By: Sabrina Beroz
What we know: Debriefing is where learning happens in simulation-based education. It is a reflective process that takes place after the simulation experience. Reflection allows the learner to integrate new information into preexisting knowledge enhancing learner outcomes; debriefing reframes prior frames.
For students, the consequences of poor debriefing processes include the failure to attain learner objectives and a dislike for simulation experiences. That is why debriefing has to be right!
Research has shown a need for education on debriefing practices – fewer than half of nurse educators have received formal debriefing training, While one-third use a theory-based debriefing method, fewer than one-fourth assess debriefing competence (Beroz, 2017; Fey & Jenkins, 2015). The International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: SimulationSM Debriefing provides criteria aimed at standard debriefing practices. As part of its Vision Series, the NLN offers a vision statement titled “Debriefing Across the Curriculum.”
Educating the Educator: Debriefing is the most difficult content to develop when teaching simulation pedagogy. As the coach, knowing the educator’s level of debriefing knowledge –beginner to advanced – is important when developing outcomes for a debriefing course. With that knowledge, objectives can be created and content applied to each objective.
To meet the needs of the novice simulation educator, foundational knowledge in debriefing should include theory, standards. and methods. More advanced content can include higher level debriefing methods and evaluation. The easy part is course content while course design is the challenge. I have tried many iterations with small and large groups of nurse educators, and here is what has worked for me.
Design 1. Getting Your Hands Dirty (for small groups)
The Set-Up: The venue for this design is a simulation center. The nurse educators are divided into groups of 3 to 5 to review established peer-reviewed, evidenced-based scenarios. The number of groups is reflective of the total number of nurse educators, and each coach has two groups: Group A and Group B.
A dry run is conducted to include prebriefing, setting a safe container, orientation to the simulation setting, and the simulation scenario. The Simulation Design Scale (NLN, 2005) is used as a guide to evaluate the simulation experience before use in real time. A member from Group A gives the scenario objectives and prework to all members of Group B and vice versa in preparation for the simulation experience. The table below shows the design for two coaches.
Debriefing: Each group of nurse educators has a turn to facilitate a simulation experience and debrief. For example, Group A will facilitate and debrief Group B, who are participants in Group A’s scenario. Roles reverse allowing Group B to facilitate and debrief Group A, the participants in Group B’s scenario. The debriefers are coached (by the coach/s) to focus on the level of the debriefer. Beginner level debriefing emphasizes the three phases of debriefing and the use of advocacy/inquiry and Socratic questioning. More advanced debriefing education centers on differentiation of theory-based debriefing methods and the evaluation of debriefing competence.
Design 2. Speaking the Language (for large groups)
The Set-Up: The venue for this design is the classroom. Divide the nurse educators into groups depending on the number in the classroom (recommend 4 to 6 in a group). Assign focus areas to each group. Focus areas are content identified from a prerecorded simulation video in need of debriefing. As they view the video, each group will concentrate on its assigned focus area. The nurse educators then work in their assigned group to develop advocacy/inquiry debriefing questions specific for their focus area. Coaches work each table to assist with the development of questions.
Debriefing: The coach models debriefing to the entire group using a scripted participant as the learner in the simulation video. The coach uses one of the focus areas and debriefs according to the theory-based debriefing method used in the simulation program. This follows with the nurse educators debriefing the scripted participant with support of the coach. Advanced level educators review a debriefing video corresponding to the simulation video and use the DASH tool for evaluation (Center for Medical Simulation, 2011).
Remember. . . . It has to be right. . . . Get your hands dirty and speak the language!
Beroz, S. (2017). A statewide survey of simulation practices using the NCSBN simulation guidelines. Clinical Simulation in Nursing, 13, 270-277.
Center for Medical Simulation. (2011). Debriefing assessment for simulation in healthcare: Student and instructor versions. Retrieved from http://www.harvardmedsim.org
Fey, M., & Jenkins, L. (2015). Debriefing practices in nursing education programs: Results from a national study. Nursing Education Perspectives, 36, 361-366.
INACSL Standards Committee (2016, December). INACSL standards of best practice: SimulationSM Debriefing. Clinical Simulation in Nursing, 12(S), S21-25.
National League for Nursing (2005). The Simulation Design Scale.
National League for Nursing. (2015). Debriefing across the curriculum [NLN Vision Series].