During this podcast, Walter interviews Jan Schmutz, PhD, a team psychologist and researcher from ETH Zurich in Switzerland. They discuss their recent paper in Academic Medicine in which they present a novel conceptual framework for team reflexivity (TR) in healthcare, and how TR can impact both patient care and learning. TR refers to how teams reflect together about goals, processes, and strategies to improve current and future performance. While team reflection after an event--i.e. debriefing--will be well-known to listeners, Jan and Walter discuss opportunities for TR both BEFORE and DURING patient care events, especially those that are highly dynamic and evolve rapidly.  Examples would be a team huddle before a major trauma patient arrives in the ED or performing a quick recap and/or evaluation of ongoing patient care to make sure the team is on the same page and not missing anything important. Jan and Walter highlight how opportunities for TR can form the basis of 'what to debrief' to help teams improve in subsequent events.

In this podcast, Vinay Nadkarni joins Adam Cheng to discuss clinical debriefing and the importance of quantitative data to inform the debriefing process.  Dr. Nadkarni reflects on the robust post-cardiac arrest debriefing program that has been established in his own institution, and discusses the key ingredients for improving patient outcomes.

1. Edelson D, Litzinger B, Arora V, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern Med. 2008;168(10):1063-1069.

2. Wolfe H, Zebuhr C, Topjian A, et al. Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes*. Crit Care Med. 2014;42(7):1688-1695.

3. Kessler D, Cheng A, Mullan P. Debriefing in the emergency department after clinical events: a practical guide. Ann Emerg Med. 2015;65(6):690-698.

In-situ simulation was long thought to be the place where simulation had to take place if you weren’t lucky enough to have a dedicated center. It is often fraught with the difficulties of scheduling at inconvenient times for the learners and the frequency of last-minute cancellations based on shifting space and learner availabilities. There are also several key safety considerations with the blending of real and simulated equipment.

However, there has also been emerging recognition of the true value of in-situ simulation in the training of clinical providers in their own environment, with their own teams, and in their own systems. It allows for a more formal evaluation of space, equipment, and systems, including the discovery of latent patient safety threats.

In this podcast, Dr. Glenn Posner of the University of Ottawa introduces us to their program of hospital-wide in-situ simulation, and specific debriefing considerations relating to an in-situ program.

In this pod cast, debrief2learn editors Vincent Grant and Adam Cheng interview Mary Fey regarding issues related to the faculty development of simulation educators.1,2 Mary shares the results of her PhD work on debriefing faculty development, and shares novel ideas for how to teach debriefing skills to the next generation of simulation educators.

1. Cheng A, Grant V, Dieckmann P, Arora S, Robinson T, Eppich W. Faculty Development for Simulation Programs. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2015;10(4):217-222. doi: 10.1097/sih.0000000000000090

2. INACSL Standards of Best Practice: SimulationSM Debriefing. Clinical Simulation in Nursing. 2016;12:S21-S25. doi: 10.1016/j.ecns.2016.09.008

In this episode, Jen Arnold (@JenArnoldMD) shares her experiences with implementing a clinical debriefing program, with foundational elements drawn from the local simulation program. Challenges and practical tips are provided for those looking to integrate debriefing as part of clinical care.  Recent articles by Kessler et al1 and Mullan et al2 provide further detail on how to achieve success with clinical debriefing programs.

In this podcast, Jenny and Adam outline the pre-briefing and debriefing moves educators can use to build a psychologically safe environment or "safe container" for learning.1 Jenny notes that psychological safety is absolutely essential in simulation because healthcare providers are putting their identity as a clinician up for critique. Consistently building a "safe container" is key because it is not how safe the facilitator believes the learners are that is important, but how safe the learners feel. Key elements such as "walking your talk," humor, and calming our brains to allow us to listen are discussed along with their associated challenges.

For step-by-step suggestions for building a psychologically safe learning environment during pre-briefing and debriefing, more content on this topic, consider reviewing the DASH Rater Handbook Elements 1 and 2. To self-assess your own pre-briefing and debriefing efforts check out the Dash Instructor-Version Instrument.

In this podcast, Walter Eppich and Michaela Kolbe talk about the use of circular questions in debriefing healthcare teams. As a psychologist and family therapist, Michaela used circular questions to promote perspective taking and reflection about family interactions. In this podcast, Michaela explains how she adapted this approach for healthcare debriefing and provides multiple examples. She also discusses an article she and her team wrote entitled: "How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns."

1. Kolbe M, Marty A, Seelandt J, Grande B. How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns. Adv Simul. 2016;1(1). doi: 10.1186/s41077-016-0029-7

In this podcast, Walter Eppich and Michaela Kolbe speak about blended debriefing strategies. Rather than using a single approach, Walter and and Michaela explore complementary blended debriefing approaches based on their papers on this topic (1,2), which allows debriefers to adapt their debriefing approaches based on their skills and other factors such as debriefing location, learner group, available time, etc. Several other studies are discussed (3-5).

1. Kolbe M, Weiss M, Grote G, et al. TeamGAINS: a tool for structured debriefings for simulation-based team trainings. BMJ Qual Saf. 2013;22(7):541-553. doi: 10.1136/bmjqs-2012-000917

2. Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS). Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2015;10(2):106-115. doi: 10.1097/sih.0000000000000072

3. Ahmed M, Arora S, Russ S, Darzi A, Vincent C, Sevdalis N. Operation Debrief. Annals of Surgery. 2013;258(6):958-963. doi: 10.1097/sla.0b013e31828c88fc

4. Krogh K, Bearman M, Nestel D. “Thinking on your feet”—a qualitative study of debriefing practice. Adv Simul. 2016;1(1). doi: 10.1186/s41077-016-0011-4

5. Arora S, Ahmed M, Paige J, et al. Objective Structured Assessment of Debriefing. Annals of Surgery. 2012;256(6):982-988. doi: 10.1097/sla.0b013e3182610c91

In the first episode of the Debrief2Learn podcast, Vince Grant, Adam Cheng, Brent Thoma, and Walter Eppich discuss the paper "Debriefing-on-Demand”: A Pilot Assessment of Using a “Pause Button” in Medical Simulation" which was recently published in Simulation in Healthcare.

Reference:

McMullen M, Wilson R, Fleming M, Mark D, Sydor D, Wang L, Zamora J, Phelan R, Burjorjee JE. “Debriefing-on-Demand”: A Pilot Assessment of Using a “Pause Button” in Medical Simulation. Simulation in Healthcare. 2016 Jun 1;11(3):157-63.