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7 tips to become a good debriefer

Fouad Marhar
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7 expert tips for effective healthcare simulation debriefing. From establishing psychological safety to utilizing open-ended questions, learn how to maximize learning outcomes and create an environment conducive to growth and collaboration in healthcare training simulations. These expert strategies empower debriefers to guide participants through reflective discussions, ensuring that every simulation session is not just an experience, but a valuable opportunity for skill enhancement and professional development

DOI: https://doi.org/10.69079/simzine.H24.n14.0008

It has been said for over 20 years that debriefing can “make or break a simulation session” and that it is “the heart and soul of simulation” (Marcus Rall).

With this in mind, here are seven elements considered essential to effective debriefing. It’s important to keep them in mind, as they explain how debriefing is structured and the usefulness of each debriefing stage and the phases that precede it. So, let’s take a closer look at what makes an effective debrief.

1. Ensuring psychological safety

Establishing psychological safety is essential to optimize learning during simulation and debriefing. Psychological safety has been defined as the ability to “behave or act without fear of negative consequences for self-image, social status or one’s own career”. For individuals to be psychologically safe, they need to be able to speak without feeling that their words will result in personal harm or rejection. To achieve this, simulation and debriefing must be conducted in a safe learning environment. To establish a safe learning environment, an explanatory pre-simulation briefing can be conducted by the debriefing facilitator(s).

2. Have an attitude that is conducive to learner learning

As a debriefing facilitator or learner, it’s essential to have a starting premise concerning the interest and abilities of the team involved in the simulation and debriefing. An example of an initial assumption borrowed from the Boston CMS team is: “We believe that all the people taking part in this simulation are intelligent, capable, keen to do their best and eager to improve.” Keeping this assumption in mind encourages the facilitator and learners to show curiosity in cases where the team is not achieving the desired results. This curiosity prompts the facilitator to examine the “frames” that lead to the observed actions. Identifying these frames in the formative evaluation process can help facilitate learning. The trainer is not in a position to make assumptions, but rather to explore the whys and wherefores of the learner’s actions. By helping them to modify their erroneous mental schemas, there is greater leverage over the student’s future actions. Advocacy and inquiry, a questioning technique used during debriefing, plays a key role in exploring the learner’s mental schemas.

3. Establish debriefing rules

Providing participants with a set of ground rules for debriefing can improve psychological safety and prevent potential difficulties.

Debriefing rules include the need for all members to actively participate in the discussion, the assurance that the discussion is confidential, and the affirmation that debriefing is focused on performance improvement (and not individual criticism). This introduction of the debriefing rules sets the atmosphere for the debriefing, and can take place during the pre-briefing or just before the first debriefing of the training day, for example. These rules will be repeated as often as necessary by the facilitators to maintain an atmosphere conducive to learning for all learners throughout the simulation training.

4. Establishing a shared mental model

For a group of simulation participants to collectively discuss a simulation experience, it is important that they have a shared understanding of the events. Time must therefore be set aside in the debriefing to establish a shared mental model of the events that took place during the simulation. To do this, team members are usually asked to review the events of the scenario, with the help of a facilitator if necessary. Many post-event debriefing conversational structures include a specific phase of conversation to recap the key events of the simulation: the descriptive phase in most models.

Once the whole team has agreed on the main events of the simulation, it’s time to focus on the elements to be analyzed in greater depth with the group, in line with the learning objectives.

5. Addressing learning objectives

In line with good teaching practice, it’s important to incorporate clear learning objectives into every simulation. It is not a simple conversation, it is a learning conversation. Similarly, addressing these learning objectives during debriefing is an important step in optimizing learning. Ensuring that learning objectives are covered during debriefing can be facilitated by including them in your scenario sheet. All debriefing structures include a phase of analysis of the learning objectives in relation to the situation experienced. Although it is important to cover all the learning objectives during the debriefing, it is not necessary to reveal them in detail to the participants. There is still a lively debate in the community on this subject, but you will decide for yourself, depending on the program, curriculum or group, whether these objectives are worth revealing.

6. Use open-ended questions

Asking open-ended questions facilitates discussion and is designed to encourage reflection and self-evaluation among simulation participants. Here are some examples of open-ended questions: “Can you tell me what happened in this sequence ?” or “Tell me about teamwork during the simulation”.

Avoid closed questions where the answer can only be yes/no. For example, “Did you notice the change in rhythm? “and “Did you have good teamwork in this simulation?”. This is a key skill for an effective facilitator, as this type of questioning opens up the field of reflection for learners, rather than limiting their answers to the question’s scope.

That said, closed questions have the virtue of being straight to the point, and are very useful in clarification phases. However, avoid using them to demonstrate that you’re right, or to steer learners towards your own line of thinking. For example, “Do we agree that calling for help is essential in the event of cardiac arrest? And that massage should be performed as quickly as possible ? Is that what you did ?”. Here, the questions are closed, but serve to demonstrate a point of view. The learner will feel trapped and think that we’re trying to mislead him. Ask him instead, “What do you know about priorities in cardiac arrest ?”

7. Let the silence do its part of the job

A period of silence often occurs after the facilitator has asked an open-ended question. During this silence, internal processes take place in the participants’ minds. They formulate their thoughts, critically analyze their mental patterns and consolidate a convincing response to the facilitator’s question. Thus, silence during debriefing is valuable for participants. Facilitators need to be patient after asking questions and use silence as an effective tool, allowing it to settle in as needed. A good tip is to hold your tongue between your teeth just after the question has been asked. This reminds you that it’s the answer that’s important and keeps you from speaking first during the silent phase. The more you respect silences, the more you allow learners to integrate information according to their perception of the situation, and THUS the more you open up learning opportunities.

Sources

1. Sawyer, T., et al. (2016). More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods. Simulation in healthcare, 11(3), 209–217. 

2.Establishing a safe container for learning in simulation. Rudolph JW et al.. Simul Healthc 2014 Rudolph, J. W.,  Raemer, D. B., & Simon, R. (2014). Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simulation in healthcare, 9(6), 339–349.

3. Phrampus P, O’Donnell J. Debriefing using a structured and supported approach. In: Levine A, DeMaria S, Schwartz A, Sim A, eds. The Comprehensive Textbook of Healthcare Simulation. 1st ed. New York, NY: Springer; 2013:73-85

4.  Rudolph, J. W., et al. (2006). There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simulation in healthcare, 1(1), 49–55.

5. Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers’ actions and participants’ reflections during team debriefings. BMJ Qual Saf. 2023 Mar;32(3):160-172. doi: 10.1136/bmjqs-2021-014393. Epub 2022 Jul 28. PMID: 35902231.

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Fouad Marhar
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Fouad Marhar

MD (Anesthesia-Critical care-Pain Medicine) International simulation Expert, Consultant Coach in Healthcare E-Health enthusiast View all Posts

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