In clinical simulation, a debriefing is not always a calm space for learning. When intense emotions, disagreements or tensions arise, the facilitator faces a ‘difficult debriefing’. Turning these challenges into learning opportunities is key to strengthening patient safety and professional engagement.
The simulation is over. Everyone in the room is silent, eyes fixed on the facilitator, waiting for the debriefing to begin. But the atmosphere is charged: one participant is frustrated by a mistake made, another seems upset, and there is palpable tension between two team members over disagreements during the simulation. The facilitator takes a breath and braces himself. He knows it will be a difficult debriefing. But he also knows that, if he can manage it well, this tense moment can be transformed into a powerful learning opportunity.
If you are an instructor or facilitator of clinical simulations, you have probably also experienced a similar situation and labeled this debriefing “difficult.” The literature agrees in defining the term “difficult debriefing” as that post-simulation reflection in which obstacles of different kinds appear that make it difficult to achieve learning (der Sahakian et al., 2015).
As we know, these obstacles can have multiple origins: the design of the case, the technology and its interaction with the participant, the level of fidelity of the scenario and the case, issues linked to the facilitator or the participant him/herself, etc. (Díaz-Guío and Cimadevilla-Calvo, 2019). This amalgam of causes confers to difficult debriefing some particularities for which every debriefer wants to be prepared.
More specifically, factors such as the presence of intense emotions on the part of the participants (due to the nature of the simulated scenario, the feeling of failure or exposure to the mistakes made) are mentioned (Rudolph et al., 2006; Eppich & Cheng, 2015). There is no doubt that the existence of disagreements or conflicts among participants about the resolution or decision making performed during clinical simulation also hinders debriefing (Roze des Ordons, Cheng, Lockyer et al., 2021). In natural teams, this is often complemented by the presence of hierarchies or power differentials among participants, which can inhibit open and honest participation.
To address these situations, experts recommend that the facilitator develop specific communication and complex conversation management skills. Several of these strategies come from settings where difficult conversations are frequent (Stone et al, 1999; Edmonson et al., 2006; Gallagher, 2009).
In this sense, when faced with debriefings that may be perceived as difficult, it is recommended to:
- establish, from the outset, a psychologically safe environment, where respect, trust and openness to dialogue are fostered (Rudolph et al., 2014);
- use techniques linked to difficult conversations such as normalization, validation, generalization, paraphrasing or naming what is happening (Grant et al., 2018), without forgetting the power of genuine curiosity questions;
- be prepared to handle stressful situations, balancing between identifying and managing emotions with redirection through questioning towards learning objectives;
- Have a solid background in clinical simulation methodology and make its pillars transparent during pre-briefing and during the session;
- As a debriefer, understand and accept the complex idiosyncrasies of debriefing, for what it means for both participants and debriefer, and for what happens in it.
There is no doubt that guiding a difficult debriefing is not only a challenge, but also a very important opportunity for growth and learning for both the participants and the facilitator.
By developing and improving specific skills in communication and management of complex situations, facilitators can transform moments identified as stressful into enriching experiences to reinforce commitment to excellence and continuous improvement in patient safety.
Bibliography
Der Sahakian, G., Alinier, G., Savoldelli, G., Oriot, D., Jaffrelot, M., & Lecomte, F. (2015). Setting Conditions for Productive Debriefing. Simulation & Gaming, 46(2), 197-208.
Des Ordons, R.; Cheng, A.; Lockyer, J.; Wilkie, R.; Grant, V.; Eppich, W. (2021). Approaches to interpersonal conflict in simulation debriefings: A qualitative study. Medical Education, 55(11): 1284-1296.
Díaz-Guío, D.A.; Cimadevilla-Calvo, B. (2019). Educación basada en simulación: debriefing, sus fundamentos, bondades y dificultades. Simulación Clínica, 1(2): 95-103.
Edmonson, A.; Smith, D. (2006). Too hot to handle? How to manage relationship conflict. California Management Review, 45: 34-54.
Eppich, W.; Cheng, A. (2015). Promoting excellence and reflective learning in simulation (PEARLS). Development and rationale for a blended approach to health care simulation debriefing. Simulation healthcare, 10: 106-115.
Gallagher, R. (2009). How to Tell Anyone Anything: Breakthrough Techniques for Handling Difficult Conversations at Work. Amacom.
Reynolds, M. (2014). The discomfort zone: how leaders turn difficult conversations into breakthroughs. Berrett-Koehler Publishers.
Rudolph, J.; Simon, R.; Dufresne, R.; Raemer, D. (2006). There’s no such thing as a‘‘non-judgmental’’debriefing: a theory and method for debriefing with good judgment. Simulation Healthcare, 1: 49–55.
Stone, D.; Patton, B.; Heen, S. (1999). Difficult conversations. How to discuss what matters most. Penguin Books. aún hoy, generar un acercamiento a los cuidados humanizados o, más bien, a la humanización sanitaria.
READ ALSO
