Debriefing with DEOR

Why Debrief?

Debriefing practices vary. Elements of debriefing may include:

Do's and Don'ts of Debriefing

DO:

DON'T:

Diagnostic Educational Objective-based Reflection (DEOR)

Barriers to Quality Debriefing

Debriefing is a critical component of the simulation experience. The progression of learning for a simulation experience generally consists of the following steps.

  1. Goals and objectives define what the student is to learn.
  2. Self-study materials start the learning.
  3. Lectures and other didactic experiences enhance the learning.
  4. Simulation focuses the learning.
  5. Scenario "Checklists" expose what has and has not been learned.
  6. Feedback reinforces what has been correctly learned and identifies and extinguishes what has not.

Using the Laerdal Debriefing Tool to Simplify and Standardize Debriefing

How does the Laerdal Debriefing tool aid this process? The following is an annotated screen shot of the Laerdal SimMan® debriefing log. The scenario was programmed to show grading in the form of a green check mark (correct) or red "x" (incorrect). Other information concerning the scenario was also programmed to appear with the debriefing log.

Laerdal Debrief Viewer

The debrief log provides a "semi-automated", standardized guide for providing student feedback during debriefing.

From Scenario


Using a Checklist to Standardize Debriefing

In situations where the Laerdal Debrief log is not available a paper or computerized checklist should be used to identify what the student did correctly and what the student did not do correctly. It is very important that each scenario have specific goals and objectives and that the checklist address these.

Focus the Debriefing to Areas Needing Improvement

The programmed scenario debrief log or the objective-based checklist enables the facilitator to focus the debriefing to those areas needing improvement. The next step is for the facilitator to probe for causes of errors. Generally the error will be one of lack of knowledge, limited or lack of skill, or erroneous judgment.
Consider the Incorrect notation from the Laerdal example above: "Did NOT assess Pain within first 5 minutes..."

Facilitator probes might include:

Student responses might include:

With a specific educational diagnosis identified, the facilitator guides the trainee to fill the knowledge/skill/judgment gap through deliberate practice.

DEOR Steps

  1. In the debriefing area cue up the debriefing log and video for that session.
  2. Check the mood & decompress/support/re-direct as needed:
    • Ask an open ended question to assess the mood of the participant(s): "How do you feel it went?"
    • Decompress/support/re-direct egos as necessary
  3. Review the overview of the case (located at the top of the debrief log when using Laerdal) to re-orient the participant(s) to the goals of the scenario.
  4. Review the log or the checklist with the student; reinforce things they did correctly.
  5. Read the general statements associated with incorrect actions. This provides the preliminary "educational diagnosis." If you or the participant(s) do not remember what happened at this point in the session, review the video together as needed.
  6. Use the preliminary educational diagnosis to specifically identify "Why" (Probe: Knowledge/Skill/Judgment). Probe from superficial to deep in each learning domain.
  7. With a specific educational diagnosis identified, guide the trainee to fill the knowledge/skill/judgment gap through:
    • providing knowledge
    • providing deliberate practice of a skill
    • reviewing how the clinical decision process could have alternately be handled
    • it may be valuable to let them re-try this applying what they learned through simulation

Note:

  1. If more than one participant is involved in the exercise, direct questions alternately to different trainees
  2. This methodology is not meant to be used for formal "Team Training" (other tools are used).

References

  1.  Lori K. McDonald, Kimberly K. Jobe, R. Key Dismukes. "Facilitating LOS Debriefing: A Training Manual." NASA Technical Memorandum 112192 DOT/FAA/AR-97/6 March 1997.
  2. Adapted from McDonald, Jobe, & Dismukes 1997.