Simulcast Journal Club March 2020 – Conceptual Framework for Development of Debriefing Skills

Introduction :  

Simulcast Journal Club is a monthly series that aims to encourage simulation educators to explore and learn from publications on Healthcare Simulation Education.  Each month we publish a case and link a paper with associated questions for discussion.  Inspired by the ALiEM MEdIC series, we moderate and summarise the discussion at the end of the month, including exploring the opinions of experts from the field. 

The journal club relies heavily on your participation and comments and while it can be confronting to post your opinions on an article online, we hope we can generate a sense of “online psychological safety” enough to empower you to post!  Your thoughts are highly valued and appreciated, however in depth or whatever your level of experience.  We look forward to hearing from you. 

Title :  “Learning to Fly 

The Case :  

Annika watched in admiration as her mentor completed a masterful multidisciplinary debrief.  Despite a pretty large crowd, William somehow managed to create a sense of intimacy that generated an enthralling and occasionally game changing conversation.  She hungered for that skillset. 

Clutching her PEARLS debriefing tool, she worked hard to break down why the conversation had been so effective, but while she found it helpful to structure her own debriefs with it, William seemed to dance about a through an array of different techniques in a way that made it hard to deconstruct afterward.  One minute he was utilising advocacy and inquiry, the next he essentially paused the discussion while facilitating an ‘expert in the room’ micro-tutorial on ventilation strategies.  It felt a bit like playing conversational strategy bingo, except that somehow when William did it, it all hung together comfortably. 

Annika had assumed that comprehensively understanding her traditional debrief phases would give her a sense of mastery in the learning conversation, but as she watched William in action it occurred to her that maybe it wasn’t being brilliant at one technique that made you an expert. 

The Article : 

Cheng, A., Eppich, W., Kolbe, M., Meguerdichian, M., Bajaj, K. and Grant, V. (2020). A Conceptual Framework for the Development of Debriefing Skills. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 15(1), pp.55-60. 

Discussion :  

When we learn about debriefing we are often taught a particular structure or conversational style that is seen to be essential to the technique.  In this month’s journal club article, Cheng et al propose a conceptual framework for development of debriefing skills, evoking the importance of adaptive expertise : the ability of a facilitator to change strategy or adapt technique on the fly to a specific situation or educational need. 

By mapping out the phases of ‘discovery, growth and maturity’, they outline stages of expertise within debriefing, but in doing so, they also challenge the notion that there is one way to debrief well,  opening us to the opportunities available to us to extend ourselves in different directions with debriefing. 

For this month we’d love to know what you think of the article, if you have any critique for the paper, and what thoughts this stimulates in your own practice regarding how you debrief, and how you cultivate growth in your colleagues. 

References : 

Cheng, A., Eppich, W., Kolbe, M., Meguerdichian, M., Bajaj, K. and Grant, V. (2020). A Conceptual Framework for the Development of Debriefing Skills. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 15(1), pp.55-60. 

About Ben Symon

Ben is a Paediatric Emergency Physician at The Prince Charles Hospital in Brisbane and a Simulation Educator at Lady Cilento Children's Hospital. He currently teaches on a variety of paediatric simulation based courses on paediatric resuscitation, trauma and CRM principles. Ben has a growing interest in encouraging clinical educators to be more familiar with simulation research.

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3 thoughts on “Simulcast Journal Club March 2020 – Conceptual Framework for Development of Debriefing Skills

  • Belinda Lowe

    What an interesting article! I’ve previously had such ‘light bulb’ moments in discovering the Dreyfus model. I’ve found this particularly helpful in the past reflecting and discussing procedural skill acquisition. I was intrigued at how this could potentially translate to the development of debriefing skills.

    Vic shared this article with our EDGE group on the Gold Coast (Educate the Educator meeting) posing the questions to us all – what stage are you at with your debriefing and what’s between you and better? I read the article with great interest and a lot of self reflection. There is so much in this article that resonated with me and my journey through learning debriefing skills.

    I was interested in the authors’ discussion around transitioning the tradition 5 step model to the 3 stages of discovery, growth and maturity. It did make me curious though whether the 3 stages were specific enough and whether it might have been helpful to break things down even further. I wondered – was there even enough points to consider a 5 stage debriefing model?? – could this be even more specific and detailed for those of us part way through this journey wanting detailed advice to improve??

    I decided to sit down and write what a 5 stage model would specifically look like to me. Interestingly in doing this – I also reflected that my personal debriefing skills are actually at different stages depending on the type of debrief ie whether I’m debriefing medical students, clinicians who work in my area of clinical expertise vs larger multi-disciplinary groups or clinicians of varying clinical backgrounds. It also helped me reflect on the specific skills I need to master/improve – to move forward.

    A huge thank you to the team of authors for such an interesting article!

    – Just trying not to look stupid
    – Rigid adherence to preformed debriefing scripts
    – Needs significant help from supervisors/Co-debriefers to formulate discussion topic points
    – Unable to manage unexpected debriefing points

    Advanced beginner
    – Aware of differing models of debriefing – PEARLS/Plus delta/DASH and outlines for these
    – Can self identify points to be discussed during the scenario
    – Difficulty in managing unexpected learning points highlighted from learners in vent phase
    – Tends to focus on specific points/content – rather than entire picture

    – Comfortable with the structure of differing debriefing models and rigid structure transforms more to a fluid conversation
    – Has the flexibility to start to switch focus depending on learner needs in vent
    – Able to draw on techniques such as advocacy inquiry to discover frames
    – Can find it difficult to manage unexpected difficult debriefing situations/conversations
    – May start co-debriefing less experienced de-brief staff

    – Perceives deviations from normal debriefs – able to begin to utilise difficult debriefing strategies
    – Increasingly comfortable with techniques such as AI
    – Have an ability to start ‘thinking on their feet’ to address unexpected learning points or events in the simulation and debrief
    – Gain reflection and can improve skills watching others debrief
    – Increasing skill co-debriefing aiding and assisting less experienced de-briefing staff

    – Not helped by rigid structures like proformas
    – Comfortable with being uncomfortable – effortlessly handles the unexpected
    – Ability to think on the fly and utilise creativity
    – Has intuition and invention – eg adjustment of a simulation and or debrief during the event, may decide to ‘redo’ particular parts of scenarios or dive into specific learning or systems issues not initially identified in planning
    – Utilises debrief techniques with great skill
    – Able to very effectively co-debrief

    • Ben Symon

      Hi Belinda,
      Thankyou so much for such a wonderful start to this month’s discussion, I’m very grateful you went to so much effort.
      Now that you’ve drafted a 5 stage model, what do you think of it? Did breaking it into 5 stages allow you to reflect on your personal development with more specificity? To me, reading it, I enjoyed some of the subtle differentiators you mention : that an expert is a great co-debriefer, that they are comfortable being uncomfortable… etc.
      I think this very much harkens back to the concept of adaptive expertise outlined within the article, and it was something that really resonated to me. Much the same way I admire PEARLS for being open to a variety of teaching and facilitation strategies, I think this concept of adaptive expertise frames in my head the idea that an element of proficiency involves allowing control of the conversation to others, such as the learners, because you trust that you can steer it if the ship goes off course somewhere rocky. There’s been a few times where I’ve been debriefing with experts, where it has just felt like flying, you can feel this sense of safety but freedom at the same time.

      • Benjamin Symon

        Hi all,
        Given our simulation community is currently heavily involved in preparing and supporting staff during the Covid19 pandemic, we will pause discussion until things die down.