Simulcast Journal Club June 2018 – First Aid

Introduction :  

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

In order for the journal club to thrive we need your comments!  Some participants report feeling nervous about their initial posts, but we work hard at ensuring this is a safe online space where your thoughts are valued and appreciated.  To ensure this, all posts are reviewed prior to posting.  We look forward to learning from you. 

Copy of Journal Club(2)

Title :  “First Aid 

“I was wondering if you could arrange a debrief for the team, Cath?” said Christine quietly.  “I know it was a week ago, but I’m getting a lot of questions from my staff about the outcome for the patient and the choices we made on the day.” 

Cath swiveled her chair towards the window and frowned. 

“I agree it’d be a good idea, and I’ve been wanting to get some critical event debriefs happening for months, but we don’t have anyone trained in that area!  I can debrief a simulation pretty well, but there’s some evidence that doing this badly could worsen PTSD symptoms!  And the times I’ve tried to get one going, people are off shift or unable to come in and anyway it’s frankly uncomfortable debriefing an event that I was in charge for.  I think we need to wait until we’ve got some trained professionals to do this sort of thing.  I’m sorry Christine.”. 

Christine eyes flared with frustration.  “I don’t think you quite understand.  I’m having trouble staffing Resus! A few nurses have asked to just do short stay only for a while, Andrew’s called in sick twice this week, and that’s not like him, and there are also some systems issues that came up with that trauma that frankly we need to acknowledge and fix before the next serious paediatric trauma comes in.”. 

“I agree that physicians shouldn’t always be in charge of debriefing.” She continued.  “But you guys are the only ones who get leave and enough pay to cover an expensive debriefing course.   Surely there has to be another way we can do this?”. 

The Article : 

Rose, S., & Cheng, A. (2018). Charge nurse facilitated clinical debriefing in the emergency department. CJEM, 1-5. doi:10.1017/cem.2018.369 
Discussion :  

Clinical educators are increasingly being asked to participate or contribute to the development of critical event debriefings in the hospital environment, but numerous barriers can get in the way.  In this month’s article from Stuart Rose & Adam Cheng, we examine a system implemented in 3 hospitals in Calgary, Canada that utilised Charge nurses to facilitate over 200 critical event debriefs in their emergency departments. 

For the journal clubbers this month, what did you think of the article?  Have you been asked to get involved in critical event debriefing?  What have been the barriers for you?  Does this article point you towards another potential solution? 


References : 

Rose, S., & Cheng, A. (2018). Charge nurse facilitated clinical debriefing in the emergency department. CJEM, 1-5. doi:10.1017/cem.2018.369 

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.

34 thoughts on “Simulcast Journal Club June 2018 – First Aid


    Love this article and the simplicity of the debriefing tool. We have been using a debriefing tool also, but ours is more cumbersome and uploading the data tends to be difficult. We often find now that debriefs are performed but that the important information is not being collected for us to review and evaluate and make systems wide changes.

    As of now, we have trained physicians and nurses and can see the benefit of having a specific designation / role for the event debriefer. Our current model is, “debrief when you think appropriate” and is open to anyone who took the training course, a mix of physicians and nurses. Despite training at least 15 people, we find debriefs being done by 2-3 people, 2 of which are physicians and 1 is a clinical nurse educator.

    My question for the paper was, although 254 debriefs have been performed in this new format… how many debriefs went through a similar time frame when it was mostly a physician based model? Also, has the trend towards debriefing continued or fizzled? Were any other interventions used to maintain the culture (emailing staff with updates regarding changes)? When we started doing debriefing in our department, we had dozens in the first few weeks. Our problem is continued buy-in. I didn’t see this in the paper and would love that data.

    • Ben Symon Post author

      Farrukh! So pumped to have you comment! Thanks for joining us.
      I agree with you that there is a lot of appeal in the streamlined approach this model takes, but that some more qualitative discussion about how such a big culture shift was achieved would make the model easier to translate to another health service.

      In your experience, are the 2 or 3 people debriefing in your dept just more passionate about it? Or is there another barrier to others facilitating?

      • Farrukh Jafri

        What I found among the 15+ people who took the debrief course, only around 8 actually did a debrief. And only me and 2 others did more than 1. Among the 30+ debriefs performed, I have done about 60% of them, so not a sustainable model. I can’t speak for the other two debriefers (although I did invite my entire SIM team to this journal club, so hopefully they respond also). I have seen a large downtrend in my event debriefing, and I don’t think I debriefed a case in the past month.

        For barriers, I often realize at the end of the shift that I should have debriefed a case. After the training course I took, we were all very excited and started trying to debrief once a day, this started to lag. The ones that continued, the three of us, were also involved in monthly meetings reviewing all the debriefs and placed recommended changes to our leadership team. The nurse educator is often not working clinically when she debriefs, so fits the charge role model in the paper.

        The shifts are always so busy and I often feel overloaded, so it often now does not don on me to debrief. This is the complaint I get also from other staff members who have not debriefed, it’s just too busy. This is why I really like the idea of a designated member to debrief, a charge nurse sounds perfect.

    • Stuart Rose

      Hi Farrukh

      Thanks for your comments and sharing some of your current process. As you mention, the challenge is not just implementing a clinical debriefing process but maintaining it as well.
      To address your questions:
      1. We did not track the numbers of debriefs before implementing INFO. Personal experience and extensive discussion with nursing, MD and respiratory tech colleagues supported what is reflected in the literature: we all wanted to debrief but in reality debriefing was not a common occurrence. When it did happen it was usually when there was a poor outcome. Cold debriefings or critical incident stress management debriefing were and still are taking place if indicated or requested.
      2. Since implementation in March 2016, the rate of debriefing has waxed and waned considerably and is anything from 1-10 per month, depending on the site and month. So far this month (May 2018) our one community hospital had 4 documented debriefings and our trauma centre has done 5. INFO is a voluntary process. We have the record of documented debriefings but similar to you, I am aware of the INFO process being used for undocumented debriefings as well.
      3. I have not sent out emails to the group. It was part of my original plan but I have not managed to make it happen. One of several things I would like to do address going forward.

      • Farrukh Jafri

        Thanks for the comments and your workflow. Documenting these can be difficult and I even printed out forms and left them in the ED and told people I will do the data input. I do feel we are missing a lot of debriefs secondary to that.

        I am impressed that you were able to keep the process going over the past two years and are still getting data monthly. Have you had to do any maintenance for the program? Debriefing refreshers? I’m very much tempted to institute your designated debriefer model.

  • Susan Eller

    As a former – and always – ED nurse, this article intrigued me. I was a very novice nurse in the mid 1980’s when CISD was gaining momentum, and I had to suspend my experiences with that complex process to read this article. I also have specific views on debriefing that have been formulated by my work in simulation-based education.

    I would be interested to talk to the team members who had gone through the process. The script articulates the basic assumption, sets ground rules for psychological safety, and provides references for those who might need further counseling. My challenge is that all that wonderful work to establish this environment could be offset by the +/∆ format. In that sense it could seem more like clinical event feedback as opposed to clinical event debriefing, so I am curious how the participants experienced it.

    I might like the streamlined approach, but would want to understand if the participants felt it was a tool that allowed them to address system – not performance – issues, and provided an opportunity to express emotions and concerns. That may have occurred, but I was unable to discern that from the article.

    • Ben Symon Post author

      Hi Susan, I’m so glad you could join us! I think what I’m hearing from your comments is concern that the INFO system appears focused on systems issues rather than staff education or deactivating resus participants emotionally , Is that right?
      I think that’s a fair critique of the process although I wonder if simply having ANY system leads to some of those things being organically addressed as a natural consequence of getting people talking.

      • Susan Eller

        Thank you for posting the image Ben – the comments due illustrate that the debriefings fostered feelings of being supported and heard. To your point that having the conversations, while maybe focused on systems, promoted teamwork.

  • Ian Summers

    Hello Ben, and all who have commented on this, and thank you to Stuart and Adam for their paper and comments (hoping Adam will join too)

    It’s an opportune paper as a team of us (Ben, Vic and Liz Crowe) prepare to run a workshop for DFTB on clinical event debriefing and grapple with the terminology, the differences and the overlaps between simulation and clinical debriefing, and within the clinical context the hot and delayed debriefing. (I can’t get my head around cold, as there is nothing cold about it, and so I will use delayed)

    What occurs to me as I read this patient is how little has been written about the emotional needs within the paper and how well equipped we probably are as simulation debriefers and as clinicians to use a reactions/events phase prior to the +/delta and then cope with the emotions that are brought to the surface. We enquire and acknowledge and deal with the emotions of our patients and our colleagues on a daily basis and I do not see the sequence I have outlined as being anything but productive with the right facilitating, psychological first aid and support backup. Here, if I have any suggestions for the excellent approach described in the paper is the deficiency. This quote: “Structured debriefing should be distinguished from defusing, whose sole purpose is venting emotions to reduce tension. Debriefing takes the additional step of conceptualizing ways to improve future performance “, is sort of true, yet I have found in clinical debriefing (and sim) debriefing that a failure to hear and acknowledge the inherent emotion or sadness of an event to be a barrier to some of the people there, as much as over dwelling can have the opposite effect on others. When something very traumatic has just occurred I like to start hot debrief with a phase like “I want to acknowledge that a young person has lost their life, and it’s a time of sadness for their family and maybe also sad for us. I want to thank you for your efforts on their behalf and my appreciation for what you just did. Are you OK? Do you feel like you are in a position to talk about what just happened? (and leave space …)

    …and then move onto an event breakdown and analysis phase if it seems right to do so.

    A process and functional debrief can itself be emotionally satisfying and therapeutic. Answering the question “could we/I have done something more..something better…” and getting an answer one way, or the other helps those gnawing self-doubts that can follow a resus and keep you up late at night. This is where respect, and honesty as part of that respect, has a place in healing.

    So, yes, I like their structure and think they ask valuable questions (especially the who, what, when,where, why, how approach to planning), and feel that the nurse led structure is incredibly valuable.

    Is it hard to sustain? Yes.

    My summary:

    do it, if you have a sim debrief background, a hot clinical debrief is right in your zone.You just need support.
    Try a reactions/events then plus/delta or other analysis framework and head to this paper for a brilliant analysis framework.

    My other tip is I much prefer the clinical environment where the event has just happened so that the physical equipment provides visualisation cues, and in some way the time pressures and expectations of freeing up the space add the framework to a brief style.

    Once again, Ben, thanks for your time and this wonderful resource.


    • Benjamin Symon

      Thanks for your detailed contribution Ian, and as we privately discussed yesterday, I agree that one thing that is missing from this debrief structure is clear goals to achieve emotional deactivation for staff post a stressful resus. I wonder if this is cultural? Is this just an Australian thing that we’re looking at? Or is it just that we are really only just starting to get a handle on what is needed for departmental debriefing in different situations?

      • Stuart Rose

        Hi Ian / Ben

        Thanks for your responses. This is a big topic with a lot of variables and more study needed. While the concept of emotion before cognition is important (for Canadians as well, I think :), unpacking those emotional aspects of the case is not something focused on during the INFO process for two reasons. Firstly, I do not want a novice debriefer to specifically ask participants how they feel about the case if the facilitator is not trained to manage the replies. I agree with your comment that if you are an experienced facilitator then unpacking the emotional aspects of the case is beneficial but it may be stressful for novice facilitators and for participants, if not managed adequately. Secondly, exploring emotions takes time. Even if things go well and the facilitation is by an experienced debriefer, it still adds a lot of time to a debriefing, which is entirely appropriate when exploring emotions but If clinical debriefings take too long it is difficult to get busy clinical staff to buy in. If things have not gone well then a hot debriefing is only part of the process and follow up including a cold debriefing may need to happen regardless. Both the personal follow up and the cold debriefing process focuses more on the emotional aspect of the case. What I have observed during the INFO process is that there may be a significant amount of emotional sharing during a debriefing but that is dependent on the team’s comfort or perhaps need, after the case. INFO is a not a perfect clinical debriefing process, but it is a start. To create a culture and expectation that debriefing is part of patient care, we need a structure and process to support debriefing at any time, not just when we have well trained facilitators available.


        • Ben Symon

          Cheers Stuart. I’m secretly kind of glad this conversation is going in this direction though, as I do find this tension between addressing the emotional and intellectual needs of our staff members particularly fascinating.
          A lot of the pressure to participate in hot debriefs in our department is actually motivated by staff voicing concern about their emotional needs. We’re mostly pre-contemplative about improving our performance in a resus unless something actually bad has happened, and ironically then we may become even more reluctant to debrief given human nature and reluctance to discuss what we’ve done wrong.

          This isn’t a critique of the paper, but I’m using the paper to springboard some more generic thoughts, but it is really interesting to me that a lot of the debrief models that seem to be out there are very specifically clinically focused due to the fear of doing some kind of emotional damage to staff by not handling their stress appropriately.

          And to me the worst thing we could do for our staff member’s emotional state is to imply that these are things we can’t talk about. I think I may be being naive, but I’ve seen more damage from suppressing emotion than from expressing it in a supportive group environment. I worry sometimes that the original cochrane review ( ) that implies single session critical stress debriefing may INCREASE PTSD scores has done a lot of damage to the cause.

          Thoughts anyone?

          • Derek Louey

            Hi Ben,

            I take it that you put up this paper because you see parallels between sim debriefing and critical incident debriefing. There may be similarities but I suspect there are also significant differences and I am not necessarily convinced the skillsets are transferable. For instance, has PTSD been reported in the sim literature from a challenging sim or poor debrief?

            My first impression about this paper is that it states an intervention with very little in the way of methods, inclusion and exclusion criteria and specific outcomes (apart from the observation that debriefing happened more regularly). It reads more like an editorial and for me it seemed to raise more theoretical and practical questions than it answered.

            If were to draw advice from the The Cochrane review:

            “The routine use of single session debriefing given to NON-SELECTED trauma victims is not supported. No evidence has been found that this procedure is effective” (capitals are mine)


            “Compulsory debriefing of victims of trauma should cease. A more appropriate response could involve a ‘screen and treat’ model (NICE 2005).”

            I think we need to think carefully about what kind of outcomes we are seeking with critical incident debriefing and consider a much more nuanced approach to who and what is being achieved particularly if there is no consistent follow-through.

            After a traumatic event, closure may be incredibly important for some people and I can’t see that happening in one session

          • Lucinda Mithen

            Thank you so much for this discussion. I am currently designing a debriefing tool for Emergency Departments that I hope to trial as part of my PhD. I am chiming in because that Cochran review has been mentioned in every discussion I have had with Executive members of my local health district. Your point regarding suppressed vs expressed emotions is how I try to counter the naysayers but it is an uphill battle. Our staff are begging for debriefing and an opportunity to express their emotions in a supportive environment. Executive believe it is not feasible or warranted.

      • Derek Louey

        Hi Ben

        I decided to have a chat to our social worker today about her overall approach to the debrief. A few things stuck out from our conversation.

        1) No-one is compelled to attend the debriefing.
        2) The agenda is completely driven by the members.
        3) ‘Permission’ is given to experience any range of emotions including distress, regret, frustration, anger including acknowledgement that sub-optimal system processes may exist or individual performance was inadequate
        3) During the debrief, she is constantly assessing gauging and managing responses and interactions to ensure psychological safety is maintained for individuals. Avoiding blame culture.
        4) She will refer or actively followup individuals who wish to take their concerns further
        5) If appropriate she offers the perspectives and experiences of the relatives

  • Sarah Janssens

    Such a great paper – thanks again Ben for posting. As I was reading this paper, i thought – wow, I love how the authors have kept is so succinct, but then as I started to think about how I might implement such a thing in my environment and I really wanted to know more detail than the paper described, as seemingly did the others who have posted so far. I presume some sort of word count has limited the authors ability to share more detail. Certainly the investment in getting this up and running seemed to use many resources, and I’m keen to understand how many T3 and Basic workshops were run with how many people to ensure that this got up and running as smoothly as it did. The infographic posted helped me understand staff perspectives, but I really hope we see some more descriptions of the impact of this on the staff and organisational outcomes – am I being too greedy to want to see some more detailed / tangible results for the investment? (I’m not a skeptic – I’m sure it’s fantastic – just yearning for more data to inspire me to action). Podcast interview????

    • Benjamin Symon

      Thanks Sarah! I guess ‘we want more’ is pretty nice feedback to receive as the authors :p

  • Benjamin Symon

    Derek thanks so much for coming along, and I always enjoy the fact that you’re quite happy to disagree and generate some healthy discussion.
    I need to go back and fully read the cochrane review before I can comment on your specific thoughts, but yes, I do think this is a great article and I think there is a significant amount of overlap between critical incident stress debriefing and educational debriefing.
    First and foremost, I think that we are fooling ourselves if we try and argue that doing an immediate, ‘hot’ debrief post a resuscitation can purely involve the intellectual deconstruction of the event without also acknowledging the need for emotional deactivation of staff. Indeed, for me, as a team leader, the emotional deactivation is more important to me than the deconstruction/analysis or +/delta of the case.
    I need to get my staff back on the floor and safe to practice, (or off the floor and being looked after, if that’s their need) and I need to let them know I care for them.
    Like Ian, I’m of the opinion that emotion and cognition can’t be separated in this instance. As such, I think it’s important with talk and think about this stuff, because it’s not going away.

    Also, from an instinctive level I just really worry that there is a blurring of PTSD definitions in the cochrane article. If my life has taught me anything, it’s the not acknowledging stress or avoiding talking about conflict is a sure fire way of making those emotions worse. I think that PTSD scoring and actual PTSD as a disease are separate entities, and I think that to suggest having an emotionally intelligent conversation after a stressful incident at work could somehow be the CAUSE of PTSD, to me, just doesn’t make sense. Association is not always causation, particularly in a hard to measure field like psych.

    My main takeaway from scanning the cochrane article is that there’s just not much decent research out there at all. Which means we need to do it. And Stuart’s leading the way! This stuff starts with a conversation and sharing of ideas, and so I disagree with your concern about the level of detail in the article’s methods. This isn’t an RCT to me, this is a sharing of ideas through publication.
    I look forward to your response! But now I have to go read the whole damn cochrane review :p

    • Derek Louey


      Hopefully your Twitter comment might draw some more traffic but you may have misinterpreted my comments. Firstly, I am not specifically saying that a single debriefing could cause PTSD nor that addressing the emotional components (vs intellectual or system) components is a un-worthwhile exercise. Worthy of mention is that debriefing in particular instances does occur in our department, not infrequently led by our departmental social worker and more often revolving around the emotional aspects. Everyone is welcome to attend but I also note that nurses seem to get more out of this than the doctors.

      I agree a lot more research needs to be done. I think we can all agree that there are staff members who have previously experienced unexpressed angst over a traumatic event (but maybe not in epidemic proportions as suggested by some on this post) and that some form of intervention would be beneficial in CERTAIN situations. What I am against is implementing universal debriefing without considering the specific goals, indications, type and magnitude of benefit and possible harms. Like any proposed clinical intervention subject to investigation, we should always assume the null hypothesis is that it makes no difference (good or bad) and go from there.

      Here is another analogy. I could say that taking aspirin and statins is a great thing. Everybody should be doing it. Cardiovascular and cerebrovascular disease is the single biggest killer of the Western population. However, as we know the magnitude of benefit depends if it is used as primary, secondary or tertiary prevention. There are high risk patients and low risk patients. The problem about giving it to ‘everybody’ is that it will not make a difference to a large proportion of people, in some it will cause troublesome side-effects and occasionally result in real harm e.g. acute GI bleeding. Not to mention the poor cost-benefit of this exercise. Universal prescription also risks diluting the measured benefit.

      This leads me to the second point. In my workplace at least, we probably encounter dozens of traumatic events in a given week. Some relatively minor e.g. a distasteful interaction with a clinician, a shouty patient ranging to a major one such as a particularly gruesome or graphic resuscitation in a young person. If I spent time debriefing every episode in a big group hug there would be no clinicians left on the floor to look after the patients! There are also have significant logistical issues in co-ordinating a next day debrief with a roster of over 200 nurses and 70 doctors. Maybe if these events in your practice are few and far between you might have the luxury to do so. Therefore, it comes down to utility. When is it of benefit, who benefits, how much and in what way and will it be worth the trouble. Now real PTSD arising from a clumsy debriefing might be unlikely (and more related to the inciting event), but my concern is that an organisation having implemented a universal debriefing programme might give itself a little pat on the back thinking they have done a great job but leave unrecognised the occasional individual who has completely unresolved and significant emotional trauma. Now I speculate how recurrent future debriefings continue to trigger memories of an original event that was not ever properly addressed. The forest for the trees.

      So in conclusion, before we go head long into a motherhood statement of ‘debriefing always and for all’ we need to consider with our current resources when we should be doing it and what outcomes do we expect and what provisions we have made for those who are at greatest risk.

      • Farrukh

        Sorry that I have been a little MIA to this conversation. Had a bit of a rough stretch. I like a lot of what Derek is saying. What is the point of the event debrief? It is such a powerful tool but the hot debrief has so much limitations and also so much more risk of harm compared to a cold debrief or a post-simulation debrief.

        We don’t debrief everything, often times we don’t debrief enough. But it becomes almost formulaic when we do it, people expect it about and I do it about twice a week. Our goal is systems improvement through our program. Let’s find the cracks in the armor and fix it. The emotion that does come out often times is focused on that also, “I was pretty frustrated when the doc had to leave the room to put in medication orders,” “I had a screaming agitated patient across the hall but I couldn’t leave this STEMI patient, I felt frustrated.” These are great emotions to get out and address the underlying issues.

        There are other situations, a pediatric arrest, an unexpected outcome, that if not done properly, can really cause much harm. I find the staff will always do an unstructured debrief by discussing the case amongst themselves. I often will avoid the systems issues in those cases and name the emotion in the room. “I’m proud of everyone in here. This was a really tough case.” and set up a cold debrief with a trained psychiatrist or social work that is optional after. You just can’t tackle this with a hot debrief and you should not.

    • Laura Rock

      Hi Ben and everyone- I am woefully late to this discussion and I wanted to chime in with two thoughts. Responding to your comment, Ben: “First and foremost, I think that we are fooling ourselves if we try and argue that doing an immediate, ‘hot’ debrief post a resuscitation can purely involve the intellectual deconstruction of the event without also acknowledging the need for emotional deactivation of staff.”
      As you know I have been teaching “emotion before cognition” for years because we simply can’t focus on rational thought when emotions are intense. (This is also why I think much “shared decision making” isn’t really shared because patients and families are too emotional when we share information to make rational, well-informed decisions.) The other issue is the idea of “emotional deactivation of staff.” There are a lot of data to support the harm of suppressing emotions, so I feel strongly that we should not promote suppression of emotion but find a way, even briefly, to validate those strong feelings. I do think we should seek two goals for managing intense emotion: 1) diminish intensity of emotion by naming and validating it to allow for effective cognitive processing and 2) explore the emotion to better understand what’s behind it. Emotions are a window into what really matters to people and if we take emotions at face value we risk losing a better understanding of ourselves and others.

      • Ben Symon Post author

        Thanks Laura for breaking down the importance of acknowledging emotion in post event debriefing. I found it helpful that you mention naming the emotions as a way of diminishing their intensity, and also exploring that emotion can gain further cognitive insights.

  • Suzanne Nelson

    I happened upon this thread from a coworker, realizing I am a little late to the discussion. I saw the article while I was attending IPSSW. We are about 2 years into a similar project. We are currently training charge nurses to conduct defusings, which we have renamed “Distress Debriefings”.
    Nurses and other health care team members who have conducted these debriefings have found them to be generally valuable. Our institution does not offer many resources for debriefing other than CISD/CISM. Our goal was to empower staff to start the conversation and provide a structure to facilitate the discussion. We are continually evolving this work and seeing this recent publication has raised some questions for us about the framework we use and if that is what is best for this type of work.
    We recently published our work as well, I am including a link to the article.
    As I am seeing the work being done I think it would beneficial to start a collaborative effort across institutions. I envision this type of work could be structured in a way that it could be more universally employed in any institution.

    • Derek Louey

      HI Suzanne,

      “Nurses and other health care team members who have conducted these debriefings have found them to be generally valuable.”

      This is what I believe needs to be unpacked. What did staff perceive as the main benefit of debriefing?

      1) Validation and affirmation of staff’s role and contribution
      2) Emotional support / Staff morale
      3) Exploring personal defence mechanisms to cope with traumatic events e.g. rationalisation, intellectualisation
      4) Quality management of system issues
      5) Addressing team work/communication/human factors issues
      6) Identifying knowledge/skills gaps and reviewing training objectives
      7) Creating the impetus for a regular simulation programme

    • Benjamin Symon

      Hi Suzanne, thanks for sharing your experiences in a similar project. I was really interested that the phrases you use to describe the process are ‘defusings’ and ‘distress debriefings’. I haven’t heard either of those specific terms before, and it suggests to me that the core goal of your debriefs are actually more towards emotional support for staff.
      I couldn’t see the link to your article, are you able to put it in? I’d love to read it.

  • Leo

    (Please note, these comments have been edited)

    A simple, sincere ‘thank you for your efforts’ (or some variant) from senior nursing and medical is hugely under-rated.
    Should be no.1, so your staff come back afterwards!

    Tips for what NOT to do.
    All done in one debrief at work:

    1. Say, ‘we do debrief’ when demonstrably untrue

    2. Critique the performance of staff not present

    3. Denigrate staff performance

    4. Have senior staff disengage mid debrief, especially when people have come from home.

    • Ben Symon Post author

      Hi Leo,
      Thanks so much for coming along. Apologies but I’ve edited your comments while trying to keep the gist of what you’ve said. While I think there are important points there about what can go wrong in a clinical debrief, I needed to de-identify the situation a little more to ensure anyone involved in that real life event didn’t recognise it here.

  • Benjamin Symon

    Hi Farrukh,
    Thanks for jumping back in to reflect on Derek’s comments.
    I was wondering if you have time if you could unpack what you mean by the “risk of harm” from a hot debrief?
    I feel like as a group we seem good at making specific arguments for a hot debrief, or a cold debrief, but when it comes to the bad outcomes we’re trying to avoid we are tending to use generalisations. So I was wondering what is the harm that you personally are concerned about?

  • Paul Elliott

    As always there is some great discussion about where we, as a simulation community, see the role of debriefing. We can all agree that debriefing is an important activity to participate in and the psychological support that it provides to both doctors and nurses. I think that this paper demonstrates a solution to an issue, however will it ever replace a full debrief or M&M meeting, no, but what it does provides is a scripted ‘hot debrief’ which can be provided in an effective manner by someone other than the medical team leader.

    There are a number of barriers to debrief following an incident which especially effect nurses and that it time and resources necessary to allow for a debrief to be run. There is no way that we can pause the busyness of our departments to allow all people involved to go and debrief for half an hour immediately after an incident. Often other things have had to already be put on hold for the emergency, which now have to be addressed and there is always the constant flow of patients in our emergency departments. This often leads to debriefs being run days after the incident, with not all people involved being able to be present.

    I think that his paper shows that an effective debrief can be performed in a systematic and scripted way which hopefully will benefit the psychological safety of our workplaces.

    • Ben Symon

      Hi Paul, thanks for your comments! I agree that hot debriefing is not a replacement for normal departmental feedback mechanisms. I think the INFO ground rules establish that tone well. Thanks for joining this month’s discussion!

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