Delivering Simulation and Debrief.
Setting up the environment.
Effective simulation requires learners to suspend disbelief
and interact with the simulation environment as if it were real.
An experienced teacher and a well simulated environment
will make simulation seem as real as possible.
Ideally, the medical equipment,
layout of the simulation environment
and storage of equipment such as drugs
should be set up as though in a real clinical environment.
The success of simulation depends on how it is used and delivered.
You do not need to have a full simulation suite or sim man to be able to deliver effective training.
Learning can even be achieved through cognitive simulation,
by discussing the steps of a scenario in detail one-on-one.
Briefing
Simulation teachers are facilitators
and need to be engaging, sincere, friendly and able to establish a rapport with the learners.
A bad experience in a simulation can lead participants to disengage very quickly.
As well as creating a safe learning environment
Facilitators should have clinical knowledge,
expertise and real experience of the clinical content
to allow their learners to have confidence in them.
During briefing all candidates should be
informed that the simulation is a safe space
what happens in the simulation teaching, stays in the simulation teaching
with only a few extreme exceptions.
It is important to make it clear that you do not expect perfection.
Setting the Scene
Briefing informs candidates of what to expect,
assist them in achieving the learning objectives
and will help to reduce anxiety.
The top five things to include in briefing should be:
Learning objectives
Clinical details of the case
Roles of the team members
Time allocated
and informing participants of the 'act as you normally would' rule
All protocols and department policies should be followed as though they were in a real life situation.
Maintaining situational awareness in the scenario
As a trainer or a team of trainers
you need to closely observe what is happening in the scenario,
react and guide if things are going off course
and be able to provide detailed feedback at the end.
You and your team need to
Perceive
Actions being carried out by learners in relation to the mannequin,
behaviours of learners
and the passage of time.
Comprehend
Is the scenario still real?
Are learners too dominant or passive?
Is the time spent in the scenario encroaching on the time for debriefing?
Are any learners stepping out of their role?
This can be a sign of feeling too stressed.
Is the the mood too quiet or too loud?
Is there too much laughter?
Predict and React
Do I need to intervene in the scenario and possibly break the realism?
Does anyone need rescuing or reining in?
Whilst the scenario is running keep notes and a dialogue in the team of trainers.
Feedback and Debrief
Debriefing ideally should be held straight after the simulation.
Feedback should relate to specific information to the learner in relation to their performance.
Video playback is a powerful teaching tool during debriefing.
It allows facilitators and learners to visually identify areas for improvement,
illustrate observable behaviours and ideas for thoughts and discussion.
High-quality debriefings can stimulate learners to continue to reflect upon their experience
even after the formal debrief has ended.
When providing feedback or teaching,
always be aware of the learners state of mind.
Your role as a confidence builder and motivator is important
as candidates will approach each simulation with varying levels of confidence.
Create a safe environment for encouraging, respectful and supportive feedback
by the way you speak,
your body language and
ensuring all voices are heard.
Before beginning the debrief it is important to clarify a structure
and set out what you will be discussing.
Facilitators at times are exposed to challenging questions,
uncontrolled emotions and divergent viewpoints.
There are three main phases to the debriefing process:
1. Reaction phase
How did the participant feel during the simulation?
One of the aims of the simulation environment
is to encourage participants to emotionally engage with the situation,
to feel how you would feel in real life.
When debriefing make sure to acknowledge all range of emotions that were felt
and encourage group discussion for subsequent reflection.
2. Understanding phase
How did the participant perform during the simulation?
You should explain what you have observed
and then move on to observations of the other participants.
It is this phase where video playback can be used to a real advantage.
Criticism should be constructive, specific and dealt with in a sensitive manner.
It is important to critique the performance, not the performer.
Clarify performance gaps or poor practice areas that need improvement
and use your clinical experience to add context.
Remember to reinforce good practice, as well as giving constructive feedback.
Ask the learner what they did well and discuss how they could improve.
This encourages reflection and self-assessment.
3. Summary phase
What did the participant learn from the simulation?
Ask the participant to state the important things that they have learnt
and how this will influence their future practice.
Summarise the topics you have covered and give options for further discussion.
Top tips on debriefing:
Brief for the debrief
Clarify the structure of the debrief
Create a safe learning environment and rapport with candidates
Reinforce good practice
Clarify poor practice or areas where there is a safety concern but do so sensitively.