list of procedural skills to be learned and practised. On completion of the programme participants were asked to provide written feedback on the content, learning and reaction in practice. Feedback from the participants was positive, with high satisfaction reported in terms of workshop organisation, content, teaching and skills practice. Participants completed an objective structured clinical examination (OSCE) at the end of the workshop, and the results for each of the five skill stations tested were good. Participants also kept a reflective logbook in practice, detailing when and how they used the skills learned during the workshop. This is the first national clinical skills assessment course of its kind to be undertaken in support of the development of a standardised approach to clinical and procedural skills. The use of structured learning with simulation, simulated and real patients, standardised procedural checklists, and peer learning and support has led to a very successful course for participants across Scotland. The clinical skills assessment course is easily transferable across professions, and could be used to develop safe and effective clinical skills practice in a wide range of settings.
Article
The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training. Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and non-verbal forms of communication. Eighty-one nursing students participated in the study. The data were collected in February and March, 2008. Video recordings from 28 simulated cardiac arrest situations in a nursing programme were analysed. Firstly, all communicative actions were coded and quantified according to content analysis. Secondly, interaction analysis was performed to capture the significance of verbal and non-verbal communication, respectively, in the moment-to-moment coordination of the team. Three phases of coordination in the resuscitation team were identified: Stating unconsciousness, Preparing for resuscitation, Initiating resuscitation. Coordination of joint assessments and actions in these phases involved a broad range of verbal and non-verbal communication modes that were necessary for achieving mutual understandings of how to continue to the next step in the algorithm. This was accomplished through a complex interplay of taking position, pointing and through verbal statements and directives. Simulation-based environments offer a promising solution in nursing education for training the coordination necessary in resuscitation teams as they give the opportunity to practice the complex interplay of verbal and non-verbal communication modes that would otherwise not be possible.
Article
Nurses and nursing students need good mathematics skills to do drug calculations correctly. As part of their undergraduate education, Norwegian nursing students must take a drug calculation test, obtaining no errors in the results. In spite of drug calculation tests, many adverse events occur, leading to a focus on drug administration skills both during students' courses and afterwards. Adverse events in drug administration can be related to poor mathematics skills education. The purpose of this study was to investigate the relationship between students' mathematics experiences in school (primary, secondary and high school) and their beliefs about being able to master the drug calculation test. A questionnaire was given to 116 first-year Bachelor of Nursing students. Those students who assessed their mathematics knowledge as poor found the requirement to obtain no errors in the drug calculation test more stressful than students who judged their mathematics knowledge as good. The youngest students were most likely to find the test requirement stressful. Teachers in high school had the most positive influence on mathematics interest, followed by teachers in secondary and primary school.
Article
Debriefing is essential element of simulation; however, practices vary greatly. Common elements include critique, correction, and evaluation of student performance and discussion of the experience. Learning occurs in simulation through contextual task training and repetition, but significant learning occurs when deep insight is made explicit through reflection during debriefing. The value of the student's learning is in the student's ability to engage in reflection that translates into actionable knowledge. Facilitating debriefing emphasizing reflection is an essential competency, yet little research and resources are available to guide best practices in debriefing. This article analyzes the concept of debriefing and identifies essential components. Examples that demonstrate defining attributes of debriefing are included. This work supports the identification of best practices and future research agendas to enable nurse educators to master the knowledge and strategies needed to provide students with significant learning during simulation.
The aim of this paper is to critically review what is felt to be important about the role of debriefing in the field of simulation-based learning, how it has come about and developed over time, and the different styles or approaches that are used and how effective the process is. A recent systematic review of high fidelity simulation literature identified feedback (including debriefing) as the most important feature of simulation-based medical education. 1 Despite this, there are surprisingly few papers in the peer-reviewed literature to illustrate how to debrief, how to teach or learn to debrief, what methods of debriefing exist and how effective they are at achieving learning objectives and goals. This review is by no means a systematic review of all the literature available on debriefing, and contains information from both peer and nonpeer reviewed sources such as meeting abstracts and presentations from within the medical field and other disciplines versed in the practice of debriefing such as military, psychology, and business. It also contains many examples of what expert facilitators have learned over years of practice in the area. We feel this would be of interest to novices in the field as an introduction to debriefing, and to experts to illustrate the gaps that currently exist, which might be addressed in further research within the medical simulation community and in collaborative ventures between other disciplines experienced in the art of debriefing.
We report on our experience with an approach to debriefing that emphasizes disclosing instructors' judgments and eliciting trainees' assumptions about the situation and their reasons for acting as they did. To highlight the importance of instructors disclosing their judgment skillfully, we call the approach "debriefing with good judgment." The approach draws on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through "reflective practice." This approach specifies a rigorous self-reflection process that helps trainees recognize and resolve pressing clinical and behavioral dilemmas raised by the simulation and the judgment of the instructor. The "debriefing with good judgment" approach is comprised of three elements. The first element is a conceptual model drawn from cognitive science. It stipulates that the trainees' "frames"--comprised of such things as knowledge, assumptions, and feelings--drive their actions. The actions, in turn, produce clinical results in a scenario. By uncovering the trainee's internal frame, the instructor can help the learner reframe internal assumptions and feelings and take action to achieve better results in the future. The second element is a stance of genuine curiosity about the trainee's frames. Presuming that the trainee's actions are an inevitable result of their frames, the instructor's job is that of a "cognitive detective" who tries to discover, through inquiry, what those frames are. The instructor establishes a "stance of curiosity" in which the trainees' mistakes are puzzles to be solved rather than simply erroneous. Finally, the approach includes a conversational technique designed to bring the judgment of the instructor and the frames of the trainee to light. The technique pairs advocacy and inquiry. Advocacy is a type of speech that includes an objective observation about and subjective judgment of the trainees' actions. Inquiry is a genuinely curious question that attempts to illuminate the trainee's frame in relation to the action described in the instructor's advocacy. We find that the approach helps instructors manage the apparent tension between sharing critical, evaluative judgments while maintaining a trusting relationship with trainees.
Article
Experiential learning is particularly useful in vocational education programs where theory needs to be linked to practice. Although experiential learning is often advocated in nursing education and the importance of debriefing and reflection is almost always espoused, the focus in the literature has tended to be on detailed descriptions of the action phase with little close analysis of how the reflective phase is facilitated. The Lewinian model described by Kolb [Experiential Learning. Experience as Source of Learning and Development, Prentice-Hall, New Jersey, 1984] and the structuring approach suggested by Thiagarajan [Experiential Learning Packages, Prentice-Hall, Englewood Cliffs, NJ, 1980] have been used as the theoretical context for an exploration of how nurse teachers describe their facilitation of the debriefing and reflective phases of experiential learning activities. Explication of the entire planned experiential learning experience is important for increasing the chances of the student being able to close the experiential learning loop. The more covert reflective phases for facilitating experiential learning are crucial and if neglected, or inexpertly and insensitively handled, may at best lead to poor learning outcomes or at worst lead to emotional damage and ;unfinished business' for the student. Interviews with eight experienced university educators elicited descriptions of how they constructed experiential activities with special reference to their descriptions of how the debriefing or reflective phases were structured.
Article
Reflection is a vital skill in contemporary nursing with student nurses expected to engage in reflective learning from the very beginning of the nurse educational programme. This article demonstrates the meaningful learning that resulted as a consequence of using critical reflection on practice. Gibbs' (1988) cycle aided the process highlighting the practical application of this cyclical framework to the author - a first-year student nurse. Matters concerning gender issues in nursing and professional conduct emerged from the analysis and were inherently explored. The article concludes by demonstrating the personal benefits of using Gibbs' (1988) cycle to varying situations and thus promoting its excellence as a learning tool for student nurses worldwide as a consequence.
Article
This paper is a review of the literature on reflection. The purpose was to unravel and make sense of the complex literature, and to identify the skills required to engage in reflection. An analysis of the literature revealed that differences between authors' accounts of reflective processes are largely those of terminology, detail and the extent to which these processes are arranged in a hierarchy. Key stages of reflection are identified and represented by a model. Skills required to engage in reflection were found to be implicit in the literature and these are identified. Methodological issues related to empirical literature are discussed. It is suggested that reflection is an important learning tool in professional education and that the skills required for reflection need to be developed in professional courses.
Article
Educational models and approaches change over time in their dominance and use, offering a wide selection to educational planners and teachers. This paper discusses aspects of experiential learning, distance learning, learning contracts, portfolios, reflection, appraisal, assessment and validation of education. It offers triggers to further thought and enables the analysis of current educational practice.
Article
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.
Et eksplorativet studie av faktorer der påvirker sikkerheten af patient-overgange (An Explorative Study of Factors Influencing Safety in Patient Handovers) [dissertation]
  • Dyrholm Siemensen
Dyrholm Siemensen IM. Et eksplorativet studie av faktorer der påvirker sikkerheten af patient-overgange (An Explorative Study of Factors Influencing Safety in Patient Handovers) [dissertation]. Lyngby, Denmark: Denmarks Technical University; 2011.
Debriefing: theory and technique Manual of Simulation in Healthcare
  • B Flanagan
Flanagan B. Debriefing: theory and technique. In: Riley RH, ed. Manual of Simulation in Healthcare. Oxford: OUP Oxford; 2008:155Y170.
Introduction of a new reflective framework to enhance students' simulation learning: a prelimnary evaluation Available at: http://hdl.handle.net
  • I Jones
  • G Alinier
Jones I, Alinier G. Introduction of a new reflective framework to enhance students' simulation learning: a prelimnary evaluation. Available at: http://hdl.handle.net/2299/6147. Accessed September 15, 2012.