What is a pre-brief?
Depending on who you ask - this is the most important part when delivering a simulation. It will orientate your learners to many components required for a successful event:
Orientation to the manikin
Orientation to the simulation environment
Orientation to actions expected - applying pulse oximetry , mimicking taking blood, inserting an IO device or needle-decompressing a pneumothorax, etc...
Orientation to audio/visual components
Safety rules - if access to LIVE defibrillators to treat them with respect
Help available and how to contact them [avoid putting REAL crash calls out - it happens!]
Participant(s) roles [if different to normal]
Faculty (stooges) available & their roles/story
How to access information / results [digital / paper / mobile - provided/personal)
How to access resources - catheters / crash trolleys etc...
Scenario Day & Time
Any time travel during the simulation? [will results be magically available quicker than in real life?]
When the scenario will end
How they can ask for the scenario to stop if problems occur (opportunity for "Hot Debriefs")
Explain that they should try as much as possible to treat the manikin and scenario as REAL -i.e. establishing the "fiction contract" (albeit their investment may be blunted by how "real" you've made the encounter as well... - more on this later)
Explain any form of formal/informal assessment being undertaken
Explain the scenario will be followed by a debrief and if new to simulation what a debrief is
Explain the necessity of confidentiality and psychological safety to maximise investment
Allocate any specific points-of-interest for observers to watch for (individual non-technical skills, clinical management, etc...)
Explain/Explore the learning agenda including any curricula links / "real-life" rationale for why the session should happen
Check the learners are ready and the "test the water" to determine if the scenario is set at the right "challenge" for them
Explain the scenario / "handover" the case +/- SBAR-type.
Not much to cover really - all without overwhelming the learner before the scenario starts - right...
INACSL defines the pre-brief as “an information or orientation session held prior to the start of a simulation-based learning experience in which instruction or preparatory information is given to the participants” with the focus around explaining goals, objectives, timings & orientation & the clinical scenario (Meakim et al., 2013).
There are some circles out there who like to "surprise" learners with a simulation, forgoing any of the above. For anyone who would like to read a very convincing piece about why you should never do this please read this article by Monteiro & Sibbald - it is very good.
As highlighted above, there is lots of responsibility when running a simulation, let alone taking observing a scenario and making decent observations of practice to inform learning discussions. Some strategies to mitigate this include the use of checklists, personalised "intro" videos, co-facilitation (when able) and sharing responsibility with the learners with appropriate debriefing strategies (covered elsewhere). An example of a checklist is available here from Healthy Simulation.
A pragmatic review of pre-briefing is covered on the Healthy Simulation Pre-Briefing page.
INACSL have produced simfographics covering this an more and are available here.
Out of the context of simulation and the wider principles of good medical education, a key principle for the rationalisation of pre-briefing include the concepts of on-boarding, constructivism, and the zone of proximal development (ZPD) among other theories.
On-boarding is the principle of familiarising learners with the content, mechanisms and objectives of the scenario - an example of which is a tutorial before a game-like activity. It is also a related element of Knowles adult learning principle.
Constructivism is "the act of learning is based on a process which connects new knowledge to pre-existing knowledge" (Dennick, 2016).
The Zone of Proximal Development refers to the space between what learners have mastered and what they should master in the next developmental stage (Groot et al, 2020).
More learning resources are available below:
An example pre-brief can be watched below:
Example Introduction to SimMan videos are available below:
*other simulation manikins and task trainers are available for purchase from several vendors
Tips for Conducting the Pre-Brief for a Simulations https://scholarworks.iupui.edu/handle/1805/13875
Standards of Best Practice: Simulation Standard I: Terminology. Clinical Simulation in Nursing, http://dx.doi.org/10.1016/j.ecns.2013.04.001
Aha! Taking on the myth that simulation-derived surprise enhances learning https://onlinelibrary.wiley.com/doi/abs/10.1111/medu.14141
Cognitive load theory for for debriefing simulations: implications for faculty development https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-018-0086-1
Establishing a Safe Container for Learning in Simulation https://www.achonline.org/Portals/36/Safe%20Container.pdf
Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83 https://www.tandfonline.com/doi/full/10.3109/0142159X.2013.828153
Constructivism: reflections on twenty five years teaching the constructivist approach in medical education - Reg Dennick, International Journal of Medical Education. 2016;7:200-205 - https://www.ijme.net/archive/7/constructivist-approach-in-medical-education.pdf
Simulation at the Frontier of the Zone of Proximal Development, A Test in Acute Care for Inexperienced Learners, Groot et al 2020 - https://journals.lww.com/academicmedicine/Abstract/publishahead/Simulation_at_the_Frontier_of_the_Zone_of_Proximal.97253.aspx