I am growing more and more concerned about the pacifism by which I hear people approaching their debriefing efforts as I travel about the world. The phrase “safe learning environment” is being hijacked into some sort of process during which the only thing that matters in the world is the feelings of the learners participating in the simulations. So much so that some are saying you shouldn’t tell students what they didn’t do correctly and that during debriefing you should only focus on that which went well and then have a group hug at the end. This is being claimed under banners of student centric debriefing, “safe learning environments”.
Do these same educators harbor the fear and trepidation that students might be sad if they perform poorly on a written test? Do these same educators realize what a disservice they are doing for the students when you step back and look at the big picture? Maybe the educators themselves have a tough time bucking up and delivering the news, doing the HARD WORK of simulation. Perhaps, this shifting or trending is partly evolving because many of the people involved in the teaching and theorizing about simulation feedback don’t see patients on the frontline of the healthcare battlefield.
I am certainly not advocating that we don’t need to be mindful of students emotions and psychological well being during simulation education activities, but come on people, healthcare decisions and actions involving patient care need to be near perfect. Every Time. We need to be certain that when participants leave our simulations they have a clear understanding of what was right and what was wrong not just do a deep dive into their feelings carefully guarded by the emotions police and find happy things to chat about.
I am sorry to be the bearer of bad news, but providing healthcare is hard work, stressful and requires excellence. We need to develop/reinforce excellence in the participants of our simulations and help them achieve their goal, which is to get better at what they do. Every healthcare professional in the world has this as a goal at some level. How we reach out to them and help them along this journey needs to be PATIENT CENTRIC because the ultimate goal is to continuously improve healthcare throughout the world.
We certainly must develop methods consistent with the levels and abilities of our simulation participants and create environments that are open to participating, learning, exploring and discussion. But we also must provide participants with information on where they are with regards to expected performance on a continuum of the development of competence. We can not hide the truth during a debriefing because the faculty is uncomfortable with delivering critical feedback, or is so concerned that the students emotional fragility will be violated if they receive the feedback. This is a violation of our ultimate relationship with the ultimate beneficiary of healthcare simulation, the patient.
During debriefings it is incumbent upon us to make sure that students are treated fairly, treat each other fairly and help to discover things needed for improvement through creating reflections on the learning activities. We also need to make sure there is crystal clarity on expected outcomes versus perceptions of performance that are reconciled. We also must guide the debriefing process in a way that is mindful of the psychological safety of the involved. I think this can be done with adequate training, re-training and continuing practice with the art of debriefing. When we achieve this, we have arrived at Patient Centered Debriefing, and that’s a place I think we all want be.
I do believe most professionals want to know what they did well as well as what they didn’t. They are the fundamental elements of being able to reflect and improve. We need to be able to have the message delivered by either a process of self-discovery, perhaps through facilitated reflection, or at other times, but just directly providing the information. This doesn’t mean it has to be harsh, or without the feelings of the person involved carefully considered, but it does mean it has to happen with a level of deliberateness that is unequivocal. It is the true art of the debriefing to be able to lead this effort and achieve these goals.
Finally I’ll close with a quote from my twelve-year-old son about one of his baseball coaches, “Dad, why does coach always tell me I did a good job when I know I messed up?” What is the answer? Not sure, but I hope that the coach doesn’t change careers and become a simulation facilitator for healthcare professionals.