Meta-debriefing

Meta-debriefing is anything which facilitates a debrief, of a debrief, such that learning, reflection, or feedback occurs. In this sense one must be observed for a meta-debrief to occur, either through active observation during real-time debriefing, or by recording oneself for review later. Please note that if a recording is taken, consent from participants should be actively sought to maintain confidentiality as often learners will only express true reflections and learn if they feel safe to do so, and thinking others may watch or listen to a video of them, even if the focus is on you, may impair the quality of the session.

Failing the above, one strategy may be to maintain a reflective log, and/or a portfolio of debriefs you have undertaken, noting what went well, or less well, and look to find routes for improvement. Equally, finding a mentor to support your personal development can be a very successful strategy.

As a critical element of simulation education, it is interesting that debriefing poses such a challenge for even the most seasoned educators—“Even after 23 years, the most experienced of us are still learning to debrief.” (Voyer & Hatala, 2015).

As with many things, there is no "right" way of progressing your debriefing style, and one route may work better for some, while another better for others, what matters is what feels "right" for you.

One strategy for more novice debriefer to gain structured feedback is to use an assessment tool, such as OSAD (Objective Structured Assessment of Debriefing), DASH (Debriefing Assessment for Simulation in Healthcare), or SHORT (Simulation in Healthcare retrOaction Rating Tool) tools. A full breakdown the each tool is available here, here, or here respectively.

If using tools isn't for you, why not attend a debriefing course - one may be running at a simulation center near you?

A highly successful group who are modelling best practice in meta-debriefing are the Meta-Debrief Club, a group from Edinburgh hosing meetings where they would review recordings of their own debriefs, identifying key 'take-home-messages' & deliberate changes to practice (O'Shea et al, 2018).

There are no shortcuts to good debriefs. Practice makes perfect, and purposeful practice is better than unfocused repetition. We know what we know, and we know what we don't know. There are known unknowns, and that is where external help comes in to provide new insights and directions for development once our own avenues for exploration have run out. Work smart, not hard.

Can't find what you're looking for? Get in touch and we may be to offer some help either pointing you towards experienced individuals in the field, or a mentor, or by helping you set up your own meta-debrief club - check out our CONTACT US page for more information.

So how DOES one really get better at debriefing?

Most of the frameworks and tools to enhance debriefing focus on the following during debriefing:

• Establishing and maintaining a rapport with learners throughout using non-threatening approach and creating a psychologically safe environment

• Explain the purpose of debriefing, expectations and objectives at the start

• Encourage participation from learners with open-ended questions and prompting for active contributions

• Fully explore reactions to events, dealing with anyone who is unhappy for any reason

• Encourage self-reflection using a step-by-step approach

• Help learners explore reasons and consequences for actions, identifying specific examples

• Provide objective feedback promoting positive behaviors and identifying gaps in performance

• Reinforce key learning points and strategies for how future improvements can be applied in practice

But what does this actually mean and how should you look to improve on this:

• Approaches should focus on cognitive skills and critical thinking to promote adaptive expertise

• Conceptualize, apply, synthesize and evaluate information gathered

• Metacognitive reflection pre-, during- & post-event for greater understanding and development

A 3 development stage has been proposed by Cheng et al (2020) in Simulation in Healthcare as follows:

1. Discovery stage: foundations introduce key knowledge of concepts, frameworks and strategies, tools and aids to facilitate beginners development by helping manage cognitive load and allow meaningful interaction with learners. This stage also benefits from self-observation and feedback, as discussed above.

2. Growth stage: Attending additional training & courses, expanding one's breadth of knowledge and skills, in addition to observing others and co-debriefing with experts can help progression. Typically will rely less on debriefing tools and blend models, adding complexity and managing increased cognitive loads. A variety of experiences and challenges will further aid development.

3. Maturity stage: At this point debriefers will have amassed significant experience but will continue to seek avenues of progression and challenge, with ongoing practice and targeted training, helping to develop a community of practice locally, supporting faculty development programs.