Debriefing is largely considered to be the most important part of simulation training. Because resuscitation is complex and emotionally stressful, debriefing allows participants to process and reflect upon the experience. They also identify opportunities for improvement in order to perform more effectively during real patient resuscitations. In order for this to happen, however, the debriefing session must support confidentiality, trust, self-analysis, and open communication. This article will describe some of the techniques that educators can use to promote the best possible learning outcomes for participants. 

Timing for debriefing

Although debriefing typically occurs when the simulation has ended, educators may choose to provide feedback during short pauses in the action. This approach of “microdebriefing” allows to stop the simulation briefly in order to focus on specific decision-making or procedural skills. After micro debriefing, educators immediately resume the simulation from that point in time. Alternatively, educators can rewind the simulation in order to provide participants with another opportunity to perform key skills. When the simulation has ended, educators can choose to conduct debriefing immediately or later on. There are pros and cons to each of these options: 

HOT Debriefing -Takes place immediately afterward

Advantages

-All simulation participants are present

-Optimal time to reflect on emotional impact 

-Recall bias is minimized

Disadvantages

-Some facilities have limited spaces for debriefing

-Participants may need to process experiences on their own before discussing them

WARM/COLD Debriefing - Takes place hours or days later

Advantages

-Simulation events are still fresh in the participants’ minds

-Educators can prepare quantitative data for evaluation

-May have more time for deeper discussion and analysis

-Participants have time for their emotions to settle

Disadvantages

-All participants may not be available to participate

-Immediate emotional impact of simulation has worn off

-Educators can reserve private location

-Participants may have less enthusiasm for debriefing

Getting started

In order for participants to benefit from the debriefing process, educators must create a safe environment that is conducive to honest, open communication. A private room is essential for effective debriefing. Participants should be reminded that the purpose of debriefing is for reflection and education, not to place blame. A good starting point is to ask participants for their initial reactions, especially after emotional or stressful simulations. Then educators can review the key clinical events that occurred during the simulation. Video recordings of the simulation may be reviewed during debriefing as an alternative to potentially faulty recall of the events. This step is particularly valuable when the patient’s diagnosis was unclear or when the participants’ interventions did not have the expected effects. Educators should make sure to focus on the main issues to avoid a lengthy recounting of the entire simulation. Key points to explore include: clinical decision-making, teamwork, and key skills that were performed. This discussion leads to the analysis phase of the debriefing.

Critical analysis of the simulation

The analysis phase takes up the most time during the debriefing as educators guide participants to gain a deeper understanding of the simulation. Aspects of performance that worked well and should continue going forward are identified, along with areas for improvement. Participants can also communicate their concerns, clarify misconceptions, as they identify their strengths and weaknesses. The AHA PEARLS Scripted Debriefing Tool can be very helpful for educators who are new to the debriefing process. Educators may also use the AHA Quality of Resuscitation Evaluation Form that provides quantitative data for analysis. A delicate balance is needed to promote learning without discouraging the participants. While the approach is always tailored to meet the needs of the particular group, beginning learners require more straightforward feedback and teaching while advanced learners can be more self-directed. As the debriefing comes to an end, educators can recap the main learning points and plans for improvement. Participants can also share what they learned from the simulation experience and how they plan to apply this knowledge in the future.  

Tools for Educators

The American Heart Association created the Get With The Guidelines® program to promote best practices in resuscitation. A variety of tools and resources are available to educators in order to improve processes and maximize effectiveness of resuscitation: 

-American Heart Association PEARLS Scripted Debriefing Tool 

-American Heart Association Resuscitation Fact Sheet

-American Heart Association Resuscitation Patient Management Tool - Cardiac Arrest

-American Heart Association Resuscitation Patient Management Tool - Post Cardiac Arrest Care

-American Heart Association Resuscitation Patient Management Tool - Acute Respiratory Compromise

-American Heart Association Resuscitation Quality of Resuscitation Evaluation Form 

The International Nursing Association of Clinical and Simulation Learning (INACSL) also identified the standards of best practice for debriefing: 

-INACSL Standards of Best Practice: Simulation Debriefing

Final Thoughts

Debriefing is an essential step in order for participants to achieve the desired learning outcomes from simulations. It gives participants time to reflect, discuss the simulation experience,fing and critically analyze their actions. In order for this to happen, however, educators need to create a supportive, confidential environment with open communication. Debriefing tools are also available from the American Heart Association to help educators create optimal experiences for participants. The DiaMedical USA team is ready to help educators integrate mock code experiences for their students. Loaded crash carts, SimRx simulated medications, SimScreens, and audio-visual solutions are available to provide complete training solutions. For more information, reach out to a DiaMedical USA expert at 877-593-6011 or info@diamedicalusa.com