Debriefing is a social event – wisdom from Walter Eppich

Case

Ellen felt anxious walking into the debrief room.

The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in head injury, and using the new intubation checklist. This was the third sim session in a series the department had agreed to run following 3 patient cases where significant desaturation occurred during intubation attempts.

Ellen thought they’d done OK but had recognized a lot of the usual ‘bad habits’ that frankly irked her when she worked on the floor with these guys – no nasal prong O2, a pretty vague conversation about who was going to actually do the tube, and low level grumbles about the time it takes to do the checklist. She was particularly disappointed that those things had come up in the last sim, and that a couple of the nurses had participated in that previous sim. “How can we actually get this into their heads?” she thought.

Entering the debrief room, Ellen knew what she wanted to bring up, but felt her stress level rising. Reactions first, she thought, and then facts. What would be a good advocacy inquiry question? What else did they say in that debriefing course…..? …….Should she let the learners dictate the topics?

And she knew that the ED consultant who was in the scenario was not a big fan of sim, and anticipated he might be difficult. His performance is probably off limits for today, she thought.

Deep breath.

“OK guys that was great. Well done”……..

In this episode of Simulcast we were delighted to talk with Walter Eppich (@LearnThruTalk). Walter is a paediatric emergency physician from Chicago, and Associate Professor of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine. He is Principal Faculty, Harvard Center for Medical Simulation (@MedSimulation), and a PhD Candidate, School of Health Professions Education, Maastricht University, Netherlands. He has published prolifically in the area of simulation debriefing.

Walter shared some general thoughts on debriefing, including ‘’letting go’’ of the idea that we must have a strong hand on the debrief, the importance of translating lessons to real practice, and the idea that participants also need to take responsibility for the process and success of the debrief. This last concept is embodied in his article with Adam Cheng (@DocChenger) on Learner Centered Debriefing, this month’s Simulcast Journal Club article.

He made the point that many of our options/ models for debriefing are more similar than they are different, as illustrated in his own blended approach, described in his PEARLs paper.

Walter then gave us a practical step by step guide to how he would approach Ellen’s debriefing case, and included additional thoughts on previewing topics, ensuring psychologic safety (see also landmark work by Amy Edmonson here), and using a strategy like the Center for Medical Simulation ‘Basic Assumption’ to maintain that positive regard for learners. He emphasized that debriefing is a social event, and one of a number of examples of learning conversations that are his passion. This is especially relevant as more simulation educators engage in debriefing after in situ scenarios, where there is an existing relationship between participants and debriefers.

Walter is also part of an exciting new simulation debriefing project with Adam Cheng and others – follow @Debrief2Learn for updates on the launch of website of same name

We’ll be hearing more from Walter on those learning conversations soon, but in the meantime enjoy his practical wisdom on the podcast.

More on debriefing from the #FOAMed blogosphere

https://www.aliem.com/2014/simlife-em-challenge/

http://injectableorange.com/2013/07/debriefing-careful-you-dont-just-give-carrot-a-little-stick-is-sometimes-needed/

http://stemlynsblog.org/good-to-talk-debrief-in-the-emergency-department/

http://intensivecarenetwork.com/radford-vandyke-simulation/

https://emsimcases.com/2015/06/30/debriefing-techniques-the-art-of-guided-reflection/

https://www.aliem.com/2014/improving-debriefing-skills-pathways-grid/