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The 3D Model of Debriefing: Defusing, Discovering, and Deepening

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Abstract

The experiential learning process involves participation in key experiences and analysis of those experiences. In health care, these experiences can occur through high-fidelity simulation or in the actual clinical setting. The most important component of this process is the postexperience analysis or debriefing. During the debriefing, individuals must reflect upon the experience, identify the mental models that led to behaviors or cognitive processes, and then build or enhance new mental models to be used in future experiences. On the basis of adult learning theory, the Kolb Experiential Learning Cycle, and the Learning Outcomes Model, we structured a framework for facilitators of debriefings entitled "the 3D Model of Debriefing: Defusing, Discovering, and Deepening." It incorporates common phases prevalent in the debriefing literature, including description of and reactions to the experience, analysis of behaviors, and application or synthesis of new knowledge into clinical practice. It can be used to enhance learning after real or simulated events.

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... Learners are less likely to participate if they feel they are being judged (Zigmont et al 2011b). ...
... In its criteria for debriefing following a simulation exercise, the INACSL states that the debrief 'should be congruent with the objectives and outcomes of the simulationbased experience' (INACSL Standards Committee 2016a). There are various debriefing tools that can be used to ensure a simulation exercise has been effective, including the 3D model of debriefing that enables participants to 'defuse, discover and deepen' their learning (Zigmont et al 2011b). If the simulation exercise is not followed by debriefing with a recognised tool, it can have potentially detrimental effects on participants, such as embarrassment and reduced confidence (INACSL Standards Committee 2016b). ...
... The simulation exercise was undertaken with a large number of observers and participants, and it was important to include everyone in the debriefing. The 3D debriefing model (Zigmont et al 2011b) was adapted to ensure all students benefited. ...
Article
Covid-19 has presented global challenges to all aspects of healthcare, including nurse education. This article describes an innovative approach at Birmingham City University to ensure student nurses continue to have simulated learning experiences. A planned patient simulation event for 500 students was redesigned to be delivered in groups of 10 via Microsoft Teams. There was a particular focus on developing the students’ growth mindset, with an emphasis learning from challenges and recognising what could have been done differently. The evaluation showed that the simulation was beneficial to students and had increased their confidence.
... Cells with k ≤ 1 are not reported. The references that serve as the basis for each of the AAR approaches are as follows: advocacy inquiry model (Senge, 1994); US Army's AAR (Department of the Army, 1993; Morrison & Meliza, 1999;Sawyer & Deering, 2013;Villado & Arthur, 2013); debriefing for meaningful learning (Dreifuerst, 2012); debriefing with good judgment (Rudolph et al., 2006); defusing, discovering, and deepening (Zigmont et al., 2011); and description, analysis, and application (Fanning & Gaba, 2007 Content courtesy of Springer Nature, terms of use apply. Rights reserved. ...
... In their conceptual review, Sawyer et al. (2016) identified seven common AAR approaches. We aggregated multiple effects from three of those approaches-debriefing with good judgment (Rudolph et al., 2006), defusing, discovering, and deepening (Zigmont et al., 2011); and the US Army's AAR (Department of the Army, 1993; Morrison & Meliza, 1999;Sawyer & Deering, 2013;Villado & Arthur, 2013)-in addition to four other approaches not identified by Sawyer et al. (2016), advocacy inquiry model (Senge, 1994); debriefing for meaningful learning (Dreifuerst, 2012); description, analysis, and application (Fanning & Gaba, 2007); and Steinwachs's (1992) approach. To be clear, these approaches all share the same underlying process of an action or event, feedback, reflection, and discussion; however, there are now a variety of ways in which this information can be elicited (Sawyer et al., 2016). ...
Article
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This study expands on Keiser and Arthur's (2021) meta-analysis of the after-action review (AAR), or debrief, by examining six additional task and training characteristics that contribute to or attenuate its effectiveness. The findings based on a bare-bones meta-analysis of results from 83 studies (134 ds [955 teams; 4,684 individuals]) indicate that the effectiveness of the AAR (overall d = 0.92) does indeed vary across the pertinent characteristics. The primary impact of this study pertains to the practical implementation of AARs; notably, the findings indicate that the AAR is particularly effective in task environments that are characterized by a combination of high complexity and ambiguity in terms of offering no intrinsic feedback. The types of tasks-often project and decision-making-that more commonly entail these characteristics are frequently used in industries that do not traditionally use the AAR. The results also suggest that more recent variants of the AAR (i.e., a reaction phase, a canned performance review) do not meaningfully add to its effectiveness. These findings are combined with those from prior meta-analyses to derive 11 empirically-based practical guidelines for the use of AARs. In sum, this study highlights the complexity of the AAR that results from the independent and interdependent influence among various components and characteristics, the examination of the effects of novel and ostensibly distinct variants or approaches to AARs, and the extension of AARs to tasks and contexts in which they are less commonly used.
... This transformational learning can occur during simulations and the subsequent debriefing sessions. Students rely on their previous knowledge and experiences while simultaneously gaining new skills and abilities as the scenario unfolds, informing their future actions and behaviors as healthcare professionals (Cranton, 2006;Zigmont et al., 2011). ...
... These unpredictable and perhaps even jarring circumstances are the types of situations that students often talk about in the classroom and may encounter in future fieldwork rotations and/or clinical practice but do not typically get to practice in simulations. While all the students may not have responded in the way they wanted or needed to, through the debriefing sessions and subsequent reflection, students considered how to integrate these new experiences with current behaviors and understanding leading to transformational learning, evidenced by an identification of areas for room to grow and evidence of growth (Cranton, 2006;Merriam & Bierema, 2014;Rutherford-Hemming, 2012;Zigmont et al., 2011). Perhaps occupational therapy programs need to consider how they can incorporate more unexpected situations or end of life scenarios into their simulation experiences. ...
Article
Occupational therapy programs are incorporating simulation experiences more regularly into their curricula. However, there continues to be a need for more evidence demonstrating simulation benefits, particularly when various client populations, standardized actors, interpersonal skill practice, and multiple disciplines are incorporated into scenarios. The purpose of this qualitative descriptive study was to describe the meaning and impact of participating in an interprofessional simulation for occupational therapy students as part of their current academic preparation and future clinical practice in the hopes of increasing the participants’ interpersonal and clinical reasoning skills. Study participants were entry-level occupational therapy doctoral students (N=64) and their written reflections represented the collected data. The interprofessional simulation involved standardized actors and challenged students’ interpersonal skills as they responded to an unexpected and emotionally charged situation. Data were analyzed line by line and incident-to-incident, and ultimately organized into a categorical structure. There were four major categories: Simulation experience, Student meaning, Future clinical impact, and Multifactorial impact. Study results suggest: 1) occupational therapy students appreciate and benefit from simulation experiences; 2) standardized actors decrease familiarity for students and adds realism; and 3) interprofessional education opportunities contribute to students’ understanding of their own role and the roles of other disciplines. When designing simulation experiences, faculty should consider incorporating unexpected circumstances to challenge the student’s interpersonal skills, using a combination of high fidelity simulations with standardized actors, and including as many disciplines as possible to fully reflect the diversity and extensive skills of the interdisciplinary team.
... 7 The International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: Simulation Design and Kolb's Experiential Learning Theory guided the design and development of the escape room. [8][9][10] Students' learning objectives for the pediatric escape room were to: apply the nursing process; use critical thinking, clinical reasoning, and clinical judgment skills; collaborate and effectively communicate with group members; and provide safe and competent client care. ...
... The 3D Model of Debriefing guided this 50-minute session. 10 Debriefing gave students an opportunity to consider their strengths and areas for improvement. Reflection questions included: How did it feel to work through the pediatric escape room? ...
Article
Existing challenges associated with pediatric clinical placements for pre-licensure nursing students were heightened when clinical agencies halted nursing student entry in response to the COVID-19 pandemic. At the same time, the pandemic created opportunities for innovative teaching strategies for pediatric clinical rotations in nursing education. The purpose of this project was to design, develop, and implement meaningful, interactive, and intentional clinical experiences for nursing students that enhanced their pediatric assessment skills, reduced their anxiety about pediatric inpatient care, and advanced their proficiency in the nursing process. Two simulated clinical experiences were created: (1) a virtual pediatric physical assessment checkoff and (2) a pediatric escape room. The pediatric physical assessment checkoff was performed in a remote, virtual setting while students used personal resources to demonstrate their assessment skills. For the escape room, students worked in small, in-person groups using the nursing process to unlock clues to improve their client's health condition. Students reported gaining meaningful clinical experiences through simulation that allowed them to apply their nursing knowledge and increased their confidence in pediatric assessment skills, dosage calculation competency, communications and interactions with the pediatric population, and teamwork abilities. The virtual pediatric physical assessment checkoff and the pediatric escape room were enjoyable and beneficial educational events that facilitated student learning.
... The present results are therefore of major importance for the design of innovative combined BFB and tDCS interventions and should now be confirmed in patients suffering from stress-related disorders before being implemented in clinical settings. While fixed 6 bpm breathing is convenient and efficient , future studies investigating long term effects of combined BFB and tDCS might benefit from a priori determination of individual resonance frequency following Lehrer's procedure [22]. Training individual to their 151 own respiratory frequency is expected to be more comfortable for participant and further potentiate the biofeedback effectiveness of repeated interventions. ...
... Simulations were always structured as follows: briefing (one to five min), scenario (10 to 20 min), and debriefing (30 to 45 min). [21][22][23] The scenarios dealt with crisis situations in the intensive care unit, operating room, and delivery room (TAMPONADE, NEONATAL, AMNIOTIC FLUID, PACEMAKER), no residents performed these scenarios beforehand (App. A). ...
Thesis
Full-text available
Le stress survient lorsque les exigences d’une situation dépassent la capacité d'adaptation individuelle. Le stress est une cause majeure d’invalidité due à ses effets néfastes sur les fonctions exécutives et ses complications sur la santé psychique et physique. Notre approche pluridisciplinaire s’ancre dans la continuité des récents travaux questionnant ses impacts, les outils de remédiation, et les sensibilités individuelles au stress. Le 1er objectif de cette thèse était de déterminer l’impact d’un stress aigu sur les capacités d’imagerie motrice (études 1, 2). Nos résultats montrent un maintien des capacités explicites et une détérioration des capacités implicites pendant et suite à un évènement stressant. Le 2nd objectif était de caractériser la période d’anticipation d’un évènement stressant, pour cela nous avons créé et testé un nouveau protocole le Trier Social Anticipatory Stress Test (étude 3). Alors que peu de moyens d’action sont envisagés pour faire face au stress aigu, le traitement habituel d’un stress chronique repose principalement sur une prise en charge médicamenteuse et des thérapies comportementales. Ces traitements peuvent entraîner des effets secondaires, des résistances et souffrir d’une faible adhésion. Il est donc nécessaire de trouver de nouvelles approches non-invasives. Le 3ème objectif était d’explorer des techniques de remédiation du stress (études 3, 4, 5, 6). Nous avons comparé l’efficacité de 4 techniques de gestion émotionnelles administrées pendant un stress d’anticipation : respiration relaxante (RESPIRATION), rétrocontrôle biologique cardiaque (VFC-RETRO), stimulation cérébrale du cortex préfrontal dorsolatéral (STCC), VFC-RETRO couplé à la STCC (VFC-RETRO + STCC). Ces techniques ont été explorées au laboratoire et durant un stress professionnel médical (simulation de soins critiques). Nos résultats indiquent que les interventions ont des effets psychophysiologiques et comportementaux spécifiques. Hormis la STCC, elles sont toutes efficaces pour réduire le stress. Comparativement à une condition contrôle, 5 min de RESPIRATION permettent d’augmenter la relaxation subjective et objective durant l’anticipation. Lorsque la respiration est couplée à un VFC-RETRO, on observe une augmentation significativement plus importante de ces marqueurs. Comparativement à une condition contrôle, 15 min de VFC-RETRO augmentent la variabilité de la fréquence cardiaque et réduit le ressenti global de stress (études 3, 4). Un couplage VFC-RETRO + STCC permet de potentialiser ces effets, d’induire une relaxation immédiate et une réduction du stress global plus importante. Concernant les performances, la RESPIRATION et le VFC-RETRO permettent d’améliorer les ressentis subjectifs de performances (études 3, 4, 5, 6). L’impact positif objectif du VFC-RETRO sur les fonctions exécutives est confirmé uniquement lorsque le niveau de base des individus est pris en compte (étude 4). Ces résultats permettent d’envisager la mise en place de techniques de remédiation du stress à grande échelle, même si les réponses de stress font l’objet de variabilités interindividuelles qui doivent être considérées. Ainsi, le 4ème objectif était d’évaluer l’influence de la personnalité sur la sensibilité au stress et l’efficacité des techniques de gestion émotionnelle (étude 7). Nos résultats montrent que les traits de névrosisme, d’extraversion et le caractère consciencieux sont importants à prendre en compte. Nos études démontrent pour la première fois l’intérêt des interventions préventives de très courtes durées, pour prévenir les réponses psychophysiologiques (VFC-RETRO + STCC > VFC-RETRO > RESPIRATION) et les détériorations cognitives fréquemment observées lors d’un stress aigu. Ces travaux ouvrent de nombreuses perspectives dans le traitement préventif et individualisé des maladies associées au stress.
... The present results are therefore of major importance for the design of innovative combined BFB and tDCS interventions and should now be confirmed in patients suffering from stress-related disorders before being implemented in clinical settings. While fixed 6 bpm breathing is convenient and efficient , future studies investigating long term effects of combined BFB and tDCS might benefit from a priori determination of individual resonance frequency following Lehrer's procedure [22]. Training individual to their 151 own respiratory frequency is expected to be more comfortable for participant and further potentiate the biofeedback effectiveness of repeated interventions. ...
... Simulations were always structured as follows: briefing (one to five min), scenario (10 to 20 min), and debriefing (30 to 45 min). [21][22][23] The scenarios dealt with crisis situations in the intensive care unit, operating room, and delivery room (TAMPONADE, NEONATAL, AMNIOTIC FLUID, PACEMAKER), no residents performed these scenarios beforehand (App. A). ...
Thesis
Full-text available
Stress occurs when situational demands exceed the individual's ability. Stress is a major cause of disability due to its detrimental effects on executive functions and its complications on psychological and physical health. Our multidisciplinary approach is in line with recent works seeking the impacts, remediation tools, and stress-related individual sensitivities. The first aim of this thesis was to determine the impact of acute stress on motor imagery ability (studies 1,2). Our results showed a deterioration of implicit motor imagery abilities following a stressful event and a maintenance of explicit abilities both during and following stress. The 2nd goal of our work was to characterize the stress anticipation period by developing a new tool: the Trier Social Anticipatory Stress test. While few interventions are designed to deal with acute stress, the usual treatment of chronic stress mainly relies on medication and behavioral therapies. These treatments can elicit side effects, resistance and poor adherence. It is therefore necessary to find non-invasive alternatives. The 3rd main was thus to explore several stress remediation techniques (studies 3,4,5,6). We compared the effectiveness of four coping techniques administered during an anticipatory stress period: relaxing breathing (BREATHING), cardiac biofeedback (BFB), dorsolateral prefrontal cortex cerebral stimulation (TDCS), cardiac biofeedback paired with tDCS (BFB + TDCS). These techniques were explored in the laboratory (studies 3,4) or during a medical occupational stress (critical care simulation) (studies 5,6,7). Our results indicate that the interventions have specific psychophysiological and behavioral effects. With the exception of tDCS, they are all effective for reducing stress. Compared to a control condition, 5 min of BREATHING increases subjective and objective relaxation during anticipation (studies 5,6), when breathing is paired with a BFB, a significantly greater increase is observed (studies 6). Compared to a control condition, 15 min of BFB increase heart rate variability and reduce the global feeling of stress (studies 3,4). The additional tCDS potentiates BFB effects, inducing immediate relaxation and a greater reduction in overall stress (studies 4). Concerning performance, BREATH and BFB improve subjective feelings of performance (studies 3,4,6). While some of our studies objectivate this increase in performance (studies 5,4), others show no difference with the control group (studies 3,6). When individuals baseline level is considered, the positive impact of BFB on executive functions is confirmed (studies 4). These results make it possible to envisage the implementation of large-scale stress remediation techniques, although stress responses remain subjected to inter-individual variability. Thus, the 4th goal was to evaluate the influence of personality on stress sensitivity and the effectiveness of emotional management techniques (studies 7). Our results show that neuroticism, extraversion, and conscientiousness are important traits to consider. Our studies demonstrate, for the first time, the interest of very short duration proactive interventions, to prevent psychophysiological responses (BFB + STCC > BFB > BREATH) and cognitive deteriorations (BFB) which are frequently observed during acute stress. This work offers fruitful perspectives in preventive and individualized treatment of stress-related diseases.
... La escala diferenciada entre desempeño inexperto, medio y experto aporta una puntuación de referencia de su capacidad técnica. Adicionalmente, estudios complementarios concluyen que, al finalizar las sesiones y actividades programadas en simulación y práctica, se aconseja incluir un interrogatorio o retroalimentación (debriefing) entre los estudiantes o, entre estos y los docentes [29][30][31] . Esto favorece la construcción del conocimiento de tipo práctico centrado en los objetivos trazados, que busca determinar aprendizajes reales, haciendo frente a posibles vacíos de conocimiento que pueden ser identificados y suplidos por los docentes de manera eficiente. ...
Article
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Introducción. La simulación como estrategia de aprendizaje activo se ha constituido en una herramienta centrada en el estudiante, para la construcción de aprendizajes en entornos seguros y el perfeccionamiento de sus habilidades técnicas. La evaluación objetiva estructurada de habilidades técnicas (OSATS, por sus siglas en inglés) es una herramienta evaluativa en el área quirúrgica, que puede ser implementada en los programas en microcirugía. Métodos. Estudio descriptivo, de corte transversal y doble ciego, donde se incluyeron 34 estudiantes de especialidades quirúrgicas, quienes fueron evaluados mediante los OSATS para los módulos finales: módulo 1: disección vascular; módulo 2: ejecución de sutura de puntos independientes; y módulo 3: ejercicios de revascularización. Al finalizar la materia, los estudiantes evaluaron la implementación de esta metodología por medio de una encuesta de satisfacción. Resultados. La evaluación del diseño de la guía práctica tipo OSATS por los estudiantes fue satisfactoria (88,2 %). Al evaluar la actividad de disección y sutura en microcirugía la consideraron de gran utilidad (88,2 %), para los ejercicios de anastomosis y revascularización (aprobación del 79,5 %). La aplicabilidad práctica y la calidad de los ejercicios mediante guías de evaluación OSATS tuvieron 94,2 % de aceptación. Conclusión. Las escalas OSATS son un instrumento útil, valido y objetivo para el modelo de evaluación por competencias en habilidades técnicas, que puede ser implementado en los modelos de enseñanza en simulación, contando con confiabilidad, validez de contenido y de constructo. Es aplicable en los programas de microcirugía, con una percepción positiva por parte de los estudiantes.
... It begins with Prebriefing, moves on with the steps of Discovering and Deepening, and ends with the targeted learning outcomes. 21 After the simulation, the model encourages participants to learn in the debriefing session. It accompanies the learning process in a similar way to other debriefing models. ...
Article
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Simulation-based education provides the transfer of the theoretical and practical knowledge gained in the learning environment to the clinical environment. Learning in a clinical simulation takes place in debriefing. Accordingly, debriefing is the main component of clinical simulation. Debriefing is conducted under the management of a facilitator and is an activity performed after the simulation. Debriefing facilitates participants’ critical thinking through reflective thinking. The primary goal in performing a debriefing is to allow facilitators and participants to participate in and reflect on the simulated clinical experience. There are various models used to facilitate the information-sharing process in a debriefing. Several models have been proposed for discussions after simulation, which have been categorized as three-phase, multiphase, and other debriefing models and frameworks. In this review, the importance and methods of debriefing in simulation-based education are discussed. Keywords: Simulation, debriefing, methods, nursing education, student
... We identified Kolb's cycle of experiential learning including a concrete experience, reflective observation, abstract conceptualization, and active experimentation as a foundation on which to structure our curriculum. 10,11 During their orientation to our clinic, PGY-1 residents received 1 hour of small group didactics on telemedicine. This didactic included a brief overview of the field of telemedicine, strategies for appropriately triaging patients between clinical venues, and an overview of virtual care etiquette. ...
Article
Background: The rapid transition to telemedicine at the onset of the COVID-19 pandemic required many providers to learn telemedicine "on the fly." As virtual care will likely remain a mainstay of outpatient medicine, it is imperative that telemedicine training be incorporated into graduate medical education. Aim: Design a telemedicine curriculum for internal medicine residents based on principles of experiential learning. Setting: VA-based internal medicine primary care clinic. Participants: Sixteen first-year internal medicine residents participated in the curriculum. Program description: The curriculum included a didactic session followed by four simulated patient encounters focused on troubleshooting technical issues, performing the virtual physical exam, coordinating team-based care, and tackling emergencies. Program evaluation: Participants reported minimal previous experience with telemedicine. After completing the training, resident confidence in conducting video visits increased from an average score of four to seven (on a 10-point scale). Residents were more likely to agree that video visits would allow them to build bonds and effectively address their patients' needs. This increased confidence persisted at 3 months after training. Discussion: Using experiential learning, we identified strategies which increased the confidence of internal medicine trainees in conducting telemedicine visits. Further research is needed to validate our findings across different practice settings.
... 7 In other words, the use of simulation allows the creation of activities according to the needs of the participants, through experiences, followed by a moment of guided reflection on the participant's performance in the activity, known as debriefing, which has a direct impact on the theoretical knowledge of the student and their professional practice. [8][9][10] ...
... There were several debriefing frameworks in virtual simulation teaching. One of the models was "3D Model of Debriefing" (Zigmont et al., 2011). The 3D Model of Debriefing provides a structured framework for students and facilitators to share the simulation experiences. ...
Article
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Aims and objectives This study aimed to evaluate the effect of a virtual simulation education programme with debriefing in undergraduate nursing students. Perceived clinical competence and learning needs of students in a simulation environment were also measured. Background Evidence showed virtual simulation education programmes provided better knowledge acquisition. However, these studies to date did not incorporate virtual simulation in the combination of a debriefing model in nursing students. Design A one-group pre-test and post-test design. Methods 188 final year undergraduate nursing students participated in the study. Linear mixed model analysis was conducted to evaluate the effect of the programme. Results Students have perceived a significant improvement in clinical competence and nursing process. Self-efficacy has also boosted. Communication and critical thinking were applied better in the traditional clinical environment. Conclusion Perceived clinical competence of Chinese nursing students has significant improvements by using virtual simulation combining a debriefing model during the COVID-19 period. Virtual simulation met students' learning needs. Future studies should include a control group for comparison and long-term measurement. Relevance to clinical practice The study provided an innovative clinical learning pedagogy to serve as a potential alternative with traditional clinical practicum during the COVID-19 period as this is substantially limited.
... In the description phase of the debriefing, students freely express their emotional reactions to the simulation experience, while a facilitator guides the reflection by providing a safe environment for openness by giving feedback in an encouraging and positive way [29,31]. In the analysis phase, the students identify behaviors in the simulated scenario that have facilitated or impaired the clinical intervention and describe their thoughts and knowledge related to the simulation activities. ...
Article
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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.
... Debriefing in simulation allows learners to actively reflect on the simulation experience, thereby deepening learning and promoting abstract conceptualization. 31 Although weekly feedback was provided to the participants, it could not be determined whether any learner reflection occurred. Therefore, learning through virtual simulation alone was not effective in changing practice. ...
Article
Purpose/aims: The purpose of this quality improvement project was to examine the use of video-simulated scenarios and mobile technology to improve accuracy of emergency department (ED) nurses' triage using the Emergency Severity Index (ESI). Design: A quality improvement project with a pre/post educational intervention design consisting of a convenience sample (n = 33) of ED registered nurses (RNs) at a large tertiary hospital in the Midwest was used. Methods: A retrospective chart review (n = 495) was completed to obtain ESI accuracy for each triage RN. For 12 consecutive weeks, the ED RNs received different video simulations via mobile technology to determine the ESI level. After receiving their scores, the project team provided the RNs the correct ESI score with rationale via mobile technology. Post intervention, a retrospective chart review was conducted to evaluate RNs' ESI accuracy. Results: Results of this ED triage educational intervention to improve the accuracy of ED nurses' ESI scores were not significant; however, this novel approach may be considered in addition to other teaching strategies to improve outcomes. Conclusions: Triage nurses' ESI scoring accuracy can be inconsistent. Therefore, to ensure patients are receiving prompt and appropriate care for their acuity level, it is important to continuously provide education on ESI scoring.
... The "D.E.B.R.I.E.F." model establishes a mnemonic to guide debriefing: Define rules, Explain learning objectives, Bench marks for performance, Review what should happen, Identify what happened, Examine why, and Finalize/formalize learning. In the "3D Model, " three phases are also proposed: Defusing, Discovering and Deepening (29,34) and the "GAS method" proposes: Gather, Analyze and Summarize (29). Recently a type of debriefing that we know as CORE Debriefing has been introduced, which has 4 phases: Compression, Observation, Reflection and Exchange. ...
Article
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In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
... Among learning theories, Kolb's experiential learning is frequently cited as the theoretical framework underpinning simulation-based learning (Sandars, 2009;Zigmont et al., 2011b). ...
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La simulation est devenue un outil pédagogique incontournable dans la formation et le développement des professionnels de santé tant sur un plan individuel que sur le plan du travail en équipe. Cependant, face à l’utilisation croissante de la simulation pour les formations en santé, nombre de questions persistent quant aux mécanismes en jeu dans l’apprentissage par simulation ainsi qu’aux modalités pédagogiques à mettre en œuvre pour optimiser l’efficacité de ces formations. L’objectif de ce travail de thèse vise d’abord une meilleure compréhension du processus d’apprentissage expérientiel à l’œuvre lors d’une session d’apprentissage par simulation pour ensuite proposer une structuration des phases du débriefing susceptibles de favoriser l’acquisition de nouvelles connaissances déclaratives et procédurales. Une première étude a permis de montrer l’efficacité de la mise en place de situations simulées lors des formations aux gestes et soins d’urgence. Une deuxième étude a confirmé l’intérêt d’un programme de simulation construit selon les principes d’apprentissage expérientiel de Kolb (1984) sur les réactions, apprentissages et comportements de soignants expérimentés travaillant en équipes pluri-professionnelles de structure mobile d’urgence et de réanimation (SMUR). Ce travail s’est ensuite centré sur la place accordée au débriefing dans l’apprentissage par simulation. Une troisième étude a précisé la place du débriefing dans l’évolution du sentiment d’efficacité personnelle des apprenants et, dans la lignée des travaux sur l’enseignement explicite, a montré la supériorité des approches structurées et explicites du débriefing par rapport aux approches implicites et réflexives pour l’apprentissage de connaissances déclaratives chez les apprenants novices (étudiants infirmiers). Une quatrième étude a ensuite montré que, pour des apprenants expérimentés en équipes pluri-professionnelles de service d’urgence, le débriefing explicite s’avérait aussi efficace qu’un débriefing réflexif sur l’évolution des connaissances déclaratives, du sentiment d’efficacité personnelle ainsi que sur les modifications comportementales. Sur un plan pragmatique, les résultats de ce travail apportent des éléments pour la mise en œuvre d’une session d’apprentissage par simulation en santé et notamment sur la manière de structurer les différentes séquences de débriefing selon le public considéré.
... Each resident participated individually in one scenario. Simulations were always structured as follows: briefing (one to five min), scenario (10 to 20 min), and debriefing (30 to 45 min) [22][23][24]. The scenarios dealt with crisis situations in the intensive care unit, operating room, and delivery room (Tamponade, Neonatal, Amniotic Fluid, Pacemaker), no residents performed these scenarios beforehand (App. ...
Article
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Background Active participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation. Methods This randomized pilot study involved the fifth-year anesthesiology and critical care residents who participated in high-fidelity at Lyon medical simulation center in 2019. Residents were randomized into three parallel interventions: relaxing breathing, relaxing breathing paired with cardiac biofeedback, and control. Each intervention was applied for five minutes immediately after the scenario briefing. The primary endpoint was the overall performance during the simulation rated by two blinded independent investigators. The secondary endpoints included component scores of overall performance and changes in psychological states. Results Thirty-four residents were included. Compared to the control group, residents in the relaxing breathing (+ 7%, 98.3% CI: 0.3 to 13.7, P = 0.013) and relaxing breathing paired with cardiac biofeedback (+ 8%, 98.3% CI: 0.82 to 14.81, P = 0.009) groups had a higher overall performance score. Following the interventions, compared to the control group, stress level was lower when participants had performed relaxing breathing alone ( P = 0.029) or paired with biofeedback ( P = 0.035). The internal relaxation level was higher in both the relaxing breathing alone ( P = 0.016) and paired with biofeedback groups ( P = 0.035). Conclusions Performing five minutes of relaxing breathing before the scenario resulted in better overall simulation performance. These preliminary findings suggest that short breathing interventions are effective in improving performance during simulation. Trial registration The study protocol was retrospectively registered on clinicaltrials.gov ( NCT04141124 , 28/10/2019).
Chapter
Research studies surrounding feedback primarily centered on frameworks designed as models for delivering feedback as well as the timing for delivering feedback. In addition, past research has also focused on individual elements that affect performance with little regard to environmental elements. This case study provides an overview of how a nurse educator utilized a performance analysis approach to providing feedback to nursing students during clinical rotations. A list of performance standards was provided to students at various checkpoints during their clinical rotation. Strategies are shared for improving the type of feedback used in healthcare settings.
Article
OBJECTIVE Intimate partner violence (IPV) is a serious public health threat in the United States, affecting millions of individuals and families. The American Association of Colleges of Nursing recommends that nursing programs, both baccalaureate and graduate, provide students didactic training and clinical experience in the assessment and management of IPV. Our goal was to expose Psychiatric Mental Health Nurse Practitioner (PMHNP) students and Family Nurse Practitioner (FNP) students to a simulated IPV scenario so they are prepared to respond appropriately to a survivor’s disclosure of IPV when they begin clinical practice. METHOD We integrated a patient simulation scenario into our PMHNP and FNP curriculum. A combined group of PMHNP and FNP students participated in a simulation in which the standardized patient provided an unlikely explanation for her injuries. If students inquired about abuse, the patient revealed that she had experienced IPV. A pre- and posttest survey was used to evaluate student knowledge gain before and after the participating in the scenario. A Related Samples Wilcoxon Signed Rank Test was used to evaluate the results. RESULTS Compared with pretest scores, students demonstrated improved confidence in screening for IPV as well as responding to a disclosure of IPV. CONCLUSION Simulation provides a method to enhance student knowledge of incidence, risk, and best practices in relation to the screening, assessment and management of IPV.
Article
The simulation environment provides opportunities for students to practice interprofessional skills in an authentic, yet safe setting. We discuss an interprofessional learning activity called Team Care Planning designed to teach interprofessional teamwork using a simulated discharge meeting involving an elderly female patient who had a cerebral vascular accident (stroke) and her adult daughter, played by standardized patients Interprofessional teams of health professions students work together to discuss the discharge plan and meet with the patient/family. Teamwork is evaluated using the Jefferson Teamwork Observation Guide®, completed by the students, faculty observers, and standardized patients. Students also report their perception of knowledge and skills gained from the interprofessional activity in an electronic evaluation. Analysis of the data indicates the initial goals of the program are being met. Students report greater understanding of roles/responsibilities of team members; and students, faculty, and standardized patients rate the experience high in terms of the quality of the teamwork. Debriefing with faculty observers promotes student reflection on performance. Receiving feedback from the standardized patients informs student personal and professional development.
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Face à des injonctions éthiques et sociales, la formation des professionnels santé est devenue un défi en particulier dans la gestion des risques en situation critique. La simulation interprofessionnelle (SIP) est un dispositif de formation incontournable dans la formation des professionnels de santé. Cependant, le dispositif de SIP favorise les effets induits par l’asymétrie sociale (peur du jugement, conflits de pouvoir, rôles hiérarchiques) perturbant la régulation des conflits sociocognitifs à la base du processus d’apprentissage. Nous avons proposé une évolution du dispositif standard vers un dispositif de SIP avec un débriefing combiné (entretien individuel avant le débriefing collectif - CODIS). Une méthodologie de recherche mixte a été menée avec comme intention de « connaître pour objectiver » les effets du dispositif et de « connaître pour expliquer » les effets observés ou mesurés. L’hypothèse principale était que le dispositif CODIS était plus efficace que la SIP standard pour le développement des compétences des équipes de soins aigus dans la gestion de situation critique. Une approche multidimensionnelle a permis de conclure que CODIS était plus efficace dans la régulation des émotions, a amélioré les interactions sociales au moment du débriefing collectif et a diminué les tensions hiérarchiques avec comme résultante l’amélioration de la performance des équipes de soins aigus dans la gestion d’une situation critique en particulier dans les comportements liés au leadership. Une réflexion épistémologique nous a conduit à nous questionner sur les modèles d’évaluation des dispositifs de formation par simulation dans le domaine de la santé. Nous proposons une approche méthodologique différente suite à ce travail de recherche afin d’explorer les effets internes et externes du dispositif. De nouvelles recherches devront être menées dans une visée transformative.
Article
This project aimed to enhance clinical education preparation in a family nurse practitioner graduate program in rural central Appalachian by providing a psychomotor skills-based simulation with the use of the defusing, discovering, and deepening (3D) debriefing method. The students were surveyed after graduation to determine effectiveness. Program outcomes to measure readiness to practice were graduation, employment, and certification rates. The postgraduation surveys indicated the simulation contributed to an increase in psychomotor skill performance, practicing safe patient care, and making independent decisions in practice. Common themes emerged of feeling “prepared for practice” and being “more marketable” with the procedural skills learned in the simulation.
Article
Virtual reality simulation provides interesting opportunities to train nurses in a safe environment. While the virtual operating room has proven to be a useful training tool for technical skills, it has been less studied for non-technical skills. This study aimed to assess “Error recognition in a virtual operating room”, using a simulation scenario designed to improve situation awareness. Eighteen scrub-nurse students and 8 expert scrub-nurses took part in the experiment. They were immersed in a virtual operating room and reported any errors they observed. There were nineteen errors with various degrees of severity. Measures were retrieved from logs (number of errors, time for detection, movements) and from questionnaires (situation awareness, subjective workload, anxiety and user experience). The results showed that the participants who detected most errors had a higher level of situation awareness, detected high-risk errors faster and felt more immersed in the virtual operating room than those detecting fewer errors. They also felt the workload was lighter and experienced more satisfaction. Students explored the operating room more than experts did and detected more errors, especially those with moderate risk. Debriefings confirmed that virtual simulation is acceptable to trainees and motivates them. It also provides useful and original material for debriefings.
Chapter
Education and clinical training in neurosurgical anesthesiology have seen tremendous progress, however, the need for more uniform and structured training is increasingly recognized by accreditation bodies. Clinical training highly depends on the availability of institutional cases, and it is difficult to perform an adequate assessment of skill competencies in rare and high-stakes clinical events. These challenges are best addressed by simulation-based education and training. In this chapter, we present basic concepts and guidelines for the development of a structured neurosurgical anesthesia simulation curriculum. Simulation education training is suitable for the identification of performance gaps, training and assessment of skill acquisition, training in rare, high-stakes events, anesthesia crisis resource management, and nontechnical skills (decision-making, communication, and multidisciplinary team training). We also present the basics of simulation scenarios development. Simulation scenarios are learner-oriented, competence-based tools that address identified clinical performance gaps. To accomplish the best educational objectives, the simulation education curriculum should always be well integrated with clinical training.
Article
Debriefing facilitates student learning of critical concepts and faculty evaluation of simulation learning outcomes. However, effective practices in debriefing after virtual simulation, including the impact of software-generated performance feedback and asynchronous group debriefing, are not well understood. Student perceptions of two different methods of postsimulation debriefing were explored by comparing software-generated performance feedback only versus software-generated feedback combined with an asynchronous, faculty-facilitated, online discussion based on the 3D Model of Debriefing. The Debriefing Experience Scale was used to evaluate self-reported debriefing experiences in 68 advanced practice nursing students before and after implementation of an online discussion-board debriefing strategy. Students reported an improved debriefing experience when simulation software-generated feedback was combined with asynchronous online discussion compared with automated software-generated feedback alone. Implications for faculty are discussed including lessons learned to support online, asynchronous debriefing experiences, and how to engage students in meaningful discussions that triangulate feedback from the simulation software, peers, and their instructor.
Article
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Debriefing is an foundamental instructional approach of simulation-based medical education in the field of healthcare simulation. In order to improve the understanding of debriefing as an instructional approach and ensure the quality of simulation-based medical education, this paper reviews the relevant critical literatures of debriefing in simulation-based medical education, and outlined the essential elements and current development status of debriefing, debriefing models, different methods used in analyze phase of debriefing, as well as the research progress of debriefing in China and abroad. Despite various debriefing models, “debriefing with good judgment” would be more likely to assure better learner improvement. In the process of debriefing, directive feedback, students' self-assessment, and focused facilitation can be reasonably used. However, there are still room for future research on how these practices could be translated and better applied in China.
Article
Introduction : Le débriefing est une analyse postévénementielle qui est une partie fondamentale du processus d’apprentissage par simulation. Il est une évaluation formative permettant d’explorer les raisons des déficits de performance dans un objectif d’amélioration des performances. La revue après action (RAA) est une technique du débriefing développée par l’armée américaine et qui explore en équipe les intentions derrière les actions. L’objectif de ce travail a été de décrire les principes de la revue après action en tant que technique et d’en déterminer l’intérêt, les avantages et les inconvénients en simulation en santé, notamment en médecine d’urgence. Méthodes : Revue narrative de la littérature traitant du débriefing en simulation par revue après action. Après analyse de la littérature dans les bases Medline, Web of Science, ScienceDirect, Pascal & Francis et Defense Technical Information Center, les articles ont été inclus s’ils répondaient aux critères suivants : apprentissage par simulation, revue après action comme méthode de débriefing. Résultats : Quinze manuscrits ont été inclus. La revue après action permet une analyse non punitive et objective de la simulation. Ses principales forces sont d’analyser collectivement les performances d’équipe et de proposer des mesures correctives. Ses principales limites sont l’absence de débriefing individuel et son inefficacité en cas d’insuffisance de formation du débriefeur. Conclusion : La revue après action est un format de débriefing favorisant les apprentissages et l’amélioration des performances d’équipe, mais explore peu les performances individuelles.
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Review of ten years activities in Medical Simulation Centre Ljubljana
Article
Background: Human immunodeficiency virus (HIV) infection and opioid use disorder (OUD) often occur as comorbid conditions. Many nurse practitioners are treating these conditions in their practice. Problem: Most advanced practice registered nursing (APRN) students do not encounter a medically complex patient with both HIV infection and OUD during their clinical experiences. Approach: We present an unfolding simulated standardized patient scenario involving both HIV infection and OUD for APRN students. During each of 3 semesters, the students encounter the patient as he presents for a sexually transmitted infection, an OUD relapse, and, finally, new-onset HIV infection. The scenarios become increasingly complex as the students progress in their clinical experiences. Conclusion: This innovative series of scenarios introduces APRN students to complex comorbid patient situations, with many issues to consider.
Article
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Debriefing is an important phase in using simulation games. Participants are invited to make a connection between experiences gained from playing the game and experiences in real-life situations. Thus, debriefing is the phase meant to encourage learning fromthe simulation game. Although design and practice of debriefing sessions should be aligned to this aim, it is necessary to distinguish different forms or modes of learning. The authors’ central argument is that the shape of debriefing will have to meet the learning objectives being pursued in a concrete simulation game. They propose a general classification of learning objectives that allows a distinction to be made between types of use of simulation games. In each of the four types distinguished, the debriefing serves different purposes for which specific requirements can be formulated.
Article
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Human beings can be proactive and engaged or, alternatively, passive and alienated, largely as a function of the social conditions in which they develop and function. Accordingly, research guided by self-determination theory has focused on the social-contextual conditions that facilitate versus forestall the natural processes of self-motivation and healthy psychological development. Specifically, factors have been examined that enhance versus undermine intrinsic motivation, self-regulation, and well-being. The findings have led to the postulate of three innate psychological needs--competence, autonomy, and relatedness--which when satisfied yield enhanced self-motivation and mental health and when thwarted lead to diminished motivation and well-being. Also considered is the significance of these psychological needs and processes within domains such as health care, education, work, sport, religion, and psychotherapy.
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1969 to 2003, 34 years. Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. HEADLINE RESULTS: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.
Article
Because of their central role in treating patients, the effectiveness of EMS services depends on EMS professionals having the skills and knowledge to perform their jobs skillfully. The problem for administrators and policy makers who oversee EMS programs is how to create a learning system that effectively improves the medical service provided by Paramedics continuously. In this study, semi-structured interviews were conducted with eight experienced Paramedics at an exemplary ambulance agency. Data from this interpretive quality study were analyzed using a constant comparative. Participants indicated that their learning was enhanced by that components related to (1) their individual characteristics, (2) the quality of their experiences, and (3) features of their work environment. The individual characteristics that contributed to their learning included: a well-tuned learning orientation; a willingness to change their mental models; and an ability to use analogical reasoning skills. Experiences that contributed to their learning: challenged their current skill level; involved them emotionally; and involved mistakes or errors on their part. The environment in which they worked enhanced their learning by providing: access to information and resources; and access to skilled mentors.
Data
Debriefing is an important phase in using simulation games. Participants are invited to make a connection between experiences gained from playing the game and experiences in real life situations. Thus, debriefing is the phase meant to encourage learning from the simulation game. While design and practice of debriefing sessions should be aligned to this aim, it is necessary to distinguish different forms or modes of learning. Our central argument is that the shape of debriefing will have to meet the learning objectives being pursued in a concrete simulation game. We propose a general classification of learning objectives that allows a distinction to be made between types of use of simulation games. In each of the four types distinguished, the debriefing serves different purposes for which specific requirements can be formulated.
Article
The ways in which farmers put their visions into action are indicative of their mental models of farming. This qualitative study explored the nature of mental models of farming and their role in farming practices among a sample of small farm operators. Three themes emerged in the data indicating that farmers' mental models of farming are influenced by prior values and knowledge, serve as guides in learning and decision-making, and are unique to each farmer. Educators who consider the mental models of farmers are more likely to succeed in supporting farmers' development of new knowledge and skills.
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Intrinsic and extrinsic types of motivation have been widely studied, and the distinction between them has shed important light on both developmental and educational practices. In this review we revisit the classic definitions of intrinsic and extrinsic motivation in light of contemporary research and theory. Intrinsic motivation remains an important construct, reflecting the natural human propensity to learn and assimilate. However, extrinsic motivation is argued to vary considerably in its relative autonomy and thus can either reflect external control or true self-regulation. The relations of both classes of motives to basic human needs for autonomy, competence and relatedness are discussed.
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Analogy and similarity are often assumed to be distinct psychological processes. In contrast to this position, the authors suggest that both similarity and analogy involve a process of structural alignment and mapping, that is, that similarity is like analogy. In this article, the authors first describe the structure-mapping process as it has been worked out for analogy. Then, this view is extended to similarity, where it is used to generate new predictions. Finally, the authors explore broader implications of structural alignment for psychological processing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Preparing to facilitate the debriefing part of a simulation game requires as much care and attention as preparing to lead the introductory and play parts. This article provides a sort of mini-manual; explaining the nature of facilitating and then guiding the reader through the three phases of description, analysis/analogy, and application. It suggests questions a facilitator might use during each of these phases.
Article
Experiential learning in the educational context incorporates real-life-based processes into the educational setting in order for them to be used and scrutinized The heart of these sorts of learning experiences is the postexperience analytic process, generally referred to as the debriefing session. This essay focuses on the debriefing process as it accompanies one form of experiential learning, simulations and games. It provides a review of the existent literature on debriefing, an analysis of the debriefing process, and effective strategies for its use. It provides an analysis of the process, identifies its components and essential phases, and presents a systematic approach to the assessment of the conduct of debriefing sessions.
Article
Experiential learning was a major part of the author's life from the earliest days with models, pictures, and travel As a college professor, he discovered simulations and games; they changed his teaching style forever Initially the author tried one or two simulations per semester and advanced to an entire social psychology course taught only with simulations. A simulation was the starting point to great knowledge rather than an end in itself Because of the author's multifaceted approach to simulations, a renaissance approach to simulation and gaming was developed through the phases of awareness, emersion, journal writing, politics, and creativity. Seventeen principles evolved in the maturation process. One principle was, After reading all the instructions for a simulation, the playing of the simulation will not be totally understood, and it will take a leap of faith to start Another was, Designing a simulation is not simple, but the simpler ones often work better. Other principles revolved around the author's innovations and refinements, which included written journal debriefing, a social psychology course with only simulations, the six Es of debriefing, no deception in a simulation, and the written concept technique in debriefing.
Article
In this article, the nature of learning is considered and the significance of promoting learning rather than teaching is explored. The notion of learning system is introduced and the active nature of learning from experience is considered. The importance of reflection in the process of learning is discussed. The role of simulations and games in promoting learning is then examined, followed by an exploration of the process of debriefing and its relationship to reflection. Finally, the role of the teacher is briefly considered.
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In this article, I review the diverse ways in which perceived self-efficacy contributes to cognitive development and functioning. Perceived self-efficacy exerts its influence through four major processes. They include cognitive, motivational, affective, and selection processes. There are three different levels at which perceived self-efficacy operates as an important contributor to academic development. Students' beliefs in their efficacy to regulate their own learning and to master academic activities determine their aspirations, level of motivation, and academic accomplishments. Teachers' beliefs in their personal efficacy to motivate and promote learning affect the types of learning environments they create and the level of academic progress their students achieve. Faculties' beliefs in their collective instructional efficacy contribute significantly to their schools' level of academic achievement. Student body characteristics influence school-level achievement more strongly by altering faculties' beliefs in their collective efficacy than through direct affects on school achievement.
Article
Explores the postexperience analytic discussion process (i.e., debriefing), proposes a conceptual framework of the process, and examines the roles taken by students and teachers in instructional simulations. Implications of reconceptualizing the debriefing analysis as a cognitive assimilation of experience are discussed in terms of communication in experience-based learning classrooms, student–teacher relationships, and teaching strategies and competencies. (7 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Debriefing was assessed as means of reversing helplessness deficits through reattribution. Fifty-five subjects listened to escapable or inescapable tones. One inescapable group, prior to anagrams, was debriefed regarding noise uncontrollability. A second inescapable group was administered anagrams by a different experimenter. While exposure to inescapable noise led to performance deficits, switching experimenters obviated these deficits. Debriefing actually facilitated anagram performance. All inescapable subjects—debriefed or not—attributed their lack of control on the noise task to experimenter interference, casting some doubt on reattribution as an explanation of debriefing's effects. Results were discussed in terms of the reformulated learned helplessness model and the ethical implications of debriefing in learned helplessness research.
Conference Paper
Introduction The use of simulators to train crisis resource management is increasing constantly [1,2]. The detailed, video-based discussion of a simulator scenario with all participants directly after the session, with the aim to enhance self-reflection, is called, ‘debriefing’.Methods A small survey was undertaken at 14 European simulator centres and at an interdisciplinary simulator workshop during the SESAM 2000 meeting in order to define the key elements of debriefing. As the numbers are very small only descriptive results are mentioned.Results Respondents claim that debriefing is the most important part of realistic simulator training. Debriefing is crucial for a successful learning process, but if performed badly it can be the source of severe harm to the trainee. Debriefing can ‘make or break’ a simulator session and can be attributed as the ‘heart and soul of simulator training’. Therefore, training of instructors in the art of debriefing should be emphasized. The debriefing instructor requires both clinical and teaching experience. As the setting of simulator training is very intense, coaching of the instructor by a psychologist is recommended.Good debriefing requires a thorough briefing beforehand. Briefing should include (a) explaining to the participants that the session concerns learning, not performance assessment, (b) that confidentiality is maintained, and (c) that making errors is important for the training benefit. A nonthreatening atmosphere should be established and the crisis management terminology should be explained. The simulator should be explained in detail. Limitations of the simulation and how to deal with them should be stated. Admitting that the simulator is not completely realistic helps trainees suspend disbelief.Elements of successful debriefing include: creating a good and friendly atmosphere, open-ended questions, facilitating of self-debriefing, positive reinforcement, open discussions on management aspects, pointing out underlying principles that lead to misconceptions/errors, using cognitive aids, showing alternatives, stressing that everybody makes errors, concentrating on few key learning points, and pointing out the good parts with the assistance of the audio-visual equipment.Elements that should be avoided during debriefing are: closed questions, criticism using destructive language, concentrating on errors, blaming and ridiculing participants, focusing too much discussion on medical points rather than on crisis management aspects, too much instructor talking, too many teaching points, too long a debriefing period.Conclusion Debriefing is the most important part of simulator training. Serious harm to trainees may result from poorly debriefed sessions. Training and coaching of instructors should be emphasized. Continuous studying and training of debriefing techniques in an interdisciplinary team involving psychologists should be the future.
Book
Experience and Educationis the best concise statement on education ever published by John Dewey, the man acknowledged to be the pre-eminent educational theorist of the twentieth century. Written more than two decades after Democracy and Education(Dewey's most comprehensive statement of his position in educational philosophy), this book demonstrates how Dewey reformulated his ideas as a result of his intervening experience with the progressive schools and in the light of the criticisms his theories had received. Analysing both "traditional" and "progressive" education, Dr. Dewey here insists that neither the old nor the new education is adequate and that each is miseducative because neither of them applies the principles of a carefully developed philosophy of experience. Many pages of this volume illustrate Dr. Dewey's ideas for a philosophy of experience and its relation to education. He particularly urges that all teachers and educators looking for a new movement in education should think in terms of the deeped and larger issues of education rather than in terms of some divisive "ism" about education, even such an "ism" as "progressivism." His philosophy, here expressed in its most essential, most readable form, predicates an American educational system that respects all sources of experience, on that offers a true learning situation that is both historical and social, both orderly and dynamic.
Article
Health care simulation is a powerful educational tool to help facilitate learning for clinicians and change their practice to improve patient outcomes and safety. To promote effective life-long learning through simulation, the educator needs to consider individuals, their experiences, and their environments. Effective education of adults through simulation requires a sound understanding of both adult learning theory and experiential learning. This review article provides a framework for developing and facilitating simulation courses, founded upon empiric and theoretic research in adult and experiential learning. Specifically, this article provides a theoretic foundation for using simulation to change practice to improve patient outcomes and safety.
Article
Sumario: If you put a dog in a green room and give it electric shocks, it learns to steer clear of that room. But what if the green room is organizational change, and people are so afraid of past experiences with it that won't try anything new? In this article, Schein unravels the key psychological elements that inhibit or promote change. His primary goal is to help organizations not only to change, but to change faster, in order to keep up with the rapidly shifting environment. He begins with abstract concepts of learning and then outlines a change management procedure that leaders can use to help their organizations change and, ultimately, to develop perpetually learning organizations. This paper is based on an invited address to the World Economic Forum, 6 February 1992, Davos, Switzerland
Article
Incluye índice Incluye bibliografía Obra sobre educación profesional, realizando propuestas sobre la manera de desarrollar la responsabilidad, auto-actualización, habilidades de aprendizaje, y efectividad, enfatizando el desempeño del ejercicio profesional en corporaciones.
Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on an improved conceptual clarity about simulation realism and related terms. The article introduces concepts into medical simulation that help to clarify potential problems during simulation and foster its goal-oriented use. The three modes of thinking about reality by Uwe Laucken help in differentiating different aspects of simulation realism (physical, semantical, phenomenal). Erving Goffman's concepts of primary frames and modulations allow for analyzing relationships between clinical cases and simulation scenarios. The as-if concept by Hans Vaihinger further qualifies the differences between both clinical and simulators settings and what is important when helping participants engage in simulation. These concepts help to take the social character of simulation into account when designing and conducting scenarios. The concepts allow for improved matching of simulation realism with desired outcomes. It is not uniformly the case that more (physical) realism means better attainment of educational goals. Although the article concentrates on mannequin-based simulations that try to recreate clinical cases to address issues of crisis resource management, the concepts also apply or can be adapted to other forms of immersive or simulation techniques.
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.
Article
Analogy is a powerful cognitive mechanism that people use to make inferences and learn new abstractions. The history of work on analogy in modern cognitive science is sketched, focusing on contributions from cognitive psychology, artificial intelligence, and philosophy of science. This review sets the stage for the 3 articles that follow in this Science Watch section.
Article
A recent review of research in continuing medical education suggests that scholarship should be integrated with practice so that practical problems can be addressed with theoretically derived yet applicable solutions. This project develops a theory describing how physicians learn and formulate decisions in the context of diagnosing Lyme disease in order that educational programs can be designed to improve accuracy in diagnosis of this disease. A qualitative study using grounded theory methodology was performed to explore the learning process of physicians when diagnosing Lyme disease. Nine physicians were interviewed, and the interview transcripts were coded into categories to form a theory about how physicians learn in practice. Patient-physician interactions initiate the learning process by setting a context for which physicians frame a problem according to familiarity. Repetitive, similar, and counter-experiences, combined with cognitive knowledge, contribute to that framework and influence how the problem is framed along a continuum of familiarity. Furthermore, these experiences serve as information that influences diagnostic decisions and physicians' behaviors. For teaching and learning, cases and examples should include sufficient variety, repetition, and counterexperiences that allow a physician to appropriately recognize and categorize a patient's signs and symptoms into a disease category. Resources for information should be readily available and current. Preceptors and physician colleagues should provide timely feedback on diagnostic accuracy, and case studies should be presented with contextual elements that facilitate the diagnosis of Lyme disease.
Article
Research on performance evaluation highlights the importance of using multiple measures to develop an accurate profile of students, yet we found no literature describing the use of a standard-setting method for determining a pass/fail cutoff for a clerkship based on multiple assessment methods. Steps in setting an absolute standard for a pass/fail grade are described. The new cut-off score was used to compare what decisions would have been made had it been applied in previous clerkships. We successfully applied the Hofstee method to ascertain a new standard pass/fail cutoff for our total surgery clerkship score. Had this absolute score been used in 4 prior clerkships, 150 instead of 152 would have passed the clerkship, and 10 instead of 8 would have failed the clerkship. A standard-setting method can be applied to a final clinical clerkship grade even when multiple performance measures are used.
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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.
A maturation in experiential learning—Principles of sim-ulation and gaming Schein EH: How can organizations learn faster? The challenge of entering the Green Roomhow-can-organizations-learn-faster-the-challenge-of-entering-the-green-room
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A simple classification model for debriefing sim-ulation games Bakken LL: Role of experience and context in learning to diagnose Lyme disease
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Trio Model of Adult Learning
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Sheckley BG, Kehrhahn M, Bell AA, et al: Trio Model of Adult Learning. Storrs, CT, University of Connecticut, Department of Educational Leadership, 2007
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Mental models and complex problem solving: Instructional effects Handling Complexity in Learning Environments: Theory and Research
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Seel NM: Mental models and complex problem solving: Instructional effects, in Elen J, Clark RE (eds): Handling Complexity in Learning Environments: Theory and Research. New York, Elsevier, 2006
How can organizations learn faster? The challenge of entering the Green Room. Sloan Manag Rev Available at: http:// sloanreview.mithow- can-organizations-learn-faster-the-challenge-of-entering-the-greenroom
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Schein EH: How can organizations learn faster? The challenge of entering the Green Room. Sloan Manag Rev. Available at: http:// sloanreview.mit.edu/the-magazine/articles/1993/winter/3428/how- can-organizations-learn-faster-the-challenge-of-entering-the-greenroom/. Accessed January 13, 2011
Facilitating LOS Debriefings: A Training Manual. Moffett Field, CA, National Aeronautics and Space Administration
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McDonnell L, Jobe K, Dismukes R: Facilitating LOS Debriefings: A Training Manual. Moffett Field, CA, National Aeronautics and Space Administration, 1997
Mental models and complex problem solving: Instructional effects
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Seel NM: Mental models and complex problem solving: Instructional effects, in Elen J, Clark RE (eds): Handling Complexity in Learning Environments: Theory and Research. New York, Elsevier, 2006
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