Implementation of Best Practices in Simulation Debriefing

Researchers have demonstrated that debriefing is the most vital component of the simulation learning experience with regard to knowledge gains for the student (Shinnick, Horwich, & Steadman, 2011). However, a national survey on debriefing practices in nursing education programs found that only 47.5 percent of faculty conducting simulations had formal training in debriefing and only 19 percent had their competency assessed. In addition, many of the programs reporting competence assessment of debriefers did not use a published instrument (Fey & Jenkins, 2015). In response to these data, an evidence-based simulation debriefing program was developed in a university school of nursing based on the International Association for Clinical Simulation and Learning (INACSL) Standard VI, the debriefing standard (Hayden, Keegan, Kardong-Edgren, & Smiley, 2014; Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014).In preparation for the development of the training program, the simulation coordinator attended training on debriefing and evaluation through the Center for Medical Simulation, the National League for Nursing Leadership Development Program for Simulation Educators, and various webinars and workshops specific to debriefing. A literature review of debriefing practices helped inform the development and implementation of the program.LITERATURE REVIEWStudies were reviewed that compared and discussed different debriefing methods, including video assisted, verbal only, and combinations of both. Chronister and Brown (2012) found that students who engaged in video-aided and verbal debriefing showed higher quality of skill improvement. Grant, Moss, Epps, and Watts (2010) concurred that video-aided debriefing is potentially useful in increasing desirable clinical behaviors. Reed, Andrews, and Ravert (2013), however, found minimal difference in performance with video-aided debriefing and verbal debriefing without video.Cantrell (2008) pointed out that debriefing is important to students because it offers opportunity for reflection, which is integral to professional development for nurses. Cantrell also stated that it is important to have students debrief immediately after a simulation event in order to integrate the experience into their knowledge base. Articles were reviewed on creating a debriefing climate that facilitates meaningful discussion (Wickers, 2010) and creating a culture of academic safety in debriefing (Ganley & Linnard-Palmer, 2012).The Debriefing Assessment for Simulation in Healthcare (DASH) tool was also reviewed. The DASH tool, created by the Center for Medical Simulation at Harvard Medical School, evaluates techniques used to conduct debriefing by examining concrete behaviors. It is composed of six elements, each rated on a 7-point Likert-type scale. The six elements are as follows: establishing an engaging learning environment, maintaining an engaging learning environment, structuring the debrief in an organized way, provoking engaging discussion, identifying and exploring performance gaps, and helping trainees achieve or sustain good future performance (Brett-Fleegler, Rudolph, Eppich, Monuteaux, Fleegler, Cheng, & Simon, 2012).DEVELOPING AND IMPLEMENTING EVIDENCE-BASED TRAININGAfter review of the literature, the authors deemed debriefing training to be the first critical step toward creating a consistent debriefing environment where students receive maximum benefit from their simulated patient scenarios and experience consistency, even with multiple debriefers (Simon, Raemer & Rudolph, 2012). Following is an outline of the steps taken in developing and implementing evidence-based training.1. The simulation coordinator and content experts reviewed scenarios to ensure clear alignment between the scenario and course objectives.2. Observation sheets and debriefing guides were created to ensure that anyone observing a scenario would have clear guidelines to follow regarding expected student behaviors. …