IPE Simulation Series is a three-part series that focuses on using Simulation in the classroom and in practice. Part 2 focuses on “IPE Learning”.
By: Judy Murphy
General Information:
Prebriefing
Prebriefing is critical to a successful simulation. “The purpose of prebriefing is to establish a psychologically safe environment for participants” (INACSL Standards Committee, 2016). Simulations can be quite intense. Participants should be asked if they have experienced any events that may be emotional triggers, like a death in the family, a family member in the ICU, or a prolonged hospitalization. Participants are then told what is expected. They are given objectives, and if they have not been in the simulation center before, they are oriented to the environment, roles, timing, and equipment.
Participants are also told that this is a safe place to make mistakes. We all make mistakes, and we learn more from making a mistake than from doing everything perfectly. A “fiction contract” can also be used, where participants agree to treat the simulation as if it were real and agree to not share what happened in the simulation with others.
Debriefing
Debriefing is also critically important to learning. There are many styles of debriefing, which should be done by someone who has been trained and is skilled. As educators we tend to start lecturing in the debriefing, whereas students get the most out of the experience if they reflect and discuss. Therefore, the debriefer should facilitate the discussion, not instruct.
Debriefing frameworks include: 1) GAS (gather, analyze, summarize); 2) Debriefing with Good Judgment and Advocacy Inquiry (Rudolph, 2006); 3) Debriefing for Meaningful Learning (DML) (Dreirfuerst, 2012); and Plus-Delta. The selection of the debriefing method depends on the participants.
- For those new to simulation, Plus-Delta is the easiest technique to use. Ask participants what went well, what didn’t go so well, and what they would do differently next time.
- Debriefing for Meaningful Learning helps learners reflect on what they experienced, how they performed, and how they can use what they learned in future practice. I like to call this “the take home message.”
- Debriefing with Good Judgment and Advocacy Inquiry are similar. With these methods you report an observation, for example, “I noticed that you put the patient on 6 liters of oxygen by nasal cannula.” “Your patient had chronic obstructive pulmonary disease” (point of view). “I wonder what your treatment strategy was” (advocacy and inquiry).
Mistakes I Have Made / Lessons I Have Learned
Although I have a lot of simulation experience, I’ve made mistakes and learned much to improve my simulation skills. For example, in one of our earlier interprofessional simulations, one of the participants broke down in tears shortly after the sim started. The beeping of the monitor is what set her off. She recently had a baby who died in the neonatal intensive care unit shortly after birth. I learned then that taking time to prebrief, and asking about prior experiences that may serve as an emotional trigger, are critically important. So, if a participant discloses a recent death or indicates she has not yet healed from a hospital incident, let that person observe the simulation and participate in the debriefing. Research shows that observers can learn as much as participants, as long as they are involved in the debriefing (Jeffries, 2012).
Debriefing should be collaborative, particularly for interprofessional simulations. For interprofessional learning I like to include both a content expert and a process expert. The process expert facilitates the discussion, sets the tone for debriefing, and promotes learning. While the role of the content expert is to pick up on errors or omissions, the content expert will sometimes take over and begin to lecture, instead of promoting active learning. If that happens, the process expert can help keep the content expert in check.
Simulation is the vehicle that drives learners to debriefing where reflection, discussion, and learning occur. It is important to remember that debriefing is a skill that is mastered over time.
Thoughts for a Better IPE Simulation Experience
Prebriefs and debriefs should be a shared responsibility when done with two or more professions. As students are more likely to work well together when faculty work well together, faculty must role model respect and collaboration among the professions in both the prebriefing and the debriefing.
Setting the tone up front is key to the success of interprofessional learning. Use the prebriefing to establish expectations for each profession. Use the checklist included below to organize and structure the prebriefing.
Running three or four simulations with the interprofessional group in a day increases everyone’s comfort zone with one another. Interprofessional simulations lead to increased comfort within the team, a stronger team alliance, and improved patient safety as all members are empowered to stop the line when necessary.
If you use a standardized patient (SP) in your simulation, be sure to include the SP in the debriefing. The SP can give some very helpful information to participants from a personal perspective, rather than a professional one. I have found that students learn a lot from SPs.
| Prebriefing Checklist | |
| · Introduce all participants and their profession. | |
| · Review objectives and Interprofessional Education Collaborative (IPEC) core competency domains: Values and Ethics, Communication, Teams and Teamwork, and Roles and Responsibilities | |
| · Review simulation rules and inquire about emotional triggers | |
| · Orient participants to rooms and equipment | |
| · Prepare teams and give them a few minutes to get to know one another. |
References
Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326-333.
INACSL Standards Committee. (2016). INACSL Standards of Best Practice: SimulationSM simulation design. Clinical Simulation in Nursing, 12, S5-S12.
Jeffries, P. R. (2012). Simulation in nursing education: From conceptualization to evaluation (Rev. ed.). New York, NY: National League for Nursing.
Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55.