Feedback and Debriefing

Recently, as part of our Senior Registrar teaching programme, we dedicated a session to ‘Feedback and Debriefing’.

This is an enormous topic and there are many ways to skin this particularly cat.

However, we tried to emphasise the features of effective feedback. Effective feedback is:

  • specific,
  • timely,
  • constructive,
  • takes place in an appropriate setting,
  • is a dialogue that includes self-evaluation by the learner, and
  • ‘feeds forwards’ – i.e. results in an action plan with SMART objectives (specific, measurable, achievable, relevant, and time-specified)

Giving effective feedback is difficult. However, feedback is as much about the ‘receiver’ as it is the ‘giver’. We should all try to become expert at receiving feedback as well. This book is a good place to learn more:

  • Stone, D and Heen,S. Thanks for the Feedback: The Science and Art of Receiving Feedback Well. Penguin Group USA, 2015 [Google books]

We also delved into the mysteries of debriefing, specifically the role of debriefing in simulation-based education.

Unfortunately, it is easy to debrief badly…

An excellent overview of effective debriefing, using a ‘debriefing with good judgement’ approach, is provided by Danielle Hart in this video lecture:

 

The approach used in The Alfred ICU in situ simulation (ICU-IS-SIM) programme is summarised here as FAST-PAGE. Other ICU-IS-SIM resources are also online.

FEELINGS AND FACTS

  • Feelings – “How do you feel?”
  • Facts – “Let’s recap what happened in this case…”

ANALYSIS OF ISSUES

‘PAGE’ each issue (decide on issues before the debrief):

  • Preview learning objective (and/or PLUS/DELTA)
  • Advocacy-inquiry (i.e. explore frames with genuine curiosity)
    • “I observed…”
    • “I think…”
    • “What was going through your mind at the time?”
  • Generalise (start with a specific example, show wider application)
  • Explain and Educate

SUMMARY

  • Summarise the issues discussed after allowing questions

TAKE HOMES

  • 3 learning points from the group

Useful links to free online resources (#FOAMsim):

Finally, here are some highly recommended readings for the simulationist-debriefer!

  • Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc. 2015 Apr;10(2):106-15. doi: 10.1097/SIH.0000000000000072. PubMed PMID: 25710312. [Full text]
  • Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007 Summer;2(2):115-25. doi: 10.1097/SIH.0b013e3180315539. Review. PubMed PMID: 19088616.
  • Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007 Jun;25(2):361-76. Review. PubMed PMID: 17574196. [Full text]

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