Debriefing 101
Janet Willhaus
Montana Simulation Conference 2017
Boise State University
© 2012 Boise State University
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Objectives
• Identify the significance of the debriefing
process in the literature.
• Discuss categories of feedback for learning
and evaluative purposes
• Practice a debriefing model
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Research and debriefing
• Learning occurs only with debriefing (Shinnick, Woo,
Horwich, & Steadman, 2011)
• “Debriefing, regardless of method should be
included in all simulation learning
experiences… “
• “Successful debriefing requires careful
planning and ability to facilitate…”
• Students want and need feedback (both peer
and instructor)
(Levett-Jones & Lapkin, In press)
(Dufrene & Young, 2014)
(Fey, Scrandis, Daniels, & Haut, 2014)
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Guidelines
• Program should use a standardized model for
debriefing
• Debriefing should use Socratic methodology
• INACSL Standards of Best Practice: Debriefing
(Alexander et al, 2015)
(Alexander et al, 2015)
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Facilitator should be competent
Conducted in specific environment
Facilitator must be able to devote full attention
Debriefing should be based on a theoretical framework
Debrief is congruent with objectives and outcomes of the
experience (INACSL Standards, 2016)
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Debriefing training study
• Debriefing survey (Fey, 2014)
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Pre-licensure programs 95% of schools requiring simulation.
80% of these had a designated simulation expert
About 80% of the experts had formal simulation training
Less than half of the programs used a structured debriefing
About one third used a model or theory
Slightly more than half used a standardized pre-briefing
approach
– Less than half of persons debriefing had received training and
less than 20% had their competence as a debriefer assessed.
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Other recent studies
• Pediatric Emergency Medicine Faculty
simulation facilitators
• INACSL membership study
• Pre-briefing
(Lee, J., Cheng, A., Angelski, C., Allain, D., & Ali, S., 2015)
(Gore, T., Van Gele, P., Ravert, P., & Mabire, C. 2012)
(McDermott, D, 2016)
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Types of debriefing
• Structured:
(Dreifuerst & Decker, 2012)
– Plus Delta (and variations) (Military, easy to use)
– Debriefing for Meaningful Learning (Dreifurst)
– Debriefing with Good Judgment (Rudolf)
• Other types:
– Interprofessional: TeamSTEPPS
• Focus on Team performance:
• Analyze: why did the event occur, what worked, and
what did not work?
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Plus Delta
What went well?
• Washed hands
• Identified patient
• Etc…
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What would you do differently?
• Assess mental status and
compare to previous…
• Notify provider of changes
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Debriefing for Meaning Learning
• Structured
– Uses a worksheet (or white board)
– Incorporates engaging, exploring, explaining,
elaborating, evaluating, extending
• Similar to Tanner’s Thinking Like a Nurse
model of clinical judgement
– Noticing, Interpreting, Responding, Reflecting
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Practice: Advocacy-Inquiry Model
• Advocacy-Inquiry method
– Debriefer identifies a part of the simulation to
explore further
– Observation or assertion coupled with a question
to the learner/participant
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Evaluating your skill
• Debriefing Assessment for Simulation in
Healthcare (DASH) instrument
– Training available through the Center for Medical
Simulation (webinars, on site)
– Assesses the instructor behaviors that facilitate
learning
– Designed with Debriefing with Good Judgement in
mind
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Some things to avoid
– “Guess what I’m thinking…” type questions
– Judgmental approach: “What went wrong or who
did something wrong…”
– Lecturing: If you are doing all the talking you are
probably not doing it right.
– “The answer is in the room somewhere. You just
need to let it come out.”
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Use Socratic Questioning
• Types of Socratic questions:
– Conceptual Clarification: “What do you think that means”; “Why
do you think that is the case?”
– Probing assumptions: “ What else can we assume and why?”
– Proving rationale, reasons, and evidence: “Why do you think this
is happening?” “Can you give me an example?”
– Questioning viewpoints and perspectives: “How can you at this
another way?”
– Probing implications: “What do you think will happen next?”
“How does this fit with what you’ve learned?”
– Asking questions about the question: “What does this mean?”
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Ways to promote engagement
• Have resources on hand
– Drug book
– Procedure book
– Text book
• Assign observers specific tasks
– Aligns with the objectives or nursing in general
– Examples: Observe for patient safety,
communication, etc.
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Practice
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Each person will take a role:
Janet W- Debrief facilitator
Rosemary- Prebrief facilitator
Phil-Standardized Patient
Janet- Nurse
Kevin- Nurse who arrives to help
David- Observer
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Practice: Using Tanner’s Model
• Insert video here:
https://www.youtube.com/watch?v=KkSDW4
4hxTk
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Emotional
Response
One word
Noticing
What did you
notice about the
situation and or
self-awareness
What was the
scenario about?
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Interpreting
Understanding of
the situation/cues
Responding
Deciding on a course
of action or what
the course of action
should have been
Reflecting
Reflection-onaction and
reflection-beyondaction
Take aways-what
did you learn?
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Conduct a DASH assessment
• DASH training (recommended) is available from
the Center for Medical Simulation.
• Element 1 (Pre-Brief): Setting the state
• Element 2-6 (Debrief)
– Maintained engaging context for learning
– Debriefing structured in an organized way
– Provoked in-depth discussions for reflection on
performance
– Identified what I did well or poorly and why
– Helped me see how to improve or sustain good
performance
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Questions?
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What to expect in Debriefing 102
• Break up into groups of 6
• Each group should have:
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Nursing student x3
Pre-brief facilitator
Debrief facilitator
Observer
• Practice facilitating using the CPR videos (x3)
• After each debriefing use a DASH tool to discuss the
debriefing
• Your room leader will help you with an overall debrief
between sessions and at the end.
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References
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Alexander, M., Durham, C., Hooper, J. I., Jeffries, P. R., Goldman, N., Kardong-Edgren, S. …Tillman, C. (2015). NCSBN
simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), 39-42.
Center for Medical Simulation (2010) Debriefing Assessment for Simulation in Healthcare (DASH)© Rater’s Handbook.
Dreifuerst, K. T. & Decker, S. (2012). Debriefing: An essential componant for learning in simulation pedagogy. In Pamela R.
Jeffries (Ed.) Simulation in Nursing Education (2nd ed) (105-129) New York: National League for Nursing
Dufrene, C. & Young, A. (2014). Successful debriefing-Best methods to achieve positive learning outcomes: A literature
review. Nurse Education Today, 34; 372-376. http://dx.doi.org/10.1016/j.nedt.2013.06.026
Fey, M. K. (2015). Debriefing practices in nursing education programs in the United States. (Doctoral Dissertation). Retrieved
from Proquest LLC. (UMI Number 3621880).
Fey, M. K., Scrandis, D., Daniels, A., & Haut, C. (2014). Learning through debriefing: Students perspectives. Clinical Simulation
in Nursing, 10(5), e249-e256. http://dx.doi.org/10.1016/j.ecns.2013.12.009
Gore, T., Van Gele, P., Ravert, P., & Mabire, C. (2012). A 2010 survey of the INACSL membership about simulation use. Clinical
Simulation in Nursing, 8(4), e125-e133. doi:10.1016/j.ecns.2012.01.002.
INACSL Standards Committee (2016, December). INACSL standards of best practice: Simulation℠ Debriefing. Clinical
Simulation in Nursing, 12(S), S21-S25. Http:..dx.doi.org/10.1016/j.ecns.2016.09.008
Lee, J., Cheng, A., Angelski, C., Allain, D., & Ali, S. (2015). High-fidelity simulation in pediatric emergency medicine. Pediatric
Emergency Care, 31(4), 260-265.
Levett-Jones, T. & Lapkin, S. (In press). A systematic review of the effectiveness of simulation debriefing in health
professional education. Nurse Education Today, http://dx.doi.ord/10.1016/j.medt.2013.09.020
Rudolf, J. W., Simon, R. , Dufresne, R. L., & Raemer, D. B. (2006). There’s no such thing as “nonjudgemental” debriefing: a
theory and method for debriefing with good judgement. Simulation in Healthcare, 1 (1); 49-55.
Shinnick, M. A., Woo, M., Horwich, T. B., & Steadman, R. (2011). Debriefing: the most important component in simulation?
Clinical Simulation in Nursing, 7(3), e105-e111. doi:10.1016/j.ecns.2010.11.005
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