Symposium: Simulation in Anaesthesia and Intensive Care Medicine 2000: Annual Meeting of the 'Society in Europe for Simulation Applied to Medicine' (SESAM): Abstracts
Rall, M*; Manser, T†; Howard, S. K‡
*Department of Anaesthesiology, University of Tuebingen, Tuebingen, Germany (E-mail: [emailprotected]), †Department of Work and Organisational Psychology, Swiss Federal Institute of Technology (ETH), Zürich, Switzerland, and ‡Department of Anaesthesiology, VA Palo Alto Health Care System, Stanford University School of Medicine, USA
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ABSTRACT NO. 2
Introduction The use of simulators to train crisis resource management is increasing constantly [1,2]. The detailed, video-based discussion of a simulator scenario with all participants directly after the session, with the aim to enhance self-reflection, is called 'debriefing'.
Methods A small survey was undertaken at 14 European simulator centres and at an interdisciplinary simulator workshop during the SESAM 2000 meeting in order to define the key elements of debriefing. As the numbers are very small only descriptive results are mentioned.
Results Respondents claim that debriefing is the most important part of realistic simulator training. Debriefing is crucial for a successful learning process, but if performed badly it can be the source of severe harm to the trainee. Debriefing can 'make or break' a simulator session and can be attributed as the 'heart and soul of simulator training'. Therefore, training of instructors in the art of debriefing should be emphasized. The debriefing instructor requires both clinical and teaching experience. As the setting of simulator training is very intense, coaching of the instructor by a psychologist is recommended.
Good debriefing requires a thorough briefing beforehand. Briefing should include (a) explaining to the participants that the session concerns learning, not performance assessment, (b) that confidentiality is maintained, and (c) that making errors is important for the training benefit. A nonthreatening atmosphere should be established and the crisis management terminology should be explained. The simulator should be explained in detail. Limitations of the simulation and how to deal with them should be stated. Admitting that the simulator is not completely realistic helps trainees suspend disbelief.
Elements of successful debriefing include: creating a good and friendly atmosphere, open-ended questions, facilitating of self-debriefing, positive reinforcement, open discussions on management aspects, pointing out underlying principles that lead to misconceptions/errors, using cognitive aids, showing alternatives, stressing that everybody makes errors, concentrating on few key learning points, and pointing out the good parts with the assistance of the audio-visual equipment.
Elements that should be avoided during debriefing are: closed questions, criticism using destructive language, concentrating on errors, blaming and ridiculing participants, focusing too much discussion on medical points rather than on crisis management aspects, too much instructor talking, too many teaching points, too long a debriefing period.
Conclusion Debriefing is the most important part of simulator training. Serious harm to trainees may result from poorly debriefed sessions. Training and coaching of instructors should be emphasized. Continuous studying and training of debriefing techniques in an interdisciplinary team involving psychologists should be the future.
References
1 Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med 1992; 63: 763-770.
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2 Gaba DM, Fish KJ, Howard SK. Crisis Management in Anesthesiology. New York, USA: Churchill Livingstone, 1994.
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