February Monthly Faculty Development Tip
Shelly Chipman, RN
The Prebrief: More than just an Orientation
Our passion and responsibility as educators is to facilitate the acquisition of knowledge and/or skills upon our students. Traditionally, this has been a rather passive process, where faculty provide information and learners absorb by listening or watching; transference of knowledge is teacher focused. Newer modalities of teaching, such as team based learning, case based and experiential learning provide a more active learning environment, thus moving accountability of learning to the student/learner (Cheng, 2016). Simulation is one such experiential educational activity, which allows learners to participate in a reproduction of a realistic clinical experience. A reflective discussion about that experience called the debrief follows and is facilitated by the instructor, and is a critical component of active learning. It provides an opportunity for deeper learning and translation of technical, cognitive and behavioral skills to clinical practice (Arefeh, 2010).
While the debrief is well recognized as an essential component of simulation education, the less well known “prebrief” is also important to learning, and sets the stage for the simulated experience and debrief. Several components of the prebrief are necessary in order to optimize learning and learner engagement:
Psychological Safety: This provides the foundation for the deep reflection needed for learning and translation of that learning to clinical practice. Psychological safety is established in the prebrief so learners feel comfortable discussing potential errors, gaps in knowledge or even successes that were revealed during the simulation scenario.
Review Expectations: Providing a clear description of what the learners can expect and what is expected of them is critical to a successful session.
Explain format-rational-agenda: This description of expectations should include an outline of agenda, explanation of any ground rules and clarification of any questions or preconceived notions that the learners may have. Transparency, clarity of objectives and rationale for training (formative vs summative) prior to the scenario is key to optimal learner participation.
Basic Assumption: Part of establishing psychological safety is setting the basic assumption of healthcare simulation, an underlying belief that learners are intelligent, well trained and want to improve (Rudolph, 2006). By setting this tone and assumption, mistakes during simulation are viewed as puzzles to be solved, rather than mistakes or faults in skill. Although this is not explicitly stated in the prebrief, it is recognized by faculty behaviors throughout the simulation session.
Review confidentiality: This includes the concept of “what happens in simulation, stays in simulation”, addressing any observers and their purpose for observing and keeping the scenarios confidential, avoiding “scenario leak” to other leaners.
Introduce Environment: This includes the space, manikin, the equipment or any other unique aspects. Introduction to the environment is critically important to provide “buy in” and prevent learners from “blaming” the lack of fidelity as an issue that may have affected their performance (Rudolph, 2014).
Encourage embracing the uncomfortable: Evidence supports the concept that some level of stress and emotion helps enhance memory (Clapper, 2014). Simulation provides an opportunity for the learners to reach that sweet spot of learning, where they are uncomfortable enough to learn, but not so uncomfortable that they cannot perform.
Fictional contract: This is where learners are asked to suspend disbelief and faculty acknowledge that it is not a perfect replica of the clinical environment must be addressed in order to make the experience more valuable.
As simulation educators, it is vitally important to provide a prebrief that sets the stage for a successful debrief and experiential learning session. By practicing each of these important components and providing a prebrief in every simulation education session, educators can provide an environment that is engaging and enhances learning. These components can be utilized in many learner-focused educational activities to promote engagement.
Encourage embracing the uncomfortable
Further Reading: (attached)
Rudolph, J, Raemer D, Simon, R. Establishing a Safe Container for Learning in Simulation: The Role of the Presimulation Briefing. Simulation in Healthcare. 2014 December 9(6): 339-349.
Arafeh,J, Hansen, S, Nichols, A. Debriefing in Simulated-Based Learning, Facilitating a Reflective Discussion. Journal of Perinatal Nursing. 2010 24(4): 302-309.
Clapper, T. C. Beyond Knowles: What those conducting simulation need to know about
adult learning theory. Clinical Simulation in Nursing. 2010 January VOL(6), e7-e14. doi:10.1016/j.ecns.2009.07.003
Cheng, A. Morse, K., Rudolph, J., Abeer, A. Runnacles, J, Eppich,W. Learner-Centered Debriefing for Health Care Simulation Education: Lessons for Faculty Development. Simulation in Healthcare. 2016 February 11(1):32-40.
Eppich, W, Cheng, A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and Rationale for a Blended Approach to Health Care Simulation Debriefing. Simulation in Healthcare. 2015 April 10(2): 106-115.
Rudolph, J, Simon, R, Dufresne, R, Raemer, D. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simulation in Healthcare. 2006 1(1):49-55.Download PDF