Challenges Associated With Debriefing

I thought I would start the New Year off with sharing some thoughts on some challenges associated with debriefing. These are excerpts from a forthcoming book chapter authored by myself and my collegue Dr. John O’Donnell………..


Challenges with Debriefing

There are a number of challenges associated with debriefing.   Some of them involve self-awareness on the part of the facilitator, the skill of the facilitator as well as resource limitations mentioned earlier.  One of most difficult challenges is the need for the facilitator to be engaged in continuous assessment in order to maintain a safe learning environment for the participants.

Controlling the individual passion focus is an important consideration for facilitators and requires self-awareness in order to avoid bias during debriefing.  As clinical educators from a variety of backgrounds it is normal for a facilitator to have a specific passion point around one or more areas of treatment. This can lead the facilitator to subconsciously pay closer attention to that particular area of treatment during the simulation, and subsequently focus on it during the debriefing. It is particularly important to maintain focus on the simulation exercise learning objectives when they are not designed in alignment with the passion focus of the facilitator. The facilitator must resist the urge to espouse upon their favorite clinical area during the debriefing. Otherwise the learning objectives for the scenario may not be successfully accomplished.

At times during simulation exercises egregious errors may occur that need to be addressed regardless of whether they were part of the learning objectives or not. Typically these errors involve behaviors that would jeopardize patient safety in the clinical setting.  If the topic surrounding the error is not part of the focal learning objectives for the simulation scenario, it is best to make mention of it, have the participants understand what the error was, describe an appropriate safe response and then quickly move on.  Let the participants know that the area or topic in which the error occurred is not the focus of the  simulation but emphasize that it is important that everyone be aware of safety issues.

The maintenance of a safe learning environment is another aspect of facilitator skill development. For example, difficult participants are sometimes encountered, emotionally charged simulations or debriefings occur and students may fail to ‘buy-in’ to the educational method.  All of these situations are under the purview of the facilitator to assist in the process that allows self-discovery and allow freedom on the part of the participants to express their thoughts, concerns, and in particular their decision-making thought processes. The facilitator must always be ready to intervene in a way that attempts to depersonalize the discussion to provide a focus on the best practices that would’ve led to the best care for the patient.

Other factors of maintaining a safe learning environment are typically covered in the orientation to the simulation exercises. Informing participants ahead of time of grading processes, confidentiality factors, the final disposition of any video and audio recordings that may occur during a simulation, will go a long way towards the participant buy in, and comfort level with the simulation process.

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