Lon Setnik, MD FACEP, MHPE %% #moc/publish | #on/debriefing | # Debriefing Why do I want to make this MOC? MOC Process: > - _**Cluster**_ ideas/notes together. > - Add lines between clusters (add the gaps). > - _**Chart**_ the empty spaces between clusters (map the gaps). > - _**Create**_ a new “thing” note. > - _**Create**_ a new “statement” note. > - _**Collide**_ your ideas. > - _**Clarify**_ your note titles. > - _**Connect**_ your notes. > - _**Cut up**_ a note into two. > - _**Combine**_ two notes into one. > - _**Cast aside**_ notes that are no longer relevant. > - _**Categorize**_ the notes in the MOC. _Mapping Concepts_ includes mostly creating links to other ideas. It is a higher order of note making. Creating Maps of concepts include finding the [[emergence]] and [[Convergence]]. This is an inherently [[Constructivism]] way of creating knowledge and storing ideas. It mirrors the way our brain works. It is a way of organizing and [[dealing with complexity]] [[Knowledge Value Making]] allows us to keep each note small, but to create meaning in and between each note. ```toc style: number min_depth: 2 max_depth: 6 ``` %% ## What's the big idea here? Debriefing is a structured conversation after an event to process and learn from that event, and plan future action. [[psychological safety]] is required for debriefing to help participants reduce the stress of the event, to process the event and potentially to take on some of the big challenges they experienced. Debriefing can help process and re-organize to move from an experience of trauma to an experience of learning, and can help build the muscles of seeing the world as a set of learning experiences. Debriefing and simulation can help or harm participants and teams, so align the debriefing process with the zone of education, use learner-centered techniques. Be clear when you are coaching (Single Loop Learning, Zone 1-2) and exploring frames (Double Loop Learning, Zone 2-3).![[SingleDouble Loop Learning.jpg]] (Roussin & Weinstock, 2017) %% ## Debriefing art / craft (Krogh et al., 2016) ![[the art of debriefing.jpg]] %% ## Debriefing Approaches ### Shared Structure - Reactions *This phase is key to moving from the activated state to a learning state, if possible. The activation level is variable and idiosyncratic.* (Ghazali et al., 2018) - Learning - Planning future action ### Plus Delta (Cheng et al., 2021) Focus on these aspects: - Figure out if you will assess global or specific performance - allow self-evaluation but guide it so it's more accurate, use that as a moment to learn how to self-assess more accurately - Define the criteria for self-assessment - Avoid Double Barrel Questions (What went well _and_ what to improve?) - Explore specific behaviors - Explore Team dynamics ![[PlusDelta 1.jpg]] ![[PlusDelta2.jpg]] ![[PlusDelta3.jpg]] ![[PlusDelta4.jpg]] ### Dynamic Plus Delta - Added reactions phase to plus delta and allowed dynamic diversion from the structure - Is this really different than PEARLS? I'm not sure. ![[CleanShot 2022-04-11 at 06.52.24.jpg]] (Kainth, 2021) ### CMS 4-phases - Introduction: What are the debriefing expectations (Name-Claim-Aim) and roles - Reactions: Emotion before cognition - Understanding - DWGJ - [[I saw I think I wonder]], [[Listening to Understand]] to diagnose, reflect, and explore - Move to the bigger picture/world/real clinical events - Identify cues for taking new action - Summary: [[Implementation intentions]] ### PEARLS - Combines 4-phases (if time and Zone 2 or 3) with Plus/Delta (if not as much time), can also be more technical cognitive teaching if more Zone 1 ![[PEARLS.jpg]] (Kainth, 2021) ## SimZones: ![[SimZones2.jpg]]![[SimZones3.jpg]] (Roussin & Weinstock, 2017) ## Conversation Structures Pay attention as the facilitator to the structure of the conversation. If the structure is off, your job is to comment and re-adjust. Goal is Pattern 1. ![[Debriefing Timing Diagrams.jpg]] Debriefing Conversational Patterns can be charted. (Coggins, 2022) ## Co-debriefing Pro-active and Reactive strategies should be used to keep the co-debriefing positive and effective. Demonstrate what you want the learners to take away as ideal methods of working together, including - "Time-Outs" - Open Negotiation - Creating a shared mental model - managing minor conflicts positively s ## Debriefing on Shift: _Find a debriefing style that meets your organizations needs and culture_ (Kam et al., 2022) - Plus/delta with reactions is a common approach - usually goal is about 10 minutes - is well received when times of dramatic change (COVID-19) or high stress ![[CleanShot 2022-04-11 at 09.20.50.jpg]] (Servotte, 2020) ## The role of routine debriefing ## Debriefing to Improve Process / Plant Design (Coleman, 2020) ![[SAFEE Debriefing Design.jpg]] ## Unrequited notes (by link) _update when creating MOC to point to this note_ These notes point directly to this note. But this note doesn't point back. ```dataview table file.mtime.year + "-" + file.mtime.month + "-" + file.mtime.day as Modified from [[Debriefing]] and !outgoing([[Debriefing]]) sort file.mtime desc ``` ## Associated notes (by tag) _Update when creating MOC to point to this tag_ These notes have this associated tag: `#on/debriefing. ```dataview table file.mtime.year + "-" + file.mtime.month + "-" + file.mtime.day as Modified from #on/debriefing and !outgoing([[Debriefing]]) sort file.mtime desc ``` ## Sources: Cheng, A., Eppich, W., Epps, C., Kolbe, M., Meguerdichian, M., & Grant, V. (2021). Embracing informed learner self-assessment during debriefing: The art of plus-delta. _Advances in Simulation_, _6_(1), 22. [https://doi.org/10.1186/s41077-021-00173-1](https://doi.org/10.1186/s41077-021-00173-1) Cheng, A., Morse, K. J., Rudolph, J., Arab, A. A., Runnacles, J., & Eppich, W. (2016). Learner-Centered Debriefing for Health Care Simulation Education: Lessons for Faculty Development. _Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare_, _11_(1), 32–40. [https://doi.org/10.1097/SIH.0000000000000136](https://doi.org/10.1097/SIH.0000000000000136) Cheng, A., Palaganas, J., Eppich, W., Rudolph, J., Robinson, T., & Grant, V. (2015). Co-debriefing for Simulation-based Education: A Primer for Facilitators. _Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare_, _10_(2), 69–75. [https://doi.org/10.1097/SIH.0000000000000077](https://doi.org/10.1097/SIH.0000000000000077) Colman, N., Dalpiaz, A., Walter, S., Chambers, M. S., & Hebbar, K. B. (2020). SAFEE: A Debriefing Tool to Identify Latent Conditions in Simulation-based Hospital Design Testing. _Advances in Simulation_, _5_(1), 14. [https://doi.org/10.1186/s41077-020-00132-2](https://doi.org/10.1186/s41077-020-00132-2) 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 in Healthcare: The Journal of the Society for Simulation in Healthcare_, _10_(2), 106–115. [https://doi.org/10.1097/SIH.0000000000000072](https://doi.org/10.1097/SIH.0000000000000072) Eppich, W. J., Hunt, E. A., Duval-Arnould, J. M., Siddall, V. J., & Cheng, A. (2015). Structuring Feedback and Debriefing to Achieve Mastery Learning Goals: _Academic Medicine_, _90_(11), 1501–1508. [https://doi.org/10.1097/ACM.0000000000000934](https://doi.org/10.1097/ACM.0000000000000934) Ghazali, D. A., Darmian-Rafei, I., Nadolny, J., Sosner, P., Ragot, S., & Oriot, D. (2018). Evaluation of stress response using psychological, biological, and electrophysiological markers during immersive simulation of life threatening events in multidisciplinary teams. _Australian Critical Care_, _31_(4), 226–233. [https://doi.org/10.1016/j.aucc.2017.07.001](https://doi.org/10.1016/j.aucc.2017.07.001) Kainth, R. (2021). Dynamic Plus-Delta: An agile debriefing approach centred around variable participant, faculty and contextual factors. _Advances in Simulation_, _6_(1), 35. [https://doi.org/10.1186/s41077-021-00185-x](https://doi.org/10.1186/s41077-021-00185-x) Kam, A. J., Gonsalves, C. L., Nordlund, S. V., Hale, S. J., Twiss, J., Cupido, C., Brar, M., & Parker, M. J. (2022). Implementation and facilitation of post-resuscitation debriefing: A comparative crossover study of two post-resuscitation debriefing frameworks. _BMC Emergency Medicine_, _22_(1), 152. [https://doi.org/10.1186/s12873-022-00707-4](https://doi.org/10.1186/s12873-022-00707-4) Kolbe, M., Eppich, W., Rudolph, J., Meguerdichian, M., Catena, H., Cripps, A., Grant, V., & Cheng, A. (2020). Managing psychological safety in debriefings: A dynamic balancing act. _BMJ Simulation and Technology Enhanced Learning_, _6_(3), 164–171. [https://doi.org/10.1136/bmjstel-2019-000470](https://doi.org/10.1136/bmjstel-2019-000470) Krogh, K., Bearman, M., & Nestel, D. (2016). “Thinking on your feet”—A qualitative study of debriefing practice. _Advances in Simulation_, _1_(1), 12. [https://doi.org/10.1186/s41077-016-0011-4](https://doi.org/10.1186/s41077-016-0011-4) Roussin, C. J., & Weinstock, P. (2017). SimZones: An Organizational Innovation for Simulation Programs and Centers. _Academic Medicine_, _92_(8), 1114–1120. [https://doi.org/10.1097/ACM.0000000000001746](https://doi.org/10.1097/ACM.0000000000001746) Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006). There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. _Simulation in Healthcare_, _1_(1), 7. Rudolph, J. W., Simon, R., Raemer, D. B., & Eppich, W. J. (2008). Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education. _Academic Emergency Medicine_, _15_(11), 1010–1016. [https://doi.org/10.1111/j.1553-2712.2008.00248.x](https://doi.org/10.1111/j.1553-2712.2008.00248.x) Sawyer, T., Eppich, W., Brett-Fleegler, M., Grant, V., & Cheng, A. (2016). More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods. _Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare_, _11_(3), 209–217. [https://doi.org/10.1097/SIH.0000000000000148](https://doi.org/10.1097/SIH.0000000000000148) Servotte, J.-C., Welch-Horan, T. B., Mullan, P., Piazza, J., Ghuysen, A., & Szyld, D. (2020). Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19. _Advances in Simulation_, _5_(1), 32. [https://doi.org/10.1186/s41077-020-00150-0](https://doi.org/10.1186/s41077-020-00150-0)