Simulcast Journal Club November 2016 – Dancing the Quickstep

Introduction :

Simulcast Journal Club is a monthly series heavily inspired by the ALiEM MEdIC Series. It 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. We moderate and summarise the discussion at the end of the month, including exploring the opinions of experts from the field.


Title : “Dancing the Quickstep”

The Case :

Nimali leaned back on the couch and gratefully took the glass of red from her husband’s hand.

“Thanks hun” she sighed, “It is definitely Wine O’Clock”.

Joe paused the TV and turned to his wife, “So how was your big course roll out?”.

“You know,” she said, “It went pretty well overall. The feedback sheets were strongly positive, everyone seemed pretty chuffed when they walked out. But I guess it’s my own performance I’m not happy with.   I’m such a perfectionist and I just wish I had more experience. I mean, I did that simulation training a few years ago and I’ve gotten a lot of hands on practice, but it’s just me doing it! I don’t have any mentors or feedback on how I’m going, and I just wish I could see how others were doing it.”

“Is this your way of saying we’re going to IMSH next year?” asked Joe.

Nimali frowned. “I’ve already had the leave request denied unfortunately. I’ll have to find some other way of hearing from the experts.”

In the meantime however, there was some camembert and Netflix that needed her full attention.

The Article :

“Thinking on your feet”—a qualitative study of debriefing practice

Krogh et al. Advances in Simulation (2016) 1:12

DOI 10.1186/s41077-016-0011-4

Discussion :

A lot of clinical simulation educators work in isolated silos without extensive feedback or growth opportunity. While there is now wide availability of structured courses to provide a baseline level of skill for these educators, it is not unusual to be learning mostly ‘on the job’ through one’s own reflection without a lot of access to experts in the field.

This month’s paper from Advances in Simulation provides a structured and thorough review of reflections from a wide variety of simulation experts on their practice, and as such is a great paper to provide a framework to approaching reflection on one’s own professional development.   It is also a masterwork of qualitative educational research.

Please enjoy this open access paper, and leave your thoughts below.

To get you started with some questions :

  • What reflections has this paper prompted about your own simulation practice?
  • What strategies would you suggest for isolated educators to connect to experts in the field and other fellow ‘coal face’ educators?


References :

“Thinking on your feet”—a qualitative study of debriefing practice

Krogh et al. Advances in Simulation (2016) 1:12

DOI 10.1186/s41077-016-0011-4


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.

13 thoughts on “Simulcast Journal Club November 2016 – Dancing the Quickstep

  • Victoria Brazil

    Great paper to select Ben.

    Refreshing approach to the recurring conundrums “How should i debrief?” and the related “Is my debriefing any good?”
    A disclosure – i was a study participant – but fortunately have no idea which number i was 🙂

    For me the take home here is that debriefing ( and perhaps education in general) is about principles and values, not formats. Structure and frameworks are clearly useful, but when we’re thinking how to translate those for the learners/ group in front of us – think back to principles.
    And i wonder whether its almost worth doing a brief ‘note to self’ as we embark on any sim based education or intervention and explicitly reflect on what our values are going into it.

    I am reminded of my own Eureka moments at as attendee at the Harvard Macy program in 2005 when it became apparent i could no longer just reactively decide i liked or disliked the teaching going on in front of me ( and, like Pavlov’s dogs do more or less of it depending on whether i liked it). Instead i was encouraged to sit back and reflect “What does the fact that i like what i see mean in terms of my assumptions about teaching and learning ?”
    Wow . Principle driven education

    All that said – i think the paper also makes us realise that volume of debriefing is good – those interviewed had a wealth of situations to draw upon as they practised their artistry and thought on their feet

    As Ben commented the paper is also remarkable as a masterclass in how to do qualitative research using interview data. Amazing to see the professionals do it, and then describe it in a way that is digestible to non-expert researchers. Makes those of us who write ‘thematic analysis will be undertaken’ in research proposals cringe a little at our inexpert use of the words.

    Thanks for the chance to comment Ben


    • Ben Symon Post author

      Thanks for your thoughts Prof :p

      I agree it’s important to reflect one’s own educational philosophies when entering simulation teaching, and I think this paper is such a great benchmark to allow myself the opportunity to sit and take stock of my own practice. i.e. Where do I sit on the learner centredness spectrum? How am I staying on top of new debriefing methods? Have I truly allowed myself to ‘become comfortable with the uncomfortable’? How well am I able to switch debriefing methods on the fly?

      I think another thing I like about this paper is that it embraces the truth that debriefing is an artform. I think many of us watch our role models execute a masterful debrief and revel in the artistry of it all, the way they can read their learners non verbal cues or engage the full spectrum of a multidisciplinary team with an effortless remark…. and it’s so beautiful to watch but also such a powerful learning experience to see all that role modelling.

      The practice development triangle framework provided that the authors have adapted I think is something I had initially under-rated, but the more I look at it the more I think it is a useful ‘self checking mechanism’, and also an approach I might take with a new simulation fellow, for example. i.e. “let’s sit down together and work out where we’re both sitting in this triangle, and how we can address our learning needs.”.

      I know for myself that I have paid more attention in recent years to learning techniques, to watching ‘artists at work’ and learning from experts, and to read from the literature, but I haven’t really sat down and asked myself what values I bring to a session.

      To go a bit ‘meta’, I’m a bit confused about why this month’s case and article has elicited less comments than usual. I know for myself, while I enjoy the paper immensely, I struggled initially with how to frame my comments. The article is so wide reaching but so concise, my RCT trained brain was unsure about how to approach it. Curious if others are having the same problem.

      Thanks to the authors for such a beautiful paper, and thanks to you VB for letting us in your head.

  • Chris Cropsey

    Before I dive into the article, can I just say that the vignettes that you create for each journal club are pretty amazing? I’m not sure how you come up with the ideas, but they are always spot-on…

    I think a lot of my thoughts echo yours, Ben. There were a couple of things that really jumped out at me while reading this article. First off, I absolutely love the concept of debriefing as artistry. The very nature of art is that it transcends the “necessary” and instead purports to illustrate something true about Human Nature (capitalization intentional). Similarly, while debriefing does certainly have a functional component, I think the best debriefings also transcend simple knowledge transference and instead leave participants with some deeper understanding. Also, like art, there are few inherently “right” or “wrong” ways to approach it. Ok, maybe some wrong ways, but certainly many different right ways. I think I have been guilty far too often of treating a debrief like a largely inflexible recipe, with numerous checkboxes to achieve. I think the concept of art is completely liberating – and, in the process, is likely much more learner-centered.

    Second, I was intrigued by the mentoring concept. I work in an institution where we do a lot of simulation, and we have numerous people in my department who have been through formal training (i.e. the CMS course) and have a fair bit of experience. And yet, I have not really availed myself of this resource. I think a lot of that has to do with time constraints – it can be difficult to get two or more people in the same place at the same time consistently to watch a debrief in person. However, the idea of video-based mentoring or feedback, which is asynchronous, really eliminates most of that issue. It’s something I plan on looking into further to try and improve my own development.

    Not sure why the comments have been less for this month, but I think it may have to do with comfort with qualitative research which I definitely have less experience with compared to quantitative, RCT-style literature. I thoroughly enjoyed it though. I’ll close by saying that even though I don’t comment every month, I am an avid consumer and I really view this as one of my windows to the wider world of simulation. It is easy to get into a rut and this is one of the things that consistently shakes up my thoughts and plants new seeds of understanding.

    • Ben Symon

      Thanks so much for your comments Chris. How’s the research going?
      I really liked the point you made about how thinking about debriefing as ‘artistry’ can be a very liberating experience, allowing us to view our debriefs less as recipes and more as canvases with which to work with!

      At my work I’ve been approached by a couple of people seeking debriefing feedback now, and it’s been a really exciting challenge to work on that sort of meta skill of faculty development. I think it’s ironically a trap that educators get stuck in, and I think if people are honest, there’s a lot of senior educators in health workplaces who get ‘deified’ and seen as gurus, but as such lose out on their own opportunities for growth. I’d love to get some video based feedback from you sometime Chris!

      • Ben Symon

        And thanks for your compliments about the vignettes! They’re fun to write, I’m glad you’re enjoying them!

  • Rowan Duys

    Hi team
    Thanks again Ben for the prep work and providing an excellent platform for learning.

    This paper, and vignette challenges me with the question Vic has been asking of her podcast guests: How do we know whether we’re doing ok or not? I find this particularly difficult to answer and my context contributes to this, so excuse me a quick explanation:

    I have been a learner during an immersive sim scenario once, on a fairly traumatic training-day during my time in the UK. I have never watched a bona fide ‘debriefing expert’ debrief a scenario and, when we started using sim in our department, there were only a handful of formally trained sim-educators using the technique in the entire region. Importantly, our learners are also simulation-naive. (It was interesting to note that some of the experts interviewed reported limited training before they embarked on debriefing.)

    The problem, therefore, is I sometimes feel like the one-eyed man, in the land of the blind. Feedback is usually very positive, mainly because people are comparing sim sessions to no training, or ‘usual-training’ which would be didactic. But that doesn’t necessarily help those of us involved with trying to establish sim in our region. We try, as much as possible, to give robust feedback when we ‘debrief the debriefer’ but again, constructive advice is difficult when you only have each other as reference points.

    This paper has been reassuring in some ways; we do try and follow much of the structure described, with a focus on developing our artistry and techniques from ham-handed towards mastery. However, I have been particularly challenged to reflect on the values that I bring to debriefing, and, going forward, I want to move from doing sim because we can, and we should, and we need to prove to everyone its great toward doing sim because its best for the learners, and ultimately best for our patients. We have committed to beginning each scenario design with the “what are learning objectives” question and this has helped us improve our learner-centredness.

    I’d be interested in references or experience around obtaining learner feedback on debriefing or if anyone uses the debriefing assessment tools described.

    Ben, November feels like the mad dash before Christmas chaos here, and if that feeling is global, this may contribute to the downturn. Don’t lose hope! I maintain this is some of the best value for time spent learning out there at the moment.

    • Ben Symon

      Thanks for your thoughts Rowan, I agree it’s hard to know how well you’re doing when people unanimously appreciate teaching of any form. Finding people comfortable enough to provide critique and feedback is challenging as well. I think it can be very easy to throw a sim together without clear learning objectives because there is inevitably benefit from the learning conversation, no matter what sim you use. But I believe (without evidence) that more focused sims with clear learning objectives and a transparent debrief surrounding them might lead to better achievement of targeted outcomes.

  • Ian Summers

    Hello Ben,

    Thanks for yet another great article to read and discuss and thanks to those who have contributed such wisdom in their comments. I think the reason that there was an initial lag in response (no longer) was that there was so much to agree with in this article and in the experience, expertise and insight of those surveyed. It’s always easy to get impassioned and write about controversy.

    It was refreshing to look beyond structure alone to see flexibility, attitude and the culture and mastery of debriefing described. As with all things self reported it makes me wonder how much of what I actually do I would be prepared to admit when I perceive that it might be outside the norm of the people I admire who would be making up the rest of the panel. I would love to see a similar interview of an expert panel on “weird things you do” or “things you do that you maybe shouldn’t” as a way of exploring the boundaries. But I must admit it was a refreshing experience to read the thoughts of this expert group and see the breadth of understanding of what it is that they do and report. I found it reassuring.

    Cheers and keep up the great work,


    • Ben Symon

      Thanks Ian, and I agree it’s tricky to talk about a paper where you just kind of ‘agree with everything’. A backhanded compliment for this paper I think, when you’ve done such a great job you’re met with nothing but praise!

      • Margaret Bearman

        Dear all,

        I’m browsing the ‘back issues’ here and it’s absolutely true, I am in full swing of the silly season (and why some schools can’t give some notice on their BBQ, open night etc is a mystery to me). However, I digress.

        One of the things that I took from writing this paper (and so pleased that everyone found it so accessible), is that we tend to focus on the microskills in teaching and assessing debriefing (eg phrasing etc, how did I do this etc). So, some the questions that are still rattling around in my mind are: how do we teach people to recognise and promote values which underpin learning? how do we holistically assess something like artistry?


        • Rowan Duys

          Thank you Margaret for joining the conversation. Ben, its like you’re putting us on the red carpet with the stars.

          Margaret, are you asking your question about teaching people to ‘recognise and promote values which underpin learning’ with regards to teachers or learners?

          I’m concerned that in our setting, through years, probably decades, of behaviourist-style and didactic teaching, we’ve created a cohort of learners that are passive, and not in control of their own learning journey. Any evidence or thoughts on the idea that exposure to simulation and the reflection inherent therein can change the way participants approach their own learning/education?

        • Ben Symon Post author

          Thanks for joining us Margaret, in response to your questions my only reflections would be that :

          – most clinical educators fall into the role due to a warm and approachable nature but don’t get formally trained about educational philosophies and as such I think ot is a blind spot for many of us.
          – How do you assess artistry ? I think maybe having an open mind about methods and focusing on whether learner outcomes were achieved, then discussing what methods were used to achieve or fail those goals.

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