Journal of Surgical Simulation 2017; 4: B: 5 - 5
Published: 11 May 2017
Special Issue: Authenticity, stress and debriefing: learning through simulation
In the context of improving patient safety, simulation-based medical education (SBME) is regarded as pivotal in the development of critical non-technical skills and clinical decision-making amongst healthcare professionals.1 SMBE is well suited to the complexity of clinical performance and utilises a blend of pedagogies to achieve the desired learning outcomes.
A central tenet of the (constructivist) teaching approach lies within experiential learning constructs to convey authenticity during the learning experience.2 Accordingly, careful, effective and supportive preparation is necessary in order to establish a safe and confidential educational space for the participants to perform. The utility of SBME that incorporates replication of realistic clinical pressure enables the participant to really feel what is it like to be under-pressure in their decision-making. This approach moves medical education away from being ‘work-as-imagined’ towards a ‘work-as-done’ perspective3 and thus it should improve resilience and reduce performance variability, promote better decision-making and lead to safer patient care when transferred into clinical practice.
An essential component to achieve high-quality SBME is structured debriefing. Sufficient time, two to three times that afforded to the scenario4, is indicated so that participants can be guided through a deep reflective exploration of the ‘work-as-done’ that unfolded during the scenario. Conventional approaches to debriefing and feedback have been traditionally based on the Pendleton ‘sandwich’ model.5 However, more contemporary methods that strongly encourage active, reflective participation include debriefing with good judgement,6 debriefing as a learning conversation,7 alongside other constructivist models 8,9 are evidenced as being effective.
A blended learning educational strategy that includes the use of authentic, deep immersion SBME is likely to promote patient safety and better improve the human factors skills associated clinical decision-making, team leadership, team followership and limit performance variability.
1. Department of Health. A Framework for Technology Enhanced Learning. London; 2011. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215316/dh_131061.pdf
2. Kolb DA. Experiential learning: experience as the source of learning and development. New Jersey: Prentice Hall; 1984.
3. Shorrock S, Williams C. Human Factors and Ergonomics in Practice. London: CRC Press; 2016. https://doi.org/10.1201/9781315587332
4. Neill MA Wooten K. High-fidelity simulation debriefing in nursing education: a literature review. Clinical Simulation in Nursing 2011; 7: e161-e168. https://doi.org/10.1016/j.ecns.2011.02.001
5. Pendleton D, Schofield T, Tate P, Havelock, P (1984). The Consultation: an Approach to Learning and Teaching. Oxford: Oxford University Press; 1984.
6. Rudolph J W, Simon R, Dufresne R, Raemer DB. (2006) There's no such thing as "nonjudgmental" debriefing: a theory and method for debriefing with good judgment. Simulation in Healthcare 2006; 1: 49-55. https://doi.org/10.1097/01266021-200600110-00006
7. Denning K. Debrief as a learning conversation. Resuscitation Council UK; 2010. https://mobilesim.files.wordpress.com/2011/03/debrief-as-a-learning-conversation.pdf accessed 14 April 2017.
8. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simulation in Healthcare 2007; 2: 115-125. https://doi.org/10.1097/SIH.0b013e3180315539
9. Kriz WC. A systemic-constructivist approach to the facilitation and debriefing of simulations and games. Simulation & Gaming 2010; 41: 663-680. https://doi.org/10.1177/1046878108319867
simulation; authenticity; debrief; human factors; medical education
This presentation was given at the one day symposium, Current Approaches to Understanding Surgical Error, University of Leeds, Leeds, UK, on 9 December 2016.
Conflicts of interest: none declared.