Effective Debriefing Tips for Simulation-based Medical Education

(From the EiC: We have a guest author this week on the ICE blog. Adam Cheng discusses his research on debriefing. This research is informed by a research program that has produced more than 30 related manuscripts. The cornerstone paper is here.)

By Adam Cheng (@DocChenger)

Cheng Adam 2013 croppedThe immense growth of simulation as a teaching modality for healthcare has drawn attention to the role of debriefing in experiential learning. While debriefing is often regarded as perhaps the most important component of simulation-based education, very little is known about the most effective debriefing methods.   In a recent systematic review, our research group reviewed the simulation debriefing literature and found only a handful of studies comparing variations of debriefing style, structure, content and context:

Cheng A, Eppich W, Grant V, Sherbino J, Zendejas-Mummert B, Cook D. Debriefing for Technology-Enhanced Simulation: A Systematic Review and Meta-analysis. Medical Education. 2014; 48:657-666.

The key messages from this systematic review are:

  • Simulation combined with debriefing is an effective teaching modality
  • The nature of debriefing, when conducted as part of a simulation-based research, is poorly described and reported in the literature
  • Use of expert modeling in combination with debriefing is effective
  • When comparing terminal vs. concurrent debriefing, results are variable and are related to the context and topic of debriefing
  • Use of video during debriefing is not more effective when compared to debriefing without video
  • No studies have been done comparing different methods of debriefing.

Given the paucity of evidence to inform our practices, how should debriefing be facilitated to best enhance learning outcomes? Perhaps the existing literature focuses too much on specific adjuncts to debriefing, and not enough on how debriefing can be tailored to the learning needs, learner type, and context for learning. Instead of mastering one specific method of debriefing, educators may be better served by developing a toolbox of skills that includes various debriefing methods and adjuncts that can be used when most appropriate.

Here are a few tips to help enhance your debriefings:

  • Be curious. If you are truly curious and interested in what the learners have to say, they are more likely to engage in reflective discussion.
  • Never make assumptions. Don’t assume you know why learners behave in a certain manner. Doing so may lead to discussion and teaching that is irrelevant.
  • Find you own voice. Don’t be paralyzed by using scripted words that are often associated with several methods of debriefing. Use the scripts but find your own voice by using your own words… keeping the end goal in mind.
  • View yourself as a learner. By adopting this perspective, you align yourself with the learners, creating a safer environment for learning, where reflective discussion in more likely to occur.
  • Be an active listener. Listen, process and assimilate what the learners have to say into your facilitation practices. This helps to create a more learner centered debriefing experience.
  • Pick your spots. Some behaviours are better suited for exploration through focused facilitation (e.g., teamwork skills), while other behaviours are better suited for directive feedback (e.g., technical skills).
  • Don’t be afraid to teach. All of us are teachers… and in many situations, learners just need to be taught!