You should always do a practice run through of the scenario ahead of time with all of the instructors and the person who will be operating the mannequin or supervising the task trainers present. You need to ensure the capabilities of the mannequin / modality fit with the scenario and all required supplies and information are accessible to the learners. If a simulation technician is running the mannequin he/she may not have a clinical background so it is good to establish a communication mechanism ahead of time for adjusting vitals, etc. Also think about how any diagnostics will be shared with the learners during the simulation.
It is important to allocate time for all 3 stages of the simulation:
The goal of pre-briefing prior to simulation is to maximize learner engagement and suspension of disbelief by creating a psychologically safe environment. It is important to establish a “fiction contract” where you acknowledge the limitations of the simulation and seek a voluntary commitment from the learners to treat it as a real situation. In addition to the fiction contract, the pre-brief should include the following items:
- Clarify Expectations
- Disclose any known issues with simulator
- Logistics – agenda, breaks, washroom location
- Safe to make mistakes, learn from them
- Prep for debrief and role of facilitator
Depending on the experience of the learners and the objectives, you may want to have cues or information built into the script for the patient or ESP to guide the learners if they get off track, alternatively you may need flexibility built into the scenario to respond accordingly to the learner’s actions.
One technique for skills or processes that are new to the learner is to build in repetition, have them run through the scenario allowing them to make mistakes, conduct the debrief, and then run through the scenario again to allow them to develop a “muscle memory” of the correct way of responding. In some cases, you may want to pause the scenario to give information or ask questions to establish the learner’s frame of reference.
The debrief is where the transfer of learning happens. It provides an opportunity to understand the learner’s frame of reference for decision-making and provide feedback, allowing you to work in partnership with the learners to create new insights. Maintaining psychological safety is key for ensuring learners engage in the discussion and transfer of learning occurs.
There are many different models for debriefing, we have included references to the PEARLS Model and Debriefing with Good Judgement. Within the PEARLS model there are multiple methods for analysis and giving feedback depending on the time available, experience of the learners and experience of the facilitator. Regardless of the model you should begin with learner reflection on the experience, follow this with feedback and analysis and end with learner’s thoughts on application of the learning to the clinical environment.
- CSTAR Prebrief Template
- Tip Sheet for Running SimMan3G
- The PEARLS Healthcare Debriefing Tool: CSTAR's recommended template for debriefing
- Establishing a Safe Container for Learning in Simulation: The Role of the Presimulation Briefing, Rudolph, Jenny W. PhD; Raemer, Daniel B. PhD; Simon, Robert EdD
- Briefing Prior to Simulation Activity, Patrick G. Hughes; Kate E. Hughes.
- Promoting Excellence and Reflective Learning in Simulation (PEARLS), Eppich, Walter MD, MEd; Cheng, Adam MD, FRCPC, FAAP
- debrief2learn.org – a website dedicated to improving healthcare outcomes by fostering good debriefing practices.
- There's No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment, Rudolph, Jenny W. PhD; Simon, Robert EdD; Dufresne, Ronald L. MS; Raemer, Daniel B. PhD
- Effects of post-scenario debriefing versus stop-and-go debriefing in medical simulation training on skill acquisition and learning experience: a randomized controlled trial. Patrick Schober, corresponding author Kay R. J. Kistemaker, Fereshte Sijani, Lothar A. Schwarte, Dick van Groeningen, and Ralf Krage