Simulcast

3 - Eppich Debriefing

Debriefing is a social event – wisdom from Walter Eppich

 

Case

Ellen felt anxious walking into the debrief room.

The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in head injury, and using the new intubation checklist. This was the third sim session in a series the department had agreed to run following 3 patient cases where significant desaturation occurred during intubation attempts.

Ellen thought they’d done OK but had recognized a lot of the usual ‘bad habits’ that frankly irked her when she worked on the floor with these guys – no nasal prong O2, a pretty vague conversation about who was going to actually do the tube, and low level grumbles about the time it takes to do the checklist. She was particularly disappointed that those things had come up in the last sim, and that a couple of the nurses had participated in that previous sim. “How can we actually get this into their heads?” she thought.

Entering the debrief room, Ellen knew what she wanted to bring up, but felt her stress level rising. Reactions first, she thought, and then facts. What would be a good advocacy inquiry question? What else did they say in that debriefing course…..? …….Should she let the learners dictate the topics?

And she knew that the ED consultant who was in the scenario was not a big fan of sim, and anticipated he might be difficult. His performance is probably off limits for today, she thought.

Deep breath.

“OK guys that was great. Well done”……..

 

In this episode of Simulcast we were delighted to talk with Walter Eppich (@LearnThruTalk). Walter is a paediatric emergency physician from Chicago, and Associate Professor of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine. He is Principal Faculty, Harvard Center for Medical Simulation (@MedSimulation), and a PhD Candidate, School of Health Professions Education, Maastricht University, Netherlands. He has published prolifically in the area of simulation debriefing.

Walter shared some general thoughts on debriefing, including ‘’letting go’’ of the idea that we must have a strong hand on the debrief, the importance of translating lessons to real practice, and the idea that participants also need to take responsibility for the process and success of the debrief. This last concept is embodied in his article with Adam Cheng (@DocChenger) on Learner Centered Debriefing, this month’s Simulcast Journal Club article.

He made the point that many of our options/ models for debriefing are more similar than they are different, as illustrated in his own blended approach, described in his PEARLs paper.

Walter then gave us a practical step by step guide to how he would approach Ellen’s debriefing case, and included additional thoughts on previewing topics, ensuring psychologic safety (see also landmark work by Amy Edmonson here), and using a strategy like the Center for Medical Simulation ‘Basic Assumption’ to maintain that positive regard for learners. He emphasized that debriefing is a social event, and one of a number of examples of learning conversations that are his passion. This is especially relevant as more simulation educators engage in debriefing after in situ scenarios, where there is an existing relationship between participants and debriefers.

Walter is also part of an exciting new simulation debriefing project with Adam Cheng and others – follow @Debrief2Learn for updates on the launch of website of same name

We’ll be hearing more from Walter on those learning conversations soon, but in the meantime enjoy his practical wisdom on the podcast.

More on debriefing from the #FOAMed blogosphere

https://www.aliem.com/2014/simlife-em-challenge/

http://injectableorange.com/2013/07/debriefing-careful-you-dont-just-give-carrot-a-little-stick-is-sometimes-needed/

http://stemlynsblog.org/good-to-talk-debrief-in-the-emergency-department/

http://intensivecarenetwork.com/radford-vandyke-simulation/

https://emsimcases.com/2015/06/30/debriefing-techniques-the-art-of-guided-reflection/

https://www.aliem.com/2014/improving-debriefing-skills-pathways-grid/

2 - Australasian Sim Congress with Julian van Dijk

2 - Pause & Discuss:

The Australasian Simulation Congress with Julian Van Dijk 

 

Collaboration is vital for successful sim programs, and yet we often work in isolation from fellow simulation enthusiasts. The Australasian Simulation Congress is a great opportunity for those of us in this part of the world to learn, to network, and to be inspired in our simulation work. It’s a joint effort for SimHealth (folks like us in healthcare), and Sim Tect (amazing simulation people from aviation, engineering, human factors, manufacturing and more) 

Big name guest speakers include Adam Cheng (@docChenger), a debriefing guru from Alberta, Canada. Look out for his new online project debreif2learn.com going live soon. Also speaking are Carrie Hamilton from the UK and William McGaghie from Chicago, USA.  

It’s on in Melbourne from Monday 26th September to Thursday 29th September, and we spoke to Julian Van Dijk (@julianvandijk2), the Sim Health conference convenor, about what to expect. 

 

 

1 - The future vision of simulation in health care. Are we there yet?

You have been asked to develop a five-year strategic plan for simulation services in your hospital. Through your literature review you recall an article by David Gaba, ‘The future vision of simulation in healthcare’. All your dreams have been answered. In 2004 Gaba mapped the dimensions of organisational applications of simulation. You are thrilled to find his projection of two possible histories viewed from 2025; one optimistic – simulation integrated into the very fabric of health care; and one pessimistic – lamenting the abject failure of simulation to progress past and ad-hoc expensive education luxury. Now your challenge lies in which history rings most true in 2016 and how do we move forward for the next five years? 

 

In 2016, the term ‘simulation’ covers a wide range of activities - procedural skills, team training, quality improvement, mannequins, simulated patients, virtual reality and much more. And yet healthcare simulation remains inaccessible, badly delivered or simply failing to live up to promise in many contexts. 

To kick off our first episode of Simulcast, Jesse and I decided to tack a step back and look at the ‘state of the art’ of healthcare simulation in 2016. We used David Gaba’s landmark paper - The future vison of simulation in health care from 2004 - as a starting point.  

David Gaba is one of the grandfathers of healthcare simulation. Trained as a biomedical engineer, a pilot and then as an anaesthesiologist, he brought a unique vision to how to train better for the work we do in healthcare.  

When he wrote this paper in 2004, healthcare simulation was in its infancy, and mostly delivered around expensive mannequins in dedicated simulation centres. I had just done my first Crisis Resource Management (CRM) course as a participant at Monash simulation that same year, and was an immediate convert to the possibilities. 

In the podcast we look at the clarity Gaba offered us in that paper - how to think about the dimensions for healthcare simulation delivery – the technology used, the participants, the learning objectives, the environment of delivery. 

But he also offered us two future visions of simulation for 2025. One is optimistic – in which healthcare sim is embedded and integrated with care, training and quality improvement. The alternate vision is one in which simulation never really ‘made it’.  

We bring our own biases and hopes to the discussion…..