Debriefing following a simulation provides time for reflection and feedback, and aims at sustaining or improving future performance. Debriefing is a key factor in simulation-based learning, helping to solidify knowledge and skills through self-reflection. Deep learning can be achieved during the debrief, and often depends on the facilitation skills of the debriefer. A skilled debriefing facilitator is able to help participants self-reflect on the simulation, asking difficult questions, and guiding participants toward accurate knowledge (Abelsson & Bisholt, 2017; Hall & Tori, 2017; Ryoo & Ha, 2015).
Providing education for facilitators on how to debrief is said to be a critical aspect of simulation training, helping to improve the success of the learning environment (Abelsson & Bisholt, 2017; Hall & Tori, 2017). However, a study by Waznonis (2014) found that many debriefers are full time faculty who facilitate a large number of debriefings with limited support, resources, and training. Lee et al., (2015) found that a standardized facilitator training, focused particularly on debriefing techniques, helped to improve facilitator comfort with simulation. Many options are available for debriefing training, but little is known regarding training and how it enhances the quality of debriefing within simulation programs (Cheng et al, 2015).
Purpose:
The purpose of the study was to look at the effect of simulation training on time management and participant experience by comparing the debriefs of novice simulation facilitators before and after formal simulation facilitator training
Methods:
Institutional Review Board approval was obtained prior to the study. The sample for the study included undergraduate nursing students from two different semesters (n=115) who were taking an obstetric/pediatric simulation course, and their two obstetric facilitators. Debriefing sessions were observed, with debriefing discussions timed. Timing including percentage of time the facilitator talked, and percentage of time the participants talked, in relation to total discussion time. In addition, the student experience during debriefing was assessed using the Debriefing Experience Scale, an instrument that is designed to evaluate the student experience during debriefing (Reed, 2012). This scale was administered immediately after the debrief.
A debriefing for a simulation on hypertension in pregnancy was chosen for the comparison. Time allocated for the simulation is 1.5 hours, and included in the simulation session is a pre-brief, the simulation, and a debrief. The facilitator manages time management and flow through each component. The facilitator and 6-8 undergraduate nursing students attend each session. Before being hired in the sim center, neither facilitator had experience facilitating simulations; however both are experienced obstetric nurses. Prior to the first observed debriefing, each had facilitated 20 simulation sessions in their new facilitator role, on three different obstetric topics; four of the simulations were on hypertension in pregnancy.
The first observed debriefing sessions were in March 2018; with three of Facilitator A’s sessions observed, and four of Facilitator B’s sessions observed. Both Facilitator A and Facilitator B attended a formal facilitator training in August 2018 at hospital-based simulation center for a large regional hospital system. The description for the course is: “during this intense, three-day course, attendees will learn to write objectives and create, run, and debrief scenarios immersed both as learners and as facilitators. Didactic content includes simulation history, philosophy, methods, and adult-learning theory.” In addition, the objective in the training related to debriefing is to “demonstrate effective debriefing skills and identify its imperative role in simulation by participating in multiple simulation experiences” (Intermountain Healthcare, 2018). The second observed debriefing sessions followed this training, and were conducted in October/November 2018, with each facilitator conducting four sessions on hypertension in pregnancy.
Results:
For the first observed debriefings, Facilitator A spent an average total time of 9.5 minutes (out of 1.5 hours) in debriefing discussion, with the facilitator talking 57% of the time, and debriefing participants talking 43% of the time. Facilitator B spent an average of 10.6 minutes (out of 1.5 hours) in debriefing discussion, with the facilitator talking 46% of the time, and debriefing participants talking 54% of the time. For the second observed debriefing, Facilitator A spent an average total time of 18.2 minutes (out of 1.5 hours) in debriefing discussion, with the facilitator talking 46% of the time, and debriefing participants talking 54% of the time. Facilitator B spent an average of 20.3 minutes (out of 1.5 hours) in debriefing discussion, with the facilitator talking 60% of the time, and debriefing participants talking 40% of the time. See Table 1 for results.
Table 1. Time aspects of debriefing
|
Date/Debriefer |
Total talk time (Average) |
Ratio of talking, Facilitator |
Ratio of talking, Participants |
Number of debriefs observed |
|
March 2018: Simulation sessions on hypertension in pregnancy |
||||
|
Facilitator A |
9.5 minutes |
57% |
43% |
3 |
|
Facilitator B |
10.6 minutes |
46 % |
54% |
4 |
|
August 2018: Formal debriefing training |
||||
|
Oct/Nov 2018: Simulation sessions on hypertension in pregnancy |
||||
|
Facilitator A |
18.2 minutes |
54% |
46% |
4 |
|
Facilitator B |
20.3 minutes |
60% |
40% |
4 |
Statistical analysis of data collected with the Debriefing Experience Scale is underway, and will be used to determine if there are any differences in the participant experience before or after facilitator training.
Limitations:
Two different student groups were used for the pre- and post- facilitator training observations, as the observed simulations were taken from different classes progressing through their nursing program. In addition, prior to the post-training observation, the facilitators facilitated two other obstetric simulations, and experience could have influenced the post-training debriefing times. However, the researchers felt it was important to keep the same topic for the compared simulation/debriefing, to provide a cleaner comparison.
Conclusion:
Time spent in debriefing discussion essentially doubled in sessions conducted by novice facilitators after they attended formal simulation facilitator training. It is apparent for these two facilitators that formal training has helped with management of simulation activities, allowing more time for debriefing. As debriefing has been identified as the component of simulation where the bulk of learning takes place, the additional time spent debriefing is sure to have a positive influence on the participant learning experience.