This book is a concise manual on debriefing techniques in a clinical educational context. It presents the most popular debriefing techniques and, hence, can be used as a reference manual by educators to help them achieve their intended debriefing objectives. The overarching objective of debriefing is to promote reflection and improve patient safety awareness at an individual and a team level. This book provides clear explanations of what constitutes a valuable and effective debriefing, and presents the various approaches that can be used and how debriefing differs from feedback. It includes key recommendations on aspects that directly or indirectly impact debriefing with different populations of learners such as students or qualified healthcare professionals of various levels of seniority. This book can also be used as a survival guide for both simulation educators and clinicians during debriefings. It includes several useful sections explaining the different phases of a debriefing session, which help learners develop and consolidate their knowledge, and identify potential knowledge or performance gaps and near misses. The underlying philosophy of this book is to also promote profound respect for the trainee by using a non-offensive debriefing approach. Debriefing facilitators will appreciate the several key sentences that will help them lead and engage their learners in the various phases of expressing their emotions and analyzing their experience and actions.
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After a MSc in neurosciences, Prof. Denis Oriot obtained his M.D. and board certification in paediatrics and anaesthesiology. He spent 2 years in Paris, specializing in paediatric intensive care. Then he flew over to Canada to spend a 2-year fellowship in Montreal Children's Hospital (McGill University) in 1989-1990, practicing clinical care (Paediatric intensive care), research, and teaching. That was his first discovery of simulation and debriefing. Back in France, he got nominated as Professor of Paediatrics at the University of Poitiers (France). Besides clinical care, Denis studied moral philosophy (Sorbonne, Paris) and obtained a Ph.D. in bioethics (University René Descartes, Paris). He has a large clinical experience with more than 20 years of practice in Paediatric Intensive Care and Paediatric Emergency Medicine. As one of the French pioneers in simulation, he developed training programmes in the early 1990's. Denis is at the head of a French nationwide simulation-based education programme through a university course on paediatric emergency procedures. He has taught simulation-based education in several overseas facilities during the last two decades. He is currently the scientific referee of the Simulation Centre in Poitiers, France. Denis also has been attending as a trainee various simulation education courses in the US about simulation and debriefing during the last 10 years. Denis has also developed several research projects in simulation about performance and stress, multi-professional teamwork and performance, disclosure of bad news, mastery trainings on specific paediatric and adult emergency procedures, and different types of debriefing approaches. He has a particular interest in assessment of procedures and global evaluation of emergency teamwork performance.
Prof. Guillaume Alinier started his academic career in 2000 at the University of Hertfordshire's (UH) School of Electronic, Communication, and Electrical Engineering as a researcher on a British Heart Foundation funded project to develop patient simulation technology for use in healthcare education. Very rapidly Guillaume started demonstrating fellow academics that, when embedded in clinical scenarios followed by a supportive debriefing period, mannequins and computer controlled patient simulators could be used in a different manner with learners to observe and understand their critical thinking, decision making, and their application of clinical skills in a more autonomous manner than previously dared by his colleagues with students. With this approach Guillaume embarked in multiple simulation-based educational activities across a range of disciplines with undergraduate students as well as in collaboration with local NHS Trusts for the training of junior doctors and healthcare professionals, and also started to contribute to the various nascent healthcare simulation-education gatherings and conferences around Europe and in the US. These activities, alongside the training that Guillaume started to provide through courses to educators from other institutions, various journal editorial responsibilities, and the roles he occupied within the wider simulation community around the world, granted Guillaume the award of a National Teaching Fellowship in 2006, a Senior Fellowship in 2009 from the Higher Education Academy (UK), a Visiting Fellowship at the University of Northumbria (UK) since 2009, and his full tenure professorship in 2011. Whilst still affiliated to UH, he is now based in Qatar working as Director of Research for Hamad Medical Corporation Ambulance Service (HMCAS). In this role he has actively led and contributed to a large number of innovative projects on a broad range of domains across several HMC departments, generally still related to simulation and human factors.
Preface 4Acknowledgements 6CHAPTER 1: Introduction to debriefing 111.1. Definition of debriefing 111.2. The place of debriefing in learning 131.3. Briefing before debriefing 131.3.1. The reasons for briefing 131.3.2. The potential issues of not briefing 191.4. Purpose of debriefing: what to debrief about? 191.5. Who, when, and where? 241.5.1. Who? 241.5.2. When? 251.5.3. Where? 251.6. The debriefer and co-debriefer 261.7. The different debriefing models and frameworks 291.7.1. The 3-phase model of debriefing 291.7.2. Other debriefing models 301.7.3. The multiphase models and frameworks of debriefing 321.7.4. The PEARLS framework 341.8. The different debriefing approaches and communication strategies 351.8.1. Directive feedback 361.8.2. Plus/delta 371.8.3. After Action Review 37<1.8.4. Advocacy-Inquiry focused facilitation 381.8.5. Other forms of feedback 391.9. References 40CHAPTER 2: How to run a debriefing? 472.1. The debriefing model used 472.2. How to introduce debriefing? 482.3. How to run the reaction phase? 492.4. How to introduce the descriptive part of the analysis phase? 502.5. How to facilitate the rest of the analysis phase? 522.6. Which investigation technique to apply during the analysis phase 532.6.1. The judgmental debriefing technique should not be used 532.6.2. The non-judgmental debriefing technique brings little benefit 542.6.3. The good-judgment debriefing technique 552.6.4. How to modulate the use of advocacy-inquiry during debriefing? 592.7. How to close performance gaps? 612.8. Verification of closure of performance gaps 632.9. How to run the summary and conclusion of a debriefing? 642.10. Summary of some key debriefing sentences 652.11. References 67CHAPTER 3: General advice and specific issues 693.1. General debriefing tips 693.2. Using a debriefing preparation checklist 713.3. Video or not video-assisted debriefing? 733.4. Using within-scenario time-outs to debrief or not? 743.5. What about running a scenario and debriefing demonstration? 753.6. How to best handle the debriefing of a multiprofessional team? 753.7. What if I feel I cannot keep what happened confidential? 763.8. What is debriefing for rapid cycle deliberate practice about? 763.9. How to prevent or handle a difficult debriefing? 763.10. How to assess debriefing? 813.11. References 85CHAPTER 4: My personal diary of debriefing experiences 884.1. About this diary's author 884.2. Strengths as a debriefer 924.3. Concerns and weaknesses as a debriefer 974.4. Appraisal from other debriefers 1024.5. Personal learning points 1074.6. Important debriefing references 1154.7. Briefing and debriefing cognitive aids 1264.7.1. Simulation session briefing card 1274.7.2. Debriefing card 129
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