Debriefing & Learning Conversations
What is a debrief?
That is a big question and an even bigger question is what is the best way to debrief. There is no right way to debrief, but a good understanding about how we learn will provide a solid foundation for structuring a debrief correctly.
So what is debriefing and why bother?
Debriefing occurs after an event, allowing learners/teams reflect, review performance with the aim to improve knowledge, skills and behaviour in a systematic way.
Within the premise of healthcare simulation, debriefing occurs following a scenario, and may be led by a single, or multiple debriefer, with, or without a content expert to support the discussion.
Experiential learning includes several theories, such as Kolb, Schon, Mastery Learning, Deliberate Practice, Boud, Bandura & Dewey if readers would wish to discover more about their works.
A summary of this and associated learning theories are covered in the slides below:
The role of the debriefer is a facilitator who is passionate, honest and curious with the focus of the experience on the learners and optimising their development.
Debriefing and feedback are often used interchangeably, in addition to reflection & reflexivity, and all fall within the premise of 'Learning Conversations'. Feedback is defined as providing statements of performance to facilitate learning and is therefore 'unidirectional'. Two good reviews of giving feedback and tricks how to deliver it well are available here & here.
Debriefing is often described as a process for facilitating learner reflections, often within a group of learners by creating a shared mental model. Reflection is a process for learners to build on previous knowledge with new experiences to inform future practice under the banner of experiential learning. Reflexivity relates to team performance and reflects the groups overall reflection and can be delivered through debriefing. In all of the above there is a general promotion for these to be conversations between the instructor and learners.
In terms of learning conversations this paper covers it all. It explains how the theoretical roots of feedback and debriefing are similar and if instructors wish to develop either they should learn about both.
One of the most challenging elements of debriefing is the need to continuously think on your feet and being adaptable / flexible. In addition many debriefers must also strategize to ensure the scenario unfolds the right way and core learning is covered during the debrief phase.
A practice development triangle framework for expert debriefing practices is available in this phenomenal article.
There are some key elements which help when debriefing:
Clear objectives stated early
The complexity of the scenario will impact how much could be covered, and may mask what should be covered.
The experience level of the learners and their familiarity with simulation, the learning environment and the time available.
The individual personalities within the group.
The facilitators background and experience.
The style of questions used, preferably open-ended and always non-judgemental*, reflecting learner statements can reiterate learning and open further discussions.
The timing of the debrief should be done as quickly after the event as possible to optimise emotive energy and the "fiz-pop" effect.
Many debriefing models follow a three stage model of gather, analyse and summarise. The videos below cover this in more depth.
There are concerns that debriefing is never non-judgemental, and instead debriefers should focus on 'good judgement' aiming for an advocacy inquiry approach.
This concept comes from this paper by Rudolph et al (2006) who explore the idea in depth, highlighting the challenge of providing psychological safety while ensuring learners are appropriately engaged, challenging beliefs and encouraging reflection. The aim of reflection is to develop "self-correcting versus "self-sealing" practice habits". The above article also provides and excellent explanation of reflection and is well worth a read. It explores how debriefing helps learners to develop new frames of understanding which allows changes in practice to occur.
Another paper helps to inform how we should focus on these "frames" of understanding commenting that debriefers are prone to the same biases when providing feedback around learner's mistakes as they were to have made them. Their "frame-based" feedback explores 3 phases reviewing the instructors opinion, reviewing immediate learning needs by understanding their actions which had led to their decisions, and promptly following on with a plan how to address their needs. This removes the potential "misdiagnosis" from instructors, allowing a better understanding of the mental models and factors which influenced the learners beliefs.
More learning resources are available below:
“Thinking on your feet”—a qualitative study of debriefing practice. Krogh et al, 2016: https://advancesinsimulation.biomedcentral.com/track/pdf/10.1186/s41077-016-0011-4
There's No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment: https://journals.lww.com/simulationinhealthcare/Fulltext/2006/00110/There_s_No_Such_Thing_as__Nonjudgmental_.6.aspx
We know what they did wrong, but not why: The case for 'frame-based' feedback - https://www.researchgate.net/publication/236664887_We_know_what_they_did_wrong_but_not_why_The_case_for_%27frame-based%27_feedback
More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods - https://pubmed.ncbi.nlm.nih.gov/27254527/
Learning Conversations: An Analysis of Their Theoretical Roots and Their Manifestations of Feedback and Debriefing in Medical Education - https://pubmed.ncbi.nlm.nih.gov/31365391/
Learning to give feedback in medical education - https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1576/toag.220.127.116.11023
Debriefing Experience Scale: Development of a Tool to Evaluate the Student Learning Experience in Debriefing - https://www.sciencedirect.com/science/article/abs/pii/S1876139911002519
DEBRIEFING FOR MEANINGFUL LEARNING: FOSTERING DEVELOPMENT OF CLINICAL REASONING THROUGH SIMULATION -https://scholarworks.iupui.edu/bitstream/handle/1805/2459/KTD%20%20Final%20Dissertation.pdf?sequence=1&isAllowed=y
Formative assessment and self‐regulated learning: a model and seven principles of good feedback practice - https://www.tandfonline.com/doi/abs/10.1080/03075070600572090